Elastography Score Research Articles

Real-time elastography in autonomously functioning thyroid nodules: relationship with TSH levels, scintigraphy, and ultrasound patterns.

Real-time elastography has been proposed to increase the sensitivity of ultrasound and improve the detection of thyroid nodules at risk of malignancy. To date sparse data on real-time elastography assessment of autonomously functioning thyroid nodules exist. Here, we investigated the potential role of real-time elastography in autonomously functioning thyroid nodule assessment. Specifically, the correlation between serum hormones and real-time elastography score, as well as other clinical and ultrasound features, was analyzed. Patients with autonomously functioning thyroid nodule identified by I-123 scintigraphy from September 2015 to July 2016 and undergoing ultrasound, real-time elastography, and thyroid function evaluation were selected. All autonomously functioning thyroid nodule were classified as RTE I (prevalence of red or green color with blue in up to 25% of the nodule area), RTE II (blue in 25-75%), or RTE III (blue in more than 75%). The association between suppressed thyroid stimulating hormone and patient's age, nodule's size, ultrasound presentation, and real-time elastography scoring was analyzed by Odds Ratio in univariate fashion and multivariate model. A number of 47 subjects with single autonomously functioning thyroid nodule were enrolled. Median age of 63 years, median size of 2.0 cm, and suppressed thyroid stimulating hormone levels in 32% of cases were found. Those nodules classified by ultrasound at high risk underwent fine-needle aspiration cytology and cancer was excluded. At real-time elastography evaluation, a 45% of autonomously functioning thyroid nodule had a hard appearance (RTE III) and had thyroid stimulating hormone significantly lower than the other (p < 0.0001). A model of multivariate logistic regression including nodule's size, ultrasound characteristics, and elastographic presentation showed that only RTE III was significantly associated with suppressed thyroid stimulating hormone (Odds Ratio of 50). Autonomously functioning thyroid nodule may have variable elasticity at real-time elastography examination, being hard score associated with reduced/suppressed thyroid stimulating hormone. For clinical practice, the presence of autonomously functioning thyroid nodule should be considered in patients with hard lesions. Also, as quoted by the most recent ATA guidelines, elastography should not be accounted for risk stratification of thyroid nodules.

Can strain elastography combined with ultrasound breast imaging reporting and data system be a more effective method in the differentiation of benign and malignant breast lesions?

To investigate whether a novel method that combines breast imaging reporting and data system (BI-RADS) with strain elastography contributes to diagnostic performance in differentiation of malignant and benign breast lesions. In 81 patients, 81 breast lesions were prospectively investigated. Breast lesions were separately evaluated with ultrasonography and strain elastography. While evaluations with ultrasonography were based on 2003 BI-RADS-US, strain elastography evaluations were based on a 5-point scale and strain ratio. Diagnostic performances of ultrasonography, strain elastography, and the combined method were compared. Among 81 lesions, 43 (53.1%) were benign and 38 (46.9%) were malignant. When a cutoff point of category 3 was used, sensitivity, specificity, positive and negative predictive values, and accuracy for BI-RADS were 100, 11.6, 50, 100, and 53%, respectively. When BI-RADS and strain ratio were combined, sensitivity, specificity, positive and negative predictive values, and accuracy were 89.5, 93, 91.9, 90.9, and 91.3%, respectively. When BI-RADS and elastography scores were combined, sensitivity, specificity, positive and negative predictive values, and accuracy were 86.8, 97.7, 97.1, 89.4, and 92.5%, respectively. The combination of strain elastography and BI-RADS was found to have better diagnostic performances to diagnose breast lesions than BI-RADS alone.

Implementation of Elastography Score and Strain Ratio in Combination with B-Mode Ultrasound Avoids Unnecessary Biopsies of Breast Lesions

The aim of this study was to evaluate whether the combination of B-mode ultrasound, elastography score (ES) and strain ratio (SR) improves diagnostic performance with respect to breast lesions. One hundred thirty lesions were prospectively evaluated by B-mode ultrasound and strain elastography, followed by fine-needle aspiration cytology/biopsy in 117 woman who were scheduled for regular breast BUS. The median ES (4.5 vs. 2.9, p < 0.001) and SR (4.9 vs. 2.3, p < 0.001) were significantly higher for malignant than for benign lesions. A sensitivity of 90.5% and specificity of 93.2% for the ES (cutoff point = 3.8) and a sensitivity of 87.5% and specificity of 87.6% for the SR (cutoff point = 3.5) were obtained. Elastography combined with B-mode ultrasound improved the specificity, accuracy and positive predictive value. Receiver operating characteristic curves yielded a higher value for the combined technique for diagnosis of breast lesions. Routine use of such a diagnostic algorithm could reduce the number of unnecessary biopsies.

The importance of compression elastography in the evaluation of thyroid nodule malignancy

Introduction/Objective. Compression, also called strain elastography imaging techniques, represent new echotomographic modality, which is a promising method for the differentiation of benign from malignant lesions, not only in the thyroid gland but also in other organs. The objective of this study is to evaluate the importance of compression elastography in the differentiation of benign and malignant thyroid nodules. Methods. We performed echotomographic examinations in B mode, and examinations using compression elastography in a total of 186 persons (152 females and 34 males, with the average age of 45.3 ? 13.5 years), with 264 nodules in the thyroid gland. Elastography was done in two steps: the first one through scoring elastographic figures, and the second one through the determination of the resistance index (strain ratio ? SR). Results. Using elastography scores by Fukunari, 44 of 60 malignant nodules had a score of 3?4, while 152 of the 204 benign nodules had a score of 1?2. Using the receiver operating characteristic (ROC) analysis, the best cut-off point obtained using elastography scores was 2, with a sensitivity of 73.3% and specificity of 74.5%. Using the software-calculated SR we found that out of 89 nodules with SR ? 2.5, 52 were malignant nodules, while out of 175 nodules with SR &lt; 2.5, 167 were benign nodules. Using the ROC analysis, the best cut-off point obtained using SR was &gt; 2.5, with a sensitivity of 86.7%, and specificity of 81.9%. Conclusion. As a follow-up of standard echotomographic examination in B mode, compression elastography is a newly developed and promising technique in the differentiation of benign from malignant lesions.

Therapeutic Effect and Location of GFP-Labeled Placental Mesenchymal Stem Cells on Hepatic Fibrosis in Rats.

Background. Liver fibrosis is a chronic progressive liver disease, but no established effective treatment exists except for liver transplantation. The present study was designed to investigate the effect of human placenta mesenchymal stem cells (hPMSCs) expressing green fluorescent protein (GFP) on carbon tetrachloride- (CCl4-) induced liver fibrosis in rats. Methods. Liver fibrosis was induced by subcutaneous injection with CCl4; hPMSCs were directly transplanted into rats through the caudal vein. The therapeutic efficacy of hPMSCs on liver fibrosis was measured by liver function tests, liver elastography, histopathology, Masson's trichrome and Sirius red staining, and immunohistochemical studies. The expression levels of fibrotic markers, transforming growth factor β1 (TGF-β1) and α-smooth muscle actin (α-SMA), were assessed using real-time polymerase chain reaction. Results. We demonstrated that liver fibrosis was significantly dampened in the hPMSC transplantation group according to the Laennec fibrosis scoring system and histological data. The Sirius red-stained collagen area and the elastography score were significantly reduced in the hPMSC-treated group. Meanwhile, hPMSC administration significantly decreased TGF-β1 and α-SMA expression and enhanced liver functions in CCl4-induced fibrotic rats. Conclusion. This study indicates that transplantation of hPMSCs could repair liver fibrosis induced by CCl4 in rats, which may serve as a valuable therapeutic approach to treat liver diseases.

Real time endoscopic ultrasound elastography and strain ratio in the diagnosis of solid pancreatic lesions.

AIMTo evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions (SPL).METHODSA total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.RESULTSSPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL.CONCLUSIONCombining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.

Elastography of Neck Masses

Elasticity (hardness) is a mechanical tissue characteristic that prevents tissue displacement under pressure. It varies in different types of tissue (fat, collagen and so forth) and in the same tissue in different pathologic states (inflammatory, malignant). During the past few years, sonographic elastography, magnetic resonance elastography and some other techniques have performed digital measurements of tissue hardness. http://www.eusjournal.com/article.asp?issn=2303-9027;year=2014;volume=3;issue=1;spage=58;epage=62;aulast=Okasha - ref1 Two techniques of elastography have evolved 1) Strain elastography (SE) 2) Shear Wave elastography (SWE) US elastography Strain scoring (patterns) system for Lymph Nodes(LN) and Thyroid masses Score 1: The entire LN is red or green, i.e., soft. Score 2: 80% or more of the cross-sectional area of the LN is red or green, i.e., soft. Score 3: 50% or more and less than 80% is red or green. Score 4: 50% or more and less than 80% is blue; and Score 5: 80% or more of the cross-sectional area of the LN is blue i.e., hard. Shear Wave Elastography SWE provides quantitative elastic information on the basis of the acoustic pulse of a US probe that stimulates tissues, thereby producing a real-time elastogram. Sonographic elastography in the neck can be primarily used to evaluate pathologies involving Lymph nodes (LN), thyroid nodules and salivary gland nodules http://www.eusjournal.com/article.asp?issn=2303-9027;year=2014;volume=3;issue=1;spage=58;epage=62;aulast=Okasha - ref4. Differentiation between reactive and metastatic lymphadenopathy is vital and one of the differentiating criteria is hardness (elasticity) of the mass. LYMPH NODES LNs that have sonographic criteria suggestive of benign nature and had elastography score of 1 hence biopsy is not indicated and the diagnoses is based on follow-up with the minimum period of 12 months. In LNs with score 2, if clinical or sonographic suspicion existed the LN was subjected to histopathological examination, but in case of low suspicion a follow-up policy can be adopted to avoid unnecessary invasive procedures. All LNs with score 3 and 4 are subjected to histopathological examination either by biopsy or FNAC. Thyroid Nodules Using strain criteria in a study by Rago differentiating benign nodules from malignant ones was a mean elasticity index of 65 kPa on SWE. The sensitivity and the specificity for malignancy were 51.9% and 97% in the case of gray-scale US and 81.5% and 97.0% in the case of the combination of gray-scale US and SWE. SWE: Sebag et al.in a study of 146 thyroid nodules form 93 patients, the cut-off point for discriminating benign nodules from malignant ones was a mean elasticity index of 65 kPa on SWE. The sensitivity and specificity for malignancy were 81.5% and 97.0% in a combination of gray-scale US and SWE, respectively While elastography is a promising technique in some organs such as the breast and the liver there have been conflicting results of its additional value in predicting thyroid malignancy and Lymp Node charachterisation

THYROID NODULES EVALUATION BY STRAIN ULTRASOUND ELASTOGRAPHY AND HISTOCYTOLOGICAL CORRELATION

Introduction: Elastography is a newly developed dynamic technique that uses ultrasound to provide an estimation of tissue stiffness by measuring the degree of distortion under the application of an external force. Ultrasound elastography has been applied to differentiate malignant from benign lesions. Material and Methods: This study included 53 consecutive patients with thyroid nodules. High resolution ultrasound elastography examination, scoring and further fine needle aspiration cytology was done in all of the cases. Tissue stiffness on ultrasound elastography was scored from one (greatest elastic strain) to five (no strain). Results: Fifty three cases were evaluated by real time ultrasound elastography.Seventeen (33%), 22 (39%), 6 (12%), 6 (12%), 2 (4%) were assigned score of 1,2,3,4 and 5 respectively.The elasticity scores 4–5 were highly predictive of malignancy with a sensitivity of 87.5%, a specificity of 97.6%, a positive predictive value of 87.5%, and a negative predictive value of 97.6%. Conclusion: Ultrasound elastography has great potential as an adjunctive tool for the diagnosis of thyroid cancer. Larger prospective studies are needed to confirm these results and establish the diagnostic accuracy of this new technique.

Maternal liver elasticity determined by acoustic radiation force impulse elastosonography in intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus and impaired liver function. The objective of the study was to evaluate maternal liver elasticity by acoustic radiation force impulse (ARFI) elastosonography in ICP and to compare it with that in healthy pregnant women. This descriptive, case-control study consisted of 33 women with healthy pregnancies and 22 women with ICP in the third trimester of gestation. Maternal liver elasticity measurements were performed by ARFI elastosonography. The maternal characteristics and perinatal outcomes of the participants were also collected. All maternal liver ARFI elastosonography scores were elevated in women with ICP compared to healthy controls (p=0.015, p=0.011, and p=0.004, respectively). There was a significant positive correlation between maternal liver enzymes and ARFI elastosonography scores (r=0.404, p=0.002 and r=0.389, p=0.003, respectively). The optimal cut-off point of maternal liver ARFI-mean elastography score to identify the risk of ICP was >1.23m/s, and the sensitivity and specificity were 68.2 and 69.7%, respectively [area under curve (AUC) 0.731, 95% confidence interval (CI) 0.594-0.869). The current study found that maternal liver stiffness measured by ARFI elastosonography was increased in pregnancies complicated with ICP.

Performance and Utility of Transient Elastography and Non-Invasive Markers of Liver Fiibrosis in Patients with Autoimmune Hepatitis: A Single Centre Experience.

ObjectivesAutoimmune hepatitis (AIH) is a relatively rare cause of hepatic dysfunction, which can lead to acute liver failure (ALV) and cirrhosis if not treated. The performance of transient elastography (TE) compared to liver biopsy has been evaluated in many liver diseases. The aim of the present study was to evaluate the performance of TE and other non-invasive markers for liver fiibrosis in patients with biopsy-proven AIH.MethodsFifty-three patients who were treated at the department of gastroenterology and hepatology of the University Clinic Essen from 2008 to 2013 included in this retrospective study. Laboratory parameters were used to calculate non-invasive markers for liver fiibrosis. Every patient underwent a liver biopsy within 6 months of the liver stiffness measurement.ResultsTransient elastography score, non-alcoholic fatty liver disease (NAFLD) fiibrosis score, Fiibrosis 4 score (FIB-4), and FibroQ were associated with the stage of fiibrosis, whereas other non-invasive markers of liver fiibrosis (aspartate transaminase (AST) to alanine transaminase (ALT) ratio, and AST to platelet ratio index (APRI)) did not demonstrate a significant correlation. NAFLD fiibrosis score and FibroQ performed slightly better in ROC curve analysis than TE in differentiating mild to moderate from severe fiibrosis (AUC 0.895 and 0.773 vs. 0.739; P < 0.001 and = 0.01, respectively), while TE performed slightly better, but still not adequate, in differentiating mild from all other stages of fiibrosis compared to NAFLD fiibrosis score and FibroQ (AUC 0.779 vs. 0.752 and 0.684; P = 0.051 and 0.009).ConclusionsTransient elastography, NAFLD fiibrosis score, and FibroQ are valuable non-invasive markers for the evaluation of liver fiibrosis in autoimmune hepatitis but they cannot replace liver biopsy, especially in differentiating mild from more advanced stages of fiibrosis.

Initial Experience With Ultrasound Elastography for Diagnosis of Major Salivary Gland Lesions.

The aim of this study was to evaluate the usefulness of ultrasound elastography, including conventional strain elastography, acoustic radiation force impulse (ARFI)-induced strain elastography, and point shear wave elastography (SWE) for diagnosis of major salivary gland lesions. Forty major salivary gland lesions underwent conventional sonography, conventional strain elastography, ARFI strain elastography, and point SWE before surgery or biopsy. The diagnostic performances of the sonographic and elastographic techniques were assessed with reference to histopathologic results. There were 32 benign (7 Warthin tumors, 17 pleomorphic adenomas, and 8 other benign lesions) and 8 malignant (1 squamous carcinoma, 2 metastases, 2 mucoepidermoid carcinomas, 1 anaplastic carcinoma, and 2 malignant lymphomas) major salivary gland lesions on pathologic analysis. No conventional sonographic features or conventional strain elastographic scores were found to be associated with malignancy (all P > .05). The ARFI strain elastographic scores between benign and malignant lesions were statistically different (P = .032) and an ARFI strain elastographic score of 4 or greater was highly predictive of malignancy (P= .025). An ARFI strain elastographic score of greater than 3 achieved specificity of 81.3% (26 of 32) and sensitivity of 62.5% (5 of 8) in differentiating benign from malignant lesions. The shear wave velocity on point SWE did not show a significant difference in distinguishing between malignant and benign lesions (6.07 versus 4.43 m/s; P > .05). However, Warthin tumors had a trend to show lower shear wave velocities compared with pleomorphic adenomas (2.84 versus 5.27 m/s; P = .024). Acoustic radiation force impulse strain elastography may be potentially useful for diagnosing major salivary gland lesions, whereas conventional strain elastography and point SWE are not helpful.

Fibrosis Progression in Untreated Hepatitis B Patients with Normal ALT by Transient Elastography

Introduction: Untreated hepatitis B virus (HBV) may lead to progression of liver fibrosis. The aim of this study is to assess fibrosis progression, as determined by transient elastography, in patients who are not on antiviral therapy as compared to patients who were on therapy. Methods: A retrospective chart review was conducted from a single center database of patients with HBV. Staging liver biopsy results from 2000-2015 were compared to staging done by transient elastography performed between the years 2013-2015. Patients were divided into two groups: those that had viral suppression (< 20 copies/mL) on treatment and those who were not on treatment that had ongoing viral replication. Student's matched sample t-test was used to determine the difference between transient elastography fibrosis staging and the initial staging by biopsy. Results: There were a total of 29 HBV patients with 15 patients that had viral suppression on antiviral treatment (5 Viread, 4 Truvada, 6 Entecavir) and 14 that were not treated. Baseline demographics can be found in Table 1. The baseline average stage of fibrosis by initial biopsy in the patients on antiviral treatment was 2.4 ± 1.6. Follow-up transient elastography scores for this group after a mean follow-up period of eight years from the initial biopsy yielded a mean stage of 2 (score of 7.5±3.4 kPa) For those patients not on treatment, the baseline average stage of fibrosis by initial biopsy was 1.3±0.47. The follow-up transient elastography scores for this group after a mean follow-up period of eight years as well from the initial biopsy yielded stage 3 (mean score of 10.2±3.2 kPa). The difference between elastography scores between these two groups was found to be significant (p < 0.005).Table 1Conclusion: Elastography test scores accurately depicted a stability in overall fibrosis in patients who achieved viral suppression for hepatitis B. Our study shows that fibrosis scores increased in patients who were not on antiviral treatment. The utility of gauging fibrosis by elastography may help determine disease severity without the need for invasive procedures such as liver biopsy. Future prospective studies are needed to further examine the use and utility of elastography scores in hepatitis B patients.

The Value of Elastography Scores in the Cytologic Diagnosis of Endoscopic Ultrasound-Guided Fine Needle Aspiration: The Experience of a Single Academic Center

The Value of Elastography Scores in the Cytologic Diagnosis of Endoscopic Ultrasound-Guided Fine Needle Aspiration: The Experience of a Single Academic Center

Hepatic Safety of Maraviroc in Patients with HIV-1 and Hepatitis C and/or B Virus: 144-Week Results from a Randomized, Placebo-Controlled Trial

In the primary 48-week analysis of a hepatic safety trial in patients with HIV-1 coinfected with HBV and/or HCV, maraviroc-containing treatment regimens were not associated with increased hepatotoxicity. In this randomized, double-blind, placebo-controlled, multicentre study, patients received maraviroc twice daily (n=70) or placebo (n=67) with concomitant antiretroviral therapy for 144 weeks (Clinicaltrials.gov identifier, NCT01327547). The primary end point was the proportion of patients with protocol-defined Grade 3/4 alanine aminotransferase (ALT) abnormalities through week 48. Key secondary end points included 144-week analysis of Grade 3/4 ALT abnormalities and liver fibrosis by enhanced liver fibrosis (ELF) testing, hepatic elastography and an optional biopsy substudy. Through 144 weeks of treatment, two (maraviroc) and three (placebo) patients met the protocol-defined Grade 3/4 ALT end point. Similar to the 48-week results, there were no statistically significant differences between groups in change from baseline in ELF or hepatic elastography. However, decreased elastography scores were noted in the maraviroc group. Blinded pathologist review suggested that 2 of 11 paired biopsies (both on maraviroc) showed signs of decreased fibrosis. One (maraviroc) and two (placebo) patients experienced treatment-related hepatobiliary adverse events (AEs). Five patients in the maraviroc group discontinued because of treatment-related AEs versus three in the placebo group. One death in the maraviroc group and two deaths in the placebo group were reported. Use of maraviroc did not increase hepatotoxicity in this population through 144 weeks. Further investigation regarding possible beneficial effects of maraviroc on liver fibrosis may be warranted.

Neck Muscles and Content of Carotid Artery as Reference Tissue for Strain Ratio – a Novel Approach to Improve the Diagnostic Performance of Thyroid Elastography?

Measurement of thyroid nodule stiffness by strain elastography already showed promising results. The aim of our study was to evaluate the diagnostic performance of elastography in predicting thyroid cancer by determination of strain ratio comparing nodule stiffness with thyroid tissue and surrounding neck tissues as well (carotid artery, neck muscles). Totally, 310 thyroid nodules in 275 patients were examined by conventional ultrasound and elastography prior to aspiration biopsy. 22(7.1%) thyroid carcinomas were histologically confirmed and included in the study. 39 benign nodules (27 confirmed by histology and 12 with benign cytology and at least 2 years stable ultrasound finding) formed control group. Elastography was evaluated qualitatively using 6-grade score and strain ratio to surrounding thyroid tissue, carotid artery and neck muscles was determined. High-risk elastographic score (4,5) was more frequent in carcinomas (67%) compared with benign nodules (11%, p<0.001). Significant differences in distribution of strain were found in all studied parameters except comparison with thyroid tissue in transversal dimension. Strain ratio comparing the stiffness with neck muscles had a higher negative predictive value than elastographic score and conventional ultrasound (92 vs. 83 and 82% respectively). Moreover, the combination of ultrasound and strain ratio to neck muscles increased sensitivity and negative predictive value to 100%. Our results suggest, that strain ratio to neck muscles in combination with ultrasound seems to have good sensitivity and negative predictive value for predicting thyroid cancer and may be beneficial in cases when comparison to surrounding thyroid tissue is problematic (Hashimoto thyroiditis, multinodular goiter, large nodule).

Diagnostic accuracy of the combined use of conventional sonography and sonoelastography in differentiating benign and malignant solitary thyroid nodules

ObjectiveTo assess the diagnostic accuracy of combined use of conventional grayscale US and sono-elastography in differentiating benign and malignant solitary thyroid nodules. Materials and methodsThis prospective study included 50 patients with solitary thyroid nodules being evaluated using grayscale US followed with sono-elastography (USE). Suspicious conventional sonographic data for malignancy then evaluated using USE were classified according to Rago criteria with calculation of strain ratio. The diagnostic performances of grayscale US, elastography with Rago criteria, for predicting thyroid malignancy were compared and cutoff value for strain ration was statistically analyzed. Finally all patients with solitary nodule were subjected to US-guided FNAC and 35 patients recommended for surgery in the form of 12 patients underwent total thyroidectomy and 23 patients underwent thyroidectomy with neck dissection. Results30 females (60%), and 20 males (40%) were included (Mean age 38) with final diagnosis comprised 29 (58%) pathologically proved benign thyroid nodules and 21 (42%) pathologically proved malignant nodules. US showed significant relation between markedly hypo-echogenicity, oval than tall, margin irregularity, presence of micro-calcification with diagnosis of thyroid malignancies with p value <0.001. Regarding sonoelastography, there was significant relation between elastography scores 4 and 5 and thyroid malignancies showing sensitivity of 80%, a specificity of 100%, and p value <0.001. The most accurate strain ratio cutoff value among studied cases was 2.52. Combination of grayscale US and sono-elastography yielded better results with sensitivity of 92%, specificity of 95%, PPV of 89%, NPV of 92% and diagnostic accuracy or efficacy of 96%. ConclusionCombined use of USE and grayscale US, showed superior performance in the differentiation of malignant and benign thyroid nodules compared with each technique alone. Suspicious US criteria with elasticity Rago scores 4 and 5 and strain ratio more than 2.52 are the most predictive signs of malignancy.

Papillary thyroid microcarcinoma co-exists with Hashimoto’s thyroiditis: Is strain elastography still useful?

To study the performance of strain elastography in differentiating papillary thyroid microcarcinoma (PTMC) combined with Hashimoto’s thyroiditis (HT), conventional ultrasound scan (US) and strain elastography (SE) were performed on 558 nodules smaller than 10mm by one examiner before surgeries. Serum concentrations of thyroid peroxidase antibody (TPO-Ab) (normal range: 0–60U/ml) were measured. Continuous variables were analyzed by independent t test. Receiver operating characteristics (ROC) curve analysis was applied to calculate the cut-off values of strain ratio (SR) and elastography score (ES). The comparison of AUCs is performed by Z test. 482 nodules were diagnosed as PTMC and there were 181 nodules co-existed with HT. SR measurements were lower in PTMC co-existed with HT when comparing to those without HT. (7.292±6.581 vs 11.319±13.155, p<0.000). Taking the data from all of the 558 nodules, the best cut-off of diagnosing PTMC was SR>2.58. When taking the data from 181 PTMC with HT, the best cut-off was SR>2.10. The diagnostic value of SR>2.1 were higher than ES>3, conventional US and combining US and SE (z=3.595, 4.876, 4.420, p<0.001), but cut-off of SR>2.1 did not show significant enhancement of diagnostic value compared to SR>2.58 (z=0.439, p=0.8903>0.001) in PTMC with HT. There is a negative relation between SR and titer of TPO-Ab (r=−0.650, p<0.0001). PTMC with high TPO-Ab (>1000) titer presented lower SR (5.972±4.118 vs 8.379±9.172, p=0.009). Although SR measurements were lower in nodules co-existed with HT when comparing those without HT, using a regular ES and cut-off of SR measurement would not influence the diagnosing performance. SE is still very useful for diagnosing PTMC with HT. PTMC with high TPO-Ab titer might require a lower cut-off of SR.

Relationship between ultrasound elastography and myofibroblast distribution in breast cancer and its clinical significance.

The study investigated the relationship between ultrasound elastography (USE) scoring and myofibroblast distribution with expression features of α-SMA + /CD34− in patients of Uyghur and Han ethnicities with breast masses in Xinjiang, China. The data was used to evaluate its clinical significance in the early diagnosis of breast cancer. A total of 300 patients with breast masses were included in the study, which involved conventional sonography and USE, with histopathologic diagnosis as the reference standard. Myofibroblast distribution was investigated by detecting the expression levels of α-SMA and CD34 in lesions using immunohistochemistry and real-time PCR. Out of 300 lesions, 185 were histologically malignant and 115 benign. The mean elasticity score for malignant lesions was significantly higher than for benign lesions. The expression level of α-SMA was elevated while the expression level of CD34 was lower in malignancies, compared with benign lesions. The expression of α-SMA was positively associated with the USE scores, while a negative relationship was observed between CD34 expression and USE scoring. The combination of USE and molecular diagnosis provides a promising modality for the early diagnosis and evaluation of the risks in particular types of breast cancer.

Correlation of Strain Elastography with Conventional Sonography and FNAC/Biopsy.

Elastography is a new promising technique that can be especially helpful when used as an adjunct to conventional B-mode ultrasound in evaluating breast lesions. To evaluate the diagnostic performance of four interpretation criteria for elastography and to compare the diagnostic performance of sonoelastography with that of conventional sonography in characterising breast lesions as benign or malignant with FNAC/biopsy correlation. One hundred breast lesions were prospectively evaluated by ultrasound as well as by strain elastography followed by FNAC/ biopsy correlation. The criteria used were Elastography Score, Strain Ratio, Distance Ratio and Area Ratio. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality. The best cut-off point was calculated for each of the interpretation criteria using the MedCalc version 10.1 software. The diagnostic performance of the interpretation criteria was compared with that of conventional sonography by the area under the receiver operating characteristic curve using SPSS software. The elastography score was found to have the best performance among the 4 criteria used with a sensitivity and specificity of 100% and 82.66%, respectively at the best cut-off point between 3 and 4. At a best cut-off point for conventional sonography between BI-RADS categories 4A and 4B, the sensitivity and specificity were found to be 96% and 92% respectively. The area under the curve value was slightly greater for conventional sonography (0.980) than for the elastography score (0.913) using receiver operating characteristic curve analysis. While all interpretation criteria were able to differentiate benign and malignant lesions with statistical significance, the elastography score was found to be the most accurate. While conventional ultrasound remains the primary modality for the characterization of breast masses, elastography was found to have a role in low suspicion lesions (BI-RADS 3 and 4A) where it's greater specificity could justify avoiding unnecessary biopsy.

Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C

Although long regarded as the gold standard for liver fibrosis staging in chronic hepatitis C (CHC), liver biopsy (LB) implies both the risk of an invasive procedure and significant variability. The aim of this study was to evaluate the diagnostic performance for transient elastography (TE) and aspartate aminotransferase to platelet index (APRI) used alone and in combination compared to liver biopsy and to analyze false positive/negative results. Patients with CHC, and no previous clinical diagnosis of cirrhosis were enrolled to undergo liver biopsy, TE and APRI. A total of 182 adult patients with a median age of 55 years and median body mass index of 26.71 kg/m2 were analyzed. On LB, 56% of patients had significant levels of fibrosis (METAVIR F≥2) and 28% had advanced fibrosis (F3/F4). The strongest performance for both tests was observed for exclusion of advanced fibrosis with good negative predictive values (89 and 86%, respectively). Low necroinflammatory activity on LB was associated with false negative TE. False positives were associated with NASH and smaller LB fragments. Correlation between APRI and Fibroscan for F≥2 was 100% and 84% for F≥3 and remained high in both false negative and false positive instances, correctly identifying F<2 in 71% of cases and F<3 in 78% (and potentially foregoing up to 84% of LB). We concluded that low individual performance indicators could be attributable to limitations of LB. Poorer differentiation of lower levels of fibrosis is a known issue for LB and remains so for noninvasive tests. Good predictability is possible, however, for advanced fibrosis.