Emean Values Research Articles

Diagnostic performance of ultrasound elastography in differentiating hepatocellular carcinoma and intrahepatic cholangiocarcinoma: a systematic review and meta-analysis.

To evaluate the diagnostic value of ultrasound elastography (USE) for characterizing hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). The protocol was pre-registered a priori at ( https://osf.io/namvk/ ). Using PubMed, Web of Science, Embase, and Cochrane Library, we found studies up to April 20, 2024 by searching HCC, ICC, and USE as keywords. Parameters of USE were directly compared between HCC and ICC patients using random-effects bivariate model on STATA 17.0, MedCalc 20.0, and Psychometrica. Trim & fill method and sensitivity analysis were also performed. Eighteen studies were included with 1057 patients, consisting of 863 HCC lesions, 188 ICC lesions, and 6 mixed lesions. The pooled Emean values of HCC and ICC were 28.3 (CI = 19.8 to 36.8) and 44.0 (CI = 20.9 to 67.2). HCC tumors were 34.3% softer than ICC while peritumoral tissue in HCC lesions was 75% stiffer than ICC lesions based on Emean. The strain value index (tumoral-to-peritumoral ratio) in HCC patients was 49.4% less than that of ICC patients. USE demonstrated a pool sensitivity of 87% (CI = 73-95%), specificity of 82% (CI = 65-92%), positive likelihood ratio of 4.8 (CI = 2.2 to 10.3), negative likelihood ratio of 0.16 (CI = 0.07 to 0.37), and diagnostic odds ratio of 31 (CI = 7 to 127) in differentiation of ICC from HCC. By evaluating tumoral and pre-tumoral stiffness, along with strain value index, USE may provide a valuable quantitative diagnostic tool for accurately differentiating HCC and ICC.

Influencing Factors, Reference Range and Repeatability of Salivary Gland Ultrasound Viscoelastic Imaging in Healthy Adults

ObjectiveThe study aimed to determine the influencing factors, reference range, the changes of salivary gland secretion function and repeatability of measurements taken from ultrasound (US) viscoelastic imaging in the salivary glands of healthy adults. MethodsFrom August 2023 to October 2023, 206 healthy adults were recruited. In November 2023, 50 healthy adults were recruited for acid stimulation testing. All volunteers underwent conventional and viscoelastic US of the salivary glands. The viscoelasticity values in different regions of interest (ROI), observers, genders, ages, body mass index (BMI) groups and before and after acid stimulation were compared separately. A two-sided 95% reference range was estimated accordingly. ResultsThere was no difference in the E-mean and V-mean values among different ROIs (p > 0.05). The intra-group correlation coefficient values between the different observers were all >0.908. Except for the influence of age on the E-mean value of the parotid gland, the V-mean of the parotid gland, the E-mean and V-mean of the submandibular gland were not affected by age, gender or BMI. Finally, differences were detected in the E-means and V-means of the parotid and submandibular glands before and after acid stimulation (p < 0.05). ConclusionUS viscoelastic imaging is a simple and reliable technique for evaluating the stiffness and viscosity of salivary glands in healthy adults. It also can be used to dynamically evaluate the changes of salivary gland secretion function.

Measurement of lacrimal gland tissue stiffness for the diagnosis of visual display terminal-associated dry eye disease using shear wave elastography

ObjectiveThis study aimed to evaluate whether lacrimal gland tissue stiffness can aid in diagnosing dry eye disease (DED) using shear wave elastography (SWE). We also aimed to assess the correlation between the subjective symptoms of ocular strain, SWE values, and other ocular examination findings (Schirmer's test and tear film breakup time [TBUT]) contributing to the diagnosis of DED. MethodsThis cross-sectional study recruited 300 participants who were engaged in video display terminal (VDT) work and had been diagnosed with DED by an ophthalmologist for more than one year, and 100 healthy participants without DED symptoms, from August 2020 to December 2021. The modified TFOS DEWS II was used for diagnosing DED. The ocular symptoms, Schirmer's test results, and TBUT of the participants were assessed using standardized methods. Eighty patients with DED and 40 sex- and age-matched healthy participants were selected as the observation and control group, respectively. The lacrimal gland tissue architecture was assessed using ultrasound. ResultThe SWE Emean value reflecting the lacrimal gland tissue stiffness of patients with DED was significantly higher than that of healthy participants (11.06 ± 1.26 for the DED group vs. 7.54 ± 1.27 for the control group, P < 0.001). In patients with DED, the Emean values of the lacrimal glands significantly correlated with the scores for subjective symptoms of ocular dryness (P < 0.001). No significant correlation was observed between the TBUT and Schirmer's test results. The area under the receiver operating characteristic (ROC) curve for SWE was 0.995. According to the ROC analysis results using an Emean cutoff value of 9.32 kPa for the diagnosis of DED, the sensitivity, specificity, positive predictive value（PPV）, and negative predictive （NPV）value were 97.5 %, 95 %, 100 %, and 95 %, respectively. Thus, SWE can be considered for diagnosing VDT-associated DED. ConclusionVDT-associated DED was associated with increased tear gland tissue stiffness. SWE aids in the quantitative detection of lacrimal gland tissue stiffness. Moreover, SWE significantly correlated with the subjective symptoms of DED.

The role of shear wave elastography in predicting endometrial cancer in patients presenting with abnormal uterine bleeding.

Shear Wave Elastography (SWE) is an objective quantitative ultrasound elastography technique that can demonstrate the stiffness of anatomical structures to aid in their detection and characterization. We aimed to evaluate the role of shear wave elastography in differentiating endometrial carcinoma from benign uterine pathologies in women with abnormal uterine bleeding. This prospective study was conducted at our institution from January 2020 to April 2020. A hundred patients with endometrial sampling planned and SWE due to abnormal uterine bleeding were included in the study. According to the histopathological results of the patients, those with normal and atrophic endometrium results were defined as group I (control group), those with benign results such as polyps and endometrial hyperplasia were defined as group II, and those with endometrial cancers were defined as group III. After adjustment for age, a statistically significant difference was found in Emean (mean and adjusted mean) value between the study groups (F2.96=86.37, p<.001, η2=0.64). The post-hoc analysis was performed with a Bonferroni adjustment. The mean Emean value was found to be statistically significantly higher in group III (17.14±0.40) compared to group I (10.39±0.26) and group II (11.49±0.32) (p<0.001). In addition, a statistically significant difference was found between the benign and normal groups. As a new diagnostic technique in gynecology, elastography appears to be a valuable tool in differentiating malign endometrial pathologies from normal or benign endometrial pathologies in females with abnormal uterine bleeding.

INFORMATIVENESS OF TRANSIENT AND TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY IN ASSESSING OF LIVER STIFFNESS IN POST-COVID-19 AND CARDIOHEPATIC SYNDROMES

Ultrasound elastography of diffuse liver diseases allows to assess liver stiffness and predict the further course of the disease, determine the tactics of patient’s management for post-Covid and cardiohepatic syndrome. The purpose of the research – to study the diagnostic informativeness and evaluate the correlation between one-dimensional and two-dimensional shear wave elastography technologies with elastometry in assessing liver stiffness in patients with post-COVID and cardiohepatic syndromes. Materials and methods. A comparative analysis of the information content and correlation between the results of one-dimensional and two-dimensional shear wave elastography of the liver was carried out in 85 patients with post-COVID (N1; n = 30) and cardiohepatic (N2; n = 25) syndromes. The control group (N3; n = 30) consisted of patients without the new coronavirus infection COVID-19 and without any pathology of the liver and biliary system. In the control group, the study of liver parenchyma stiffness using shear wave elastography was carried out by lobes and segments. Standard variation statistics algorithms were used, taking into account the type of data distribution in the statistical analysis. Quantitative indicators with a normal distribution were described using arithmetic means (M) and standard deviations (SD), boundaries of the 95% confidence interval (95% CI). In the absence of a normal distribution, quantitative data were described using the median (Me) and lower and upper quartiles (Q1–Q3). Research results. The stiffness values (Emean) in the projection of segments VI, VII had larger values (p = 0.02) when compared with other segments. We obtained the following Emean values in transient elastography: in the group of patients with post-COVID syndrome (N1) – 10.02 kPa; in the group of patients with chronic heart failure (N2) – 14.09 kPa, which turned out to be significantly higher than the stiffness of the liver parenchyma among healthy individuals, where the Emean value was 4.90 kPa (p = 0.05). With shear wave elastography, the results were also higher in the group of patients with chronic heart failure (N2), where Emean was 20.90 kPa, compared to the group of patients with post-COVID syndrome (N1) – 11.86 kPa. Conclusions. The results of shear wave elastography were successful in 100% of cases, the results of transient elastography in 84.6% of cases. Correlation analysis of connections in a group of patients with chronic heart failure according to TE and SWE showed a weak positive direct linear correlation. A positive direct linear correlation of medium strength was obtained in assessing the correlation in the group of patients with post-COVID syndrome.

Comparison of sound touch elastography and quantification for assessing the renal pathologic changes in patients with proteinuria

ObjectiveSound touch elastography (STE) and sound touch quantification (STQ) are novel imaging methods to evaluate tissue stiffness. This study aims to investigate renal stiffness in patients with chronic kidney disease (CKD) by STE and STQ, using renal biopsy as ‘gold standard’.MethodsBetween 2019 January and 2022 June, 60 patients who underwent renal biopsy for proteinuria (cases) and 45 healthy volunteers (controls) at our hospital were included in this study. The maximum and mean elastic modulus (Emax, Emean) of region of interest in right kidney were measured by STE and STQ techniques. Biochemical profiles and renal biopsy findings were recorded.ResultsBoth Emax and Emean measured by STE were significantly different between cases and controls. ROC analysis of STE measurements revealed using a cutoff of 13.53 kPa for Emax and 10.16 kPa for Emean, the area under the curve (AUC) to distinguish nephropathy from healthy was 0.718 and 0.744. Analysis of ROC for STQ measurements showed that using a cutoff value of 15.87 kPa for Emax and 9.95 kPa for Emean, the AUC for the nephropathy was 0.612 and 0.569. Emax and Emean values were significantly different among CKD patients with mild, moderate and severe pathological stage. The Emax value for STE was positively related to Scr, β2-MG (r = 0.257, 0.292, p < 0.05).ConclusionBoth STE and STQ are non-invasive, feasible methods to quantitatively evaluate renal stiffness. STE is more effective than STQ in the diagnosis of CKD patients with proteinuria.Critical relevance statementSound touch elastography is more effective than sound touch quantification in the diagnosis of chronic kidney disease patients with proteinuria.Key points• Emax and Emean measured by STE were different between cases and controls.• Emax and Emean were different among CKD patients with different pathological stages.• The Emax value for STE was positively related to serum creatinine, β2-microglobulinGraphical

Exploring the anatomical factors influencing testes elasticity via ultrasound shear wave elastography: Preliminary results

PurposeThe aim of this study is to evaluate the anatomical factors influencing elasticity values of normal testicular parenchyma using shear wave elastography (SWE). MethodsThis study examined 68 healthy male volunteers (117 testes in which standard transverse axis ultrasonography views could be obtained) via conventional scrotal ultrasonography and SWE. Both the mean (EMean) and standard deviation (ESD) elasticity values were acquired. ResultsIn the standard transverse axis view of the rete testis at the mid-lateral edge of the testes, the EMean values in 2mm the testicular parenchyma from the rete testis and the testicular capsule at the same level as the rete testis were all significantly larger than in the central zone (P<0.001, P<0.001, respectively). The EMean value in the testicular parenchyma 2mm from the testicular capsule on the line formed approximately 45° below the horizontal line of the rete testis was significantly larger than in the rete testis approximately 45° above the horizontal line (P<0.001). In two standard transverse axis views, the ESD values in other regions were significantly larger than those in the central zones (all P<0.001). Also, the EMean values in the transmediastinal arteries were larger than those of the surrounding normal testicular parenchyma (P<0.001). ConclusionBased on SWE, factors including the testicular capsule, the density of testicular fibrous septa, the depth of the Q-Box™, and the transmediastinal artery may influence the testes elasticity measurement.

Correlation of shear-wave elastography parameters with the molecular subtype and axillary lymph node status in breast cancer

PurposeTo examine correlations between shear-wave elastography (SWE) parameters with molecular subtype and axillary lymph node (LN) status of breast cancer. MethodsWe retrospectively analyzed 545 consecutive women (mean age, 52.7 ± 10.7 years; range, 26–83) with breast cancer who underwent preoperative breast ultrasound with SWE between December 2019 and January 2021. SWE parameters (Emax, Emean, and Eratio) and the histopathologic information from surgical specimens including histologic type, histologic grade, size of invasive cancer, hormone receptor and HER2 status, Ki-67 proliferation index, and axillary LN status were analyzed. The relationships between SWE parameters and histopathologic findings were analyzed using an independent sample t-test, one-way ANOVA test with Tukey's post hoc test, and logistic regression analyses. ResultsHigher stiffness values of SWE were associated with larger lesion size (>20 mm) on ultrasound, high histologic grade, larger invasive cancer size (>20 mm), high Ki-67, and axillary LN metastasis. Emax and Emean were the lowest in the luminal A-like subtype, and all three parameters were the highest in the triple-negative subtype. Lower value of Emax was independently associated with the luminal A-like subtype (P = 0.04). Higher value of Emean was independently associated with axillary LN metastasis for tumors ≤ 20 mm (P = 0.03). ConclusionIncreases in the tumor stiffness values on SWE were significantly associated with aggressive histopathologic features of breast cancer. Lower stiffness values were associated with the luminal A-like subtype, and tumors with higher stiffness values were associated with axillary LN metastasis in small breast cancers.

Prediction of Molecular Subtypes Using Superb Microvascular Imaging and Shear Wave Elastography in Invasive Breast Carcinomas

To investigate the efficacy of the advanced imaging methods, superb microvascular imaging (SMI) and shear wave elastography (SWE) in predicting molecular subtypes in invasive breast carcinomas. A total of 210 biopsy-proven breast carcinomas in 200 patients who underwent ultrasound (US) imaging with SMI and SWE were included in this study. Quantitative analyses were performed using mean elasticity (Emean) score by SWE and vascular index (VI) by SMI. For qualitative assessment of microvascularity, first, lesions were graded according to Adler's classification in four types. Then, a new morphological model was used to classify the microvascular architecture into six patterns: type one, no signal; type two, penetrant; type three, rim-like; type four, dot-like/linear/regional; type five, wheel-like and type six, irregular signals. The correlation between these variables and molecular subtypes, nuclear grade, the Ki-67 levels and axillary status was investigated. The average VI and Emean values were relatively higher in non-luminal subtypes (VI, p=0.002; Emean, p > 0.05). The two microvascularisation models were significantly able to differentiate the molecular subtypes according to the Kruskal Wallis test (p < 0.05). Rim-like, penetrant and regional patterns were primarily observed in luminal subtypes. The dominant pattern in non-luminal subtypes was wheel-like pattern. VI, Emean, Adler's classification and morphological vascularisation model were not significantly correlated with the nuclear grade, Ki-67 index or axillary status. The proposed microvascular categorization model may be more valuable in predicting molecular subtypes of breast carcinomas compared to VI and Emean and may contribute to the management of breast carcinomas as a non-invasive variable.

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

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

Magnetic resonance imaging and shear wave elastography comparison in the evaluation of breast lesions

This study aims to compare the Magnetic Resonance Imaging (MRI) and Shear Wave Elastography (SWE) data and investigate their contribution to diagnosis when both are individually used and combined. This study included the consent of 46 diagnostic biopsy patients after their breast MRI examination was performed. Mass appearance patients in the sonographic evaluation were SWE examined before the biopsy. In MR examination, lesion localization, size, contrast curves, contrast enhancement features, intensity in the fat-suppressed T2A sequence, Emean value in SWE examination, and histopathological results were examined. Individual and combined use of MRI and SWE findings were evaluated with histopathological results. The diagnosis consistency was compared according to the histopathological results of the malignant-benign defined lesions. Higher sensitivity in MRI; higher specificity and accuracy in SWE were acquired when both methods were compared. The accuracy of MRI improved when MRI use is combined with SWE. The combined use of SWE with MRI increases the diagnostic accuracy in breast lesion characterization. We observed that lesions showing a type 3 enhancement curve and iso-hypointense on the T2W sequence in breast MRI could be predicted to show a stiff elasticity pattern on SWE due to higher elastography values.

Evaluation of Functional Recovery Following Achilles Tendon Ruptures by Shear Wave Elastography: A Before-and-After Study

Background: Sonoelastography is extensively used for clinical diagnosis. Different types of elastography can be used to assess the elastic properties (stiffness) of tissues. For quantitative analyses, shear wave elastography (SWE) has been applied as a non-invasive method in the past decade. Today, SWE is widely used for diagnosing diseases. However, a limited number of studies have investigated musculoskeletal injuries and neoplastic diseases. Objectives: This study aimed to evaluate the postoperative functional recovery of Achilles tendon ruptures by SWE to determine the Achilles tendon function and provide reliable evidence for clinicians. Patients and Methods: SWE was used to measure elasticity in 67 patients with Achilles tendon ruptures. In the postoperative stage, 17 patients were lost to follow-up. The remaining 50 patients with Achilles tendon ruptures were examined. Each patient was followed-up for one, three, and six months postoperatively. The 0° flexion of the ankle joint was considered as the standard position. The mean elasticity (Emean) of the Achilles tendon was measured and recorded at different time points before and after surgery. Besides, the thickness and width of the Achilles tendon were measured at the corresponding time points. Results: The mean elasticity (Emean) of normal and ruptured Achilles tendons was 447.4 ± 59.57 and 63.84 ± 45.18 kPa, respectively in 50 patients with ruptured Achilles tendons before surgery. On the other hand, the Emean values of ruptured Achilles tendons in one-, three-, and six-month follow-ups were 110.3 ± 35.60, 183.4 ± 46.08, and 279.1 ± 48.18 kPa in 50 patients, respectively. Regarding the Emean, the difference between the five time points was significant (F = 418.5, P &lt; 0.01). With prolongation of postoperative recovery, the Emean of the Achilles tendon gradually increased; the Emean value significantly increased at six months after surgery. Conclusion: The quantitative analysis of the postoperative function of Achilles tendon, based on the Emean value obtained by SWE, can be helpful in guiding clinicians to objectively examine the prognosis of patients.

The Value of Shear Wave Elastography in Predicting the Risk of Endometrial Cancer and Atypical Endometrial Hyperplasia.

To evaluate shear wave elastography (SWE) technology diagnosis value of endometrial cancer (EC) and atypical endometrial hyperplasia (AEH), and to establish predictive logistic regression models for the diagnosis of EC and AEH. Clinical information collection, transvaginal conventional ultrasonography, and SWE check were performed on 122 patients, who were perimenopausal or postmenopausal vaginal bleeding with ≥4.5 mm thick endometrium. The maximal (Emax) and mean (Emean) of Young's modulus for the endometrium were obtained. Using pathology as the gold standard, ROC curves were plotted to evaluate Young's modulus on the diagnostic effectiveness of EC and AEH. Single-factor analysis and bivariate logistic regression methods were applied to assess the clinical variables, transuaginal conventional ultrasonography variables, and Young's modulus on the identification of EC and AEH. Out of 122 cases of endometrial lesions, 85 cases were benign lesions, and the remaining 37 cases were EC and AEH. The Emax and Emean for the benign group were 29.80 ± 11.40 and 17.96 ± 8.05 kPa, respectively. The Emax and Emean values for EC and AEH group were 59.49 ± 16.95 and 38.46 ± 17.10 kPa, respectively. Emax and Emean for both groups were statistically significant, with p <.001. In the logistical regression analysis, endometrial thickness, Color score, and Young's modulus were identified as independent risk factors for EC and AEH. SWE technology plays an important role in the diagnosis of EC and AEH, and the diagnostic effectiveness would be higher when combined with conventional ultrasonography.

Can measuring perilesional tissue stiffness and stiff rim sign improve the diagnostic performance between benign and malignant breast lesions?

To evaluate tissue stiffness values around breast lesions and stiff rim sign for the differentiation of benign and malignant lesions. A total of 192 patients (mean age, 44.6 ± 13.6years) with 199 breast lesions were included in this retrospective study. All lesions were pathologically proven by US-guided core needle biopsy (CNB), Mammotome biopsy, or surgery. We first observed the presence or absence of a stiff rim sign, which was defined as a red or orange halo around the breast lesion. The shell around the breast lesion on SWE was then automatically drawn by machine, with a width of 1mm, 2mm, and 3mm. The elasticity moduli of the lesion and surrounding tissue were recorded, including maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), and elasticity ratio (shell/lesion ratio). The optimal thresholds of elasticity moduli were calculated according to the receiver operating characteristic (ROC) curve. There were 75 malignant lesions and 124 benign ones. The average Emax and Emean of lesions and shell were significantly higher in the malignant group than in the benign group (P < 0.05). The optimal cut-off value of Emax for diagnosing malignant lesions was 101.7kPa, with a sensitivity of 66.3% and specificity of 87.9%. The optimal cut-off value of Emean was 29.1kPa, with a sensitivity of 65.3% and specificity of 79.8%. The stiff rim sign had the highest diagnostic performance for malignancy as compared with other elastic parameters, with an accuracy of 88.4%. However, measuring peritumoral tissue stiffness can achieve relatively high sensitivity, whereas specificity was not improved significantly. The stiffness of tissue surrounding breast malignancies was significantly higher than the surrounding benign lesions. Stiff rim sign has the potential to improve the diagnostic performance of breast lesions.

Application of Shear Wave Elastography to Evaluate the Stiffness of Normal Testes and Inflammatory Epididymal Tail Masses.

This study aimed to investigate the application value of shear wave elastography in examining normal testes and inflammatory epididymal tail masses. We examined 110 healthy male volunteers (with a total of 220 testes) and 25 patients with epididymitis via conventional scrotal ultrasonography and shear wave elastography. The mean (Emean), minimal (Emin), maximal (Emax), and standard deviation (ESD) values of elasticity were acquired. The inflammatory masses were assessed at initial diagnosis, at weeks 1 and 2 of standard anti-inflammatory treatment, upon remission, and at 2 weeks after remission. The Emean values of different regions in testes varied in the following order: center region (3.14 ± 0.35 kPa) < upper- or lower-pole capsule (upper, 3.94 ± 0.90 kPa; lower, 3.94 ± 0.97 kPa) < posterior capsule (5.96 ± 1.46 kPa) < anterior capsule (6.27 ± 1.58 kPa). The Emean value of the center of the testicular parenchyma in the short axis was significantly larger than that in the long axis (3.47 ± 0.32 vs 3.14 ± 0.35 kPa; P < 0.05). There were significant differences in the Emean value between inflammatory epididymal tail masses at initial diagnosis, at 1 and 2 weeks after treatment, upon remission, and at 2 weeks after remission (P < 0.05). Shear wave elastography can be used to reflect the relative hardness of normal testes and inflammatory epididymal tail masses.

Роль ультразвукової еластографії зсувної хвилі в діагностиці аденоміоза та/або гіперпластичних процесів ендометрія

Today, hysteroscopy, ultrasound and magnetic resonance imaging are most often used in clinical practice for the diagnosis of adenomyosis. However, the high frequency of diagnostic errors (from 20 to 40%), depending on the experience of the operator and equipment, detailing the structure of the myometrium and the parameters of ultrasound differentiation of adenomyosis, requires the search for new optimal diagnostic methods. The purpose of our study was to determine the parameters of ultrasound elastography of the shear wave in patients with adenomyosis and / or hyperplastic processes of the endometrium. Material and methods. The study included 128 patients aged from 27 to 53 years (mean 39.4 ± 8.6). The first group included 38 (29.6%) patients diagnosed with grade I-II adenomyosis, the second group had 41 (32.1%) patients with a combination of grade I-II adenomyosis with endometrial hyperplastic processes and / or uterine leiomyoma, the third group consisted of 39 (30.5%) women only with hyperplastic processes of the endometrium. The control fourth group included 10 (7.8%) women without endometrial pathology, who sought women's advice on primary infertility. Results and discussion. When performing shear wave elastography, significant differences in the color of myometrial mapping were found between patients of the first, third and control groups (p &lt;0.001). Unchanged myometrium in all patients of the control group was represented by shades of blue, and the staining was uniform in 9 (90%) subjects. In patients of the first group, the myometrium was stained with shades of red in 31 (81.63%) cases and shades of yellow in 3 (7.8%) cases; in 23 (60.5%) cases there was inhomogeneous red staining and in 14 (36.8%) cases staining was inhomogeneous in shades of red-yellow-light blue. When performing elastography in patients of the second group in the projection of the myoma was more often detected staining in shades of red in 20 (48.8%) cases, yellow in 6 (14.6%) and light blue in 3 (7.3%) cases; in 28 (68.3%) cases there was inhomogeneous red staining and in 19 (46.3%) cases staining was inhomogeneous in shades of red-yellow-light blue. In the third group in the projection of the leiomatous node was more often determined by staining in shades of red in 22 (56.4%) cases, yellow in 8 (20.5%) and light blue in 6 (15.4%) cases, colors on the background of the blue myometrium; inhomogeneous staining of myomatous nodes was detected in 31 (79.5%), and homogeneous staining was in 7 (17.9%) cases. Unchanged myometrium in the control group was characterized by significantly lower values of the Young's modulus 25.2 (17.9-34.1 kPa), while in the group of adenomyosis the average value of Emean reached 71.8 (17.9-281.3 kPa), was maximally high and significantly different from the indicators of the control group and from the indicators of group 3 patients 29.6 (13.5-58.9 kPa). The rates of patients of the second group, in whom grade I-II adenomyosis was combined with endometrial hyperplastic processes and / or uterine leiomyoma 54.7 (15.6-133.9 kPa) were also significantly higher than the values of the control group and the third group. Conclusion. Shear wave ultrasound is a minimally invasive and accessible method of high-quality preoperative diagnosis, necessary to avoid hysterectomy and clarify the diagnosis without surgery, which is recommended for use in practice to improve the accuracy of diagnosis of adenomyosis

Effect of Calcifications on Shear-Wave Elastography in Evaluating Breast Lesions

This study aimed to investigate the effect of calcifications on shear-wave elastography in evaluating breast lesions. We retrospectively reviewed ultrasound images of 673 breast lesions and compared the elasticity between lesions with and without calcifications in three subgroups: benign lesions, in situ carcinomas and invasive carcinomas. Breast lesions were confirmed histologically (n = 401) or by follow-up images for more than 2 y (n = 272). Calcifications were present in 25.3% (170/673) of the lesions. The Emean values with and without calcifications, respectively, were as follows: 62.8 and 29.8 kPa in benign lesions (p = 0.000), 114.6 and 52.8 kPa in in situ carcinomas (p = 0.037) and 171.9 and 146.4 kPa in invasive carcinomas (p = 0.018). The presence of calcifications significantly increased the Emean of breast lesions. Shear-wave elastography should be carefully interpreted in benign lesions with calcifications and in situ carcinomas without calcifications.

Ultrasound hepatic elastography with decaying signal technology allows assessing the degree of steatosis and dynamic monitoring of the effectiveness of NAFLD treatment

The purpose of the research is to study the informativeness of the technology of Controlled Attenuation Parameter (CAP) in Shear Wave Elastography (SWE) in determining the degree of severity of liver steatosis depending on the elastometric quantitative values of liver fibrosis in a one-time study in a given volume of parenchima liver in patients with non-alcoholic fatty liver disease (NAFLD).Materials and methods of research. The study included 169 patients with NHTSA between the ages of 19 and 81, the average age was 41.7 ±11.3 years, examined in the “City Clinical Hospital No. 1” of the Ministry of Health, Chuvashia (Cheboksary, Russia). Patients with functional disorders of bile evacuation (n= 72) were the first group; the 2nd group were the patients with liver steatosis without manifestations of liver fibrosis (n = 28); the 3rd contained the patients with cirrhosis of the liver (n = 25); patients with chronic viral hepatitis B and C (n= 44) were in the 4th group. All patients were screened with ultrasonic shear wave elastography with elastometry in one-dimensional (TE) (FibroScan 502 TOUCH, France) and two dimensional (2DSWE) modes (Aixplorer, Supersonic Imagine, France). Elastometry (kPa) and steatometry (dB/m) were completed simultaneously within the same volume of the analyzed liver tissue with two sensing devices of “FibroScan 502 TOUCH”. The statistical processing was carried out with the help of IBM SPSS Statistics 10.0. The results are reflected in the form of median (Me), minimum (min), maximum (max) and medium (Emean) values, standard deviation (SD) of Jung’s elasticity module. Correlational analysis of the received values of parameters F and S was made with the descriptive method of Bland-Altman and the method of Spearman.Results and discussion. The average quantitative values of the severity of liver steatosis in patients with cirrhosis of liver had reliably lower values (234.5±62.1 dB/m) than in those suffering from steatosis of the liver without fibrosis (347.5±37.6 dB/m) and patients with chronic viral hepatitis (245.9±57.3dB/m, p lt; 0.001). The values of fibrosis in the same amount of the tested liver tissue with liver cirrhosis (45.5± 22.3 kP) were higher than similar rates in the other groups of patients with NAFLD (p lt; 0.001). Diagnostic informational content of the method of controlled ultrasound attenuation in establishing the degree of manifestation of liver steatosis had a higher specificity with II degree of liver steatosis (99.29% with a sensitivity of 84.92%).The results of the study allow us to recommend ultrasound elastography with the technology of controlled ultrasound attenuation to determine the severity of liver steatosis for both primary diagnosis and for dynamic monitoring of the liver condition of patients with NAFLD.

A retrospective study of reducing unnecessary thyroid biopsy for American College of Radiology Thyroid Imaging Reporting and Data Systems 4 assessment through applying shear wave elastography.

Objective The purpose of the study is to quantitatively assess shear-wave elastography (SWE) value in American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS) 4. Materials and methods One hundred and fifty-two ACR TI-RADS 4 thyroid nodules undergoing SWE were included in the study. The mean (EMean), minimum (EMin) and maximum (EMax) of SWE elasticity were measured. Results The areas under the receiver operating characteristic (ROC) curves for SWE EMean, EMin and EMax in detecting benign and malignant nodules were 0.95, 0.83 and 0.84, respectively. Cut-off value of EMean ≤ 23.30 kPa is able to downgrade the lesion category to ACR TI-RADS 3 and cut-off value of EMean ≥ 52.14 kPa is able to upgrade the lesion category to ACR TI-RADS 5. Conclusions The EMean of SWE will probably identify nodules that have a high potential for benignity in ACR TI-RADS 4. It may help identify and select benign nodules while reducing unnecessary biopsy of benign thyroid nodules.

Suggested amendment of TI-RADS classification of thyroid nodules by shear wave elastography.

The application of the ultrasound elastography and Thyroid Imaging Reporting and Data System (TI-RADS) classification further expands the scope of ultrasound differential diagnosis between benign and malignant thyroid nodules. To investigate the value of the quantitative parameter of ultrasonic shear waves in optimizing the TI-RADS classification of thyroid nodules. A total of 168 thyroid nodules, initially classified using TI-RADS and scanned by shear wave elastography (SWE), were retrospectively analyzed. All cases were diagnosed by fine needle aspiration and histology following surgery. The benign rate of TI-RADS 3 nodules was 76.5%, while the benign rate of TI-RADS 4a nodules was 71.7%. Furthermore, the malignant rate of TI-RADS 4b nodules was 69.7%, while the malignant rate of TI-RADS 4c nodules was 85.7%. In differentiating benign from malignant nodules, the combination of TI-RADS classification and Emean had the largest area under the receiver operating characteristic curve (AUC). Using an Emean value of 42.25 kpa as the cut-off point, the malignant rate of TI-RADS 4a nodules decreased from 28.3% to 23.5%, while the malignant rate of TI-RADS 4b nodules increased from 69.7% to 79.4%. Compared to conventional ultrasound alone, the sensitivity, negative predictive value, and AUC of conventional ultrasound combined with SWE in the diagnosis of benign and malignant thyroid nodules significantly improved (P=0.012, 0.029, 0.001). The SWE technique can be used to further determine the benign and malignant nature of TI-RADS 4 lesions, providing further reference for the choice of clinical treatment. The TI-RADS classification system corrected by SWE is more significant in the diagnosis of benign and malignant thyroid nodules.