Elastography For Prediction Research Articles

Splenic and Liver Elastography in Prediction of Esophageal Varices and Variceal Severity in Patients with Chronic Liver Disease: A Diagnostic Validation Study

Abstract Objective The aim of this study was to assess the value of shear wave elastography (SWE) to predict the presence of esophageal varices (EVs) and to predict high-grade EV in patients with chronic liver disease (CLD). Methods A cross-sectional observational study was conducted. One hundred twenty-one CLD patients were recruited. Liver stiffness (LS) and splenic stiffness (SS) were measured using SWE. Results Evaluation of LS is superior to SS in predicting the presence of EV. Evaluation of SS is more valuable than LS in grading EV. Conclusion LS and SS have good diagnostic performance in predicting and grading varices. SWE is simple to incorporate into standard ultrasonography assessments in patients with CLD. SWE can be used as an adjunct to upper gastrointestinal endoscopy to screen and monitor CLD patient.

Role of P-shear wave hepatic elastography in prediction of high-risk varices in patients affected by compensated advanced chronic liver disease

Role of P-shear wave hepatic elastography in prediction of high-risk varices in patients affected by compensated advanced chronic liver disease

Evaluation of Transient Elastography in Prediction Of De novo Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and it is also a common cause of death in patients with chronic liver disease. The curative treatment options for HCC that are currently available are surgical resection, liver transplantation and radiofrequency ablation .Despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA. Aim of the work To evaluate the role of transient elastography (as an indirect indicator to degree of liver fibrosis) in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation in hepatitis C related hepatocellular carcinoma .And to compare between transient elastography and other non invasive fibrosis indices in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation hepatitis C related hepatocellular carcinoma Patients and methods This prospective cohrt study was conducted on hepatocellular carcinoma patient, who underwent radiofrequency ablation in Tropical Medicine Department in Eldemerdash and Ain Shams Specialized Hospital, HCC clinic Ain Shams University Hospitals, Cairo, Egypt between march, 2017 and May, 2019. Data of the patient, who underwent radiofrequency ablation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and underwent radiofrequency ablation were followed up for 12 months. Results TE revealed 28 patients with F4 and only 2 patients with F3, the mean measurement of liver stiffness was (22.45 ± 10.36) KPa. There was a significant negative correlation between LS and denovo recurrence of HCC (mean of LS in patients with complete response was 17.19 ± 3.32 and the mean of LS in patient with denovo recurrence was 36,94 ± 5.93,with the The best cut off value ≥24.65 (p value < 0.001)). There was no significant correlation between CDC, FIB4, API scores and denovo recurrence of HCC. Also it was found that the LS was significantly associated with prediction of manifestation of hepatic decompensation after RFA (means of LS in patient without manifestation decompensation after RFA (p value <0.001) .Regarding prediction of mortality, LS at cut off value > 42 .75 (p value = 0,031) was significantly associated with prediction of mortality after one year of RFA. As regard serum non invasive fibrosis indices our results showed correlation between FIB4 score and hepatic decompensation after one year of intervention (the mean of FIB4 score in patients ascites and jaundice was 6.05 ± 4.71 (p value = 0.05) ).Therewas no statistically significant correlation between CDS and API with hepatic decompensation after RFA .As regard role of serum non invasive fibrosis indices in prediction of mortality after RFA, FIB4 score, CDS and API were statistically non significant. Conclusion Our data suggest that LS measurement is a useful predictor of HCC de novorecurrence overall survival and possibility of hepatic decompensation after RFA

Placental elastography in second trimester preeclampsia prediction: A prospective study.

The aim of the study was to evaluate the diagnostic potential of placental shear wave elastography in predicting preeclampsia at 16 to 20 weeks of gestation. A total of 230 pregnant women between 16 and 20 weeks of gestation were observed for the study. These women underwent shear wave elastography ElastPQ (Philips Healthcare, Bothell, Washington, USA) of the placenta. The mean value of placental shear modulus was obtained for each participant. These participants were followed up for the development of preeclampsia and were divided into two groups; group A included those who developed preeclampsia and group B included those who remained normotensive until delivery. The elasticity values of the two groups were compared, and the ROC curve was drawn to obtain the best cut-off value that would predict the onset of preeclampsia. Placental shear modulus varied from 1.03 kPa to 7.4 kPa at 16 to 20 weeks of gestation with an average of 2.74 ± 0.87 kPa. There was a statistically significant difference in the mean value of elasticity between two groups, being 4.61 kPa in group A and 2.51 kPa in group B. Maximum diagnostic accuracy was obtained at 2.9667 kPa with area under the curve 0.970, sensitivity 92%, specificity 91.71%, positive predictive value 57.5% and negative predictive value 98.9%. Stiffness of placenta, quantitatively measured by SWE at 16 to 20 weeks of gestation, is higher in the women who develop preeclampsia and hence may be used for predicting preeclampsia.

Abstract PS13-13: The value of shear-wave elastography for prediction of treatment response to neoadjuvant chemotherapy in patients with breast cancer

Abstract Introduction Recently, Shear-wave elastography (SWE) has been known to be useful for the diagnosis of breast cancer and lymph node metastasis. However, little is known about whether SWE can predict the response to neoadjuvant chemotherapy in patients with breast cancer. This study aimed to investigate the relationship between treatment response and elasticity values. Method Pre-treatment shear-wave elastography was performed in 394 patients who underwent neoadjuvant chemotherapy followed by surgery at Gangnam Severance Hospital from January 2012 to May 2020. We evaluated the pathologic complete response (pCR, defined as ypTis/T0, No) according to elasticity values such as ‘Mean stiffness’, ‘Minimum stiffness’, ‘Maximum stiffness’, and ‘Ratio’. Results A total of 394 patients, 147 (37.3%) achieved pCR. All elasticity values were significantly lower in patients with pCR after neoadjuvant chemotherapy than those with the residual invasive tumor. In the multivariable analysis, the mean stiffness (OR 0.995; 95% CIs, 0.989-1.000; P=0.039) and the maximum stiffness (OR 0.995; 95% CIs, 0.990-0.999; P=0.024) were independent predictive factors for pCR after adjusting clinic-pathologic factors. Besides, the tumor-infiltrating lymphocytes (TILs) evaluated in biopsy samples were inversely correlated with pre-treatment mean stiffness (CC -0.053, P=0.044), and elasticity ratio (CC-0.288, P=0.033). Conclusion In this study, pre-treatment elasticity values measured by SWE were significantly associated with pCR in breast cancer. Our results suggest that SWE can be a useful diagnostic tool for predicting treatment response in patients with breast cancer who will receive neoadjuvant chemotherapy. Citation Format: Soong June Bae, Min Ji Kim, Yoon Jin Cha, Na Lae Eun, Dooreh Kim, Janghee Lee, Sung Gwe Ahn, Eon Ju Son, Joon Jeong. The value of shear-wave elastography for prediction of treatment response to neoadjuvant chemotherapy in patients with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-13.

Efficacy of Ultrasound Intrinsic Compression Strain Elastography in Prediction of Malignancy in Thyroid Nodules with Fine Needle Aspiration Cytology Correlation

Background: Different diagnostic modalities are used to evaluate and diagnose efficiently thyroid nodules. These include Clinical Examinations, Thyroid Function Test (TFT), Scintiscan, Ultrasonography (USG), Fine Needle Aspiration Cytology (FNAC), and Histopathological examination. However, clinical assessment, TFT and USG have been poor parameters for assessing thyroid nodules. The objective is to this study was aimed to evaluate the efficacy of Ultrasound Elastography for the prediction of malignancy in thyroid nodule. Subjects and Methods:After obtaining written informed consent, demographic data such as age, sex and clinical features like, swelling, mode of onset, difficulty in swallowing, difficulty in breathing, hoarseness of voice obtained through an interview and recorded on predesigned and pretested proforma (Annexure II). Further these patients were subjected Grayscale Ultrasound, Ultrasound Elastography and FNAC. Results: Malignant lesions were noted in 19 patients on FNAC. Among them, 16 (84.21%) patients had malignant lesions while 3 (15.79%) patients had benign lesions based on combined USE and ECI criteria. This difference was statistically significant (p<0.001). The sensitivity of combined USE and ECI criteria in the diagnosis of malignant lesions was 84.21% with Specificity of 81.69%, PPV 55.17% and NPV 95.08%. Conclusion: Based on the findings of this study it may be concluded that, USE as determined by the Ragos criteria, TI RADS score are highly associated with malignant thyroid lesions and useful in differentiating the malignant thyroid lesions from benign ones.

S3244 EUS Elastography in Prediction of Lymph Node Metastases in Suspected GI Cancer: A Pilot Study

INTRODUCTION: Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for local staging of malignant gastrointestinal (GI) cancers. Four features are used to predict metastatic lymph nodes (LNs) with 80% accuracy if all are present: hypoechogenicity, well-defined margins, round shape, and size >1 cm. Despite near 100% specificity, the challenges of obtaining a sample limits the use of FNA. EUS elastography is a real-time technology (EUS-RTE) with the potential to differentiate malignant and benign tissue via color histogram. Investigators have speculated that the subjectivity of color interpretation leads to variable results. Image J is a processing software that can be used to help minimize bias. Our goal is to establish a quantitative EUS criterion for assessment of LNs. METHODS: At least 3 EUS-RTE images of each LN were obtained. The endoscopist recorded his assessment of the LN based on the four criteria described above (“endoscopist’s impression”). If at least 3 of the 4 criteria were present, the LN was considered malignant. FNA was performed if feasible. All images were from a linear echoendoscope. Images without adequate transducer pressure as measured by the strain graph display or cytology were excluded. A stylus was used to outline the entire LN in B-mode, which was considered the region of interest (ROI). This outline was superimposed on the corresponding color histogram for processing. The number of red, green and blue pixels and total area of each ROI were quantified using Image J. RESULTS: Twenty-one LNs from 19 patients were included in the final analysis. Ten LNs were malignant (45%). Most procedures were performed for suspected esophageal or pancreatic cancer (14/19). A comparison of the endoscopist’s impression, blue pixels as a predictor of malignancy and red pixels as a predictor of benign LN is depicted in Figure 1. Sensitivity and specificity of the endoscopist’s impression was 90% and 67% respectively; accuracy was 80%. The endoscopist’s impression performed the best (95% CI, 0.63-0.98), but the difference was not statistically significant. CONCLUSION: Our study was limited by a small sample size and selection of the ROI may be another source of subjectivity. While Image J did not outperform current EUS criteria, firm conclusions cannot be drawn. Further study with a larger cohort is necessary to refine our interpretation of elastography and determine if post-procedure processing of elastography images is a useful adjunct.Figure 1

Importance of shear-wave elastography in prediction of Achilles tendon rupture.

It was demonstrated that about 6% of patients with a ruptured Achilles tendon experience the rupture of contralateral tendon in the future; the aim of this study was to estimate the risk for rupture of contralateral tendon in patients who underwent surgical reconstruction of ruptured Achilles tendon by using subjective questionnaires and shear-wave elastography. Twenty-four patients who underwent surgical repair of the ruptured Achilles tendon and twelve age-matched healthy controls were examined with ultrasound SWE. Functional outcomes were assessed with American Orthopedic Foot and Ankle Society (AOFAS) scoring system and subjective rating system which we introduced and validated. The elasticity of injured tendon was markedly decreased (by 42%) compared to the contralateral tendon of the patient, as expected. Both AOFAS score and our novel subjective assessment scale positively correlate with ultrasound SWE values in ruptured Achilles tendons. The elasticity of contralateral Achilles tendons in patients was 23% lower than among healthy individuals. Irrespective of the lack of difference in the subjective feeling assessed by AOFAS, the contralateral tendon in the patients with reconstructed Achilles tendon has significantly lower stiffness than healthy individuals. Therefore, contralateral tendons in patients who suffered from rupture are more prone to future ruptures.

Comparative Efficacy of Ultrasonography and Acoustic Radiation Force Impulse (ARFI) Elastography in Prediction of Malignancy in Thyroid Nodules

Objective: The incidence of malignancy in thyroid nodules is infrequent, but this trend may be reversing. The present study was conducted to emphasize the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging, in addition to conventional gray-scale ultrasonography (US), for differentiating benign and malignant thyroid nodules. Methods: A total of 141 patients with thyroid nodules (≥10 mm) were included in the study and were evaluated with US, Doppler, and ARFI elastography using Siemens S2000 Acuson ultrasound equipment. Results: The sonographic patterns most predictive and indicative of malignancy included irregular margins and presence of microcalcifications. The Doppler findings in isolation were not extremely sensitive in the detection of malignancy. The shear wave velocity cutoff value on ARFI imaging using receiver operating characteristic curves for differentiation of benign and malignant nodules were noted at 2.87 m/s. ARFI imaging performed better than US and Doppler with sensitivity of 75%, specificity of 96%, and accuracy of 94%. Conclusion: ARFI elastography could be utilized as a reliable initial screening test for detection of malignancy in thyroid nodules.

36. Platelet count to splenic diameter ratio (PSR) and liver stiffness by mr elastography in prediction of esophageal varices in patients with chronic liver disease

Background and Aims: Endoscopy remains primary modality for detection and surveillance of esophageal varices (EV). Non-invasive parameters like Platelets, splenomegaly and Liver stiffness correlate with portal HTN. MR Elastography (MRE) is more accurate than fibroscan for liver stiffness across larger area and can be performed in patients with ascites. We aimed to use Platelet count to Splenic diameter ratio (PSR) and MR elastography measured Liver stiffness as non- invasive predictors of esophageal varices in patients with CLD. Methods: 64 patients with CLD were enrolled into study. All patients underwent clinical examination, blood tests and USG abdomen. PSR was calculated. Esophageal varices diagnosed based on EGD. Liver stiffness was measured by MRE as per protocol. Results: Mean age of study group was 49.14 ± 11.74 yrs with predominant male (70%) population. 56% patients had esophageal varices. Platelets and PSR negatively correlated whereas MRE Liver stiffness positively correlated with varices (P < 0.05). Mean MRE LS was 4.65 ± 1.53 kPa, 5.98 ± 2.14 kPa and 6.17 ± 2.14 kPa in those with no varices, varices and high grade varices (HGEVs) respectively. AUROC was 0.704 (95%CI: 0.572–0.836. P < 0.05) at MRELS 4.85 kPa (Sens = 72.2%; Specificity = 71.4%) and 0.728 (95%CI: 0.601–0.855. P < 0.05) at 5.1 kPa (sens = 71%; specificity = 78.8%) respectively for varices and HGEVs (p < 0.05). Mean PSR was 1474.57 ± 52.03 and 645.77 ± 224.93 (p < 0.001). AUROC for predicting varices was 0.963 at PSR of 899 (sensitivity = 91.7%; specificity = 72.2%) and 0.949 at 831.5 for HGEVs (sens = 93.5% and specif = 90.9%) (P < 0.001). Combination of MRELS and PSR increased Specificity (96.42%) with decrease in sensitivity (69.44%) (PPV = 96.15%; NPV = 71.05%; k = 0.634). Conclusions: MR Elastography is fairly accurate in predicting varices but cannot replace endoscopy. PSR is inexpensive and useful noninvasive method for identifying esophageal varices and thereby help reducing number of endoscopies in patients with low risk of varices. The combination is more specific and may be useful in excluding varices. The authors have none to declare.

Assessment of splenic stiffness using elastography for prediction of varices in HCV-related hepatic cirrhosis

Assessment of splenic stiffness using elastography for prediction of varices in HCV-related hepatic cirrhosis

Role of Ultrasound Elastography in Prediction of Malignancy in Thyroid Nodules

Background. Ultrasonography is considered useful to distinguish between solid and cystic thyroid nodules and to stratify a nodule’s risk of cancer as low, medium, or high. Ultrasound (US) elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions. Elastography possibly can solve the dilemma in reaching an accurate diagnosis for the cytologically known as indeterminate nodules. Aim. To evaluate the sensitivity and specificity of US elastography in the diagnosis of thyroid cancer. Patients and methods. This prospective study included 40 patients. The total number of nodules was 46, they were all euthyroid. Laboratory investigations were done including FT3, FT4, and TSH to exclude hot nodules. Neck US, US elastography, and fine-needle aspiration were done to all patients, and US elastography scoring system from 1 to 4 was used. Results. Four out of the 46 studied nodules were malignant. The ROC curve for elastography score (E-score) showed high sensitivity, specificity for the diagnosis of malignant thyroid nodules with a cut-off value of E-score 4 and high significance (p < 0.001), the area under curve was 0.92. The sensitivity was 75.0% and specificity was 100%. For E-score more than 2, the sensitivity was 100% and specificity was 85.37%. Conclusion. US elastography can be used to increase both the sensitivity and the specificity of US for the detection of malignant thyroid nodules, and so it seems to have great potential as a new tool for the diagnosis of thyroid cancer.

Evaluation of Tumor Stiffness by Elastography Is Predictive for Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer

Breast elastography (EG), which can objectively evaluate tumor stiffness, has been useful for differentiation of benign and malignant breast lesions. However, the value of EG for prediction of response to systemic therapy is poorly understood. The baseline evaluations of EG in 55 patients who received neoadjuvant chemotherapy were reviewed. We investigated the correlation between tumor stiffness and response to neoadjuvant chemotherapy. Tumor stiffness was evaluated by the Tsukuba elasticity scoring system. The mean EG scores were significant lower for the clinical and pathologic complete response (pCR) groups than for the others. When we categorized patients into two groups according to tumor stiffness, 26 patients were assigned to the low EG group (soft, scores from 1 to 3) and 29 patients were assigned to the high EG group (hard, score 4 and 5). The low EG group had significantly higher clinical complete response and pCR rates than the high EG group (clinical complete response, low EG group 38 % vs. high EG group 10 %, P = 0.024; pCR, low EG group 50 % vs. high EG group 14 %, P = 0.003, respectively). Furthermore, multivariate analysis indicated that estrogen receptor, human epidermal growth factor receptor 2, and low EG (odds ratio 13.04, 95 % confidence interval 1.19-458.28, P = 0.035) were independent predictive factors of pCR. Tumor stiffness evaluated by EG bears predictive potential for response to neoadjuvant chemotherapy. Stiffness evaluated by EG may be recognized as a clinically significant tumor characteristic, comparable to other data obtained by functional imaging techniques.

Clinical Application of Transient Elastography in Prediction of Portal Hypertension Related Complication in Patients with Chronic Liver Diseases

Liver cirrhosis (LC) is the final evaluative stage of chronic liver diseases with dynamic progressive process to multiple complications especially splenomegaly and esophageal varices(EV). Efforts have been made to develop non-invasive predictive models that may correlate with LC and EV. The role of liver stiffness measurement (LSM)- and spleen stiffness measurement (SSM) by transient elastography (TE) in the diagnosis of LC and prediction of EV was studied on 90 subjects selected from the outpatient clinics of Bakhash Hospitals. They were classified into three groups: GI included 10 healthy volunteers as a control group, GII included 20 chronic hepatitis (CH) patients and GIII included 60 cirrhotic patients. Patients in GIII were further subdivided equally into two subgroups A & B according to presence or absence of EV. GIII patients were evaluated by gastroscope for screening and grading of EV. All groups were subjected to complete blood picture, liver and kidney function testes and abdominal ultrasonography as well as LSM (right lobe) and SSM by using fibroscan. LS were significantly higher in LC patients as compared with CH patients and controls. At a cutoff value of 9.8 kPa, sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) for LC were 90%, 73%, 55% &78% respectively. At a cutoff value of 17.75 kPa (no varices vs. varices at any grade), sensitivity, specificity, PPV & NPV for prediction of EV were 92%, 46.2%, 73% & 67.2% respectively. LS at cut off values of 14.4 KPa predicted the splenomegaly. SSM at 50.4 KPa being the best cut-off value for prediction of varices with sensitivity, specificity, PPV, NPV & accuracy were 81.2%, 73.2%, 88.7%, 48.8% & 79.4% respectively. Combination of LS >17 KPa & SS > 52, predicted EV with 87.6% diagnostic accuracy. As regard EV prediction, combination of LSM & SSM had a highest diagnostic accuracy than PSR (76.9% vs. 87.6).