Performance Of Shear Wave Elastography Research Articles

Systematic review and meta-analysis of the diagnostic performance of lacrimal gland ultrasound elastography in primary Sjögren's syndrome.

This research conducted a comprehensive evaluation of the effectiveness of ultrasonic elastography (USE) in detecting lacrimal gland involvement in individuals suffering from primary Sjögren's syndrome (pSS). A comprehensive search was undertaken across multiple databases including PubMed, the Cochrane Library, EMBASE, Wanfang, Web of Science, and the Chinese National Knowledge Infrastructure, to gather relevant literature pertaining to the application of USE in diagnosing pSS from January 1, 2000, to October 1, 2023. Pooled data were used to calculate sensitivity, specificity, and diagnostic odds ratios. Several summary metrics were used to evaluate SWE's performance in detecting pSS, including the area under the receiver operating characteristic curve, diagnostic odds ratios, sensitivities, and specificities. Five pertinent studies included a total of 273 patients. Shear wave elastography (SWE) demonstrated a pooled sensitivity of 0.88 (95% CI 0.77-0.94) and specificity of 0.94 (95% CI 0.88-0.98), with an area under the receiver operating characteristic curve of 0.97 (95% CI 0.95-0.98). SWE exhibited a positive likelihood ratio of 15.86 (95% CI 6.99-36.00) and a negative likelihood ratio of 0.13 (95% CI 0.07-0.25). No evidence of publication bias was observed (p = 0.70). SWE demonstrates a remarkable degree of precision in detecting lacrimal gland involvement in individuals suffering from pSS.

Comparative evaluation of shear wave elastography elasticity values in thyroid nodules with cytology results and TI-RADS scoring in differentiation of benign–malignant nodules

PurposeThe aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS).MethodsThis prospective study included 370 thyroid nodules in 308 patients aged 18–70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules.ResultsOne hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001).ConclusionThis study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules.

Impact of Region-of-Interest Size on the Diagnostic Performance of Shear Wave Elastography in Differentiating Thyroid Nodules.

This study investigated the impact of different region-of-interest (ROI) sizes (Max, 1 mm, and 2 mm) on shear wave elastography (SWE) in differentiating between malignant and benign thyroid nodules. The study cohort comprised 129 thyroid nodules (50 malignant, 79 benign) and 78 normal subjects. Diagnostic efficacy was assessed through pairwise comparisons of area under the curve (AUC) values in receiver operating characteristic analysis by using DeLong's test. Our results indicated significant differences in all SWE elasticity metrics between the groups, with malignant nodules exhibiting higher values than benign nodules (p < 0.05). Smaller ROIs (1 and 2 mm) were found to outperform the max ROI in terms of diagnostic accuracy, particularly for the Emax and Emin elasticity metrics. Emax(1mm) had the highest diagnostic accuracy, with an AUC of 0.883, sensitivity of 74.0%, and specificity of 86.1%. This study underscores the significant influence of ROI size selection on the diagnostic performance of SWE, offering valuable insights for future research and clinical applications in thyroid nodule assessment.

Diagnostic performance of shear wave elastography in thyroid nodules with indeterminate cytology: A systematic review and meta-analysis

PurposeThyroid nodules classified as indeterminate in previous fine-needle aspiration cytology often necessitate additional evaluation to determine their histology, while shear wave elastography (SWE) offers an alternative option in this regard. The objective of this study was to assess the diagnostic effectiveness of SWE in evaluating indeterminate nodules. MethodsThe PubMed, EMBASE, and Web of Science databases were searched from 1st January 1970 to 1st March 2023. The studies were reviewed and the data was extracted by two separate reviewers. A Bayesian bivariate model was utilized to quantitatively synthesize the diagnostic accuracy and yield of the studies in R. ResultsA total of seven studies, involving indeterminate thyroid nodules undergoing SWE were included, and the overall malignancy rate was 34.1% (307/900). The summarized estimates of sensitivity and specificity were 0.792 (95% credible interval [CI], 0.727–0.850) and 0.845 (95% CI, 0.797–0.887), respectively. The summarized estimate for the diagnostic odds ratio (DOR) was 17.8 (95% CI, 14.0–22.6). Summarized receiver operating characteristic (SROC) plots indicated a trade-off between sensitivity and specificity, and the estimate of AUC was 0.866 (95% CI, 0.834–0.895). The summary estimates for positive and negative likelihood ratios were 4.67 (95% CI, 3.98–5.85) and 0.26 (95% CI, 0.23–0.28), respectively. ConclusionsThe overall accuracy of SWE remains satisfactory in indeterminate thyroid nodules. However, it should be noted that the available data are still extremely limited, and more studies or guidelines are required to provide further insights.

Shear Wave Elastography for Assessment of Biopsy-Proven Renal Fibrosis: A Systematic Review and Meta-analysis.

The purpose of this meta-analysis was to evaluate the diagnostic performance of shear wave elastography (SWE) for the staging of renal fibrosis in patients with chronic kidney disease (CKD). Classification of CKD into mild, moderate and severe fibrosis was based on renal biopsy pathology (glomerulosclerosis, tubulointerstitial injury and vascular sclerosis). The Cochrane Library, Medline, PubMed, Web of Science, EMBASE and CNKI databases were searched from January 1, 2009, to April 20, 2022. Pooled sensitivity, specificity, diagnostic odds ratio and area under the receiver operating characteristic curve (AUROC) were calculated using random effects models. A total of 1394 patients from 14 studies were included in the final analysis. For mild, moderate and severe renal fibrosis, SWE had a sensitivity of 0.79 (95% confidence interval [CI]: 0.67-0.88), 0.73 (95% CI: 0.65-0.80) and 0.87 (95% CI: 0.71-0.95); a specificity of 0.82 (95% CI: 0.75-0.87), 72% (95% CI: 0.67-0.77) and 0.83 (95% CI: 0.80-0.86); an AUROC of 0.87 (95% CI: 0.84-0.90), 0.78 (95% CI: 0.75-0.82) and 0.86 (95% CI: 0.82-0.88); and a diagnostic odds ratio of 17 (95% CI: 7-43), 7 (95% CI: 4-12) and 34 (95% CI: 13-88), respectively. Meta-regressions revealed that the publication date, system used and number of valid measurements of SWE were the main causes of heterogeneity. SWE is a good technique for diagnosing mild and severe renal fibrosis, as well as a fair technique for diagnosing moderate fibrosis.

Comparison of the diagnostic performance of shear wave elastography with shear wave dispersion for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma

PurposeThis prospective study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic fibrosis in patients with hepatocellular carcinoma before resection. MethodA total of 210 consecutive patients with hepatocellular carcinoma (HCC) who were scheduled to undergo hepatectomy were prospectively enrolled, pre-operative SWE and SWD examinations were performed. Fibrosis staging and necroinflammatory activity were determined histopathologically according to the Scheuer standard. Multivariate linear regression analysis was used to identify factors associated with SWE and SWD values. The performance of SWE and SWD were determined by receiver operating characteristic (ROC) analysis. ResultsBoth SWE and SWD values of liver were highly correlated with liver fibrosis stage and necroinflammatory activity (p < 0.05). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (p < 0.001). ROC analysis revealed that SWE that predicted substantial fibrosis (S ≥ 2), severe fibrosis (S ≥ 3) and cirrhosis (S = 4) were 0.895, 0.877 and 0.854, the SWD that predicted substantial fibrosis (S ≥ 2), severe fibrosis (S ≥ 3) and cirrhosis (S = 4) were 0.857, 0.815 and 0.791. SWE had better diagnostic performance than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4). ConclusionsBoth SWE and SWD are useful, accurate and non-invasive methods for evaluating hepatic fibrosis in patients with hepatocellular carcinoma adapted to hepatectomy, SWE is a more accurate imaging modality than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4).

Shear wave elastography and pulsed doppler for breast lesions: Similar diagnostic performance and positively correlated stiffness and blood flow resistance

PurposeTo compare the diagnostic performance of shear wave elastography (SWE) and pulsed Doppler ultrasound in breast lesions, and to explore whether the quantitative SWE parameters correlated with pulsed Doppler ultrasound parameters. Materials and methodsSeventy-nine patients with 79 breast lesions who had undergone conventional ultrasound, pulsed Doppler ultrasound and SWE examination were included. All of them underwent core needle biopsy or surgery within one week. Parameters including Emax (the maximum elastic modulus), Emean (mean elastic modulus), Emin (minimum elastic modulus), Esd (elastic modulus standard deviation), and RI (resistive index), PI (pulsatility index), PSV (peak systolic velocity) and EDV (end diastolic velocity) were obtained for statistical analysis. ResultsAlmost all SWE parameters were significantly different between benign and malignant breast lesions (P＜0.05). There was no significant difference between Esd and PI (P＞0.05), which had the best AUC among SWE and vascular parameters respectively (0.877 vs. 0.871). Emax showed a moderate correlation with PI (P = 0.000, r = 0.552) and RI (P = 0.000, r = 0.544), and Esd moderately correlated with PI (P = 0.000, r = 0.567) and RI (P = 0.000, r = 0.546). For the benign group, no parameters showed any significant correlation (P＞0.05), while for the malignant group, Emax and Esd also significantly correlated with PI or RI. ConclusionsSWE and pulsed Doppler ultrasound had similar diagnostic efficacy for breast lesions. SWE and pulsed Doppler parameters were significantly correlated in breast lesions, especially in malignant ones, indicating the potential association between elastographic and vascular characteristics of breast tumors.

Shear wave elastography in optic neuritis: diagnostic accuracy of the optic nerve and adjacent fat tissue values.

Introduction: In this study, we attempt to determine the diagnostic performance of shear wave elastography of the optic nerve and adjacent fat tissue in patients with optic neuritis. Methods: The study included a patient group consisting of 72 eyes of 36 patients who were diagnosed with unilateral optic neuritis, and an age-matched control group of 36 eyes of 18 healthy subjects. The patient group consisted of 25 multiple sclerosis patients and 11 recurrent isolated optic neuritis patients. The mean shear wave elastography values of the optic nerves and intraorbital fat tissue adjacent optic nerves were recorded using m/s and kPa as units. ROC curve analysis was performed, and the diagnostic accuracy of shear wave elastography values was determined. Results: The mean shear wave elastography values of the optic nerves with neuritis (2.49 ± 0.41 m/s and 17.56 ± 4.42 kPa) were significantly higher than the values of the contralateral normal optic nerves (1.71 ± 0.32 m/s and 9.02 ± 2.34 kPa) (p = 0.006 and p = 0.004, respectively) in the optic neuritis group. The mean shear wave elastography values of intraorbital fat tissue adjacent optic nerves with neuritis (1.87 ± 0.32 m/s and 9.65 ± 1.12 kPa) were significantly higher than the values of the contralateral normal side (1.47 ± 0.27 m/s and 6.78 ± 1.14 kPa) (p = 0.025 and p = 0.022, respectively) in the optic neuritis group. ROC curve analysis showed a high diagnostic accuracy for determining optic neuritis with shear wave elastography values of the optic nerves (AUC 0.955 [95% CI, 0.933–0.978] in m/s and AUC 0.967 [95% CI, 0.940–0.985] in kPa). Conclusions: Shear wave elastography may be an important alternative diagnostic tool in the diagnosis of optic neuritis.

Shear wave elastography of ulnar nerve in arm: An observational study for evaluation of performance

Objectives: The performance of shear wave elastography (SWE) for peripheral nerve pathology, predominantly compressive neuropathy, has been studied with the median nerve, sciatic nerve, and tibial nerve. However, studies for ulnar nerve are limited in literature. The aim of the study was to study the performance of SWE for ulnar nerve in arm by analyzing the correlation of elasticity value by two transducers of the same ultrasound system. Material and Methods: This was a prospective observational study. Elasticity of ulnar nerve was measured in the mid-arm and supracondylar region in longitudinal and transverse planes with two different transducers of the same ultrasound system. The reliability of measurement was assessed by interclass correlation of values obtained. Results: Ninety-two ulnar nerve measurement sets were analyzed. The ages of the patients ranged from 14 years to 76 years, with a median age of 50. The SWE values obtained by two probes showed a weak interclass correlation coefficient value &lt;0.5. Conclusion: Quantitative SWE measurements of the ulnar nerve in the arm by two transducers showed a weak interclass correlation. It should be used with caution as a diagnostic tool with a universally acceptable cut off values.

Performance of shear wave elastography: A single centre pilot study of mixed etiology liver disease patients with normal BMI.

To assess the performance of shear wave ultrasound elastography (SWE) for non-invasive grading of fibrosis in normal BMI patients with varied aetiology chronic liver disease. Prospective SWE liver and spleen stiffness (LS, SS respectively) of 124 patients (94 men, mean age 45.4±12.4years, mean BMI 19.66±1.49) with CLD of mixed aetiology, who underwent liver biopsy, between January 2019-20 was analysed using receiver operating curve (ROC) and classification analysis regression tree (CART) to determine fibrosis cut-off values and nominal logistical regression to quantify fibrosis. Of 124 patients, 50 (40%) had non-alcoholic steatohepatitis (NASH), 31 (25%) chronic hepatitis B (CHB) and 43 (35%) alcoholic liver disease (ALD) on biopsy. Overall mean LS and SS of the study population was 11.81±5.9 and 16.88±10.8kPa, respectively. LS cut-off value <8kPa was consistent with F0, 9-14kPa for F1-F2 and >14.9kPa for F3-F4 fibrosis on biopsy. On application of CART, LS value < 5.3kPa was discriminative for NASH, 5.32 to <12.64kPa for CHB, >12.64kPa for ALD, SS <15.3kPa was discriminative for NASH, 15.3-30kPa for CHB and >30kPa for ALD in our study population. SWE is a viable non-invasive tool for assessment of liver fibrosis grading in a population of mixed aetiology CLD. LS values in conjunction with SS are promising predictors of F2-F3 fibrosis with potential to discriminate select categories like CHB and NASH in such a population.

Diagnostic Performance of Shear Wave Elastography in the Noninvasive Evaluation of Liver Inflammation of Chronic Hepatitis B Patients.

In the current study, we sought to delineate the elastographic characteristics and further compare the diagnostic performance of various shear wave elastography modalities in hepatitis B virus patients whose liver fibrosis stage was less than F2 by liver biopsy. We retrospectively studied the clinical and imaging data of chronic hepatitis B virus patients who underwent liver biopsy at our hospital between January 2017 and October 2017. Totally, 102 patients were eligible for the study. The mean Young modulus of sound touch elastography (STE) and sound touch quantify (STQ) gradually increased as inflammation grade of the liver rose from G0 to G3. Spearman rank correlation analysis revealed that the mean Young modulus of STE and STQ significantly correlated with hepatic inflammation grade (r = 0.341, P < 0.05). The area under the receiver operating characteristic curve (AUC) was the highest for the mean Young modulus of STE (AUC = 0.740; P = 0.015) followed by that of STQ (AUC = 0.684; P = 0.063) for G ≥ 2 hepatic inflammation and the AUC was the highest for the mean Young modulus of STE (AUC = 0.920; P = 0.000) followed by that of STQ (AUC = 0.910; P = 0.000) for G ≥ 3 hepatic inflammation. The current study demonstrated that the mean Young modulus of STE and STQ could serve as a useful diagnostic marker for hepatic inflammation of hepatitis B virus patients with no apparent liver fibrosis.

Diagnostic Accuracy of Shear Wave Elastography as an Adjunct Tool in Detecting Axillary Lymph Nodes Metastasis

This study evaluates the diagnostic performance of shear wave elastography (SWE) in differentiating between benign and axillary lymph node (ALN) metastasis in breast carcinoma. Breast lesions and axillae of 107 patients were assessed using B-mode ultrasound and SWE. Histopathology was the diagnostic gold standard. In metastatic axillary lymph nodes, qualitative SWE using color patterns had the highest area under curve (AUC) value, followed by B-mode Ultrasound (cortical thickening >3 mm) and quantitative SWE using Emax of 15.2 kPa (AUC of 81.3%, 70.1%, and 61.2%, respectively). Qualitative SWE exhibited better diagnostic performance than the other two parameters, with sensitivity of 96.0% and specificity of 56.1%. Combination of B-mode Ultrasound (using cortical thickness of >3 mm as cut-off point) and qualitative SWE (Color patterns of 2 to 4) showed sensitivity of 71.6%, specificity of 95%, PPV of 96%, NPV of 66.7%, and accuracy of 80.4%. Qualitative SWE assessment exhibited higher accuracy compared to quantitative values. Qualitative SWE as an adjunct to B-mode ultrasound can further improve the diagnostic accuracy of metastatic ALN in breast cancer.

Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis

PurposeWe aimed to assess the diagnostic performance of shear wave elastography (SWE) to assess perinodular stiffness before fine needle aspiration (FNA) of thyroid nodules with a maximum diameter of 1.0 cm. MethodThis retrospective study included 69 thyroid nodules in 68 patients who underwent conventional ultrasound and SWE before ultrasound-guided FNA or surgical excision. The stiffness of perinodular regions was evaluated using wave patterns. Quantitative SWE features were also assessed. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were calculated using conventional ultrasound and conventional ultrasound with SWE. ResultsOf the 69 nodules, 57(82.6 %)were malignant and 12(17.4 %)were benign. The maximum elastic modulus (Emax) was higher for malignant nodules(P＜ 0.05). There was no significant difference in mean elastic modulus or minimum elastic modulus between malignant and benign nodules. The Emax≥ 28.2 kPa was the best cut-off value for malignant base on receiver operating curve. Perinodular stiffness was significantly greater for malignant nodules compared with benign nodules according to shear wave patterns. Compared with ultrasound alone, the rate of benign lesions recommended for FNA decreased from 75.0 % (9/12) to 25.0 % (3/12) with conventional ultrasound plus SWE. ConclusionSWE provides quantitative and qualitative information when used with conventional ultrasound. SWE has the potential to reduce the number of unnecessary FNA procedures.

The performance of shear wave elastography on evaluating liver changes in obese and overweight children.

Real time shear-wave elastography (SWE) is a non-invasive imaging method which can quantitatively assess liver stiffness. Obesity and its complication are increasing with improving lifestyles in our century. We evaluated the performance of SWE for detecting liver changes (fatty liver, steatohepatitis) in obese and overweight children, in addition to this, we determined the diagnostic accuracy and clinical usefulness of SWE in non-alcoholic fatty liver disease (NAFLD). Obese and overweight 41 children within the age range of 6-15 years were included in this singlecenter prospective study. Biochemical evaluation for aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglyceride (TG), total cholesterol (TC) levels, as well as conventional ultrasound and SWE of the liver were performed in the patient group. These values were compared with values of 25 normal weight and healthy children in the age range of 6-16 years. The mean SWE values was 13.7 ± 5.5 kiloPascal (kPa) and 2.03 ± 0.35 meter/second (m/s) in patient group and 7.99 ± 2.81 kPa and 1.62 ± 0.21 m/s in control group (p < 0.01). The receiver-operating characteristics (ROC) analysis was performed to determine the optimum cut-off value for elastography values (kPa) to evaluate liver changes; area under the curve was 87.5% (95% CI 79.3-95.8). When the cutoff value was set as 10.45 kPa, the sensitivity and the specificity was 69.2% and 100%, respectively. We could not observe a statistically significant difference when we compared the elastography values (kPa and m/s) according to presence of hepatosteatosis (p=0.581 and 0.172). There were no significant correlations between SWE and AST, ALT values. SWE may be a useful and accurate imaging method to evaluate liver changes and monitor NAFLD in obese and overweight children.

Diagnostic performance of shear wave elastography in discriminating malignant and benign breast lesions : Our experience with QelaXtoTM software.

We sought to evaluate the diagnostic performance of quantitative elastography (shear wave elastography) and to establish the optimal cutoff value to differentiate malignant and benign breast lesions using QelaXtoTM software. We conducted a retrospective observational study of adult women with suspicious breast lesions (BIRADS 3, 4 or 5) who underwent programmed ultrasound-guided core biopsies. Breast lesions were assessed using quantitative elastography combined with B-mode ultrasound. Histopathology was used as reference standard. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated, and a ROC curve analysis was conducted. Three elastography cutoff values were considered: 36, 50 and 80 kPa. We included 143 women (mean age of 56 years) with a total of 145 breast lesions: 68 benign tumors (47.26%) and 77 malignancies (52.74%). Mean elasticity measurements of benign and malignant lesions were significantly different (24.6 kPa, SD 28.47, vs. 101.49 kPa, SD 47.38, [Formula: see text]). Using the 50 kPa cutoff, elastography showed a global sensitivity of 87% to discriminate malignant lesions (AUC = 0.897). Moreover, sensitivity was 90.7% when lesions were located 5-40 mm below the skin surface (optimal elastographic field of view). Our false positive rate was 17.65%, comprised mainly of fibroepithelial neoplasms, fibroadenomas and fibrosis. Quantitative elastography can differentiate malignant and benign breast lesions with acceptable to excellent performance. In our sample, the QelaXtoTM software showed a lower optimal cutoff than other ultrasound systems.

Shear Wave Elastography Performance in Noninvasive Assessment of Liver Cirrhosis in Liver Transplant Recipients With the Recurrence of Hepatitis C Infection

BackgroundThe recurrence of hepatitis C (HCV) after liver transplant (LTX) leads to graft fibrosis and cirrhosis. Liver biopsy remains the criterion standard for their diagnosis and monitoring. Our objective was evaluation of shear wave elastography (SWE) in patients with HCV recurrence after LTX and its comparison with histopathologic fibrosis assessment scoring systems. MethodsA total of 101 LTX recipients with HCV recurrence (42 women [41.6%] and 59 men [58.4%]) were evaluated by graft biopsy specimens (Ishak, Scheurer, and meta-analysis of histologic data in viral hepatitis [Metavir] score) and SWE (liver stiffness). Median age of patients was 59.4 years; median time from LTX was 84.9 months. The study protocol conforms with the Declaration of Helsinki. ResultsMedian liver stiffness was 21.3 kPa. To differentiate between liver fibrosis and cirrhosis, patients were divided into 2 subgroups: Ishak score fibrosis (1-4 [85.2%]) and cirrhosis (5-6 [13.9%]); Scheurer score fibrosis (0-3 [85.2%]) and cirrhosis (4 [12.9%]); Metavir score fibrosis (0-3 [85.2%]) and cirrhosis (4 [14.9%]). We have observed statistically significant differences between liver fibrosis and liver cirrhosis groups defined on the basis of Ishak, Scheurer, and Metavir scoring systems: 20.8 kPa vs 29.6 kPa (P = .001), 20.7 kPa vs 30.3 kPa (P = .0005), and 20.7 kPa vs 28.8 kPa (P = .002), respectively. ConclusionsOur results indicate that SWE may be useful in differentiating patients with advanced cirrhosis from those with fibrosis and may be helpful in the noninvasive diagnosis and monitoring of HCV recurrence after LTX.

Diagnostic Performance of a Combination of Shear Wave Elastography and B-Mode Ultrasonography in Differentiating Benign From Malignant Thyroid Nodules.

ObjectivesThis study was conducted to compare clinicopathologic and radiologic factors between benign and malignant thyroid nodules and to evaluate the diagnostic performance of shear wave elastography (SWE) combined with B-mode ultrasonography (US) in differentiating malignant from benign thyroid nodules.MethodsThis retrospective study included 92 consecutive patients with 95 thyroid nodules examined on B-mode US and SWE before US-guided fine-needle aspiration biopsy or surgical excision. B-mode US findings (composition, echogenicity, margin, shape, and calcification) and SWE elasticity parameters (maximum [Emax], mean, minimum, and nodule-to-normal parenchymal ratio of elasticity) were reviewed and compared between benign and malignant thyroid nodules. The diagnostic performance of B-mode US and SWE for predicting malignant thyroid nodules was analyzed. The optimal cutoff values of elasticity parameters for identifying malignancy were determined. Diagnostic performance was compared between B-mode US only, SWE only, and the combination of B-mode US with SWE.ResultsOn multivariate logistic regression analysis, age (odds ratio [OR], 0.90; P=0.028), a taller-than-wide shape (OR, 11.3; P=0.040), the presence of calcifications (OR, 15.0; P=0.021), and Emax (OR, 1.22; P=0.021) were independent predictors of malignancy in thyroid nodules. The combined use of B-mode US findings and SWE yielded improvements in sensitivity, the positive predictive value, the negative predictive value, and accuracy compared with the use of B-mode US findings only, but with no statistical significance.ConclusionWhen SWE was combined with B-mode US, the diagnostic performance was better than when only B-mode US was used, although the difference was not statistically significant.

Diagnosis of carpal tunnel syndrome: A comparative study of shear wave elastography, morphometry and artificial intelligence techniques

Ultrasonography is an acceptable modality to evaluate median nerve (MN) in patients with carpal tunnel syndrome (CTS). Additional investigations are needed to evaluate sonographic parameters and compare their performances with artificial intelligence (AI) methods. The aim of this study is to compare the performance of shear wave elastography, morphometry, and AI techniques to predict MN entrapment accurately. 200 wrists including 100 CTS and 100 control wrists were included. Twelve morphological and five elasticity parameters were measured from each MN. Two AI techniques namely, support vector machine (SVM), and convolutional neural network (CNN) were used to diagnose CTS. MN area with area under receiver-operating characteristic curve (AUC) of 0.949 and mean elasticity with AUC of 0.942 showed the highest performance to differentiate CTS from control wrists among morphological and elasticity parameters, respectively. The CNN achieved the best performance with AUC of 0.980, while SVM obtained AUC of 0.943 in testing dataset to diagnose CTC. MN is larger, stiffer, more irregular and extended in CTS patients. Deep learning technique yielded the highest performance in diagnosing CTS automatically. AI methods have vast potential to be implemented in clinical practice as an auxiliary tool for the assessment of CTS with high accuracy.

Meniscus Stiffness Measured with Shear Wave Elastography is Correlated with Meniscus Degeneration

The aim of this study was to evaluate the diagnostic performance of shear wave elastography (SWE) in human meniscus degeneration, with histology serving as the standard of reference. This comparative in vivo and ex vivo study was performed in 15 medial and 15 lateral menisci from 13 patients undergoing total knee arthroplasty (TKA) for primary osteoarthritis with varus deformity. Patients underwent in vivo coronal measurement with SWE for meniscus before surgery. Then, ex vivo assessment of meniscus stiffness with SWE was performed with the tissue obtained after TKA. SWE measurements were made in coronal and sagittal views with respect to the meniscus. Samples were analyzed histologically on a 0–18 scale according to the level of degeneration based on surface integrity, cellularity, fiber organization, collagen alignment and Safranin O staining intensity. The correlation between SWE measurement scale and histology was analyzed using Spearman's correlation. The area under the receiver operating characteristic curve (AUROC) was used to calculate the diagnostic performance of SWE in evaluating meniscus degeneration. Significant increases in stiffness were observed with increasing histologic degeneration in both in vivo and ex vivo coronal SWE. AUROCs were 0.79 (95% confidence interval [CI]: 0.49–1.00) for in vivo coronal SWE, 0.73 (95% CI: 0.53–0.95) for ex vivo coronal SWE and 0.56 (95% CI: 0.27–0.84) for ex vivo sagittal SWE. The medial meniscus, which exhibited more degeneration on histologic analysis, had greater stiffness than the lateral meniscus on ex vivo coronal SWE. The values of meniscus stiffness measured with SWE are correlated with the degree of meniscus degeneration. Further large-scale prospective studies may confirm the diagnostic performance of SWE as a non-invasive tool to assess meniscus degeneration.

Assessment of Fibrosis in Liver Transplant Recipients: Diagnostic Performance of Shear Wave Elastography (SWE) and Correlation of SWE Findings With Biopsy Results.

OBJECTIVE. Liver transplant patients are monitored for rejection and hepatic fibrosis and often undergo liver biopsies. The purpose of the present study is to determine whether noninvasive shear wave elastography (SWE) can quantify fibrosis in liver transplant recipients, with the aim of decreasing and possibly eliminating unnecessary biopsies for patients with suspected or progressive hepatic fibrosis. MATERIALS AND METHODS. Between May 1, 2015, and December 31, 2017, our prospective study evaluated 111 adult liver transplant patients (age range, 23-79 years) who underwent 147 ultrasound (US) SWE examinations of the right hepatic lobe followed by biopsies. SWE values were compared with the histologic fibrosis (Metavir) scores of the biopsy samples. SWE threshold values were determined using classification and regression tree analysis by anchoring to the degree of fibrosis. The sensitivity, specificity, positive predictive value, and negative predictive value (with 95% CIs) were calculated on the basis of the threshold value. Overall prediction accuracy was estimated using the AUC value from the ROC curve. RESULTS. From the 147 US SWE examinations and liver biopsies, consistent threshold values were identified for patients with no or minimal fibrosis (Metavir scores of F0 and F1, respectively) compared with significant fibrosis (Metavir scores of F2, F3, or F4). A median SWE value of 1.76 m/s or less denoted no or minimal fibrosis, whereas a value greater than 1.76 m/s denoted significant fibrosis. The sensitivity of US SWE examinations in classifying fibrosis was 0.77 (95% CI, 0.5-0.93). The specificity, positive predictive value, and negative predictive value were 0.79 (95% CI, 0.71-0.86), 0.33 (95% CI, 0.19-0.49), and 0.96 (95% CI, 0.91-0.99), respectively. CONCLUSION. Liver transplant patients may avoid liver biopsy if US SWE examination shows a median shear wave velocity of 1.76 or less, which corresponds to a Metavir score of F0 or F1, denoting no or minimal fibrosis.