Point Shear Wave Elastography Research Articles

Serum Irisin, Myostatin, and Myonectin Correlate with Metabolic Health Markers, Liver Disease Progression, and Blood Pressure in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease and Hypertension

Background/Objectives: Recent data indicate the involvement of skeletal muscles in the regulation of metabolism and in the pathogenesis of chronic noncommunicable diseases. The goal of our study was to describe the serum concentrations of myokines in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN) and their correlation with laboratory parameters, blood pressure (BP), and MASLD severity. Methods: A total of 67 patients with MASLD and HTN underwent anthropometric measurements, laboratory tests, and point shear-wave elastography. The serum concentrations of myokines were measured using enzyme-linked immunosorbent assay (ELISA). Results: Patients with detectable serum myonectin concentrations had significantly higher maximum systolic blood pressure (p = 0.022) and higher blood levels of uric acid (p = 0.029). Serum irisin concentration ≥ 6.1 μg/mL was associated with higher FLI values (p = 0.042) and liver stiffness (p = 0.034), as well as with slightly higher waist circumference (p = 0.082) and triglyceride level (p = 0.062). Patients with serum myostatin concentration ≥ 4.98 ng/mL were significantly older (p = 0.033) and had a lower blood albumin level (p = 0.043). Conclusions: In conclusion, the myokine profile in patients with MASLD and HTN correlates both with the severity of MASLD and the parameters characteristic of metabolic health, suggesting the possible contribution of altered irisin, myonectin, and myostatin concentrations to the occurrence of cardiometabolic risks in patients with MASLD.

Diagnosis and management of Canine Renal Cell Carcinoma with special reference to Shear Wave Elastography

This report focuses on the diagnosis and surgical management of unilateral renal cell carcinoma in a 7-year-old male intact German Shepherd dog. The dog was presented with fever, haematuria, inappetence, infrequent bouts of emesis, and progressive weight loss. Palpation revealed a hard, round mass in the right cranial abdomen. A presumptive diagnosis of unilateral renal neoplasm was made based on clinical signs, haematobiochemical analysis, and radiography. B-mode ultrasound examination demonstrated an enlarged right kidney extending up to the ventral midline. The kidney exhibited heterogenous echotexture, loss of renal architecture, and only a small healthy portion at the caudal pole. Point Shear Wave Elastography analysis revealed elevated values both in terms Shear Wave Velocity (m/sec) and Young’s Modulus Stiffness Value (kPa), indicating the presence of renal malignancy. To treat the condition, unilateral nephroureterectomy was performed under general anaesthesia. Histopathological examination confirmed the diagnosis of renal cell carcinoma. Consequently, it can be concluded that B-mode ultrasonography, Point Shear Wave Elastography, and nephroureterectomy played crucial roles in the successful diagnosis and surgical management of unilateral renal cell carcinoma.

Hepatocellular Cancer Surveillance in Patients with Advanced Chronic Liver Disease

BackgroundPatients with advanced chronic liver disease (ACLD) are at high risk of developing hepatocellular carcinoma (HCC). Therefore, biannual surveillance is recommended. This large-scale multicenter study aimed to stratify the risk of HCC development in ACLD.MethodsFrom 3016 patients with ACLD screened in 17 European and Chinese centers, 2340 patients with liver stiffness measurement (LSM) determined using different techniques (two-dimensional shear-wave elastography [2D-SWE], transient elastography, and point shear-wave elastography) and with different disease severities were included. Cox regression was used to explore risk factors for HCC. We used these data to create an algorithm, named PLEASE, but referred to in this manuscript as “the algorithm”; the algorithm was validated in internal and two external cohorts across elastography techniques.ResultsHCC developed in 127 (5.4%) patients during follow-up. LSM by 2D-SWE (hazard ratio: 2.28) was found to be associated with developing HCC, alongside age, sex, etiology, and platelet count (C-index: 0.8428). We thus established the algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×109/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Within 2 years, with a median follow-up of 13.7 months, patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%).ConclusionsOur algorithm stratified patients into two groups: those at higher risk of developing HCC and those at lower risk. Our data provide equipoise to test the prospective utility of the algorithm with respect to clinical decisions about screening patients with ACLD for incident HCC. (Funded by the German Research Foundation and others; ClinicalTrials.gov number, NCT03389152.)

Point Shear Wave Elastography for Assessment of Liver Stiffness in Normal Individuals and in Patients With Non-alcoholic Fatty Liver Disease.

Background Non-alcoholic fatty liver disease (NAFLD) is an increasing health issue worldwide, driven by rising rates of diabetes, obesity, and hypertriglyceridemia. Often asymptomatic, NAFLD is diagnosed through blood tests, imaging, and sometimes liver biopsy. Some cases advance to non-alcoholic steatohepatitis (NASH), which can lead to complications like liver cirrhosis and liver failure. While liver biopsy is the standard test for diagnosis, non-invasive methods such as shear wave elastography (SWE) offer a simpler and more reproducible alternative for diagnosing NAFLD. This is crucial for early intervention and preventing the progression of liver damage. Objectives The objectives of the study were to measure and compare liver stiffness in healthy individuals and patients with NAFLD using point shear wave elastography (pSWE), as well as to correlate liver stiffness in NAFLD patients with the ultrasonographic grades of fatty liver. Materials and methods This observational study was carried out at Dr. D. Y. Patil Medical College, Hospitaland Research Centre in Pune, India, from December 2022 to April 2024. The study involved 82 participants in total, with 41 patients diagnosed with NAFLD (cases) and 41 healthy individuals with a sonographically normal liver (controls). pSWE was performed on each participant to measure liver stiffness, with results expressed in kilopascals (kPa). The procedure was conducted using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea). Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, USA). Non-parametric tests, such as the Mann-Whitney test and Kruskal-Wallis test, were used to evaluate the significance of differences. A p-value of less than 0.05 was considered statistically significant. Results The mean liver stiffness, measured in kilopascals (kPa), was higher in NAFLD patients (cases) (10±5.1 kPa) than in normal individuals (controls) (4.4±0.7 kPa). This difference was statistically significant, with a p-value of less than 0.001. A positive correlation (rho=0.848, p<0.001) was found between the ultrasonographic grade of fatty liver and liver stiffness in NAFLD patients. Conclusion Our study demonstrated that individuals with NAFLD exhibited significantly higher liver stiffness compared to healthy individuals, as measured by ultrasound SWE. These findings suggest that pSWE could serve as a valuable, non-invasive diagnostic tool for assessing liver stiffness in NAFLD patients. Additionally, pSWE holds the potential for evaluating and monitoring the progression of the disease. However, further research with larger sample sizes is necessary to determine the prognostic significance of liver stiffness in these patients.

Predictive value of renal shear wave elastography in liver cirrhosis

BackgroundIn liver cirrhosis, prognosis is profoundly affected by renal function. This study evaluates the usefulness of renal stiffness measurement by point-shear wave elastography and renal perfusion by duplex. MethodsIn this case-control study, organ stiffness was quantified using point-shear wave elastography and duplex sonography to calculate the arterial resistive (RI) and pulsatility indices (PI) in 123 patients, including patients with liver cirrhosis with (LC+A) and without ascites (LC-A) and patients without liver cirrhosis (NLC). ResultsPI and RI were significantly increased in LC-A and LC+A compared to NLC (p<0.001) and correlated with MELD and Child Pugh scores. Point-shear wave elastography showed significantly lower renal stiffness in LC+A compared to LC-A (p<0.01) and NLC (p<0.001). Renal stiffness correlated inversely with MELD and Child Pugh scores.Reduced renal stiffness, but not PI or RI, was associated with the presence of hepatorenal syndrome (p<0.001). Reduced renal stiffness was associated with an increased risk of death due to complications of liver cirrhosis within 3 years (p<0.01). ConclusionPoint-shear wave elastography and duplex sonography correlate with progression of liver cirrhosis, but only shear wave elastography represents a valuable prognostic tool for hepatorenal syndrome and mortality in patients with liver cirrhosis.

Assessing Placental Shear Wave Elastography as a Tool for Evaluating Preeclampsia.

Background Hypertensive disorders of pregnancy, especially its dreaded complication preeclampsia, remain a major cause of morbidity and mortality for both the mother and the fetus. Existing tools for the prediction of preeclampsia remain inadequate in their sensitivity and specificity. Hence, there is an urgent need for a reliable, economically feasible, and objective marker for its diagnosis/early prediction. In this regard, shear wave elastography has shown great promise. Shear wave elastography is a novel method to quantify tissue stiffness, which is objective and has significantly lower inter-observer variability. Objectives We aim to quantify the tissue elasticity using point shear wave elastography (pSWE) in the placentas of diagnosed cases of preeclampsia and to compare them with the placentas of healthy controls in order to evaluate if there is a significant statistical difference between the two. Materials and methods This comparative study was conducted at the Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, from August 2022 to July 2024. The study included 60 participants, divided into two groups: 30 patients with preeclampsia and 30 healthy pregnancies. Placental stiffness was measured using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea), and pSWE was performed with a curvilinear probe. Data was analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), and the significance of differences between the two groups was assessed using an independent t-test with a p-value of <0.05, considered statistically significant. Results The mean placental stiffness, measured in kilopascals (kPa), was significantly higher in the preeclampsia group (11.71 ± 1.52 kPa) in comparison to the healthy group (3.36 ± 0.66 kPa) (p = 0.001). Patients suffering from preeclampsia were found to have significantly higher levels of placental stiffness. Conclusion Early diagnosis remains key to managing preeclampsia so that adequate monitoring and treatment could be provided to the patients. Our study showed that there is a significant statistical difference in the placental stiffness in patients with preeclampsia in comparison to a healthy placenta. Hence, shear wave elastography can be used as a supplementary tool to aid in the diagnosis/prediction of preeclampsia.

Significance of Correlation of Shear Wave Elastography With Fibrosis-4 in a Cohort of Patients With Diabetes and Nonalcoholic Fatty Liver Disease.

Background Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as a cause of chronic liver disease. It can lead to complications such as decompensated liver cirrhosis and hepatocellular carcinoma. Objectives This study aimed to assess liver stiffness using point shear wave elastography in patients with diabetes and NAFLD and to compare the results with the FIB-4 (fibrosis-4) score, AST/ALT (aspartate aminotransferase-to-alanine aminotransferase) ratio, and APRI (AST-to-Platelet Ratio Index). Materials and methods A cross-sectional study was conducted on type 2 diabetes patients who underwent point shear wave liver elastography for liver stiffness estimation between January 2020 and February 2023. Demographic data such as age, sex, and laboratory data (AST, ALT, and platelet count) were recorded. FIB-4 score, APRI, and AST/ALT ratio were calculated for these patients. The results of the FIB-4 score and APRI were then compared with the shear wave liver elastography fibrosis scores. Results The analysis included 60 patients, of whom 50 (83.33%) were male, with a mean age of 44.8 years (SD: 11.02; range: 21-69). Thirty-six patients (60%) had significant fibrosis. There was a significant positive correlation between the shear wave elastography results and the FIB-4 and APRI scores. Conclusion The findings revealed that nearly two-thirds of the study group had significant fibrosis (≥F2), highlighting the need for early NAFLD diagnosis and treatment. Noninvasive laboratory serum markers, in conjunction with shear wave liver elastography, are useful for diagnosing severe fibrosis.

Quality Assurance of Point and 2D Shear Wave Elastography through the Establishment of Baseline Data Using Phantoms.

Ultrasound elastography has been available on most modern systems; however, the implementation of quality processes tends to be ad hoc. It is essential for a medical physicist to benchmark elastography measurements on each system and track them over time, especially after major software upgrades or repairs. This study aims to establish baseline data using phantoms and monitor them for quality assurance in elastography. In this paper, we utilized two phantoms: a set of cylinders, each with a composite material with varying Young's moduli, and an anthropomorphic abdominal phantom containing a liver modeled to represent early-stage fibrosis. These phantoms were imaged using three ultrasound manufacturers' elastography functions with either point or 2D elastography. The abdominal phantom was also imaged using magnetic resonance elastography (MRE) as it is recognized as the non-invasive gold standard for staging liver fibrosis. The scaling factor was determined based on the data acquired using MR and US elastography from the same vendor. The ultrasound elastography measurements showed inconsistency between different manufacturers, but within the same manufacturer, the measurements showed high repeatability. In conclusion, we have established baseline data for quality assurance procedures and specified the criteria for the acceptable range in liver fibrosis phantoms during routine testing.

The feasibility of point shear wave elastography (pSWE) in the assessment of pancreas stiffness in diabetic patients and healthy volunteers.

Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by the dysfunctional metabolism of carbohydrates, fats, and proteins caused by impaired insulin secretion and insulin resistance. This study investigated the feasibility of using point shear wave elastography (pSWE) of the pancreas by comparing the shear wave velocity (SWV) measurements of three anatomical areas in patients with T1DM and healthy volunteers. This study included 30 patients with T1DM (9 male, 21 female) and 23 healthy controls (11 men, 12 women). Two experienced certified operators performed the examinations and took the SWV measurements. The mean SWV of the entire pancreas parenchyma differed significantly between patients and controls (1.1 ± 0.29 and 0.74 ± 0.19 m/s, respectively; p ≤ 0.001). Moreover, the SWVs of the pancreatic segments were significantly different in patients and controls; the mean SWV values of the pancreas head, body, and tail (respectively) in patients vs. controls were 0.99 ± 0.36 vs. 0.76 ± 0.26 m/s (p = 0.012), 1.1 ± 0.52 vs. 0.74 ± 0.23 (p ≤ 0.001), and 1.0 ± 0.34 vs. 0.73 ± 0.28 (p ≤ 0.001). This study confirmed the feasibility of quantifying pancreas tissue stiffness with pSWE and revealed that patients with T1DM had higher pancreas tissue stiffness than controls. Further studies are required to determine the potential value of pSWE as a screening tool in patients with prediabetes.

Point Shear Wave Elastography for Splenic Assessment: A Comparative Study of Splenomegaly and Normal Spleens.

Background The spleen, a key immunological organ, plays a crucial role in filtering aged or damaged red blood cells. Splenomegaly, an enlargement of the spleen, can arise from a variety of physiological and pathological conditions, including hematological disorders, hepatic diseases, and infections. Accurate diagnosis and evaluation of splenomegaly are essential for effective treatment. Objectives The objective of this study was to evaluate splenic stiffness in patients with splenomegaly using point shear wave elastography (pSWE) and compare the findings with those of individuals with normal spleen. Materials and methods This hospital-based observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, from October 2022 to December 2023. The study included 56 participants, divided into two groups: 28 patients with splenomegaly and 28 healthy controls. Spleen stiffness was measured using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea), and pSWE was performed with a curvilinear probe. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), and the significance of differences was assessed using an independent t-test with a p-value of <0.05, considered statistically significant. Results The mean spleen stiffness, measured in kilopascals (kPa), was significantly higher in individuals with splenomegaly (32.05 ± 12.54 kPa) compared to controls (22.9 ± 9.49 kPa) (p = 0.003). A positive correlation (rho = 0.482, p < 0.001) was observed between spleen diameter and spleen stiffness. Conclusion This study demonstrates that pSWE is an effective, non-invasive tool for assessing spleen stiffness. The higher spleen stiffness in splenomegaly patients underscores pSWE's diagnostic utility, with a positive correlation between spleen diameter and stiffness. Further multi-center studies are recommended to validate these findings, highlighting pSWE's promise in evaluating and monitoring splenic disorders.

Evaluation of iron overload in visceral organs in thalassemia patients by point shear-wave elastography.

The aim of this study was to investigate the value of point shear-wave elastography (pSWE) in the measurement of iron overload in the liver and other visceral organs in patients with beta thalassemia major (BTM). The study included 103 patients diagnosed with BTM who were referred to our clinic for cardiac and liver T2* measurement and a control group of 120 age- and gender-matched healthy volunteers. Cardiac and hepatic T2* measurements were performed in the patient group. Hepatic, pancreatic, splenic, and renal pSWE values were measured in both groups. The pSWE values were compared between the two groups. In the patient group, correlations between pSWE values, cardiac-hepatic T2* values and hepatic size, patient age, and serum ferritin levels were analyzed. Hepatic, pancreatic, splenic, and renal pSWE values were significantly higher in the patient group compared to the control group (p ≤ 0.001, < 0.001, 0.014, 0.026, respectively). In the patient group, hepatic pSWE values established a significant correlation with cardiac T2* values, liver size-T2*, pancreatic pSWE values, serum ferritin levels, and age (p = 0.006, < 0.001, 0.001, 0.042, 0.001, 0.032, respectively). In the ROC analysis, the area under the ROC curve was 0.807 for hepatic pSWE in the discrimination of thalassemia patients and healthy controls, and the cut-off value was 1.42, which gave a sensitivity and specificity of 75.7% and 75%, respectively. CONCLUSıON: Point shear-wave elastography can be a useful technique in the clinical measurement of iron overload in the liver, pancreas, spleen, and kidney.

Comparison of transient elastography and shear wave elastography in patients with MAFLD: A single-center experience.

Metabolic-associated fatty liver disease and liver fibrosis are intimately linked to insulin resistance, type 2 diabetes, obesity, and metabolic syndrome. Transient elastography (TE) and point shear wave elastography (pSWE) were used to measure liver stiffness in patients who met the ultrasound criteria for steatotic liver diseases (SLD). This study compared two methods for estimating liver stiffness in patients with SLD, which in turn correlated with liver fibrosis. Ultrasound B-mode imaging was used to identify SLD. In total, 250 MAFLD patients were recruited. Patient characteristics, laboratory investigations, and liver stiffness measurements using TE and pSWE were assessed on the same day. In the study, 56.0% of the patients were male, with a mean age of 41.5 ± 10.7 years. The correlation between TE and pSWE was significant (Spearman's r = 0.867*, p < 0.001). The Bland-Altman Plot analysis confirmed this, with 97.5% of variations in LSM falling within 95% agreement ranges. Cohen's κ was used to assess the agreement between TE and pSWE fibrosis stages, showing almost perfect agreement (83.5% kappa agreement) and a strong association between pSWE and TE in the assessment fibrosis stages. In patients with MAFLD, TE, and SWE are reliable methods for measuring liver stiffness and can be used as non-invasive screening tools for the assessment of fibrosis in SLD.

Acoustic Radiation Forced Impulse of the Liver and the Spleen, Combined with Spleen Dimension and Platelet Count in New Ratio Scores, Identifies High-Risk Esophageal Varices in Well-Compensated Cirrhotic Patients.

Acoustic radiation forced impulse (ARFI) is an integrated ultrasound method, measuring stiffness by point shear wave elastography. To evaluate the diagnostic performance of the ARFI of the liver and the spleen, combined with spleen dimension and platelet count, in predicting high-risk esophageal varices (HRVs) in cirrhotic patients, a prospective and cross-sectional study was conducted between February 2017 and February 2021. The following ratio scores were calculated based on ARFI measurements: ALSDP (ARFI Liver-Spleen Diameter-to-Platelet Ratio Score), ASSDP (ARFI Spleen-Spleen Diameter-to-Platelet Ratio Score), ASSAP (ARFI Spleen-Spleen Area-to-Platelet Ratio Score), and ALSAP (ARFI Liver-Spleen Area-to-Platelet Ratio Score). In 100 enrolled subjects, spleen ARFI, ASSDP, and ASSAP were significantly associated with HRVs in the prospective short- and long-term follow-ups and in the cross-sectional study (p < 0.05), while ALSDP and ALSAP were associated with HRVs only in the prospective long-term follow-up and cross-sectional study (p< 0.05). ASSAP was the best ARFI ratio score for HRVs at the long-term follow-up [value of area under curve (AUC) = 0.88], although all the ARFI ratio scores performed better than individual liver and spleen ARFI (AUC > 0.7). In our study, ARFI ratio scores can predict, in well-compensated cirrhotic patients, the risk of developing HVRs in short- and long-term periods.

Two dimensional shear wave elastography—Basic principles and current applications

AbstractUltrasound‐based elastography techniques are increasingly available on modern ultrasound systems. The application of elastography extends the utility of ultrasound, yielding new information about the impact of disease on tissue biomechanics. By modifying the B‐mode imaging pulse, an Acoustic Radiation Force Impulse produces shear waves in selected tissue. Quantifying the speed of the resultant shear wave provides an indirect assessment of tissue stiffness, with stiffer tissue producing faster shear wave movement than softer tissue. Two main types of ultrasound shear wave elastography are currently in use. Point shear wave elastography uses one or two pulses to measure shear wave speeds over a small fixed area. Alternatively, two‐dimensional shear‐wave elastography provides a colour elastogram map over a larger area, allowing the operator to select specific regions of interest to measure shear wave speed. This article will discuss the essential physics principles, and clinical uses of two‐dimensional shear wave elastography, aiming to provide sonographers with a basic understanding of the technology and current applications.

Feasibility of Point Shear Wave Elastography for Evaluating Renal Cortical Thickness: A Prospective Study.

Chronic Kidney Disease [CKD] affects individuals of different age groups worldwide. Moreover, CKD is associated with several risk factors, including obesity, lifestyle, and hypertension, which are common in the Middle East. Ultrasonography is the examination of choice for CKD. In recent years, Shear Wave Elastography [SWE] has developed through the continued development of ultrasound and received substantial attention ;therefore, it can be used to measure tissue stiffness. The study aimed to use point Shear Wave Elastography [p-SWE] to determine the correlation between diabetes and cortical renal thickness in detecting pathologies. This study was performed at the King Abdul-Aziz University Hospital. We examined 61 patients who underwent SWE. The patients were classified into two groups based on the presence or absence of type 2 Diabetes Mellitus [DM]. The results showed that there was a significant correlation between cortical stiffness and DM duration [p<0.005]. In addition, there was a negative correlation between cortical stiffness and cortical thickness [p=0.147] in patients with DM. Moreover, the eGFR decreased with an increase in cortical stiffness [p=0.499]. The cortical thickness in patients with and without DM was 0.750 ± 0.2 kPa and 0.788 ± 0.4 kPa, respectively. The kidney stiffness in patients with DM and control patients was 8.5 ± 8.6 cm and 14.0 ± 25.16 cm, respectively. This study showed that kidney p-SWE measurements were reliable. Therefore, further studies assessing kidney stiffness in patients with and without people with diabetes are recommended.

Current evidence for lung ultrasound elastography in the field of pneumology: a systematic review.

Elastography is a technology that has strongly impacted several medical specialties; however, it is not yet applied as part of standard clinical practice in the field of pulmonology. The objective of this systematic review is to analyse the evidence available to date in relation to pleuropulmonary ultrasound elastography, focusing on the three pathologies with the most publications: subpleural consolidations, interstitial lung diseases and pleural effusion. Original in vivo studies published up until 12 August 2023 in the Embase, MEDLINE or Web of Science databases were included. The QUADAS-2 tool was applied to analyse bias. We found 613 records in database search. After duplicates removal, we screened 246 records and finally included 18 papers. The average cohort sample size was 109 patients. The elastography modes most frequently used were strain (22.2%), transient elastography (22.2%), point shear-wave elastography (38.9%) and two-dimensional shear-wave elastography (22.2%). The possibility of a meta-analysis was ruled out because of the heterogeneity of the studies included. The currently available literature indicates that pleuropulmonary ultrasound elastography produces promising and consistent results, although the lack of standardisation in the use of the technique and in the elastography modes employed still impedes its use in daily clinical pneumology practice. The development of a clinical guideline establishing a common nomenclature and standardised techniques for pleuropulmonary elastography will be imperative to generate quality scientific evidence in this field.

Comparison of Transient Elastography and Point Shear Wave Elastography for Analysis of Liver Stiffness: A Prospective Study.

Liver stiffness measurement (LSM) by Fibroscan is the most used non-invasive method to assess liver fibrosis. Recently, point-shear wave elastography (pSWE) has been introduced as a simple alternative non-invasive test. Therefore, we aimed to compare the results of these two techniques. One hundred and eighty-four consecutive patients attending our outpatient ultrasound clinic were recruited. LSM was performed by both Fibroscan and pSWE. Statistical analysis was conducted by Spearman's test for correlation and linear regression. Bland-Altman graphs and ROC curves were drawn with area under the curve (AUC). Overall, the correlation of LS between Fibroscan and pSWE was substantial (r = 0.68, p < 0.001). Linear regression showed a coefficient b= 0.94 ± 0.02. The Bland-Altman plot found a bias of -0.10, with only 11 values exceeding the 95% confidence interval. When only considering patients with a LSM of > 10 kPa (n = 31), we found an excellent r = 0.79 (0.60-0.90, p < 0.001). A cutoff of 12.15 kPa for pSWE had sensitivity = 74.2% and specificity = 99.3% to detect relevant fibrosis, with an AUC = 0.98. The highest correlation was observed for hepatitis C (r = 0.91) and alcoholic liver disease (ALD)(r = 0.99). In conclusion, pSWE shows LSM estimation in agreement with Fibroscan in most cases, and the best concordance was observed for hepatitis C and ALD, and for higher ranges of LS.

Point Shear Wave Elastography Detected Liver Stiffness Increased in Pediatric Patient With Thalassemia Major.

Transient elastography (TE) and point shear wave elastography (pSWE) are 2 elastographic ultrasound examinations used in liver stiffness (LS) measurement. It was shown that the LS value detected by TE in pediatric β-thalassemia major patients has increased, and there was no LS evaluation obtained with pSWE in literature. Thus, in this study, it was aimed to evaluate LS with pSWE examination in children with thalassemia major and to determine LS-related parameters in these patients. Sixty-three schoolchildren with a diagnosis of β-thalassemia major and 21 healthy controls between the ages of 7 and 18 years were included. In addition to routine anamnesis, physical examination, and laboratory examinations, renal and liver ultrasounds were performed. Liver stiffness values were measured by pSWE examination. Serum levels of urea, aspartate-aminotransferase, alanine-aminotransferase, iron, and ferritin were significantly higher in patients, and serum creatinine, iron binding capacity, and hemoglobin levels were found to be significantly lower (P < 0.05 for each). Liver stiffness values were significantly higher in patients compared with healthy controls. In linear regression analysis, serum iron and iron binding capacity values were found to be closely related with LS (P < 0.001 vs. β = 0.482 and P = 0.047 vs. β = 0.237, respectively). Liver stiffness values obtained by pSWE examination increase significantly in patients. According to the results of our study, in addition to the previously known TE method, we think that the LS evaluation obtained by pSWE, a new method that can make more accurate measurements, can be used in the possible early detection of target organ damage in children with thalassemia major.

Quantitative studies on B-mode ultrasound and point shear wave elastography of kidneys in nonazotemic dogs.

Renal diseases in dogs can be diagnosed effectively using B-mode ultrasound. Point shear wave elastography (pSWE) has demonstrated usefulness in diagnosing renal diseases in human medicine. However, its application in veterinary medicine is in its nascent stage. It was hypothesized that establishing pSWE reference values in nonazotemic dogs would prove valuable in differentiating renal diseases. In light of this, a single-center, quantitative study with an objective to normalize B-mode ultrasound parameters and pSWE values of the kidney in nonazotemic dogs was conducted. A total of 198 animals presented with clinical signs of anorexia, vomiting, weight loss, and dehydration were enrolled in the study spanning 2 years. Among them, 52 nonazotemic dogs were included as subjects for the study. B-mode ultrasound quantitative parameters, including length (L), breadth (B), height (H), cortical thickness (RCT), and medulla thickness (RMT) of the kidneys, as well as the diameter of the aorta (Ao), were normalized. Additionally, calculated parameters such as L:Ao, B:Ao, H:Ao, RCT:Ao, and corticomedullary ratios were worked out. Point shear wave elastography values were obtained from the cranial and caudal poles of renal cortices using ElastPQ stiffness software. The pSWE values of kidneys in nonazotemic dogs were normalized. The mean±standard error values were 1.04±0.08m/s (95% confidence interval: 0.88-1.19m/s) and 4.18±0.62kPa (95% confidence interval: 2.93-5.42kPa). In conclusion, B-mode ultrasound quantitative parameters, ratios, and pSWE values were normalized in nonazotemic dogs, which may prove valuable in differentiating renal pathologies in canine patients.

Point-shear wave elastography generated by acoustic radiation force impulse in chronic pancreatitis.

Transcutaneous point-shear wave elastography (p-SWE) performed using an acoustic radiation force impulse can be used to quantify pancreatic stiffness in chronic pancreatitis (CP). We aimed to evaluate its usefulness to diagnose and monitor CP. 175 participants were included in this prospective study including patients with CP (n=65), liver cirrhosis (LC; n=60), alcohol abuse (n=10) and healthy controls (n=40). Point-shear wave elastography of the pancreas was performed and quantified as median shear wave velocity (SWV). In the same way, p-SWE of the spleen served as a marker of portal hypertension. The M-ANNHEIM Severity score was used as global marker for disease activity in CP. Compared to healthy controls, pancreatic SWV was significantly elevated in CP (1.38 vs. 0.96m/s; p<0.0001, MWU-test). Pancreatic SWV was increased in alcoholic CP but not in hereditary CP. Receiver operating characteristic analysis revealed 1.2m/s as the optimal cut-off to identify non-heredity-CP subjects (90% specificity; 81% sensitivity; 92% positive predictive value). Pancreatic SWV correlated significantly with the M-ANNHEIM Severity score, severity of CP-typical complications (both p<0.05, linear regression analysis), morphological changes of the pancreas and need for hospital treatment (both p<0.05, MWU-test) but not with exocrine or endocrine insufficiency. Pancreatic SWV >1.7m/s was identified to predict M-ANNHEIM Severity score ≥11 points. Pancreatic SWV was also elevated in LC (1.42m/s; p<0.001), correlating with increased splenic SWV. Transcutaneous pancreatic p-SWE represents a bedside, cost-effective and non-invasive tool which adds valuable information to the process of diagnosing and monitoring CP. By portal hypertension, an increased pancreatic SWV must be expected.