Evaluation Of Tissue Stiffness Research Articles

Ultrasonographic Assessment of Tissue Stiffness: Recent Progress in Transient Elastography and Shear Wave Elastography in the Liver and Various Organs.

Ultrasonography is a noninvasive and widely accessible modality in clinical practice. Recently, ultrasonography has been used to evaluate tissue stiffness; the two representative techniques are transient elastography (FibroScan®) and shear wave elastography. These modalities are now generally used for the assessment of liver fibrosis, the prediction of hepatocarcinogenesis, and determining prognosis. In addition, shear wave elastography is available, not only for the liver but also for various other organs, including the breast and brain. In the breast and brain, shear wave elastography distinguishes malignant lesions from benign ones. Moreover, shear wave elastography can be useful for differentiating between ischemic and hemorrhagic strokes. This review summarizes the recent progress in transient elastography and shear wave elastography of the liver and introduces the advantages of ultrasonographic assessment of tissue stiffness in various organs, including the breast, brain, kidney, heart, thyroid, pancreas, muscle, and bone.

Advancements in the application of uterine ultrasound elastography.

This article reviews recent advances in ultrasound elastography in diagnosing and evaluating the normal nongravid uterus and the infertile uterus in the gynecologic patient. Focusing on the most recent primary literature, studies have demonstrated new findings among a breadth of gynecologic clinical settings. Studies in the nongravid uterus have found that menopausal status, age, and menstrual phase have not been associated with changes in uterine tissue stiffness. Focusing on myometrial disease, there have been conflicting data regarding the ability to distinguish uterine fibroids from adenomyosis. One area of expanding research surrounding uterine elastography includes the infertile population, where ongoing studies attempt to provide a predictive model using shear wave elastography (SWE) in patients undergoing in-vitro fertilization. Ultrasound elastography has become an increasingly studied and utilized tool in assessing physiologic and pathologic processes in the field of gynecology. Evaluating tissue stiffness through strain and SWE can serve to improve diagnosis of various uterine and cervical lesions, as well as prognosticate outcomes after fertility treatments. This growing area of research will continue to establish the role and application of ultrasound elastography into clinical practice.

Can ultrasound shear wave elastography differentiate between malignant and benign pleural effusions?

BackgroundMalignant pleural effusion is a common and unfortunately serious condition that is related to life poor quality and mortality. The majority of malignant pleural effusion is metastatic in nature, with the most encountered primary neoplasm in men is the lung cancer while in women is the breast cancer. Ultrasound elastography, with its ability of evaluating tissue stiffness, has been used to differentiate malignant from benign diseases. Shear wave elastography (SWE) has been explored in several organs, like the liver, breast, thyroid, lymph nodes and prostate, with the pleura can now be included among the growing list of SWE applications. Shear wave elastography may help in the differentiation of transudative and exudative types of pleural effusions.ResultsIn this study, a total of 36 patients were included, 50% revealed malignant pleural effusions (10/18 mesothelioma) and (8/18 metastatic), while the 50% revealed benign pleural effusions (9/18 transudates) and (9/18 exudates). By using sensitivity analysis test of the SWE values with V1 represents the minimum value, V2 the maximum value to calculate the cutoff values that will be used in our final diagnosis in order to differentiate benign and malignant cases. V1 shear wave elastography can significantly predict the malignant pleural effusion with p value 0.001 using a cutoff 48 kPa with calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were as follows 94.4%, 88.9%, 89.5% & 94.4% respectively with diagnostic accuracy of 92%. SWE maximum value (V2) can significantly predict the malignant pleural effusion with p value 0.001 using a cutoff 54.2 kPa, with calculated sensitivity, specificity, PPV and NPV were as follows 94.4%, 94.4%, 94.4% and 94.4% respectively with diagnostic accuracy 94.4%. So, through comparing both cutoff values, we concluded that the cutoff value 2 is better with greater specificity, PPV and NPV in relation to the final diagnosis.ConclusionsCombination of both conventional transthoracic ultrasound and SWE quantitative and qualitative abilities in assessment of both pleural and parenchymal lesions can result in high diagnostic accuracy. Shear wave elastography alone is a sensitive, specific, useful, cost-effective, widely available and noninvasive tool for assessment of tissue stiffness and in matters of high sensitivity. 54.2 kPa can be used as the cutoff value to distinguish MPE from benign pleural disease.

Bowel Stiffness Assessed by Shear-Wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients With Crohn's Disease.

There is a lack of reliable predictors of disease behavior progression in patients with Crohn's disease (CD). Real-time shear-wave elastography (SWE) is a novel method for evaluating tissue stiffness. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression. We retrospectively collected data from patients with CD with the nonstenotic nonpenetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound at baseline and were followed up. The end point was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. Cox regression analysis was performed for the association between baseline characteristics and subsequent end points. In addition, a multivariate nomogram was established to predict the risk of disease behavior progression quantitatively. A total of 130 patients with CD with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE was the only independent predictor of disease behavior progression (hazard ratio 1.08, 95% confidence interval 1.03-1.12, P = 0.001). A reverse of the HR appeared at the cutoff 12.75 kPa. The nomogram incorporating SWE and other clinical characteristics showed a good prediction performance (area under the curve = 0.792). Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. Patients with CD with SWE >12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases.

P289 Bowel Stiffness Assessed by Shear-wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients with Crohn’s Disease

Abstract Background There is a lack of reliable predictors of disease behavior progression in patients with Crohn’s disease (CD). Real-time shear-wave elastography (SWE), a novel method for evaluating tissue stiffness, is reportedly helpful in determining the prognosis of liver cirrhosis or breast cancer. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression. Methods We retrospectively collected data from CD patients with the non-stenotic non-penetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound with SWE measurement at baseline and were followed up. The endpoint was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. A multivariate Cox regression model was used to explore the association between baseline SWE and subsequent outcome. We also established a multivariate nomogram to predict the risk of disease behavior progression and evaluated its performance with receiver operating characteristic curve and decision curve analysis. Results A total of 130 CD patients with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE ≥12.75 kPa was the only independent predictor of disease behavior progression (HR 1.08, 95% CI 1.03-1.12, P=0.001, Fig 1A). A restricted cubic spline with multiple covariates adjusted showed an approximately linear positive correlation between SWE and the risk of disease behavior progression, with a cut-off of 12.75 kPa (Fig 1B). We further established a multivariate nomogram incorporating SWE and other clinical characteristics to predict the risk of disease behavior progression quantitatively (Fig 1C). Compared to the model composed solely of SWE, the multivariate nomogram showed a higher but less significant performance (0.738 vs. 0.792, p=0.169, Fig 1D). However, the decision curve analysis showed that the model outperformed the single indicator of SWE in predicting endpoint events, especially those occured after 12 months of baseline (Fig 1E). Conclusion Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. CD patients with SWE ≥12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases, which warrants timely intervention.

The Use of Shear-Wave Ultrasound Elastography in the Diagnosis and Monitoring of Musculoskeletal Injuries.

Ultrasound elastography is a valuable method employed to evaluate tissue stiffness, with shear-wave elastography (SWE) recently gaining significance in various settings. This literature review aims to explore the potential of SWE as a diagnostic and monitoring tool for musculoskeletal injuries. In total, 15 studies were found and included in the review. The outcomes of these studies demonstrate the effectiveness of SWE in detecting stiffness changes in individuals diagnosed with Achilles tendinopathy, Achilles tendon rupture, rotator cuff rupture, tendinosis of the long head of the biceps tendon, injury of the supraspinatus muscle, medial tibial stress syndrome, and patellar tendinopathy. Moreover, SWE proves its efficacy in distinguishing variations in tissue stiffness before the commencement and after the completion of rehabilitation in cases of Achilles tendon rupture and patellar tendinopathy. In summary, the findings from this review suggest that SWE holds promise as a viable tool for diagnosing and monitoring specific musculoskeletal injuries. However, while the field of ultrasound elastography for assessing musculoskeletal injuries has made considerable progress, further research is imperative to corroborate these findings in the future.

Relationship Between Achilles Tendon Stiffness Using Myoton PRO and Translation Using a Tensile Testing Machine: A Biomechanical Study of a Porcine Model.

Background Achilles tendinopathy is a common ankle disorder in both the general population and athletes. This condition can alter the mechanical characteristics of the Achilles tendon (AT) by decreasing tendon stiffness. Achilles tendinopathy is primarily treated conservatively; however, few monitoring tools exist for evaluating the condition of the AT. The Myoton PRO (Myoton AS, Tallinn, Estonia) device is a handheld tool used to evaluate tissue stiffness. However, no basic studies have examined the validity ofMyoton PRO for assessing the AT. This study aimed to assess the validity of Myoton PRO using animal ATs and to examine its clinical applicability. Methods We used 28 fresh porcine ankles and evaluated AT stiffness at the calcaneus insertion site (AT0) and 2.0 cm above the calcaneus (AT2) using Myoton PRO. We also measured changes in the AT length using a tensile testing machine during the cyclic loading test. We investigated the correlation between dynamic stiffness and length change. Furthermore, we assessed the difference in stiffness between AT0 and AT2. Results The dynamic stiffness was 717.6 ± 183.1 N/m at AT0 and 467.4 ± 152.3 N/m at AT2. The change in length during the cyclic loading test was 1.8 ± 0.7 mm. The correlation between dynamic stiffness and length change was as follows: AT0, r=-0.61; AT2, r=-0.64 (P<0.001). The dynamic stiffness at AT0 was significantly greater than that at AT2 (P<0.001). Conclusions AT assessment using Myoton PRO has potential clinical utility as an indicator of tissue stiffness.

Acute Effects of Running on Shear Wave Elastography Measures of the Achilles Tendon and Calf Muscles in Professional Female Handball and Volleyball Players.

Shear Wave Elastography (SWE) is currently used to detect tissue pathologies, i.e., tendinopathy. For preventive medicine, it is important to examine the sensitivity of SWE and to investigate how stiffness measures are affected by methodological variables. The aim of this study is to examine shear wave elastography (SWE) measures in order to compare the pre- and post-running values and to determine the correlation between the shear wave speed values (m/s). SWE examinations of the Achilles tendon (AT), soleus muscle (MS) and gastrocnemius muscle (MG)) were performed in 24 healthy professional female athletes. Measurements of the shear wave speed (m/s) were taken before and after incremental treadmill running until exhaustion. Correlations were investigated using the Pearson correlation coefficient and were examined for significance using the Student's t-test. The pre- and post-exercise shear wave speed did not differ. The pre-exercise and post-exercise stiffness for MS (r = 0.613), MG (r = 0.609) and AT (r = 0.583) correlated strongly. The pre-exercise values and changes in stiffness showed a significant correlation (p < 0.001). In professional athletes, acute exercise induces different tissue stiffness changes in AT, MS and MG for each individual. Thus, exercise activity immediately prior to the SWE measurement needs to be factored in when evaluating tissue stiffness.

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

Assessment of the upper limb muscles in patients with Fukuyama muscular dystrophy: Noninvasive assessment using visual ultrasound muscle analysis and shear wave elastography

Fukuyama-type congenital muscular dystrophy (FCMD) is severe, childhood-onset muscular dystrophy. Recently, our group has discovered a potential treatment using antisense oligonucleotides. Therefore, an effective, reliable, and objective method of assessing muscle is needed. Ultrasound is a minimally invasive tool that can be applied without radiation exposure or pain. Evaluating tissue stiffness by shear wave elastography (SWE) has especially recently attracted attention. Here, we aimed to evaluate SWE value of the upper limb muscles: biceps brachii, triceps brachii, brachioradialis, abductor pollicis brevis, and abductor finger muscle in patients with FCMD. Upper extremity function was evaluated by visual muscle ultrasound analysis (VMUA) and SWE in 13 patients with FCMD and 20 healthy controls. The motor function evaluation tool was used to evaluate motor function, and the correlation with the dynamics of the SWE was determined. VMUA scaled using the Heckmatt scale was higher in patients with FCMD. SWE was also significantly higher and stiffer in the biceps brachii and brachioradialis in patients with FCMD. Furthermore, the severity of FCMD symptoms was correlated with muscle stiffness. We conclude that VMUA and SWE can be useful tools for monitoring muscle atrophy and upper limb function in patients with FCMD.

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes.

Simple SummaryPersisting cervical lymphadenopathy should be further evaluated to distinguish benign infectious enlargements from malignant diseases such as cancer of the upper airway tract, with head and neck squamous cell carcinoma or lymphatic diseases being the most common ones. Ultrasound (US) remains the primary imaging modality for assessment of cervical lymph nodes (CLN) due to their superficial localization. We aimed to investigate whether US examination and classification of CLN can be improved by adding multiparametric applications to the established B-mode–US technique by evaluating tissue stiffness and micro-vascularization. Our results show that tissue stiffness was significantly higher in malignant CLN, even in subgroups without B-mode criteria indicating malignancy. Shear wave elastography is an easy, fast and noninvasive tool available on most US devices today. This may help to detect malignant CLN with higher accuracy and help patients in cancer aftercare to detect recurrent CLN metastasis and to consecutively assess necessary treatment faster.Background: Enlarged cervical lymph nodes (CLN) are preferably examined by ultrasound (US) by using criteria such as size and echogenicity to assess benign and suspicious CLN, which should be histologically evaluated. This study aims to assess the differentiation of malign and benign CLN by using multiparametric US applications (mpUS). Methods: 101 patients received a standardized US protocol prior to surgical intervention using B-mode–US, shear-wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). SWE was assessed by 2D real-time SWE conducting a minimum of five measurements, CEUS parameters were assessed with post-processing perfusion software. Histopathological confirmation served as the gold standard. Results: B-mode–US and SWE analysis of 104 CLN (36 benign, 68 malignant) showed a significant difference between benign and malignant lesions, presenting a larger long axis and higher tissue stiffness (both p < 0.001). Moreover, tissue stiffness assessed by SWE was significantly higher in CLN with regular B-mode–US criteria (Solbiati Index > 2 and short-axis < 1 cm, p < 0.001). No perfusion parameter on CEUS showed a significant differentiation between benign and malignant CLN. Discussion: As the only multiparametric parameter, SWE showed higher tissue stiffness in malignant CLN, also in subgroups with regular B-mode criteria. This fast and easy application may be a promising noninvasive tool to US examination to ameliorate the sonographic differentiation of inconclusive CLN.

Stiffness reduction and collagenase resistance of aging lungs measured using scanning acoustic microscopy.

Lung tissue stiffness is altered with aging. Quantitatively evaluating lung function is difficult using a light microscope (LM) alone. Scanning acoustic microscope (SAM) calculates the speed-of-sound (SOS) using sections to obtain histological images by plotting SOS values on the screen. As SOS is positively correlated with stiffness, SAM has a superior characteristic of simultaneously evaluating tissue stiffness and structure. SOS images of healthy bronchioles, arterioles, and alveoli were compared among young, middle-aged, and old lung sections. Formalin-fixed, paraffin-embedded (FFPE) sections consistently exhibited relatively higher SOS values than fresh-frozen sections, indicating that FFPE became stiffer but retained the relative stiffness reflecting fresh samples. All lung components exhibited gradually declining SOS values with aging and were associated with structural alterations such as loss of smooth muscles, collagen, and elastic fibers. Moreover, reaction to collagenase digestion resulted in decreased SOS values. SOS values of all components were significantly reduced in young and middle-aged groups, whereas no significant reduction was observed in the old group. Protease damage in the absence of regeneration or loss of elastic components was present in old lungs, which exbited dilated bronchioles and alveoli. Aging lungs gradually lose stiffness with decreasing structural components without exposure to specific insults such as inflammation.

Imaging of Fibrosis in Chronic Pancreatitis.

Chronic pancreatitis (CP) describes long-standing inflammation of the pancreas, which leads to irreversible and progressive inflammation of the pancreas with fibrosis. CP also leads to abdominal pain, malnutrition, and permanent impairment of exocrine/endocrine functions. However, it is difficult to assess CP pathologically, and imaging modalities therefore play an important role in the diagnosis and assessment of CP. There are four modalities typically used to assess CP. Pancreatic duct features are assessed with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP is a rather invasive diagnostic modality for CP, and can result in adverse events such as post-ERCP pancreatitis. Computed tomography (CT) is often the most appropriate initial imaging modality for patients with suspected CP, and has high diagnostic specificity. However, CT findings typically only appear in advanced stages of CP, and it is difficult to detect early CP. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as CT and magnetic resonance imaging (MRI), and is considered the most reliable and efficient diagnostic modality for pancreatic diseases. The EUS-based Rosemont classification plays an important role in diagnosing CP in clinical practice. Evaluation of tissue stiffness can be another option to assess the diagnosis and progression of CP, and MRI and EUS can be used to assess CP not only with imaging, but also with elasticity measurement. MR and EUS elastography are expected to provide new alternative diagnostic tools for assessment of fibrosis in CP, which is difficult to evaluate pathologically.

TGF-\u03b21 and its signal molecules: are they correlated with the elasticity characteristics of breast lesions?

BackgroundShear wave elastography can evaluate tissue stiffness. Previous studies showed that the elasticity characteristics of breast lesions were related to the components of extracellular matrix which was regulated by transforming growth factor beta 1(TGF-β1) directly or indirectly. However, the correlation of the expression level of TGF-β1, its signal molecules and elasticity characteristics of breast lesions have rarely been reported. The purpose of this study was to investigate the correlation between the expression level of TGF-β1, its signal molecules, and the elasticity characteristics of breast lesions.Methods135 breast lesions in 130 patients were included. Elasticity parameters, including elasticity modulus, the elasticity ratio, the “stiff rim sign”, were recorded before biopsy and surgical excision. The expression levels of TGF-β1 and its signal molecules, including Smad2/3, Erk1/2, p38 mitogen-activated protein kinase (MAPK), c-Jun N-terminal kinase 2 (JNK2), phosphoinositide 3-kinase (PI3K), and protein kinase B (PKB/AKT) were detected by immunohistochemistry. The diagnostic performance of the expression level of those molecules and their correlation with the elasticity characteristics were analyzed.ResultsElasticity parameters and the expression levels of TGF- β1 and its signal molecules of benign lesions were lower than those of malignant lesions (P<0.0001). The expression levels of TGF- β1 and its signal molecules were correlated with elasticity parameters. The expression levels of TGF- β1 and its signal molecules in lesions with “stiff rim sign” were higher than those without “stiff rim sign” (P<0.05). And the expression levels of Smad2/3, Erk1/2, p38 MAPK, JNK2, PI3K and AKT were correlated with that of TGF- β1. The area under the curve for receiver operator characteristic curve of TGF-β1 and its signal molecules in the differentiation of malignant and benign breast lesions ranged from 0.920–0.960.ConclusionsThe expression levels of TGF-β1, its signal molecules of breast lesions showed good diagnostic performance and were correlated with the elasticity parameters. The expression levels of signal molecules were correlated with that of TGF- β1, which speculated that TGF- β1 might play an important role in the regulation of breast lesion elasticity parameters and multiple signal molecule expressions.

Tissue stiffness in BPH patients from magnetic resonance elastography

BackgroundBPH is commonly found in older men which can lead to lower urinary tract symptoms. Magnetic resonance elastography (MRE) is an innovative, noninvasive imaging technique used to evaluate tissue stiffness. There has not been any study, however, that assessed the tissue stiffness in patients with BPH. A prospective descriptive study was performed to demonstrated MRI and MRE techniques of the prostate gland in ten patients with BPH to assess tissue stiffness, features of BPH on MRI and components of BPH in the area of increased stiffness.ResultsMRI and MRE examinations in all patients were successful without any complications. The mean tissue stiffness of the whole prostate gland was 4.40 ± 0.71 kPa with good reproducibility (ICC 0.82). Stromal components and mixed glandular-stromal components tended to be associated with the areas of increased stiffness on stiffness images, 50.6% for stromal components and 37.9% for mixed glandular-stromal components. Some MRI findings were seen on the patients with high mean stiffness values such as prostatic calcification, type-5 BPH pattern and large prostate volumes.ConclusionsProstate MRE is a useful noninvasive reproducible diagnostic tool for evaluating prostate tissue stiffness by both qualitative and quantitative assessments. The mean prostate tissue stiffness from MRE in patients with BPH in this study was 4.40 ± 0.71 kPa. Some MRI features might be associated with increased tissue stiffness.Trial registration: PID 229. Registered 4 October 2019. http://md.redcap.kku.ac.th

Influence of Examiners’ Experience and Region of Interest Location on Semiquantitative Elastography Validity and Reliability

Semi-quantitative elastography is a promising imaging technique to evaluate tissue stiffness differences, providing data regarding relative stiffness differences between two targets. The aims of this study were to assess the validity, inter-examiner reliability and variability of semi-quantitative elastography for calculating strain ratios (SR) in a homogeneous gel phantom in different locations within the image. A diagnostic accuracy study was performed in a homogeneous stiffness phantom. Four examiners participated (two novice and two experienced). Each examiner assessed the SR in two locations. Difference between examiners, variability of measurements, SR error and absolute error, mean error of the measurements and coefficient of variation were calculated. The agreement between examiners, validity and variability of measurements were higher in the central area than the lateral areas of the images. Thus, the experience of the examiner was relevant for the concordance of the measurements in the lateral areas of the images (SR difference of 0.14 ± 0.05; p &lt; 0.001), but not for the central area (SR difference of 0.05 ± 0.02; p &gt; 0.05). Our data suggested that semi-quantitative elastography is an accurate tool for assessing small magnitude stiffness differences within the same image in central areas, but the experience of the examiner is a determinant factor.

A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer.

The incidence and mortality rate of breast cancer (BC) in women currently ranks first worldwide, and neoadjuvant chemotherapy (NAC) is widely used in patients with BC. A variety of imaging assessment methods have been used to predict and evaluate the response to NAC. Ultrasound (US) has many advantages, such as being inexpensive and offering a convenient modality for follow-up detection without radiation emission. Although conventional grayscale US is typically used to predict the response to NAC, this approach is limited in its ability to distinguish viable tumor tissue from fibrotic scar tissue. Contrast-enhanced ultrasound (CEUS) combined with a time-intensity curve (TIC) not only provides information on blood perfusion but also reveals a variety of quantitative parameters; elastography has the potential capacity to predict NAC efficiency by evaluating tissue stiffness. Both CEUS and elastography can greatly improve the accuracy of predicting NAC responses. Other US techniques, including three-dimensional (3D) techniques, quantitative ultrasound (QUS) and US-guided near-infrared (NIR) diffuse optical tomography (DOT) systems, also have advantages in assessing NAC response. This paper reviews the different US technologies used for predicting NAC response in BC patients based on the previous literature.

The place of B-mode ultrasonography, shear-wave elastography, and superb microvascular imaging in the pre-diagnosis of androgenetic alopecia.

Androgenetic alopecia (AGA) is the most common cause of hair loss in males. Physical examination and history are the most important examinations in diagnosis of the disease. As yet, there is no diagnostic method to be able to determine which individuals will develop AGA. Shear-wave elastography (SWE) is a novel diagnostic tool, which can evaluate tissue stiffness. Superb microvascular imaging (SMI) can determine low flow in microvessels. The aim of the current study was to determine whether or not AGA would develop in individuals with normal hair and a family history of AGA using B-mode US, SMI, and SWE. The study included 26 patients clinically diagnosed with AGA and a control group of 26 volunteers. Thickness with the distance from the epidermis to the calvarium (ECD) on the hairline and cranial subcutaneous tissue thickness (CSTD) were determined to be statistically significantly thinner in the AGA group than in the control group (p<0.0001). For the differentiation of the AGA patients, the cutoff value was determined to be 5.5mm for ECD and 4.05mm for CSTD. The cranial epidermis-dermis (CED) stiffness values both as meter/second (m/s) and kilopascals (kPa) were statistically significantly lower in the AGA patients than in the control group (p<0.0001). The cutoff values were 6.075 as m/s and 104.4 as kPa. The results of this study demonstrated that differentiation could be made of individuals before the development of AGA from normal healthy individuals with CSTD measurement on B-mode US and CED stiffness measurement on SWE.

Psödoanjiyomatöz stromal hiperplazinin shear dalga elastografi bulguları

Pseudoangiomatous stromal hyperplasia (PASH) is a benign entity defined in 1987. Conventional breast imaging methods, including mammography, ultrasonography, and magnetic resonance imaging findings have been published in the literature before. Sonoelastography (SE) is an imaging method that allows us to evaluate tissue stiffness in vivo. Many studies have shown that SE increases the specificity of B-mode US in the discrimination of benign-malignant lesions. In this case report, it was shown that PASH is of high stiffness in shear wave elastography evaluation. To our best knowledge, this is the first case presenting SWE findings of PASH in the published literature.

Acoustic radiation force impulse imaging: normal values of spleen stiffness in healthy children

BackgroundAcoustic radiation force impulse (ARFI) imaging is a noninvasive ultrasound elastography technique for evaluating tissue stiffness. The association of liver and spleen stiffness provides additional information in the assessment of portal hypertension. The technique and normal values of spleen stiffness by point shear wave elastography (p-SWE) in pediatrics have not been well documented.ObjectiveOur aim is to describe the feasibility and normal ARFI elastography values in the spleen for healthy children and to compare measurements in two different probe positions (the axial and sagittal planes).Materials and methodsSpleen p-SWE using ARFI values were measured with a 6C1 probe in 102 healthy children (age range: 8 weeks to 17 years) divided into four age groups. An average of nine (standard deviation: two) spleen stiffness measurements were taken during free breathing in each plane (axial and sagittal). The impact of age and measurement plane in the spleen was analyzed using multivariate models.ResultsThere was no significant difference in spleen stiffness values taken at different ages, with an average of the medians of 2.43±0.31 m/s. There was no significant difference based on probe orientation: sagittal plane (median: 2.46±0.29 m/s) and axial plane (median: 2.43±0.32 m/s) with Student’s t-test P=0.18. The mean depth of measurement varied between 2.3 cm and 3.7 cm, according to age.ConclusionNormal spleen stiffness values using ARFI imaging in children do not vary with age and correspond to a median of 2.43 m/s. No significant difference was found when using different probe positions.