Mean Shear Wave Elastography Research Articles

Shear-wave elastography of canine patellar tendons in healthy dogs and the influence of stifle joint angle.

Elastography is a sonographic modality that measures tissue stiffness, a mechanical property of tissues, and a biomarker for disease. Canine musculoskeletal application to the patellar tendon has been limited to semiqualitative strain elastography. This prospective study aimed to quantitatively evaluate patellar tendon stiffness using shear-wave elastography with a color map superimposed over the tendon, a propagation map for quality control, and measurements at specific regions of interest in 16 clinically normal sedated dogs weighing 25kg or greater. Tendon stiffness using shear-wave elastography (SWE) was assessed at different stifle angles and in three regions to determine if angle and location affected stiffness. All dogs were screened with general and orthopedic exams, lateral stifle radiographs, and patellar tendon 2D ultrasound. Shear-wave elastography was performed from a long axis at various stifle angles at the proximal, middle, and distal tendon segments. Quality diagnostic SWE results varied significantly with stifle angle, and 150° of extension was the only angle found to be clinically useful based on the ease of obtaining measurable results and a quality control propagation wave. Patellar tendons were primarily stiff with a red color elastogram. The proximal and middle segments, measured at various angles, had a mean SWE velocity of 7.32±0.90m/s. Tendon stiffness did not differ along tendon length when measured in greater extension. However, stiffness decreased in the middle segment of the tendon at 150° when compared with 120°. This study establishes a quantitative baseline of normal patellar tendon stiffness to compare with pathologic states.

Pancreatic Shear Wave Elastography in Pediatrics with Type I DM

Abstract Background Type I diabetes milletus (DM) is one of the most prevalent autoimmune diseases in the pediatric age group. It is characterized by pancreatic inflammation in the early stages due to autoimmune destruction of the insulin producing beta cells with subsequent fibrosis in the late stages. Conventional gray-scale ultrasonography can provide detailed information about the bio- mechanical structure of tissues when used with the new method of elastography. As tissues affected by a variety of pathologic processes display different mechanical features, stiffness differences may be used to differentiate diffuse diseases or focal lesions. Objective To assess the role of pancreatic shear wave elastography (SWE) in children with type I diabetes in comparison to control subjects. Methods A cross-sectional study over the course of 6 months from March 2023 till September 2023. It included 41 cases with laboratory proven type I DM on insulin therapy and 41 age and gender matched non-diabetic controls referred to our department from the outpatient pediatric clinics for and abdominal ultra-sonography. C-peptide and HbA1C of the cases were measured. Conventional B-mode ultrasonography and pancreatic SWE were performed using the General Electric Logiq P9 ultrasound system. Results Conventional B-mode abdominal ultra-sonography together with pancreatic shear wave elastography were done to the entire study group. There was no significant difference by B-mode noted between the study subjects regarding echogenicity and homogeneity. Shear wave elastography (SWE) values of the diabetic cases and non-diabetic controls were compared and revealed a significant difference between both groups being faster in the cases than in the control group with p-value <0.05. Shear wave elastography values of the cases were compared to each other in respect to their disease duration, age, C-peptide levels and HBA1C levels and there was a statistically significant positive correlation between SWE, disease duration and age with p-value <0.001, while there was statistically significant negative correlation between mean of SWE and level of C-peptide with p-value <0.001. There was no significant correlation with HbA1c with p-value 0.116. Conclusion Type I DM affects pancreatic tissue stiffness as evident by the difference in the mean SWE values of the diabetic cases and the non-diabetic controls. Pancreatic SWE changes significantly in correlation to disease duration, age and C-peptide. Hence, SWE might serve as a new promising non-invasive imaging modality for monitoring and following up type 1 diabetes in children.

Shear wave elastography as a diagnostic tool in biliary atresia and liver fibrosis

BackgroundThe study aims to investigate Shear Wave Elastography's accuracy in assessing pediatric cholestasis and differentiating biliary atresia from other causes. The early diagnosis of cholestasis in newborns, when caused by true liver disease and not physiological or transient jaundice is usually eluded. To maximize the diagnostic reliability of ultrasound as an initial imaging modality to diagnose biliary atresia, ultrasound elastography has been introduced as a quantitative non-invasive sonographic technique to measure liver stiffness which is presumed to be different in biliary atresia from other cholestasis as well as follow-up liver stiffness post-Kasai operation.ResultsTen patients (34.48%) were diagnosed with cholestasis with normal/low GGT. Five patients (17.24%) were diagnosed with hepatitis, and 2 patients had syndromes (10.34%). Other causes were found in 11 patients (37.93%). Major bile duct obstruction with fibrosis/cirrhosis was the majority of findings found in biliary atresia patients (100%), most of them with mild fibrosis (40%), followed by moderate (36.67%), then marked fibrosis (13.33%) and secondary cirrhosis (10%). ROC curve analysis shows that the best cut-off value for SWE = 1.97 with a sensitivity of 75.0% and specificity of 83.5%, with positive and negative predictive values were 82.8% and 74.1%, respectively. Mean shear wave elastography was significantly higher among the biliary atresia group (median 2.86) than in non-biliary atresia (median 1.81) and control groups (median 1.64) (P < 0.001) The best cut-off value of shear wear elastography for predicting outcome in pediatric patients post-Kasai procedure was 3.55, with a sensitivity of 66.7%, specificity of 64.7%, positive and negative predictive values were 25% and 91.7% respectively, with accuracy 65%.ConclusionThe results of this study suggest that shear-wave elastography is a useful diagnostic tool for differentiating biliary atresia from other causes of cholestasis in pediatric patients, with a high sensitivity and specificity. Further studies are needed to validate the findings and determine the optimal cut-off value for shear wear elastography in clinical practice.

Improvement of hepatic fibrosis after tenofovir disoproxil fumarate switching to tenofovir alafenamide for three years.

Both tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are the first-line treatments for chronic hepatitis B (CHB). We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase (ALT) improvement, but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis. To assess the benefits of TDF switching to TAF for 3 years on ALT, aspartate aminotransferase (AST), and hepatic fibrosis improvement in patients with CHB. A single center retrospective study on 53 patients with CHB who were initially treated with TDF, then switched to TAF to determine dynamic patterns of ALT, AST, AST to platelet ratio index (APRI), fibrosis-4 (FIB-4) scores, and shear wave elastography (SWE) reading improvement at switching week 144, and the associated factors. The mean age was 55 (28-80); 45.3%, males; 15.1%, clinical cirrhosis; mean baseline ALT, 24.8; AST, 25.7 U/L; APRI, 0.37; and FIB-4, 1.66. After 144 weeks TDF switching to TAF, mean ALT and AST were reduced to 19.7 and 21, respectively. From baseline to switching week 144, the rates of ALT and AST < 35 (male)/25 (female) and < 30 (male)/19 (female) were persistently increased; hepatic fibrosis was also improved by APRI < 0.5, from 79.2% to 96.2%; FIB-4 < 1.45, from 52.8% to 58.5%, respectively; mean APRI was reduced to 0.27; FIB-4, to 1.38; and mean SWE reading, from 7.05 to 6.30 kPa after a mean of 109 weeks switching. The renal function was stable and the frequency of patients with glomerular filtration rate > 60 mL/min was increased from 86.5% at baseline to 88.2% at switching week 144. Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement, but also hepatic fibrosis improvement by APRI, FIB-4 scores, as well as SWE reading, the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.

Utilization of Texture Analysis in Differentiating Benign and Malignant Breast Masses: Comparison of Grayscale Ultrasound, Shear Wave Elastography, and Radiomic Features.

This study aims to determine which qualitative and quantitative US features are independently associated with malignancy, including those derived from grayscale imaging morphology, shear wave elastography (SWE), and texture analysis. This single-center retrospective study was approved by the institutional research ethics board. Consecutive breast US studies performed between January and December 2020 were included. Images were acquired using a Canon Aplio i800 US unit (Canon Medical Systems, Inc., CA) and i18LX5 wideband linear matrix transducer. Grayscale US features, SWE mean, and median elasticity were obtained. Single representative grayscale images were analyzed using dedicated software (LIFEx, version 6.30). First-order and gray-level co-occurrence matrix second-order texture features were extracted. Multivariate logistic regression was performed to assess for predictors of malignancy (STATA v16.1). One hundred forty-seven cases with complete SWE data were selected for analysis (mean age 54.3, range 21-92). The following variables were found to be independently associated with malignancy: age (P <.001), family history (P = .013), irregular mass shape (P = .024), and stiffness on SWE (mean SWE ≥40 kPa; P <.001). Remaining variables (including texture features) were not found to be independently associated with malignancy (P >.05). US texture analysis features were not associated with malignancy independent of other qualitative and quantitative US characteristics currently utilized in clinical practice. This suggests texture analysis may not be warranted when differentiating benign and malignant breast masses on US. In contrast, irregular mass shape on grayscale imaging and increased stiffness on SWE were found to be independent predictors of malignancy.

Prospective Evaluation of Normal Supraspinatus Muscle Using Shear Wave Elastography: Comparison With Symptomatic Tendon Tears.

This study aimed to evaluate normal supraspinatus (SS) muscle elasticity using shear wave elastography (SWE) in an asymptomatic group, analyze its correlation with demographic factors and ultrasound (US) grayscale grade, and compare the elasticity between normal SS muscles and symptomatic SS muscles with tendon tears. A prospective study was conducted with 101 adult patients with normal SS muscle scheduled for surgery due to a contralateral shoulder with SS tendon tear. Both shoulders underwent US examinations, including SWE. The SWE values, including mean and median elasticity, as well as the elasticity ratio, were analyzed for their correlation with demographic characteristics and grayscale grades. A comparison of SWE values was performed between the normal and symptomatic SS muscle groups. The mean SWE modulus of the normal SS muscle was 27.87 kPa (±49.04), with an elasticity ratio of approximately 1.52 (±0.03). Males exhibited slightly higher elasticity ratios compared with females (1.61 vs 1.45, P = .016). The interobserver agreement for all SWE measurements was excellent (>0.8). Grayscale grade increased with age, showing a similar pattern in females (P < .001). However, no significant correlation was observed between SWE values and grayscale grade in the normal SS muscle group. SWE values in normal SS muscles were significantly lower than those with tendon tears (P < .001). SWE provides objective measurements of normal SS muscle elasticity. Gender-based variations were observed, with males exhibiting slightly higher elastography ratios. SWE values were significantly lower in asymptomatic SS muscles compared with those with tendon tears.

Correlation of shear-wave elastography stiffness and apparent diffusion coefficient values with tumor characteristics in breast cancer

We aimed to investigate the correlation between shear-wave elastography (SWE) and apparent diffusion coefficient (ADC) values in breast cancer and to identify the associated characteristics. We included 91 breast cancer patients who underwent SWE and breast MRI prior to surgery between January 2016 and November 2017. We measured the lesion’s mean (Emean) and maximum (Emax) elasticities of SWE and ADC values. We evaluated the correlation between SWE, ADC values and tumor size. The mean SWE and ADC values were compared for categorical variable of the pathological/imaging characteristics. ADC values showed negative correlation with Emean (r = − 0.315, p = 0.002) and Emax (r = − 0.326, p = 0.002). SWE was positively correlated with tumor size (r = 0.343–0.366, p < 0.001). A higher SWE value indicated a tendency towards a higher T stage (p < 0.001). Triple-negative breast cancer showed the highest SWE values (p = 0.02). SWE were significantly higher in breast cancers with posterior enhancement, vascularity, and washout kinetics (p < 0.02). SWE stiffness and ADC values were negatively correlated in breast cancer. SWE values correlated significantly with tumor size, and were higher in triple-negative subtype and aggressive imaging characteristics.

Comparison of testicular stiffness values obtained by ultrasound shear-wave elastography and magnetic resonance elastography in normal healthy volunteers

Objectives: This study aimed to contribute to the standardization of elastography by comparing stiffness values obtained from ultrasound shear wave elastography (SWE) and magnetic resonance elastography (MRE) of the testicular parenchyma in healthy volunteers. Methods: A total of 22 healthy volunteers (44 testes) were included in this study. Of the 26 cases analyzed, four were excluded from the study due to the exclusion criteria. The testicular parenchyma of the included patients was evaluated using MRE and SWE examinations. Pearson's correlation test was used to calculate the correlation between age and stiffness values, testicular volumes and stiffness values, and stiffness values from both examinations. Results: The mean SWE stiffness of the right testes was 5.560±3.1 kPa and the mean SWE stiffness of the left testes was 5.361±2.9 kPa. The mean MRE stiffness of the right testes was 6960.11±460 Pa and the mean MRE stiffness of the left testes was 6560.19±310 Pa. There was no significant correlation between SWE and MRE stiffness values (P=0.096). There was also no significant statistical correlation between SWE and MRE stiffness values and testicular volumes (P=0.17 and P=0.093, respectively). Conclusions: No statistical correlation was found between the stiffness values obtained by SWE and those obtained by MRE in the normal testicular parenchyma. Additionally, no conclusive relationship between stiffness levels, age, or testicular volume was discovered.

Combined Assessment of 2-D Ultrasound and Real-Time Shear Wave Elastography of Low-Intensity Pulsed Ultrasound Therapy Efficacy in Rabbits with Achilles Tendinopathy

ObjectivesLow-intensity pulsed ultrasound (LIPUS) has been gradually used to treat Achilles tendinopathy. However, there are limited noninvasive and efficient instruments for monitoring the LIPUS efficacy in Achilles tendinopathy. The purpose of this study was to assess the therapeutic effectiveness of LIPUS following Achilles tendinopathy by two-dimensional (2D) ultrasound and real-time shear wave elastography (SWE). MethodsNinety New Zealand white rabbits were divided into control, sham, and LIPUS groups after tendinopathy modeling. On days 1, 4, 7, 14, and 28, the Achilles tendon thickness and SWE Young's modulus on the long axis were measured. The tissues of the Achilles tendon were then evaluated histologically. ResultsThe mean SWE values increased while the average thickness and histologic scores decreased, especially in the LIPUS group (9.5% and 80.7% on Day 28, respectively). The SWE values in the LIPUS group were significantly lower than those in the control group on Day 1 (121.0 KPa vs. 177.6 KPa) and peaked on Day 7 (173.7 KPa, p<0.001). By Day 28, the SWE value had approached that of the control (191.2 KPa vs. 192.4 KPa), and it had been significantly higher than that in the sham group since Day 7. SWE values and histologic scores were correlated (r = -0.792, p<0.01). The average thickness decreased in the three groups but did not show significant differences. Conclusions2D ultrasound is beneficial to the diagnosis of Achilles tendinopathy. SWE could quantify changes in Achilles tendon stiffness noninvasively during LIPUS treatment, enabling the study of early Achilles tendon healing after LIPUS treatment.

Evaluation of placenta in patients with gestational diabetes using shear wave elastography and superb microvascular imaging.

Gestational diabetes mellitus (GDM) is a common disease, and the placenta shows various functional and morphological changes in these patients. Superb microvascular imaging (SMI) and shear wave elastography (SWE) are innovative ultrasound (US) methods that provide detailed information about tissue vascularization and elasticity. To evaluate placental changes in patients with GDM with SMI and SWE methods. For this case-control study, 20 healthy and 20 women with GDM were included. Women at >21 weeks of pregnancy were evaluated with SMI and SWE by two independent radiologists. Mean SMI values and mean SWE values from three different region of interest-based measurements were compared between the two groups. We identified that the mean SMI and SWE value ​​of the GDM group was found to be significantly higher than that of the control group (P = 0.002, P = 0.001 respectively). Using a receiver operating characteristic curve, the cutoff value of the SMI ratio, which maximizes the prediction of the presence of GDM, was 0.1234279750 (95% confidence interval [CI] = 0.625-0.920), the SWE cut-off value was 15.5 kPa (95% CI = 0.794-0.989). We have demonstrated that evaluation with SMI and SWE might allow quantitative assessment of the morphological changes of placentas in women with GDM. We believe that the use of innovative methods such as SMI and SWE in addition to conventional US examinations in daily practice and studies will provide significant clinical benefits to patient management.

Correlation Between Postpartum Myometrial Elasticity and Obstetric Complications in Pregnant Women with Gestational Diabetes Mellitus.

To investigate postpartum myometrial elasticity in pregnant women with gestational diabetes mellitus (GDM) using shear wave elastography (SWE) and analyze the correlation between myometrial SWE values and obstetric complications. Clinical data of women who gave birth at Affiliated Hospital of Yangzhou University from August 2022 to July 2023 were retrospectively analyzed and divided into two groups based on GDM diagnosis: the GDM group and the healthy control group. SWE was used to measure the elasticity values of the anterior and posterior myometrial walls in both groups. Differences in placental attachment position and SWE values at the placental attachment site were compared between the two groups. Spearman correlation analysis was utilized to evaluate the correlation between SWE values and obstetric complications. Glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG), 2-hour postprandial glucose (2h PG), triglycerides (TG), and total cholesterol (TC) levels were higher in the GDM group than in the healthy control group (P<0.05). There was a statistically significant difference in placental attachment position between the two groups (P<0.05). In both the GDM (17.52±0.42 vs 25.29±0.74, P=0.001) and control groups (14.06±5.01 vs 22.20±6.34, P=0.001), mean SWE values were significantly lower for anterior versus posterior placental attachment, and mean SWE values were also significantly higher in the GDM versus control group for both anterior (17.52±0.42 vs 14.06±5.01, P=0.001) and posterior placental attachment (25.29±0.74 vs 22.20±6.34, P=0.001). Spearman correlation analysis showed that postpartum hemorrhage (r=0.632, P=0.017), preeclampsia (r=0.818, P=0.014), premature rupture of membranes (r=0.710, P=0.012), placental abruption (r=0.732, P=0.031), and ketoacidosis (r=0.729, P=0.022) were negatively correlated with average myometrial SWE values in the GDM group (P<0.05). SWE values at the placental attachment site were higher in GDM patients than in healthy pregnant women, and myometrial elasticity was positively correlated with obstetric complications.

Testicular Evaluation Using Shear Wave Elastography (SWE) in Patients with Varicocele.

To assess the possible influence of the presence of varicocele on the quantification of testicular stiffness. Ultrasound with shear wave elastography (SWE) was performed on 48 consecutive patients (96 testicles) referred following urology consultation for different reasons. A total of 94 testes were studied and distributed in three groups: testes with varicocele (group A, n = 19), contralateral normal testes (group B; n = 13) and control group (group C, n = 62). Age, testicular volume and testicular parenchymal tissue stiffness values of the three groups were compared using the Kruskal-Wallis test. The mean age of the patients was 42.1 ± 11.1 years. The main reason for consultation was infertility (64.6%). The mean SWE value was 4 ± 0.4 kPa (kilopascal) in group A, 4 ± 0.5 kPa in group B and 4.2 ± 0.7 kPa in group C or control. The testicular volume was 15.8 ± 3.8 mL in group A, 16 ± 4.3 mL in group B and 16.4 ± 5.9 mL in group C. No statistically significant differences were found between the three groups in terms of age, testicular volume and tissue stiffness values. Tissue stiffness values were higher in our control group (healthy testicles) than in patients with varicocele.

Shear wave elastography parameters adds prognostic value to adverse outcome in kidney transplantation recipients

Introduction The tissue stiffness of donor kidneys in transplantation may increase due to pathological changes such as glomerulosclerosis and interstitial fibrosis, and those changes associate worse outcomes in kidney transplantation recipients. Ultrasound elastography is a noninvasive imaging examination with the ability to quantitatively reflect tissue stiffness. Aim of this study was to evaluate the prognostic value of ultrasound elastography for adverse kidney outcome in kidney transplantation recipients. Methods Shear wave elastography (SWE) examinations were performed by two independent operators in kidney transplantation recipients. The primary outcome was a composite of kidney graft deterioration, all-cause re-hospitalization, and all-cause mortality. Survival analysis was calculated by Kaplan-Meier curves with the log-rank test and Cox regression analysis. Results A total of 161 patients (mean age 46 years, 63.4% men) were followed for a median of 20.1 months. 27 patients (16.77%) reached the primary endpoint. The mean and median tissue stiffness at the medulla (hazard ratio: 1.265 and 1.229, respectively), estimated glomerular filtration rate (eGFR), and serum albumin level were associated with the primary outcome in univariate Cox regression. Adding mean or median medulla SWE to a baseline model containing eGFR and albumin significantly improved its discrimination (C-statistics: 0.736 for the baseline, 0.766 and 0.772 for the model added mean and median medulla SWE, respectively). Conclusion The medullary tissue stiffness of kidney allograft measured by shear wave elastography may provide incremental prognostic value to adverse outcomes in kidney transplantation recipients. Including SWE parameters in kidney transplantation recipients management could be considered to improve risk stratification.

Evaluation of Main Lacrimal Gland through Shear-wave Ultrasound Elastography in Patients with Low Schirmer Value

To compare main lacrimal gland values through shear-wave elastography (SWE) in patients with low Schirmer value and unspecified Sjögren's syndrome (SS) with healthy controls. Admitted to the ophthalmology department with Schirmer value <10 mm, randomly selected 46 eyes of 46 patients evaluated for Sjögren's syndrome (SS) in the rheumatology department between December 2022 and April 2023 were classified as low Schirmer group (LSG). Randomly selected 48 eyes of 48 patients at a similar age with Schirmer value >10 mm were included as controls. Main lacrimal gland SWE measurements in LSG and control groups were recorded and compared as meter/second (m/sec). Mean SWE values of the main lacrimal gland were measured as 2.78 ± 0.66 m/sec and 2.26 ± 0.29 m/sec in LSG and controls. SWE measurements were significantly higher in LSG patients than in controls (p<0.001). No significant correlation was found in the analysis between the Schirmer and the main lacrimal gland SWE values in LSG patients (p=0.702, r=0.058). No significant correlation was also detected between the Schirmer and main lacrimal gland SWE values in controls (p=0.097, r=0.242). No significant relationship was also found between age, gender, body mass index (BMI), and SWE values (p=0.351, p=0.493, p=0.328, respectively). Mean SWE value of the main lacrimal gland was determined as significantly higher in patients with aqueous lacrimal insufficiency without SS than in controls. We consider that SWE measurements may be an imaging method to support the diagnosis of aqueous lacrimal insufficiency and used in follow-ups of those with dry eye syndrome (DES) in the future.

Transrectal shear wave elastography for detection of prostate cancer.

To evaluate the value of transrectal shear-wave-elastography(SWE) to differentiate benign and malignant tissues in patients with suspected prostate cancer. Between January and May 2019, the study was designed as a prospective clinical study. The SWE value of 504 cores measured before biopsy and the pathology result of each core were used in the statistical analysis. The SWE values of benign and malignant cores were compared according to pathology results. ROC analysis was used to calculate the best cut-off SWE value for differentiating malignancy from benign tissues. Specificity, sensitivity, negative, and positive predictive values (NPV, PPV) were also calculated for cut-off value. Prostate cancer was detected in 74 (14.7%) of 504 core biopsies. The mean SWE values were found significantly higher in malignant cores (71.1 kPa) than benign cores (42.3 kPa) (p < 0.001). Cores with gleason score 7 had a significantly higher SWE value than Gleason score 6 (p = 0.009). The cut-off value to differentiate malignancy and area-under-curve were calculated 35.85 kPa, 0.733, respectively. The sensitivity, specificity, NPV, and PPV were 83%, 49%, 78%, and 95%, respectively for 35.85 kPa value. The malignant tissues have significantly higher SWE values. Also high gleason score was shown to be associated with high SWE values. To predict the prostate cancer, the difference of SWE values of between benign and malignant tissues has high sensitivity. In the near future, to prevent unnecessary prostate biopsies, SWE will be part of the standard protocol for prostate imaging.

MP47-10 TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY: A PROMISING TOOL IN PREDICTING ADHERENT PERINEPHRIC FAT IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP47-10 TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY: A PROMISING TOOL IN PREDICTING ADHERENT PERINEPHRIC FAT IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY Francesca Ambrosini, Francesco Chierigo, Veronica Giasotto, Guano Giovanni, Giovanni Marchi, Marco Martiriggiano, Giulia Carboni, Andrea Sorrentino, Guglielmo Mantica, Marco Borghesi, and Carlo Terrone Francesca AmbrosiniFrancesca Ambrosini More articles by this author , Francesco ChierigoFrancesco Chierigo More articles by this author , Veronica GiasottoVeronica Giasotto More articles by this author , Guano GiovanniGuano Giovanni More articles by this author , Giovanni MarchiGiovanni Marchi More articles by this author , Marco MartiriggianoMarco Martiriggiano More articles by this author , Giulia CarboniGiulia Carboni More articles by this author , Andrea SorrentinoAndrea Sorrentino More articles by this author , Guglielmo ManticaGuglielmo Mantica More articles by this author , Marco BorghesiMarco Borghesi More articles by this author , and Carlo TerroneCarlo Terrone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mayo Adhesive Probability (MAP) score predicts the presence of adherent perinephric fat (APF) which may increase the surgical complexity of partial nephrectomy. We assessed the role of 2D shear-wave elastography (SWE) in predicting the presence of APF with the goal to describe a novel model for the preoperative assessment of patients submitted to robot-assisted partial nephrectomy (RAPN). METHODS: Consecutive patients submitted to RAPN were prospectively enrolled between January 2021 and January 2022. Data were collected regarding patients’ characteristics, tumor features (RENAL, PADUA, SPARE score, MAP score ). Presence of APF was defined by the surgeon intraoperatively. Perirenal fat stiffness was preoperatively assessed with two-dimensional (2D) SWE. Each sampling was repeated 3 times and the mean value was recorded. We relied on multivariable logistic regression models to test whether APF was associated with higher values of mean SWE, gender, BMI, and MAP score. Models’ predictive ability of the presence of APF was assessed using the concordance index (C-index). Linear regression models investigated the association between APF and OT. RESULTS: 55 patients were collected of whom 31 (56%) did not have APF and 24 (44%) had APF. No statistically significant differences were reported among patients with or without APF with regards to age, preoperative creatinine and glomerular filtration rate, gender, BMI, smoking habit, diabetes, and cT stage. Hypertension was reported in 17 (71%) out of 24 patients with APF and in 13 (42%) patients out of 31 without APF (p=0.033).In single-variable analysis, there was a significantly increased likelihood of APF in males (92% VS 8,3% p=0.004) and in patients with a higher median (IQR) SWE (9.0 (8.0, 11.5) VS 5.8 (4.8, 7.0) p<0.001).MAP score had a good predictive ability of APF on its own (C-index = 0,876). The model including SWE alone had a similar predictive value (C-index = 0,84).The most effective model in predicting APF included SWE, gender and BMI (C-index = 0,91).The median (IQR) OT was 160 (132 – 182) minutes and 185 (179 – 222) minutes in patients without or with APF, respectively (p=0.01).The linear regression analysis showed that the presence of APF is associated with higher total OT (R squared = 0,097, p=0.012). CONCLUSIONS: The multivariable model including gender, BMI and the mean value of three measures of SWE highly predicts the presence of APF. The presence of APF impacts the total OT. A larger sample size is needed to validate the model and to create a score that effectively predicts APF. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesca Ambrosini More articles by this author Francesco Chierigo More articles by this author Veronica Giasotto More articles by this author Guano Giovanni More articles by this author Giovanni Marchi More articles by this author Marco Martiriggiano More articles by this author Giulia Carboni More articles by this author Andrea Sorrentino More articles by this author Guglielmo Mantica More articles by this author Marco Borghesi More articles by this author Carlo Terrone More articles by this author Expand All Advertisement PDF downloadLoading ...

Predicting Malignancy of Thyroid Micronodules: Radiomics Analysis Based on Two Types of Ultrasound Elastography Images

To develop a multimodal ultrasound radiomics nomogram for accurate classification of thyroid micronodules. A retrospective study including 181 thyroid micronodules within 179 patients was conducted. Radiomics features were extracted from strain elastography (SE), shear wave elastography (SWE) and B-mode ultrasound (BMUS) images. Minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms were used to select malignancy-related features. BMUS, SE, and SWE radiomics scores (Rad-scores) were then constructed. Multivariable logistic regression was conducted using radiomics signatures along with clinical data, and a nomogram was ultimately established. The calibration, discriminative, and clinical usefulness were considered to evaluate its performance. A clinical prediction model was also built using independent clinical risk factors for comparison. An aspect ratio ≥ 1, mean elasticity index, BMUS Rad-score, SE Rad-score, and SWE Rad-score were identified as the independent predictors for predicting malignancy of thyroid micronodules by multivariable logistic regression. The radiomics nomogram based on these characteristics showed favorable calibration and discriminative capabilities (AUCs: 0.903 and 0.881 for training and validation cohorts, respectively), all outperforming clinical prediction model (AUCs: 0.791 and 0.626, respectively). The decision curve analysis also confirmed clinical usefulness of the nomogram. The significant improvement of net reclassification index and integrated discriminatory improvement indicated that multimodal ultrasound radiomics signatures might work as new imaging markers for classifying thyroid micronodules. The nomogram combining multimodal ultrasound radiomics features and clinical factors has the potential to be used for accurate diagnosis of thyroid micronodules in the clinic.

Measurement of the stiffness of the normal terminal ileum mesentery using shear-wave elastography

ObjectiveTo investigate the feasibility of using shear-wave elastography (SWE) to measure the stiffness of the normal terminal ileum mesentery, and to establish its normal reference range. MethodsNinety-five normal subjects and 22 patients with mesentery-related disease were included. The average Young's modulus of the normal terminal ileal mesentery was measured by SWE ultrasound. The thickness and the extent to which mesenteric fat extended around the intestinal circumference of the normal terminal ileum were also recorded. The normal reference range was established and the SWE values of normal and diseased subjects were compared. ResultsTransabdominal SWE examination of the terminal ileum mesentery was successfully performed on 91 subjects (95.8 %). The mean extent range, thickness, and SWE value of the normal terminal ileum mesentery were 1/4 (1/5–1/3), 6.8 ± 2.4 mm, and 4.3 ± 2.1 kPa, respectively. These parameters did not differ significantly between genders, and across age and body mass index groups (all P > 0.05). The intra- and inter-operator consistencies were excellent for the replicated SWE measurements (0.801 [95 % confidence interval: 0.560–0.916] and 0.751 (95 % confidence interval: 0.388–0.900], respectively). The mean mesenteric elasticity in diseased subjects was 21.9 ± 10.7 kPa, which was significantly higher than that in normal subjects (P < 0.001). The cut-off value for mesenteric elasticity was 9.3 kPa, with a sensitivity of 90 % and a specificity of 100 % (P < 0.001). ConclusionSWE can be used to reliably evaluate the stiffness of the terminal ileum mesentery in normal subjects.

Increased arterial stiffness and accelerated atherosclerosis in Takayasu arteritis

IntroductionCardiovascular diseases are the leading causes of morbidity and mortality in patients with Takayasu arteritis (TAK). Arterial stiffness and accelerated atherosclerosis have been reported in TAK, however, morphological changes in the arterial wall have not been adequately addressed. Shear wave elastography (SWE) is a new, non-invasive, direct and quantitative method of ultrasonography (US) that evaluates elasticity of biological tissues. MethodsA total of 50 patients with TAK (44F/6 M; mean age: 39.8 ± 8.2 years), 43 with systemic lupus erythematosus (SLE) (38F/5 M; 38.0 ± 7.9 years) and 57 healthy controls (HCs) (50F/7M: 39.5 ± 7.1 years) were studied using carotid B mode US and SWE. Carotid artery intima-media thickness (CCA IMT) and SWE were measured and the atherosclerotic plaques were recorded. Clinical characteristics and cardiovascular risk factors were determined. Intra and inter observer reproducibility was assessed and found good agreement. ResultsThe mean IMT in the right and left carotid arteries was significantly higher only among patients with TAK when compared to SLE and HCs. Carotid artery plaques were significantly increased only in patients with TAK. On the other hand, the mean SWE value was significantly increased among both TAK and SLE patients when compared to HCs, whereas patients with TAK had the highest value. These were also true after adjustments were made for atherosclerotic risk factors and after all those with atherosclerotic plaques were excluded from the analysis. TAK itself, diastolic blood pressure levels and IMT were independently associated with SWE. ConclusionsMarkedly increased CCA IMT and SWE values appear to be uniquely associated with TAK, suggesting that they could be used as diagnostic tools. Arterial stiffness occurs independently from atherosclerosis and is associated with arterial thickening. Further studies should investigate whether CCA SWE values could predict cardiovascular morbidity and mortality. Strong association with premature atherosclerosis could be also considered as a unique feature of TAK.

Factors Affecting Thyroid Elastography in Healthy Children and Patients with Hashimoto's Thyroiditis.

Hashimoto's thyroiditis (HT) is the most common form of thyroiditis in childhood. In addition to thyroid ultrasonography, shear-wave elastography (SWE) can evaluate thyroid parenchyma tissue stiffness, and more detailed findings can be obtained. We aimed to evaluate the relationship between SWE values and clinical, biochemical and hormonal parameters of individuals both in patients with HT and in healthy individuals. We compared 46 newly diagnosed HT cases with 46 healthy controls. We examined the effect of all metabolic parameters and thyroid-related markers on SWE values. The mean SWE values in patients with euthyroid HT were 12.5 ± 5.1 kilopascal (kPa), it was 8.2 ± 2.82 kPa in healthy controls (p< 0.001). Although the clinical (age, gender and body mass index) and laboratory parameters (such as thyroid function tests, HOMA-IR, IGF-1 values, which we think may affect SWE scores) of children with HT and healthy controls were statistically similar (p> 0.05), except for thyroid autoantibodies and thyroglobulin, SWE values and thyroid volume were significantly higher in individuals with HT (p< 0.001). Multiple linear regression analysis was performed to evaluate the direction and degree of the effect of the variables on thyroid elasticity scores, it was observed that age (p: 0.002), BMI SDS (p: 0.04) and Anti-TPO (p: 0.008) levels were effective on the thyroid elasticity score in the regression model. We detected a SWE cut-off value of 9.68 kPa with 68% sensitivity and 72% specificity, a 70% positive predictive value, and a 69% negative predictive value in thyroid elastography to differentiate cases with HT from healthy controls. Our results show that any metabolic factor other than BMI SDS has no effect on SWE scores, especially in healthy children. There is a positive correlation between BMI SDS and SWE in healthy children (r=0.353; p=0.02), but not in the patients with HT (r=0.196; p=0.19). Likewise, age is another factor affecting SWE in only healthy children. We do not recommend routine evaluation of any laboratory parameter other than thyroid functions before thyroid elastography.