Diagnostic Performance Of Ultrasound Elastography Research Articles

The diagnostic performance of salivary gland ultrasound elastography in Sjögren's syndrome and sicca symptoms: a systematic review and meta-analysis.

To systematically evaluate the diagnostic performance of ultrasound elastography (USE) in distinguishing primary Sjögren's syndrome (pSS) from healthy/disease controls. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for published literature on USE for diagnosing pSS. Bivariate random effects models were used to calculate the pooled sensitivity and specificity of USE. To determine the factors influencing heterogeneity, meta-regression and subgroup analyses were performed to assess country, diagnostic criteria, imaging mechanisms, shear wave elastography techniques, measurement location, control group category, and patient age. Publication bias was assessed using the asymmetry of the Deeks funnel plot. Fifteen articles covering 816 patients and 735 control participants were included. USE showed a pooled sensitivity of 0.80 (95% CI: 0.71-0.87) and specificity of 0.87 (95% CI: 0.78-0.92). Meta-regression and subgroup analyses revealed that shear wave elastography techniques, measurement location, and patient age were significant factors that affected study heterogeneity (p < 0.05). Elastography performs better in diagnosing patients aged ≤ 51years compared to patients aged > 51years. There was no significant publication bias. USE demonstrates high accuracy in differentiating between pSS and healthy/disease control groups. Ultrasound elastography, as a non-invasive and cost-effective technique, can be used to distinguish primary Sjögren's syndrome from disease/healthy control groups by measuring the stiffness of salivary glands. • Ultrasound elastography is an acceptable technique for the diagnosis of primary Sjögren's syndrome. • The pooled sensitivity and specificity of ultrasound elastography for diagnosing primary Sjögren's syndrome were 0.80 and 0.87, respectively. • In patients aged ≤ 51years with primary Sjögren's syndrome, ultrasound elastography showed good diagnostic performance.

The diagnostic performance of ultrasound elastography for biliary atresia: A meta-analysis.

Biliary atresia (BA) is a severe inflammatory obliterative cholangiopathy of infancy that requires early diagnosis and prompt surgical intervention. In this study, we aimed to obtain comprehensive evidence on the diagnostic performance of liver stiffness measurement by ultrasound elastography in the detection of BA through a meta-analysis. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for studies that investigated the diagnostic performance of ultrasound elastography in the detection of BA up to January 10, 2022. In this study, in order to summarize the diagnostic performance of ultrasound elastography, the summary receiver operating characteristic (SROC) modeling was constructed. Heterogeneity was estimated with the I 2 statistic. Multiple subgroup analyses were also performed. Fourteen studies from eleven articles, including 774 BA patients, 850 non-BA patients, and 173 controls were included in the present meta-analysis. The summary sensitivity and specificity of ultrasound elastography for liver stiffness were 85% [95% confidence interval (CI): 79-89%] and 82% (95% CI: 73-88%) with the I 2 value of 82.90 and 84.33%, respectively. The area under the SROC curve (AUROC) using ultrasound elastography for diagnosing BA was 0.90 (95% CI: 0.87-0.92). In addition, a subgroup analysis of 9 two-dimensional shear wave elastography studies was also performed. Subgroup analysis revealed that the summary sensitivity and specificity were 85% (95% CI: 77-91%) and 79% (95% CI: 71-86%), respectively, and the summary AUROC was 0.89 (95% CI: 0.86-0.92). Ultrasound elastography exhibits good diagnostic accuracy for BA and can be served as a non-invasive tool to facilitate the differential diagnosis of BA.

Ultrasound elastography for the evaluation of plantar fasciitis: A systematic review and meta-analysis

PurposeThis meta-analysis aimed to investigate the utility of ultrasound (US) elastography in the assessment of plantar fasciitis (PF). MethodsWe searched PubMed, Embase, and Scopus and systemically reviewed clinical studies that used US elastography for imaging PF. The primary outcome was the comparison of plantar fascia stiffness between healthy controls and patients with PF, quantified using the weighted mean difference (WMD) and standardized mean difference (SMD). ResultsEleven studies were included in the final systematic review and meta-analysis. In six studies that employed shear wave elastography, patients with PF had a lower shear wave velocity, with a WMD of −1.772 m/s (95 % confidence interval [CI], −2.663 to −0.880) and an SMD of −1.239 m/s (95 % CI, −1.876 to −0.603), compared to those with asymptomatic heels. One study using the strain ratio showed that the WMD and SMD of patients with diseased heels vs healthy controls were −0.400 (95 % CI, −0.850 to 0.050) and −0.442 (95 % CI, −0.946 to 0.062), respectively. In six articles that use the color histogram of strain elastography, less stiffness was consistently reported in the diseased plantar fascia compared with healthy controls. ConclusionThis meta-analysis showed that the plantar fasciae were less stiff in the PF group than in asymptomatic subjects. The diagnostic performance of US elastography (over B-mode) warrants further investigation.

Elastography Assisted BI-RADS in the Preoperative Breast Magnetic Resonance Imaging 4a Lesions in China.

A considerable number of benign lesions, especially category 4a lesions on Breast Imaging Reporting and Data System Magnetic Resonance Imaging (BI-RADS-MRI), were biopsied according to BI-RADS-MRI, which was a diagnostic imaging challenge. This study aimed to evaluate the diagnostic performance of ultrasound elastography (UE) assisted Breast Imaging Reporting and Data System (BI-RADS) for BI-RADS-MRI category 4a lesions. Between January 2017 and December 2019, 228 breast lesions categorized as BI-RADS-MRI 4a were included. Conventional ultrasound (US) and UE were performed to evaluate each lesion. Pathology results were used as the gold standard. The diagnostic performances of different UE methods and our re-assessment proposal were evaluated. When BI-RADS-MRI category 4a, BI-RADS-US category 3-4a, the stiffness of soft or intermediate in elasticity assessment according to the fifth edition of the BI-RADS atlas, strain ratio < 1.335, age ≤ 52 years, and the maximum diameter of lesion ≤20 mm were simultaneously met, an ultrasound-guided empty needle biopsy was not recommended, but short-term ultrasound follow-up for 3-6 months was recommended, and biopsy was performed after changes in evaluation. In this way, 95 of 228 BI-RADS-MRI category 4a lesions avoided biopsies, and the number of patients with biopsies decreased by 41.7%. UE offers benefits in the characterization of BI-RADS-MRI category 4a lesions. Ultrasound and elastography can help optimize therapy recommendations for BI-RADS-MRI category 4a lesions by our re-assessment proposal.

Diagnostic performance of quantitative and qualitative elastography for the differentiation of benign and malignant cervical lymph nodes: A protocol for systematic review and meta-analysis.

Background:Studies have shown inconsistent results regarding the diagnostic performance of quantitative and qualitative elastography for the differentiation of benign and malignant cervical lymph nodes. This meta-analysis aimed to estimate the diagnostic performance of ultrasound elastography in patients with cervical lymphadenopathy.Methods:We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the May 30, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.Results:This systematic review will determine the accuracy of shear wave elastography and strain elastography in the differential diagnosis between benign and malignant cervical lymph nodes.Conclusion:Its findings will provide helpful evidence for the accuracy of shear wave elastography and strain elastography in the differential diagnosis between benign and malignant cervical lymph nodes.Systematic review registration:INPLASY202150109.

Diagnostic performance of elastography for breast non-mass lesions: A systematic review and meta-analysis

PurposeThis systematic review and meta-analysis aimed to evaluate the diagnostic performance of ultrasound elastography in the differentiation of benign and malignant breast non-mass lesions (NMLs). MethodsPubMed, Cochrane Library, and Embase databases were searched for eligible studies up to end of June 2021. The diagnostic performance of elastography for NMLs was investigated using pooled sensitivity and specificity, likelihood ratio, diagnostic odds ratio (DOR), post-test probability, and the area under hierarchical summary receiver operating characteristic curve (HSROC). ResultsEleven studies involving 812 NMLs (malignant 414) were included. The pooled sensitivity, specificity, DOR, positive likelihood ratio, and negative likelihood of elastography for the differentiation of benign and malignant breast NMLs were 79% (95 %CI: 71–85), 86% (95 %CI: 79–91), 23.32 (95 %CI: 13.38–40.66), 5.67 (95 %CI: 3.79–8.47), and 0.24 (95 %CI: 0.17–0.34), respectively. No significant publication bias existed. The area under the HSROC curve was 90% (95 %CI: 87–92). Fagan plots demonstrated good clinical utility. However, substantial heterogeneity existed. Country, measurement index, and number of lesions served as potential sources of heterogeneity. ConclusionsThe results of this study suggest that elastography has high diagnostic accuracy in differentiating between malignant and benign NMLs. Elastography can be a feasible and non-invasive tool for breast NMLs.

Developing and validating deep learning-based heterogeneous model to improve diagnostic performance of ultrasound elastography for axillary lymph node metastasis of early breast cancer.

e12583 Background: To improve the performance of ultrasound (US) for diagnosing metastatic axillary lymph node (ALN), machine learning was used to reveal the inherently medical hints from ultrasonic images and assist pre-treatment evaluation of ALN for patients with early breast cancer. Methods: A total of 214 eligible patients with 220 breast lesions, from whom 220 target ALNs of ipsilateral axillae underwent ultrasound elastography (UE), were prospectively recruited. Based on feature extraction and fusion of B-mode and shear wave elastography (SWE) images of 140 target ALNs using radiomics and deep learning, with reference to the axillary pathological evaluation from training cohort, a proposed deep learning-based heterogeneous model (DLHM) was established and then validated by a collection of B-mode and SWE images of 80 target ALNs from testing cohort. Performance was compared between UE based on radiological criteria and DLHM in terms of areas under the receiver operating characteristics curve (AUC), sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for diagnosing ALN metastasis. Results: DLHM achieved an excellent performance for both training and validation cohorts. In the prospectively testing cohort, DLHM demonstrated the best diagnostic performance with AUC of 0.911(95% confidence interval [CI]: 0.826, 0.963) in identifying metastatic ALN, which significantly outperformed UE in terms of AUC (0.707, 95% CI: 0.595, 0.804, P&lt;0.001). Conclusions: DLHM provides an effective, accurate and non-invasive preoperative method for assisting the diagnosis of ALN metastasis in patients with early breast cancer.[Table: see text]

Comments: Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis

We read with great interest the research article entitled “Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis” by Xie and Yu (). The authors claimed that the results of strain ultrasound elastography should be carefully evaluated when small thyroid nodules are close to the carotid artery. They indicated that the use of cytology to determine nodule parameters is effective in determining the diagnostic ability of strain ultrasound elastography. However, [...]

556 Poster - Role of Ultrasound Elastography in characterization of breast lesions: Does it really count?

Background: To compare the diagnostic performance of Ultrasound Elastography, Ultrasonography (Greyscale & Colour Doppler) and Digital Mammography in the characterisation of breast lesions using Pathological diagnosis as Gold standard.

Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease: A Step Forward for Better Evaluation Using Ultrasound Elastography.

Simple SummaryNon-alcoholic fatty liver disease (NAFLD) attracts a lot of attention, due to the increasing prevalence and progression to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Consequently, new non-invasive, cost-effective diagnostic methods are needed. This review aims to explore the diagnostic performance of ultrasound (US) elastography in NAFLD and NAFLD-related HCC, adding a new dimension to the conventional US examination—the liver stiffness quantification. The vibration controlled transient elastography (VCTE), and 2D-Shear wave elastography (2D-SWE) are effective in staging liver fibrosis in NAFLD. VCTE presents the upside of assessing steatosis through the controlled attenuation parameter. Hereby, we critically reviewed the elastography techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography and 2D-SWE. 2D-SWE presents a great potential to differentiate malignant from benign FLLs, guiding the clinician towards the next diagnostic steps. As a disease-specific surveillance tool, US elastography presents prognostic capability, improving the NAFLD-related HCC monitoring.The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population prompts for a quick response from physicians. As NAFLD can progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), new non-invasive, rapid, cost-effective diagnostic methods are needed. In this review, we explore the diagnostic performance of ultrasound elastography for non-invasive assessment of NAFLD and NAFLD-related HCC. Elastography provides a new dimension to the conventional ultrasound examination, by adding the liver stiffness quantification in the diagnostic algorithm. Whilst the most efficient elastographic techniques in staging liver fibrosis in NAFLD are vibration controlled transient elastography (VCTE) and 2D-Shear wave elastography (2D-SWE), VCTE presents the upside of assessing steatosis through the controlled attenuation parameter (CAP). Hereby, we have also critically reviewed the most important elastographic techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography (pSWE) and 2D-SWE. As our paper shows, elastography should not be considered as a substitute for FLL biopsy because of the stiffness values overlap. Furthermore, by using non-invasive, disease-specific surveillance tools, such as US elastography, a subset of the non-cirrhotic NAFLD patients at risk for developing HCC can be detected early, leading to a better outcome. A recent ultrasomics study exemplified the wide potential of 2D-SWE to differentiate benign FLLs from malignant ones, guiding the clinician towards the next steps of diagnosis and contributing to better long-term disease surveillance.

Diagnostic Performance of Ultrasound Elastography and Serologic Fibrosis Indices for Evaluation of Hepatic Involvement in Wilson Disease.

To investigate the diagnostic value of transient elastography (TE), 2-dimensional (2D) shear wave elastography (SWE), and the serologic fibrosis indices aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) score for Wilson disease (WD). We retrospectively identified patients with a diagnosis of WD who underwent TE and 2D SWE on the same day. Their APRI and FIB-4 scores were calculated. Hepatic involvement was classified into 5 clinical categories (I-V) based on the laboratory findings, hepatic morphologic characteristics on ultrasound (US) imaging, and clinical symptoms of cirrhosis: I, normal (n = 17); II, only biochemical abnormality (n = 15); III, altered hepatic morphologic characteristics (n = 10); IV, compensated liver cirrhosis (n = 3); and V, decompensated liver cirrhosis (n = 0). We compared the area under the receiver operating characteristic curve (AUROC) data for TE, 2D SWE, the APRI, and the FIB-4 score. A combined assessment of the serologic markers and US elastography was performed, and the AUROCs of the combinations were compared. Forty-five patients were included in the study (median age, 16.0 years; range, 3-35 years). Transient elastography, 2D SWE, and APRI were comparable in distinguishing the clinical categories (AUROC, 0.799-0.928). The FIB-4 score showed lower diagnostic value in distinguishing clinical category I from the other categories (AUROC, 0.647). Combining the serologic markers and US elastography significantly increased the AUROC value of the FIB-4 score (with TE and 2D SWE, P = .01 and .02). Transient elastography and 2D SWE showed excellent diagnostic accuracy for differentiating the clinical categories of hepatic involvement. The APRI showed better diagnostic performance than the FIB-4 score. The assessment of hepatic manifestations in WD can be improved by combining US elastography with serologic indices.

Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis

OBJECTIVES:Ultrasound-guided fine-needle aspiration biopsies are recommended for the detection of suspicious thyroid nodules. However, the best approach regarding suspicious ultrasound features for thyroid nodules is still unclear. This study aimed to evaluate the effect of location and size of thyroid nodules on the diagnostic performance of strain ultrasound elastography. In addition, this study evaluated whether ultrasound elastography predicts malignancy in thyroid nodules.METHODS:Data regarding the size, depth, and distance from the carotid artery of nodules, the elasticity contrast index, and the nature of nodules were analyzed.RESULTS:There was no significant difference in the depth (p=0.092) and the distance from the carotid artery (p=0.061) between benign and suspicious nodules. Suspicious nodules were smaller than benign nodules (p<0.0001, q=23.84) and had a higher elasticity contrast index (p<0.0001, q=21.05). The depth of nodules and the size of the nodule were not associated with the correct value of the elasticity contrast index (p>0.05 for both). The diagnostic performance of ultrasound elastography was not affected by the distance of the nodules from the carotid artery if they were located ≥15 mm from the carotid artery (p=0.5960). However, if the suspicious nodules were located <15 mm from the carotid artery, the diagnostic accuracy was hampered (p=0.006).CONCLUSIONS:The strain ultrasound elastography should be carefully evaluated when small thyroid nodules are located near the carotid artery.

Ultrasound elastography: a novel tool for the differential diagnosis of pleural effusion.

Traditional thoracic ultrasound (TUS) is often the initial tool used to help diagnose malignant pleural effusion (MPE). Ultrasound elastography, a relatively new technique, has been used to differentiate malignant disease from benign disease by evaluating tissue "stiffness". However, no studies evaluating the efficacy of ultrasound elastography for diagnosing MPE are available. We assessed the value of ultrasound elsatography for diagnosing MPE prospectively. All 244 enrolled patients were divided into a development set and a validation set in chronological order. The cut-off elasticity index was established using a receiver operating characteristic curve constructed from the continuous data of the patients in the development set. The diagnostic performance of ultrasound elastography was compared with that of TUS in the validation set. In the development set, the mean elasticity index (47.25 kPa) was the optimal cut-off. In the validation set, pleural ultrasound elastography had a sensitivity of 83.64%, a specificity of 90.67%, a positive predictive value of 86.79%, a negative predictive value of 88.31%, a positive likelihood ratio of 8.96 and a negative likelihood ratio of 0.18 for diagnosing MPE. The sensitivity of ultrasound elastography was significantly higher (p=0.006) than that of TUS (60%). Pleural ultrasound elastography is a better technique than TUS for differentiating MPE from benign pleural disease.

Diagnostic Performance of Ultrasound Elastography for Evaluating Portal Hypertension in Children: A Systematic Review and Meta-analysis.

To assess the diagnostic performance of ultrasound (US) elastography in evaluating portal hypertension in children and compare the liver and spleen stiffness values between the portal hypertension and control groups. Studies in the MEDLINE and Embase databases were selected that investigated the diagnostic performance of US elastography in children with portal hypertension up to December 21, 2017. Pooled sensitivity and specificity data were assessed by hierarchical logistic regression modeling. Eleven studies were included in the systematic review, and a meta-analysis could be conducted in 7 of these publications to evaluate the diagnostic performance of US elastography. The summary sensitivity and specificity of this method for liver stiffness were 90% (95% confidence interval [CI], 83%-94%) and 79% (95% CI, 73%-84%), respectively, and the area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90-0.94). A subgroup analysis of 5 transient elastographic studies revealed similar diagnostic performance (sensitivity, 90%; specificity, 78%). In 10 of the 11 studies that investigated liver stiffness and 2 of the 3 studies that also measured spleen stiffness, patients in the portal hypertension group had a significantly higher stiffness value than the control group (P < .05). Ultrasound elastography shows good performance in diagnosing portal hypertension and can identify significant differences in liver and spleen stiffness in children with this condition. This method thus has considerable potential as a noninvasive tool for screening portal hypertension-related complications in children with chronic liver disease.

Pleural Ultrasound Elastography: A Novel Technique for the Differential Diagnosis of Malignant Pleural Effusion

Introduction: Traditional thoracic ultrasound (TUS) is often the initial tool used to help diagnose malignant pleural effusion (MPE). Ultrasound elastography (UE), a new technique, has been used to differentiate malignant disease from benign disease by evaluating tissue hardness. However, no studies evaluating the efficacy of UE in diagnosing MPE are available. We assessed the diagnostic value of UE for diagnosing MPE prospectively. Methods: All 244 enrolled patients were divided into a development set and a validation set in chronological order. TUS and UE were performed to diagnose MPE. The cut-off elasticity values (the mean and maximal values) were established using a receiver operating characteristic (ROC) curve constructed from continuous data of the patients in the development set. The diagnostic performance of UE was compared with that of TUS in the validation set. Results: In development set, the mean elasticity value (47·25 kPa) was the optimal cut-off. In the validation set, pleural UE had a sensitivity of 83·64%, a specificity of 90·67%, a positive predictive value (PPV) of 86·79%, and a negative predictive value (NPV) of 88·31% for distinguishing MPE from benign pleural effusion. The sensitivity of UE was significantly higher (p=0·006) than that of TUS (sensitivity of 60·00%, specificity of 93·33%, PPV of 86·84%, and NPV of 76·09%). Pleural UE detected 91·11% (41/45) of MPE cases from among false-negative cases as determined by TUS in all patients. Conclusion: Pleural UE is a good technique compared with TUS for differentiating MPE from benign pleural disease, especially in high tuberculosis burden countries. Funding Statement: The authors state: No funding source was involved. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: This study was approved by the Institutional Ethical Review Board of the First Hospital of China Medical University, and written informed consent was obtained from all patients.

US Elastography Using Carotid Artery Pulsation May Increase the Diagnostic Accuracy for Thyroid Nodules with US-Pathology Discordance

This study evaluated the diagnostic performance of ultrasound elastography (USE) using carotid arterial pulsation and determined the reproducibility of USE for thyroid nodules. A total of 148 patients with 173 thyroid nodules participated. The mean elasticity contrast index (ECI) was significantly higher in malignant nodules (3.1 ± 1.5) than in benign nodules (1.7 ± 0.8) (p < 0.001). When a cut-off ECI value of 3.5 was used, the diagnostic accuracy (78.6%) of gray-scale ultrasound (US) + ECI was the highest compared with that of the gray-scale US (76.9%) and ECI (67.1%). In 16 of 43 nodules (37.2%) with US-pathology, discordance could be correctly reclassified as benign (8 of 11) or malignant (8 of 32). The intra-class correlation coefficient for inter-observer agreement was 0.96, and those for intra-observer agreement were 0.97 and 0.98. Thyroid nodules with ECI values of >3.5 may have an additional value to increase the diagnostic accuracy for nodules with US-pathology discordance with reproducible results.

Us Elastography Using Carotid Artery Pulsation May Increase the Diagnostic Accuracy for Thyroid Nodules with Us - Pathology Discordance

To prospectively evaluate the diagnostic performance of ultrasound elastography (USE) using carotid arterial pulsation and to determine interobserver and intraobserver agreements of USE for thyroid nodules. US examination and USE using carotid artery pulsation were performed in 148 patients with 173 nodules in a prospective design. The US features and elasticity contrast index (ECI) were assessed by observer 1 and the ECI was reassessed by observer 2. ROC curve analysis was performed to evaluate the diagnostic performance and to compare the AUC (Az) values of gray-scale US, ECI, and a combined assessment. Intraclass correlation coefficient (ICC) value was used to evaluate the interobserver and intraobserver agreements in the measured ECI values. Among a total of 173 nodules, 95 nodules were malignant and 78 nodules were benign. The mean ECI was significantly higher in malignant nodules (3.1 ± 1.5) than in benign nodules (1.7 ± 0.8) (p < 0.001). The Az values of each dataset were 0.768 (95% CI, 0.698–0.828) for gray-scale US, 0.695 (0.621–0.763) for ECI, and 0.782 (0.713–0.841) for a combined assessment. ICC for interobserver agreement was 0.96 (p < 0.001), and for intraobserver agreement were 0.97 (p < 0.001) and 0.98 (p < 0.001) for observer 1 and 2, respectively. Excellent interobserver and intraobserver agreement was found in thyroid USE. USE using carotid artery pulsation may have a potential role to increase the diagnostic accuracy for nodules with US-pathology discordance with reproducible results.

What we need to know when performing and interpreting US elastography.

According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.

Ultrasound Elastography Combined With BI-RADS–US Classification System: Is It Helpful for the Diagnostic Performance of Conventional Ultrasonography?

PurposeTo evaluate the additive diagnostic performance of ultrasound elastography (UE) to ultrasound (US) with the 2003 or 2013 Breast Imaging Reporting and Data System (BI-RADS)–US classification systems for the differentiation of benign and malignant breast lesions. MethodsFrom June 2010 to December 2012, 738 women with 770 breast lesions were recruited into this retrospective study. Breast lesions were evaluated separately by US, UE, and both. US assessment was based on the 2003 or 2013 BI-RADS–US, and UE assessment was based on a previously reported 5-point scale. Diagnostic performance of US, UE, and both was compared. ResultsBefore category 4 lesions were subdivided, the area under the receiver operating characteristic curve (AUC) for US, UE, and both were, respectively, 0.735, 0.877, 0.878 (P < .01). When subcategories of 4 lesions were considered, the AUC for US, UE, and both were, respectively, 0.865, 0.877, and 0.883 (P > .05). Adding UE to analysis of 4A lesions can decrease the percentages of malignancy to 2.56%. ConclusionWhen the 2003 BI-RADS was considered, UE could give US some help in differentiating breast lesions. However, when the 2013 BI-RADS was considered, UE gave little help to US, although it reduced unnecessary biopsies of benign category 4A lesions.

Can ultrasound elastography be used as a new technique in the differentiation of undescended testes and reactive lymph nodes in children?

To determine the diagnostic performance of ultrasound elastography in the differentiation of reactive lymph nodes and undescended testes in children. Seventy-two undescended testes and 34 reactive lymph nodes were prospectively examined with the elastography technique. Four elastographic patterns were used for classification based on the distribution of the blue area. The strain ratios and elasticity patterns of the undescended testes and reactive lymph nodes were evaluated independently by two radiologists. Interobserver agreement and diagnostic performance were analysed. Thirty of the 34 reactive lymph nodes were classified as exhibiting high-strain elastographic patterns (considered Type 1 or Type 2, with blue areas in ˂50% of the tissue) by both observers; in contrast, 67 and 71 of 72 undescended testes were classified as exhibiting low-strain elastographic patterns (considered Type 3 or Type 4, with blue areas in >50% of tissue) by radiologists 1 and 2, respectively. The respective mean strain ratios measured by the two radiologists were 0.60±0.03 and 0.62±0.02 for the reactive lymph nodes and 0.25±0.08 and 0.25±0.09 for the undescended testes. There were significant differences in the elasticity patterns and strain ratios between the reactive lymph nodes and the undescended testes (p<0.001). The interobserver agreement was excellent for the four elasticity patterns with a weighted kappa coefficient of 0.872. The concordance of the strain ratios between the observers was excellent in the present study (intra-class correlation score: 0.988). In the majority of cases, conventional two-dimensional ultrasound could be used to differentiate undescended testes from reactive lymph nodes with acceptable accuracy. Although the incremental value of elastography is limited, this technique might have a role in some specific cases.