Combination Of Shear Wave Elastography Research Articles

The value of quantitative and a new qualitative color pattern shear wave elastography for the differentiation of ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm.

This study aims to evaluate the diagnostic performance of quantitative shear wave elastography (SWE) and a new qualitative color pattern SWE for the differentiation of benign and malignant American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR TI-RADS) 4 or 5 category thyroid nodules measuring ≤10 mm. From May 2020 to July 2022, a total of 237 patients with 270 thyroid nodules were enrolled, and conventional ultrasound and SWE examinations were performed for each patient. Each ACR TI-RADS 4 or 5 category thyroid nodule measuring ≤10 mm was evaluated by quantitative SWE and a new qualitative color pattern SWE. The diagnostic performance of quantitative SWE parameters, the new qualitative color pattern SWE, and the combination of SWE with ACR TI-RADS, respectively, for the differentiation of benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm was evaluated and compared. Among 270 thyroid nodules in 237 patients, 72 (26.67%) thyroid nodules were benign and 198 (73.33%) thyroid nodules were malignant. The qualitative color pattern SWE showed better diagnostic performance than the quantitative SWE parameters. When combining the qualitative color pattern SWE with ACR TI-RADS scores, with the optimal cutoff value of the total points ≥8, the thyroid nodules were considered malignant. The sensitivity, specificity, accuracy, and AUC were 89.90%, 56.94%, 81.11%, and 0.820 (95% CI: 0.768-0.864), respectively. Compared with using qualitative color pattern SWE alone, the combination of qualitative color pattern SWE and ACR TI-RADS had better diagnostic performance, which was significantly different (p < 0.05). The combination of qualitative SWE color patterns and ACR TI-RADS had high sensitivity and accuracy, which might be a convenient and useful method to differentiate benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm. It would be helpful for the management of thyroid nodules and improving prognosis.

Application of Ultrasound Shear Wave Elastography Combined With BRAFV600E Mutation for the Diagnosis of Papillary Thyroid Carcinoma.

This prospective study aimed to investigate the combination of shear wave elastography (SWE) and BRAFV600E mutation testing for the diagnosis of papillary thyroid carcinoma (PTC). One hundred thyroid nodules with an American College of Radiology thyroid imaging reporting and data system classification of 4 or 5 were subjected to SWE measurement, BRAFV600E genotyping, fine-needle aspiration, and surgery. Nonparametric statistical tests were used to compare the differences in the elastic parameters and BRAF genotypes between benign and malignant thyroid nodules of PTC, and receiver operating characteristic curve analysis was conducted to compare the diagnostic efficacy. In addition, the correlations between elastic parameters and BRAFV600E mutation in PTC were analyzed using binary logistic regression. The SWE, BRAFV600E, and their combination exhibited sensitivities of 72.9%, 81.3%, and 85.4%, respectively, and specificities of 66.7%, 90.3%, and 86.5%, respectively, in the diagnosis of PTC ( P < 0.05). The SWE, BRAFV600E, and their combination exhibited sensitivities of 50.0%, 24.1% and 56.3%, respectively, and specificities of 89.7%, 87.5% and 82.8%, respectively, in the diagnosis of central cervical lymph node metastasis ( P < 0.05). The combined use of SWE and BRAFV600E detection had the largest area under the curve, indicating that this combination is more effective in diagnosing PTC and lymph node metastasis in the central region than either method alone. Furthermore, Emax was positively associated with the BRAFV600E genotype. In conclusion, the combination of SWE and BRAFV600E genotype detection can improve the diagnostic efficacy for PTC. Emax can predict the BRAFV600E mutation status.

Diagnostic value of shear wave elastography combined with super microvascular imaging for BI-RADS 3-5 nodules.

To investigate the diagnostic value of shear wave elastography (SWE) and super microvascular imaging (SMI) integrated with the traditional ultrasound breast imaging reporting and data system (BI-RADS) classification in differentiating between benign and malignant breast nodules. For analysis, 88 patients with 110 breast nodules assessed as BI-RADS 3-5 by conventional ultrasound were selected. SWE and SMI evaluations were conducted separately, and all nodules were verified as benign or malignant ones by pathology. Receiver operating characteristic (ROC) curves were plotted after obtaining quantitative parameters of different shear waves of nodules, including maximum (Emax), mean (Emean), minimum (Emin) Young's modulus, modulus standard deviation (SD), and modulus ratio (Eratio). The best cut-off value, specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant nodules employing Emax were obtained, and the diagnostic value of combining Emax and BI-RADS classification was compared. SMI graded nodule based on the Alder blood flow grading standard, whereas the BI-RADS classification was based on microvascular morphology. We assessed the diagnostic value of SMI for breast nodules and investigated the diagnostic efficacy of SWE combined with SMI in differentiating benign and malignant breast nodules with BI-RADS classification 3-5. The adjusted the BI-RADS classification using SMI and SWE technologies promoted the sensitivity, specificity, and accuracy of discriminating benign and malignant breast nodules (P < 0.05). The combination of traditional ultrasound BI-RADS classification with SWE and SMI technologies offered high sensitivity, specificity, accuracy, PPV, and NPV for identifying benign and malignant breast lesions. Moreover, combining SWE and SMI technologies with the adjusted BI-RADS classificationhad the best diagnostic efficacy for distinguishing benign and malignant breast nodules with BI-RADS 3-5. The combination of SWE and SMI with the adjusted BI-RADS classification is a promising diagnostic method for differentiating benign and malignant breast nodules.

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world.

This study aimed to explore the value of strain elastography (SE) and shear wave elastography (SWE) following the World Federation of Ultrasound in Medicine and Biology (WFUMB) guidelines and recommendations in the real world in distinguishing benign and malignant breast lesions and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions. This prospective study included 274 breast lesions. The elastography score (ES) by the Tsukuba score, the strain ratio (SR) for SE, and Emax for SWE of the lesion(A) and the regions(A') included the lesion and the margin (0.5-5mm) surrounding the lesion were measured. The sensitivity, specificity, and AUC were calculated and compared by the cutoff values recommended by WFUMB guidelines. When scores of 1 to 3 were classified as probably benign by WFUMB recommendation, the ES was significantly higher in malignant lesions compared to benign lesions (p < 0.05) in all lesions. For the cohort by size >20mm, the sensitivity was 100%, and the specificity was 45.5%. ES had the highest AUC: 0.79(95% CI 0.72-0.86) with a sensitivity of 96.2%, and a specificity of 61.8% for the cohort by size ≤20 mm. For the Emax-A'-S2.5mm, when the high stiffness would be considered with Emax above 80 kPa in SWE, the malignant lesions were diagnosed with a sensitivity of 95.8%, a specificity of 43.3% for all lesions, a sensitivity of 88.5% for lesions with size ≤20 mm, and sensitivity of 100.0% for lesions with size >20mm. In 84 lesions of BI-RADS category 4a, if category 4a lesions with ES of 1-3 points or Emax-A'-S2.5 less than 80 kPa could be downgraded to category 3, 52 (61.9%) lesions could be no biopsy, including two malignancies. If category 4a lesions with ES of 1-3 points and Emax-A'-S2.5 less than 80kPa could be downgraded to category 3, 23 (27.4%) lesions could be no biopsy, with no malignancy. The elastography score for SE and Emax-A' for SWE after our modification were beneficial in the diagnosis of breast cancer. The combination of SWE and SE could effectively reduce the biopsy rate of BI-RADS category 4a lesions.

Combined use of shear-wave elastography and Doppler ultrasonography in equivocal fibroepithelial lesions of the breast diagnosed by core needle biopsy.

The aim of this study was to evaluate the diagnostic value of shear-wave elastography (SWE) combined with Doppler ultrasonography (US) in selecting equivocal breast fibroepithelial lesions (FELs) for follow-up without further excision. A retrospective analysis was conducted of 88 patients with equivocal breast FELs (FELs with the possibility of both fibroadenoma [FA] and phyllodes tumor [PT]) diagnosed by core needle biopsy (CNB). For post-CNB treatment, surgical or vacuum-assisted excision was performed on 88 equivocal FELs, of which 56 were diagnosed as FAs and 32 as PTs on histopathology. Mean elasticity (Emean) and vascularity were determined using SWE and Doppler US. The diagnostic performances of B-mode US, SWE, and Doppler US were calculated to differentiate FAs and PTs in the excised equivocal FELs. In the excised equivocal FELs diagnosed by CNB, FAs showed significantly lower median Emean values (36.4 vs. 66.7 kPa, P=0.005) and more frequent low vascularity (0-1 vessel flow signal) (P<0.001) than PTs. For the differentiation of FAs and PTs, the combination of Emean of >60.9 kPa and high vascularity (≥2 vessel flows) showed a sensitivity and negative predictive value of 100%, as well as better performance in other diagnostic values than B-mode US alone (Breast Imaging Reporting and Data System ≥4A) (all P<0.05). Equivocal breast FELs showing both low elasticity and low vascularity were not upgraded to PTs upon further excision. Therefore, the combination of SWE and color Doppler US mode might help select patients with equivocal FELs for whom further excision is unnecessary.

Role of shear wave elastography as an adjunct to axillary ultrasonography in predicting nodal metastasis in breast cancer patients with suspicious nodes.

To evaluate the role of shear wave elastography (SWE) of suspicious axillary lymph nodes and its combination with B-mode USG in predicting nodal metastasis in breast cancer patients. Prospective observational study was performed from June 2018 to August 2020 on breast cancer patients with suspicious axillary nodes on USG. B-mode features (cortical thickness, effacement of fatty hilum, non-hilar blood flow and round shape) and SWE parameters (Emax, Emin, Emean and ESD) of the node with the thickest cortex were evaluated. Diagnostic performances of USG, SWE and their combination were estimated using pathological status of the node on biopsy as the gold standard. Of the 54 patients evaluated, optimal elasticity maps were obtained in 49 nodes of 49 patients (mean age, 46.3 ± 12.1 years; 48/49 (98%) females). On biopsy, 38 nodes (77.6%) had metastasis, while 11 (22.4%) had reactive hyperplasia. Emax, Emin, Emean and ESD of both cortex and hilum were significantly higher in metastatic than reactive nodes. Emax (cortex) ≥14.9 kPa had the best diagnostic performance (sensitivity, 73.7%; specificity, 81.8%). Cortical thickness ≥6.7 mm had the best diagnostic performance among B-mode features (sensitivity, 89.5%; specificity, 72.7%). Combining cortical thickness with effacement of fatty hilum and/or non-hilar blood flow yielded sensitivity of 89.5% and specificity of 90.9%. Addition of Emax (cortex) to cortical thickness and combination of ≥2 B-mode features increased their specificities to 90.9 and 100%, respectively. Metastatic axillary nodes are stiffer than reactive nodes on SWE in breast cancer patients. Emax (cortex) has the best diagnostic performance in differentiating between reactive hyperplasia and nodal metastasis. Combination of Emax (cortex) and cortical thickness increases the specificity for diagnosing metastasis, especially in nodes showing only cortical thickening. Combination of SWE and B-mode USG is highly specific for differentiating metastasis from reactive hyperplasia in suspicious nodes of breast carcinoma patients, especially in nodes with only cortical thickening.

Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer-A Multicenter Study.

PurposeTo develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound.Materials and MethodsA total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated.ResultsA significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulus of the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis.ConclusionA 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.

Combination of shear wave elastography and BI-RADS in identification of solid breast masses

BackgroundTo explore the value of quantitative shear wave elastography (SWE) plus the Breast Imaging Reporting and Data System (BI-RADS) in the identification of solid breast masses.MethodsA total of 108 patients with 120 solid breast masses admitted to our hospital from January 2019 to January 2020 were enrolled in this study. The pathological examination served as the gold standard for definitive diagnosis. Both SWE and BI-RADS grading were performed.ResultsOut of the 120 solid breast masses in 108 patients, 75 benign and 45 malignant masses were pathologically confirmed. The size, shape, margin, internal echo, microcalcification, lateral acoustic shadow, and posterior acoustic enhancement of benign and malignant masses were significantly different (all P < 0.05). The E mean, E max, SD, and E ratio of benign and malignant masses were significantly different (all P < 0.05). The E min was similar between benign and malignant masses (P > 0.05). The percentage of Adler grade II-III of the benign masses was lower than that of the malignant masses (P < 0.05). BI-RADS plus SWE yielded higher diagnostic specificity and positive predictive value than either BI-RADS or SWE; BI-RADS plus SWE yielded the highest diagnostic accuracy among the three methods (all P < 0.05).ConclusionSWE plus routine ultrasonography BI-RADS has a higher value in differentiating benign from malignant breast masses than color doppler or SWE alone, which should be further promoted in clinical practice.

Systematic review and meta-analysis: gray-scale ultrasound and shear wave elastography in the diagnosis of primipara pregnancy and delivery.

The combination of shear wave elastography (SWE) and gray-scale ultrasound is widely used in the measurement of female pelvic floor muscle. However, the value of gray-scale ultrasound combined with SWE in the evaluation of primipara pregnancy and delivery is still controversial. Using the PubMed, Web of Science, Spring and Science Direct databases, clinical studies on gray-scale ultrasound combined with SWE on the diagnosis of primiparous pregnancy and childbirth published from January 2010 to December 2020 were searched. The RevMan5.3 software was used to conduct a meta-analysis of the indicators of gray-scale ultrasound combined with SWE for primiparas and non-primiparas, including: age, body mass index (BMI), gestational age at examination, gestational age at delivery, fetal weight, cervical length, shear wave velocity (SWV), front lip SWV, back lip SWV, Young's modulus and SWE index. Heterogeneity of the assessment results was tested using Cochran's chi-square. A total of 13 articles were included. Age, BMI before delivery, gestational age (when gray-scale ultrasound was combined with SWE examination), gestational age at delivery, neonatal weight, cervical depth, SWV of placental margin, SWV of anterior lip, SWV of posterior lip and Young's modulus of the study group were significantly different from those of the control group. The elastic modulus of the perineal body and the SWE of the anterior lip of the study group were significantly higher than those of the control group [mean difference (MD) =8.11, 4.39, 95% confidence interval (CI): 3.90-12.31, 0.94-7.83; Z=3.78, 2.49, P=0.0002, 0.01]. The SWE of the posterior lip in the study group was significantly lower than that in the control group (MD =-4.34, 95% CI: -7.23 to 1.44; Z=2.93, P=0.003). The number of cases in the control group in the included articles was significantly more than that in the observation group, and there were fewer descriptions of gray-scale ultrasound combined with SWE indicators in the included articles. There may be a certain degree of bias for indicators without obvious heterogeneity, and further analysis was required through a large number of clinical verifications. However, this study can provide certain reference values for the diagnosis of primipara pregnancy.

Diagnostic value of median nerve shear wave ultrasound elastography in diagnosis and differentiation of carpal tunnel syndrome severity

BackgroundCarpal tunnel syndrome (CTS) is the commonest type of peripheral nerve entrapment syndromes. The study aimed at evaluation of diagnostic value of median nerve stiffness measured by shear wave ultrasound elastography for diagnosis and differentiation of CTS severity, correlated to electrophysiological studies. This case–control study involved 40 patients (56 wrists) with CTS of different severity and 40 controls (40 wrists). All participants underwent electrophysiological study to assess the CTS severity, high-resolution conventional B-mode ultrasound to assess cross-sectional area “CSA” of median nerve at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm, and shear wave ultrasound elastography with measurement of median nerve mean stiffness and correlation to electrophysiological results as the reference standard.ResultsMean median nerve stiffness by shear wave US elastography was increased in patients with CTS compared to controls and across the different CTS severity groups (P value < 0.001 & 0.001, respectively). The cutoff value by ROC curve analysis for median nerve stiffness to differentiate between patients with CTS and control group was 65.4 kPa (P value < 0.001, 94.6% sensitivity, 97.3% specificity). Higher diagnostic accuracy was noted with the combination of shear wave elastography and conventional B-mode US with improved AUC (B-mode + shear wave; 0.962, P value < 0.001).ConclusionsShear wave ultrasound elastography of median nerve was able to discriminate different severity subgroups of CTS with high sensitivity, while conventional US couldn’t. The diagnostic accuracy of CTS was improved when combined high-resolution conventional B-mode US and complementary shear wave ultrasound elastography.

The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis.

Background Baveno VI criteria, based on liver stiffness (LS) measured by transient elastography and platelet counts (PLT), have been proposed to avoid unnecessary endoscopy screening for high-risk varices (HRVs). However, the cut-off value of LS measured by 2D-SWE and PLT to predict HRVs in compensated hepatitis B-related cirrhotic patients remains unknown. Aims To prospectively analyze the cut-off of the combination of LS measured by 2D-SWE and PLT in predicting HRVs and the influence of antiviral therapies in its efficacy. Methods Serum parameters, LS, and endoscopy results were obtained from 160 compensated hepatitis B-related cirrhotic patients. The accuracy of the combined algorithm was assessed in the whole cohort and subgroups with or without consecutive antiviral therapies in the past 6 months. Results In the whole cohort, the optimal cut-off value of LS for HRVs was 14.5 kPa. Patients with a LS value < 14.5 kPa with a PLT value > 110 × 109/L can be excluded from HRVs (NPV = 0.99, endoscopy saved rates = 0.68). Conversely, a LS value of ≥14.5 kPa and a PLT value of ≤110 × 109/L indicated HRVs, with accurate rates of 82.35%, and 10.63% of patients can avoid additional endoscopy screening. Moreover, antiviral therapy had no significant effect on the accuracy and rates saved from further endoscopy screening, when comparing patients with or without antiviral therapies (all p values > 0.05). Conclusions The combination of LS (14.5 kPa) measured by 2D-SWE and PLT (110 × 109/L) can predict HRVs accurately in compensated hepatitis B-related cirrhotic patients without significant interference of antiviral therapy histories.

Shear Wave Elastography Combined with Thyroid Imaging Report and Data System for Risk Stratification of Thyroid Nodule Malignant Tumor

Benign and malignant thyroid cancer diagnosis is crucial. Our study intends to evaluate the role of shear wave elastography (SWE) and thyroid imaging report and data system (TI-RADS) in diagnosing the benign and malignant thyroid nodules. 100 thyroid nodules patients were recruited and evaluated by SWE and TI-RADS before fine needle biopsy and/or surgery. The maximum elastic index (Emax), mean elasticity index of thyroid nodules (Emean), minimum elastic index (Emin) and elastic ratio (ER) was measured and compared between different imaging. Ultrasound diagnosis showed solid nodules with significant hypoechoic, unclear boundary, and microcalcification. TI-RADS value was measured based on suspected ultrasound features. Combination of SWE and TI-RADS was performed. Among the 100 nodules, 38 were benign (38.0%), 62 were malignant (62.0%), and malignant nodules had significantly elevated SWE and TI-RADS compared with benign nodules (P &lt; 0.001). The optimal SWE threshold for Emax was 51.95 kPa, with a sensitivity of 81.44% and specificity of 83.19%. There were two methods for combining SWE and TI-RADS. One was sequential detection, with a specificity of 95.80%, positive similarity ratio of 18.16 and PPV of 96.73%; the other was parallel detection method with a sensitivity of 94.85%, negative similarity ratio of 0.07 and PPV of 90.00%. Our results suggest that combination of SWE and TI-RADS might be applied to identify benign and malignant thyroid cancers.

Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis.

PurposeThis study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE.MethodsA systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool.ResultsTwenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively.ConclusionAdding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies.

Changes in indicators of fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on the stage of cirrhosis

Objective was to study changes in liver parenchyma fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on decompensation using shear wave elastography and FIB-4 index.Material and methods. The study included 204 patients. Among them, 78 patients (Group I) had alcoholic liver cirrhosis (ALC) and 126 patients (Group II) had a combination of ALC with non-alcoholic fatty liver disease (NAFLD). Patients were subgrouped according to compensation classes by the Child-Pugh score (A, B, C). The degree of liver parenchyma fibrosis was assessed by calculating the FIB-4 (FibroIndex-4) and the liver parenchyma elasticity (kPa) determined by the shear wave elastography method.Results. Values of liver parenchyma elasticity in patients of group II of classes A, B, and C were higher compared to group I same classes (P &lt; 0.05). FIB-4 indicators in patients of group II were higher than classes A, B, and C compared to group I (P &lt; 0.05). In patients with ALC in combination with NAFLD, direct correlations were established between the value of Child-Pugh score and the elasticity of the liver parenchyma, the value of the MELD index and the elasticity of the liver parenchyma, the value of Child-Pugh score and FIB-4 index, the value of MELD index and FIB-4 index, FIB-4 index and liver parenchyma elasticity.Conclusions. In patients with ALC according to elastography and FIB-4 index, fibrosis indicators increase depending on the stage of decompensation. According to elastography and FIB-4 index in patients with ALC, fibrosis indicators were higher in combination with NAFLD at all stages of liver cirrhosis. The magnitude of fibrosis in patients with ALC in combination with NAFLD according to elastography and the FIB-4 index correlates with the severity of liver cirrhosis by Child-Pugh and MELD prognostic index. The combination of shear wave elastography and FIB-4 index are important diagnostic indicators for assessing the degree of fibrosis in the liver.

Diagnostic Performance of a Combination of Shear Wave Elastography and B-Mode Ultrasonography in Differentiating Benign From Malignant Thyroid Nodules.

ObjectivesThis study was conducted to compare clinicopathologic and radiologic factors between benign and malignant thyroid nodules and to evaluate the diagnostic performance of shear wave elastography (SWE) combined with B-mode ultrasonography (US) in differentiating malignant from benign thyroid nodules.MethodsThis retrospective study included 92 consecutive patients with 95 thyroid nodules examined on B-mode US and SWE before US-guided fine-needle aspiration biopsy or surgical excision. B-mode US findings (composition, echogenicity, margin, shape, and calcification) and SWE elasticity parameters (maximum [Emax], mean, minimum, and nodule-to-normal parenchymal ratio of elasticity) were reviewed and compared between benign and malignant thyroid nodules. The diagnostic performance of B-mode US and SWE for predicting malignant thyroid nodules was analyzed. The optimal cutoff values of elasticity parameters for identifying malignancy were determined. Diagnostic performance was compared between B-mode US only, SWE only, and the combination of B-mode US with SWE.ResultsOn multivariate logistic regression analysis, age (odds ratio [OR], 0.90; P=0.028), a taller-than-wide shape (OR, 11.3; P=0.040), the presence of calcifications (OR, 15.0; P=0.021), and Emax (OR, 1.22; P=0.021) were independent predictors of malignancy in thyroid nodules. The combined use of B-mode US findings and SWE yielded improvements in sensitivity, the positive predictive value, the negative predictive value, and accuracy compared with the use of B-mode US findings only, but with no statistical significance.ConclusionWhen SWE was combined with B-mode US, the diagnostic performance was better than when only B-mode US was used, although the difference was not statistically significant.

Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar Fasciitis

The current imaging standard for diagnosing plantar fasciitis is B-Mode ultrasound (B-US). The aim of this study was to determine the diagnostic potential of Shear Wave Elastography (SWE) and the correlation of clinical scores to elastographic parameters. Diagnostic case-control study with n = 82 plantar fascia (PF). PF were divided into three subgroups: (1) symptomatic PF (n = 39); (2) control group of unilateral asymptomatic PF (n = 23); (3) bilateral asymptomatic PF (n = 20). Reference standard for positive findings in B-US was a PF thickness greater than 4 mm. For SWE tissue elasticity (Young's modulus kPa; shear wave speed m/s) was measured at Location 1: directly at the calcaneus; Location 2: +1 cm distal of the calcaneus and Location 3: central part of the calcaneus. Sensitivity, specificity, and diagnostic accuracy as well as correlation to American Orthopaedic Foot and Ankle Score (AOFAS) and Food Functional Index (FFI) were determined. Symptomatic PF are thicker (4.2 mm, n = 39) than asymptomatic (3.0 mm, n = 43) (p < 0.001). Thickness of the PF (n = 82) correlated poorly to clinical scores (p = 0.001): FFI-pain (r = 0.349); FFI-function (r = 0.381); AOFAS (r = -0.387). Cut-off point for positive SWE finding was 51.5 kPa (4.14 m/s). Symptomatic PF (31.9 kPa, 3.26 m/s, n = 39) differ significantly from asymptomatic PF (93.3 kPa, 5.58 m/s, n = 43) with significant differences at L1 between all groups (p < 0.001). Correlation between Young's modulus (n = 82) and clinical scores was strong (p < 0.001): FFI-pain (r = -0.595); FFI-function (r = -0.567); AOFAS (r = 0.623,). B-US: sensitivity (61%), specificity (95%); SWE sensitivity (85%), specificity (83%). The combination of SWE and B-US increases the sensitivity (100%) with a diagnostic accuracy of 90%. Based on our results, we could show that SWE can improve the diagnostic accuracy in patients with plantar fasciitis compared to B-US. II.

Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy.

BackgroundWe evaluated shear-wave elastography (SWE) and color Doppler ultrasonography (US) features for fibroepithelial lesions (FELs), and to evaluate their utility to differentiate fibroadenomas (FAs) and phyllodes tumors (PTs).MethodsThis retrospective study included 67 FELs pathologically confirmed (49 FAs, 18 PTs). B-mode US, SWE and color Doppler US were performed for each lesion. Mean elasticity (Emean), maximum elasticity (Emax), and vascularity were determined by SWE and Doppler US. Diagnostic performances were calculated to differentiate FAs and PTs. Equivocal FELs diagnosed by core needle biopsy (CNB) were further analyzed.ResultsMedian Emean and Emax were significantly lower for FAs than PTs (Emean, 15.7 vs. 66.7 kPa; Emax, 21.0 vs. 76.7 kPa, P<0.01). Low vascularity (0–1 vessel flow) on color Doppler US were more frequent in FAs than in PTs (P<0.01). SWE showed significantly higher specificities (Emean >43.9 kPa, 89.8%; Emax >46.1 kPa, 79.6%) than B-mode US (42.9%) (P<0.01) for differentiating PTs from FAs. Other diagnostic values of SWE and overall diagnostic values of Doppler US were not significantly different from B-mode US (P>0.05). The combination of SWE and Doppler US with ‘Emean>43.9 kPa or high vascularity (≥2 vessel flows)’ showed a higher area under the curve (0.786 vs. 0.687) and higher diagnostic values than B-mode US (sensitivity, 100 vs. 94.4%; specificity, 57.1 vs. 42.9%; positive predictive value, 46.2 vs. 37.8%; negative predictive value, 100 vs. 95.5%), without statistical significance (P>0.05). Of the 30 equivocal FELs, all lesions with ‘Emean≤43.9 kPa and low vascularity (0–1 vessel flow)’ (23.3%, 7/30) were finally confirmed as FAs by excision.ConclusionFAs have a tendency to have less stiffness and lower vascularity than PTs. Combined SWE and color Doppler US may help patients with equivocal FELs diagnosed by CNB avoid unnecessary excision.

Combination of shear wave elastography and Ki-67 index as a novel predictive modality for the pathological response to neoadjuvant chemotherapy in patients with invasive breast cancer

PurposeThis study evaluated shear wave elastography (SWE) and SWE combined with the Ki-67 index as novel predictive modalities for the pathological response of invasive breast cancer to neoadjuvant chemotherapy (NAC). MethodsThe prospective study recruited 66 eligible patients from July 2014 to November 2015. Tumour stiffness, which corresponds with tumour progression and invasiveness, was assessed by quantitative SWE 1 d before biopsy (time point t0, elasticity E0), 1 d before next NAC cycle (t1−t5, E1−E5), and 1 d before surgery (t6, E6). The relative changes in SWE parameters after the first and second NAC cycles were considered as the variables [ΔE (t1), ΔE (t2)]. The pathological response was classified according to the residual cancer burden (RCB) protocol. Correlations between RCB scores and variables were evaluated. The predictive diagnostic performances of SWE parameters, Ki-67 index, and the predictive RCB (predRCB) score determined by a linear regression model were compared. ResultsSome immunohistochemical and molecular factors and SWE parameters were significantly different among the three RCB groups. The ΔEmean (t2) and Ki-67 had significantly better diagnostic performance than other parameters regarding predicting the pathological response (the RCB-I response and RCB-III resistance). However, the correlation between ΔEmean (t2) and Ki-67 index was significantly weaker as a diagnostic predictor (r = 0.29). We generated a new predictive modality, predRCB, which is a multivariable linear regression model that combines ΔEmean (t2) and the Ki-67 index. The predRCB modality showed better diagnostic performance than SWE parameters and Ki-67 index alone. ConclusionOur findings highlight the potential utility for adding the Ki-67 index to the SWE results, which may improve the predictive power of SWE and facilitate personalising the treatment regimens of patients with breast cancer. These results should be validated in the future by performing a multicentre prospective study with a larger cohort.

Liver Fibrosis Evaluation Using Real-time Shear Wave Elastography in Hepatitis C-Monoinfected and Human Immunodeficiency Virus/Hepatitis C-Coinfected Patients.

A few studies have evaluated real-time shear wave elastography (SWE) for assessing liver fibrosis by measuring liver stiffness in patients with chronic hepatitis C virus (HCV) infection, but they excluded human immunodeficiency virus/HCV-coinfected patients. We investigated the diagnostic performance of liver stiffness measured by SWE as a noninvasive predictor of liver fibrosis in HCV using liver biopsy as a reference standard, including monoinfected and coinfected patients. We measured liver stiffness in patients with HCV undergoing liver biopsy (METAVIR fibrosis staging). Eighty patients (53 monoinfected and 27 coinfected) were included. There was a significant correlation between liver stiffness and fibrosis stage (ρ = 0.685; P < .001). Areas under the receiver operating characteristic curve were 0.841, 0.879, and 0.975 when comparing fibrosis stages F0-F1 versus F2-F4, F0-F2 versus F3-F4, and F0-F3 versus F4, respectively. Suggested cutoff values were 8.5 kPa for F2, 10.4 kPa for F3, and 11.3 kPa for F4, with sensitivity and specificity of 81% and 84%, 81% and 95%, and 100% and 90%. There was no significant difference between the liver stiffness of monoinfected and coinfected patients (P = .453). When combining SWE with the fibrosis-4 score, accuracy increased from 82% to 88% and from 88% to 96%, with incongruent results of 26% and 29%, for F0-F1 versus F2-F4 and F0-F2 versus F3-F4. Shear wave elastography of the liver is an effective noninvasive predictor of liver fibrosis in patients with HCV. There was no significant difference between monoinfected and coinfected patients; hence, the same cutoff values can be used for both groups. Combination of SWE with the fibrosis-4 score leads to higher accuracy, although at the expense of inconclusive results in some patients.

A Set of Shear Wave Elastography Quantitative Parameters Combined with Ultrasound BI-RADS to Assess Benign and Malignant Breast Lesions

The goal of this study was to determine whether a combination of shear wave elastography (SWE) quantitative parameters could improve the accuracy of ultrasonography in the differentiation of benign and malignant breast lesions. Two hundred seventy-nine breast lesions in 251 women were evaluated with ultrasonography and SWE; pathologic results of all lesions were available. Each lesion was classified according to the Breast Imaging Reporting and Data System (BI-RADS) for ultrasound. SWE quantitative parameters, including maximum elastic value (Emax), mean elastic value (Emean), standard deviation (SD) and ratio of Emean of the lesion to Emean of the surrounding parenchyma (Eratio), were recorded. A receiver operating characteristic curve was used to determine their cutoff values. When any of the four parameters was equal to or higher than the cutoff value, the set of SWE parameters was counted as positive. When both BI-RADS and the set were positive, lesions were evaluated as positive for malignancy. We compared the performance of this combination with use of BI-RADS, Emax, Emean, SD or Eratio alone and also with the combination of BI-RADS and Emax for benign/malignant differentiation. The combination of Emax, Emean, SD, or Eratio with BI-RADS had a sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden index of 0.967, 0.912, 0.908, 0.969, 0.938 and 0.879, respectively. The accuracy was the highest (p < 0.01) without loss of sensitivity. Combining a set of SWE quantitative parameters (Emax, Emean, SD and Eratio) could improve the accuracy of ultrasonography in differentiation of benign from malignant breast lesions, without loss of sensitivity.