Efficacy Of Shear Wave Elastography Research Articles

Diagnostic utility of renal shear wave elastography and renal Doppler findings in diabetic nephropathy: a case–control study

BackgroundDiabetes mellitus is a common systemic disease that affects the kidneys and could eventually develop an end-stage renal failure. Renal biopsy is considered a gold standard for histological characterization of diabetic nephropathy, of which renal fibrosis is a dominant component, affecting its stiffness. The objective of this study is to investigate a correlation between renal stiffness obtained by shear wave elastography, renal Doppler resistivity indices, laboratory findings, and the histological characterization depicted by renal biopsies (if feasible) in diabetic nephropathy patients and to compare their results with those obtained from normal population to explore the diagnostic efficacy of shear wave elastography. Shear wave elastography and color duplex US were performed in twenty-six diabetic nephropathy patients and twenty-six healthy (age and sex-matched) control subjects. The shear wave elastography-derived mean value of the renal tissue stiffness was measured (in kilopascals) as well as the resistivity indices of segmental renal arteries, and then the mean values were correlated to patients' clinical-laboratory data (serum creatinine and albumin/ creatinine ratio) and the biopsy results, if feasible.ResultsA significant positive correlation was found between the mean resistivity indices and the mean renal cortical stiffness at one hand and the patients' clinical-laboratory data with statistically significant differences found between the control, early, and late stages of diabetic nephropathy.ConclusionsShear wave elastography is a promising, non-invasive, and accurate diagnostic tool for assessment and differentiation between early and late stages of diabetic nephropathy with a significant positive correlation to the clinical-laboratory and renal Doppler findings.

The value of shear wave elastography in diagnosis and assessment of systemic sclerosis.

The aim was to determine the efficacy of shear wave elastography (SWE) in assessing skin stiffness and aiding in the diagnosis of patients with systemic sclerosis (SSc). A total of 66 patients with SSc, 100 healthy individuals and 27 patients with SSc-like disorders were included. SWE was performed at 17 modified Rodnan skin score (mRSS) measurement sites. The correlation between SWE and clinical profiles was assessed, and the diagnostic value of SSc was explored. The SWE values at all 17 mRSS sites were significantly higher in SSc than in the healthy group [54.95 (45.95, 66.55) vs 41.10 (39.18, 45.45) m/s, P < 0.001]. For clinically uninvolved sites (mRSS = 0) of patients with SSc, 11 of 17 sites showed significantly higher SWE values compared with healthy controls. SWE was positively correlated with total mRSS (r = 0.783, P < 0.001), the European Scleroderma Study Group disease activity index (r = 0.707, P < 0.001) and histological collagen deposition (r = 0.749, P = 0.013). SWE effectively distinguished patients with SSc from patients with SSc-like disorders (area under the curve, AUC = 0.819). Use of SWE-detected skin sclerosis showed a significantly higher sensitivity compared with 1980 ACR criteria [0.818 (95% CI 0.709, 0.893) vs 0.727 (95% CI 0.610, 0.820), P = 0.031]. SWE correlates well with disease activity and collagen deposition in the skin, provides greater reliability than mRSS and aids in the diagnosis of SSc. SWE could be considered as a convenient and reliable quantitative tool for assessing skin sclerosis and disease progression in SSc.

EVALUATION OF LIVER ELASTICITY USING pSWE AND 2D-SWE TECHNIQUES IN HEALTHY CHILDREN

Objective&#x0D; Shear wave elastography (SWE) is a new&#x0D; ultrasonography technique that can non-invasively&#x0D; evaluate liver stiffness. The efficacy of SWE in adults&#x0D; has been demonstrated by numerous studies, but&#x0D; there are few SWE studies of pediatric groups. Since&#x0D; the liver stiffness values (LSV) vary according to the&#x0D; device and the SWE method used, standard reference&#x0D; values have not been established as yet. The aim of&#x0D; this study was to establish the reference values of&#x0D; normal liver stiffness in healthy children according to&#x0D; the two SWE methods.&#x0D; Materials and Method&#x0D; Liver stiffness values were measured using the two&#x0D; different SWE methods of point SWE (pSWE) and&#x0D; 2-dimensional SWE (2D-SWE) in 107 healthy children&#x0D; aged 8-18 years with no liver disease. The pSWE&#x0D; (EPQ) and 2D-SWE (EQI) measurements were taken&#x0D; in one session on the same device (Philips Epiq Elite)&#x0D; and after at least 4 hours of fasting. The effects on&#x0D; liver elasticity values were investigated of gender,&#x0D; age, body mass index (BMI), some biochemical&#x0D; markers (such as fasting blood glucose, aspartate&#x0D; aminotransferase (AST), alanine aminotransferase&#x0D; (ALT), albumin, platelet, INR) and liver size.&#x0D; Results&#x0D; The mean LSV was 4.04±0.84kPa ((95% confidence&#x0D; interval (CI):3.67-4.42)) on pSWE and 4.41±0.71kPa&#x0D; (95% CI:4.09-4.72) on 2D-SWE. The upper limit LSVs&#x0D; were found to be 4.42kPa and 4.72kPa, respectively.&#x0D; The LSVs measured on 2D-SWE were found to be&#x0D; higher than on pSWE ((median; min-max, 4.34kPa;&#x0D; 2.82-6kPa and 3.86kPa; 2.55–5.78, respectively,&#x0D; (r=0.59, p

Efficacy of shear wave elastography for the diagnosis of chronic pancreatitis.

Shear wave elastography (SWE) is a clinical method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for diagnosing chronic pancreatitis. We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (CT) values of the pancreas. Patients were classified as having a normal pancreas (NP), early chronic pancreatitis (ECP), or chronic pancreatitis (CP). SW elasticity (SWe), SW dispersion (SWd), and CT values between groups were analyzed. SWe significantly differed between the CP and NP/ECP groups (NP vs CP; P=0.001, ECP vs CP; P=0.026,), while SWd showed a significant difference only between the NP and CP group (NP vs CP; P=0.001). The CT values were significantly different between the CP and NP/ECP groups (NP vs CP; P=0.0006, ECP vs CP; P=0.0027). Pancreatic SWE and CT values were helpful in the diagnosis of chronic pancreatitis. SWd may reveal status changes in ECP.

Comparison of Placental Elasticity and Different Spectral Doppler Indices in Normal and Intrauterine Growth Restricted Fetuses

Objective: Comparison of Placental Elasticity and different spectral Doppler indices in normal and intrauterine growth restricted fetuses to establish efficacy of shear wave elastography in early detection of Intrauterine Growth Restricted (IUGR). Design: Cross sectional comparative. 290 pregnant women previously diagnosed by ultrasound as normal and intrauterine growth restriction fetuses which were included in this study, placental elasicity in both groups was evalauted by SWE (shearwave elastography) and compared. Methods: Primarily both groups were scanned for grayscale and Color Doppler ultrasonography in which we took the measurements of resistivity and pulsatility indices of umbilical artery (UA), uterine artery and MCA (middle cerebral artery). In these groups placental elasticity was evaluated by SWE .The ratios of strain were compared between both groups. Statistical study was carried out by using Mann-Whitney test. Cut-off values for elasticity were analyzed by plotting receiver operative characteristic curve (ROC), sensitivity. Specificity and DA&#x0D; (diagnostic accuracy) for IUGR were designed established on Shear wave elastography measurements. Results: The mean placental elasticity in intrauterine growth restriction (IUGR) and in normal groups was 28.71+7.28 and 5.64+1.53, respectively while in the IUGR group median placental elasticity was 27+7 and 5.50+2 with statistically elevated median among patients in the IUGR group (P

An investigation of the efficacy of shear wave elastography in the characterization of benign and malignant liver lesions.

PurposeTo investigate whether shear wave elastography (SWE) examination, which has recently been proposed as an accessory radiological examination technique, is effective in characterizing focal liver lesions (FLLs).Material and methodsA total of 105 patients, comprising 48 males and 57 females, underwent SWE examination. The mean age of the patients was 53.31 ± 1.59 (age range 5-87) years. The SWE measurements were obtained from FLLs that were approximately 2 to 8 cm in depth in a box that was approximately 0.5 × 1 cm wide on an ultrasonography (USG) screen from approximately 2 different locations. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic SWE values in the differentiation of benign and malignant lesions. Sensitivity, specificity, and positive predictive and negative predictive values were calculated in the presence of significant limit values.ResultsThe SWE values, in kPa and m/s, in the malignant lesions were significantly higher than those in the benign lesions (p = 0.006, p = 0.011). In the ROC curve analysis, the cut-off value was calculated as 9.005 kPa in the differentiation of malignant lesions from benign lesions. The area under the ROC curve was calculated as 0.656 in the range of 0.551-0.761 with 95% reliability. Sensitivity was calculated as 64.2%, specificity as 61.5%, positive predictive value as 63%, and negative predictive value as 62.7%.ConclusionsIn addition to providing little contribution to the differentiation of benign and malignant lesions, the SWE technique is thought to contribute to a certain extent, especially in suspected cases, during the diagnosis with cross-sectional methods.

Efficacy of shear wave elastography in malignity assessment of thyroid nodules with atypia of undetermined significance and comparison with TI-RADS

Efficacy of shear wave elastography in malignity assessment of thyroid nodules with atypia of undetermined significance and comparison with TI-RADS

Influence of lesion size on shear wave elastography in the diagnosis of benign and malignant thyroid nodules

In shear wave elastography (SWE) studies, the optimal cutoff value of Young’s modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method. The objective of this study was to evaluate the influence of thyroid nodule size on the clinical diagnostic efficacy of SWE. A total of 356 thyroid nodules of 280 patients were divided into three groups according to size (Group A: ≤ 1 cm; Group B: 1–2 cm; Group C: ≥ 2 cm). SWE was used to measure the maximum Young's modulus (Emax) values of all thyroid nodules. Receiver operating characteristic (ROC) curves were drawn with pathological results as the gold standard. For all nodules, the optimal cutoff value of Emax in SWE for diagnosing malignant thyroid nodules was 36.2 kPa. The sensitivity and specificity were 76.5% and 78.4%, respectively. Groups A, B, and C had different optimal Emax cutoff values of 33.7 kPa, 37.7 kPa, and 55.1 kPa, respectively. The area under the ROC curve (AUC) values of Groups A, B, and C (0.844, 0.886, and 0.935, respectively) were all greater than the values for all lesions (0.830). The specificity values of Groups A, B, and C (86.4%, 82.6%, and 88.2%, respectively) were all increased, and the sensitivity values of Groups B and C (89.7% and 96.4%, respectively) were also increased compared with the values for all lesions. Thyroid nodule size affects the optimal Emax cutoff value of SWE. We suggest that different cutoff values be used to diagnose benign and malignant thyroid nodules according to lesion size.

Efficacy of shear wave elastography in predicting preeclampsia in the first trimester.

This study aimed to investigate the predictive value of shear wave elastography (SWE) for preeclampsia (PE) in first-trimester pregnancies. Singleton pregnant women aged 18-45 years, who underwent routine first-trimester prenatal examinations (11-13 weeks+6 days) were enrolled. Pregnancies with anterior placenta and normal first-trimester screening test results were included in the study group. The SWE measurements of six areas of the placenta were performed, and the mean value was estimated. The perinatal outcomes and the demographic data were also collected. The receiver operating characteristic curve analysis was used for the accuracy of predicting PE. This study consisted of 84 patients, of which 9 were diagnosed with PE during the follow-up. The mean SWE value of the PE patients was higher than that of patients with normal pregnancies (p=0.002). The analysis showed that the optimal cutoff value was 7.43 kPa to predict PE in the placentas of first-trimester pregnancies, with 88% sensitivity and 78% specificity. The SWE values of the placenta in the first trimester were different between normal patients and those who are subsequently developing PE. SWE may be a suitable tool for predicting PE in pregnant women.

Efficacy of Differential Diagnosis of Thyroid Nodules by Shear Wave Elastography-the Stiffness Map.

BackgroundFine needle aspiration is the gold standard for differential diagnosis of thyroid nodules; however, the malignancy rate for indeterminate cytology is 20% to 50%.ObjectiveWe evaluated the efficacy of shear wave elastography added to ultrasonography for differential diagnosis of thyroid nodules.MethodsWe retrospectively reviewed the medical records of 258 consecutive patients. Thyroid nodules were divided into 4 categories according to maximum elasticity (EMax) and nodule depth/width (D/W) ratio: Category 1 (EMax ≥ 42.6 kPa; D/W < 0.9); Category 2 (EMax < 42.6 kPa; D/W < 0.9); Category 3 (EMax ≥ 42.6 kPa; D/W ≥ 0.9); and Category 4 (EMax < 42.6 kPa; D/W ≥ 0.9). The EMax cutoff value was set using receiver operating characteristic (ROC) curve analysis to predict nodular hyperplasia (NH) vs follicular neoplasm (FN). Cutoff value for nodule D/W ratio was set using ROC curve analysis for malignancy.ResultsNH was the most prevalent pathology group in Category 1, FN in Category 2, and papillary thyroid carcinoma in Category 3. Category 3 demonstrated the highest rate of malignancy (81.8%) and had 55.4% sensitivity and 90% specificity for predicting malignancy. When assessing the benign pathology of NH in follicular patterned lesion, Category 1 demonstrated the highest NH prevalence of 88.9% (34/37) and had 73.9% sensitivity and 85.0% specificity.ConclusionThe performance for malignancy was highest in Category 3 and predictive ability for benign pathology of NH in follicular lesion was highest in Category 1. The information of EMax and nodule D/W ratio was useful to predict the pathology of thyroid nodules.

Efficacy of Shear Wave Elastography in the Differentiation of Acute and Subacute Deep Venous Thrombosis.

It is important to know the age of clot formation to determine an appropriate treatment for deep vein thrombosis (DVT). The present study aims to differentiate between acute and subacute DVT using the shear wave elastography (SWE) technique. Patients with complaints no longer than 4 weeks and who were found to have early-stage (acute-subacute) thrombus on ultrasound (US) between January 2020 and May 2020 were included in the study. All of the patients underwent SWE using a Philips Healthcare EPIQ 5 Ultrasound System Inc. device with a high-resolution linear US probe (eL18-4, 22-2 MHz). Included in the study were 50 patients, including 23 with acute DVT and 27 with subacute DVT. Of the patients, 22 were women and 28 were men, and the mean age was 46.32 ± 11.33 years (range: 24-74 years). The mean SWE value was 2.63± 0.16 (2.39-2.96) in patients with acute DVT and 3.34± 0.31 (2.65-3.88) in patients with subacute DVT. The findings were statistically significant in the comparison of the 2 groups using an independent samples t test (P < 0.001). In the receiver operating characteristic analysis, the area under the curve was found to be 97.6%. When the cutoff value was taken as 2.85 according to the area under the curve, sensitivity was found to be 96.3%, and specificity was 91.3%. Thrombus stage plays a critical role in treatment decisions in DVT in the lower extremities. The present study reveals that the shear wave US elastography technique can be used to discriminate between acute and subacute DVT.

Efficacy of Differential Diagnosis of Thyroid Nodules by Shear Wave Elastography, the Stiffness Map

Background: Fine-needle aspiration (FNA) is the first step in the differential diagnosis of thyroid nodules. However, malignancy rate of the indeterminate FNA is reported as 20-50 %. We aimed to evaluate the efficacy of shear wave elastography (SWE), the map of stiffness in the differential diagnosis of the histopathology of thyroid nodules. Methods: We retrospectively reviewed the medical records of 258 consecutive patients who visited the thyroid clinic for thyroid nodules and who underwent SWE before ultrasound-guided FNA and/or core-needle biopsy. We analyzed the EI using the total nodular region of interest method by the Q-Box Trace program. Thyroid nodules were divided in to 4 categoies according to maximum elasticity (EMax) and nodule depth/width (D/W) ratio; Category 1 (EMax ≥42.6 kPa & D/W<0.9), Category 2 (EMax <42.6 kPa & D/W<0.9), Category 3 (EMax ≥42.6 kPa & D/W≥ 0.9) and Category 4 (EMax<46.2 kPa & D/W≥ 0.9). The cutoff value of EMax was set using ROC curve analysis to predict follicular neoplasm (FN) from nodular hyperplasia (NH). Cutoff value ​​for nodule D/W ratio was set using ROC curve analysis to differentiate malignant nodule. Results: FN showed the lowest EMax among all pathologies and lower EMax than NH (p<0.05). FN was distributed mostly in the category 2 (70%) and NH was distributed mainly in the category 1 (73.9%). CLT belonged mostly to the category 1 (57.1%). PTC belonged in majority to the category 3 (58.9%) and the rest.to the category 1 (25%). So NH was the most frequent pathology group in category 1.FN was the most frequent pathology group in the category 2 and PTC was the most frequent pathology group in the category 3. Conclusion: SWE showed characteristic patterns of various pathology groups reflecting the degree of fibrosis and the information of EMax and nodule depth/width (D/W) ratio determining the category was useful to predict the pathology of thyroid nodules along with the advantage of noninvasiveness.

Efficacy of shear wave elastography for assessment of liver function in patients with heart failure.

AimsLiver dysfunction is important for prognosis in heart failure (HF). Shear wave elastography (SWE), which is a novel ultrasound technique for charactering tissues, has been used in liver diseases. However, clinical implication of SWE, including dispersion slope, remains unknown in heart diseases. This study aimed to evaluate the efficacy of SWE assessing liver function in the severity of HF.Methods and resultsWe enrolled 316 consecutive patients with or suspected heart diseases, who were classified according to the American College of Cardiology Foundation/American Heart Association stage of HF, including 37 with Stage A, 139 with Stage B, 114 with Stage C, and 26 with Stage D, and 45 normal subjects. Elasticity and dispersion slope of shear wave were assessed according to the HF stage. Elasticity and dispersion slope were not elevated in normal subjects and patients with Stage A. Elasticity was slightly increased from Stage A to Stage C and was remarkably elevated in Stage D (normal: 5.2 ± 1.1 kPa, Stage A: 5.4 ± 1.2 kPa, Stage B: 6.4 ± 1.8 kPa, Stage C: 7.8 ± 3.5 kPa, and Stage D: 17.7 ± 12.7 kPa), whereas dispersion slope was gradually increased from Stage A to Stage D (normal: 9.7 ± 1.7m/s/kHz, Stage A: 10.4 ± 1.6m/s/kHz, Stage B: 11.7 ± 2.4m/s/kHz, Stage C: 13.2 ± 3.4m/s/kHz, and Stage D: 17.6 ± 5.6 m/s/kHz). In the early HF stage, dispersion slope was elevated. In the advanced HF stage, both elasticity and dispersion slope were elevated. Liver function test abnormalities were observed only from Stage C or Stage D.ConclusionsDispersion slope could detect early liver damage, and the combination of elasticity and dispersion slope could clarify the progression of liver dysfunction in HF. SWE may be valuable to manage therapeutic strategies in patients with HF.

Efficacy of shear wave elastography for evaluating right ventricular myocardial fibrosis in monocrotaline-induced pulmonary hypertension rats

BackgroundRight ventricular (RV) function is important for outcomes in pulmonary hypertension. Evaluation of RV myocardial characteristics is useful to assess the disease severity. Shear wave elastography (SWE) provides information of shear wave (SW) elasticity, which is related to tissue hardness, and SW dispersion slope, which reflects tissue viscosity. This study aimed to test the hypothesis that SW elasticity is increased and SW dispersion slope is decreased in the right ventricle of monocrotaline (MCT)-induced pulmonary hypertension rats. MethodsRats were divided into MCT-induced pulmonary hypertension group (n = 10) and control group (n = 10). SW elasticity and SW dispersion slope were measured on excised hearts. Myocardial fibrosis was evaluated histologically. ResultsRV hypertrophy was observed in the MCT group. SW elasticity of right ventricle was higher in the MCT group than in the control group (3.5 ± 0.9 kPa vs. 2.5 ± 0.4 kPa, p < 0.01). SW dispersion slope of right ventricle was lower in the MCT group than in the control group (5.3 ± 1.7 m/s/kHz vs. 7.7 ± 1.5 m/s/kHz, p < 0.01). The fibrosis area of right ventricle was increased in MCT group compared with control group (18 ± 5% vs. 8 ± 3%, p < 0.01), and was positively related to SW elasticity and negatively related to SW dispersion slope. ConclusionsHigher SW elasticity and lower SW dispersion slope were observed in the fibrotic myocardium of right ventricle in MCT-induced pulmonary hypertension rats. SWE may have the potential to evaluate RV function by assessing myocardial characteristics.

Efficacy of Shear Wave Elastography for the Early Diagnosis of Biliary Atresia

Efficacy of Shear Wave Elastography for the Early Diagnosis of Biliary Atresia

Differentiating solid breast masses: comparison of the diagnostic efficacy of shear wave elastography and magnetic resonance imaging.

Shear wave elastography (SWE) quantitatively determines the nature of the breast lesions. Few previous studies have compared the diagnostic value of this modality with other imaging techniques. The present study aimed to compare the diagnostic value of SWE with that of magnetic resonance imaging (MRI) in detecting the nature of the breast masses. In this cross-sectional study, 80 patients with breast lumps who had Breast Imaging Reporting and Data System (BI-RADS) score of three or higher based on mammography and/or screening ultrasonography, underwent 3D SWE and MRI. The lesions were classified according to MRI BI-RADS scoring; Mean elasticity (Emean) and elasticity ratio (Eratio) for each lesion were also determined by SWE. The results of these two modalities were compared with histopathologic diagnosis as the gold standard method; diagnostic value and diagnostic agreement were then calculated. Of the masses, 46.2% were histopathologically proven to be malignant. The Emean for benign and malignant masses was 34.04±19.51kPa and 161.92±58.14kPa, respectively. Both modalities had diagnostic agreement with histopathologic results (p<0.001). Kappa coefficient was 0.87 for SWE and 0.42 for MRI. The sensitivity of both methods was 94.59% (95% CI: 81.81-99.34), while the specificity and accuracy were 48.84% [95% CI: 33.31-64.54] and 70.0% [95% CI: 58.72-79.74] for MRI, and 93.02% [95% CI: 80.94-98.54] and 93.75% [95% CI: 86.01-97.94] for SWE. SWE has better diagnostic value in terms of determining the nature of the breast masses. SWE can increase the diagnostic function of differentiating benign masses from malignant ones.

Evaluation of perforating venous insufficiency with shear wave elastography: a preliminary study.

The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements. A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett's perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett's PV diameter and the presence of reflux in Cockett's PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs. The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P < 0.001). A significant and positive relation was seen between increased PV diameter and SWE values (P < 0.001) and there was a significant relationship between the presence of perforating vein insufficiency and increase in PV diameter. A statistically significant increase was detected in SWE values for the PV for those with reflux in the great saphenous vein (P < 0.001). The best cut-off values that can be used to detect perforating vein insufficiency were found 34.600 for kPa and 3.375 for m/s. SWE may be used effectively in addition to conventional Doppler ultrasound examination in diagnosing and following perforating vein insufficiency.

SWE combined with ACR TI-RADS categories for malignancy risk stratification of thyroid nodules with indeterminate FNA cytology.

To compare the diagnostic efficacy of shear wave elastography (SWE) comnined with ACR TI-RADS categories for malignancy risk stratification of thyroid nodules with interminate FNA cytology. The clinical data, sonographic features, ACR TI-RADS grading and shear wave elastography images of 193 patients of surgical pathologically proven thyroid nodules with interminate FNA cytology were retrospectively analyzed. The diagnostic efficacy of ACR TI-RADS categories, the maximum Young's modulus (Emax) of SWE and the combination of the two were calculated respectively. The ROC curves were drawn using surgical pathology results as the gold standard. The ROC curves indicated that the cut-off value of ACR TI-RADS and Emax of SWE was TR5 and 41.2 kPa respectively, and the area under the ROC curve (AUC) was 0.864 (95% CI: 0.879-0.934) and 0.858 (95% CI: 0.796-0.920) respectively. The diagnostic sensitivity, specificity and accuracy of ACR TI-RADS was 81.4% (127/156), 84.8% (31/37), and 81.9% (158/193), respectively. That of SWE Emax was 80.8% (126/156), 78.4% (29/37), and 80.3% (155/193), respectively. After SWE combined with ACR TI-RADS, the sensitivity, specificity and accuracy was 94.2% (147/156), 75.7% (28/37), and 90.7% (175/193), respectively. ACR TI-RADS classification system and shear wave elastography had high diagnostic efficacy for thyroid nodules with interminate FNA cytology. The combination of the two could improve diagnostic sensitivity and accuracy, and could help to differentiate benign and malignant thyroid nodules with interminate FNA cytology.

2D shear wave elastography (SWE) performance versus vibration-controlled transient elastography (VCTE/fibroscan) in the assessment of liver stiffness in chronic hepatitis

BackgroundThe assessment of liver stiffness and the degree of fibrosis are important factors affecting the management strategy. Multiple non-invasive tools are now available to offer an adequate alternative to biopsy. In this study, we tried to compare the performance of 2D shear wave elastography (SWE) to the transient elastography/fibroscan as a non-invasive tool in the prediction of liver stiffness. This is a prospective study of 215 patients confirmed by serology to have positive virus C or B infection. 2D SWE was done followed by vibration-controlled transient elastography (VCTE) known as fibroscan at the same session. Biopsy results were collected.ResultsThe mean age was 51.07 years ± 6.07 SD. Five cases were excluded due to insufficient data. Fibroscan failed in 30 cases out of 210 cases (failure rate of 14.3%) compared with only 12 patients (6.7% failure rate) while using SWE. Only 180 patients completed the study to the result analysis. SWE results showed significant agreement to the fibroscan results with 86.7% agreement with a tendency for overestimation of the degree of fibrosis (11.7%). The efficacy of SWE was the highest during the assessment of patients with F0 (98.9%), F1 (97.8%), and F4 (93.3%) respectively and relatively low in F2 (92.8%) and F3 (90.6%).Conclusion2D SWE is a relatively recent non-invasive tool in the assessment of liver fibrosis grading which can be used as an alternative to the fibroscan with almost similar diagnostic performance especially when fibroscan is not capable to obtain adequate results such as in obesity and ascites.

Diagnostic value of shear wave sonoelastography in differentiation of benign from malignant thyroid nodules

PurposeTo study the efficacy of shear wave elastography (SWE), using both qualitative and quantitative methods, alone and in conjunction with other B-mode features. Method117 patients with 123 nodules were studied both by conventional ultrasonography and SWE. Size, echogenicity, margins, internal calcification (micro- or macro-calcification), composition, shape and color Doppler were assessed for each nodule. The elasticity was assessed both qualitatively and quantitatively. Velocity in the ROI (Region of Interest) was calculated in the stiffest portions for 3 times, and maximum and mean velocity were obtained. ROC curve was analyzed to calculate the best cut-off value of the SWV (Shear Wave Velocity). Univariate logistic regression was used to examine the maximum and mean SWV as discrete variables and the results were compared to key variables of conventional US (Ultrasound) features. Result123 nodules in 117 patients were evaluated. Poor margins, hypoechogenicity, micro-calcification, color Doppler grades III and IV, color map grades IV and V, maximum and minimum velocity had significant correlation with malignancy. The highest Nagelkerke R2 belonged to maximum and mean velocity (R2 = 41.2 and 39 respectively) which propose them as the strongest predictors of malignancy. The best cut-off point for differentiation of benign from malignant nodules was 3.63 m/s for maximum velocity (sensitivity of 90 %, specificity of 78.2 %,) and 3.44 m/s for mean velocity (sensitivity of 90 %, specificity of 76.4 %). ConclusionThe Real-time SWE is a promising test for the preoperative malignancy risk stratification of patients and maximum velocity has the strongest predictive value for both conventional and elastography variables.