Point Shear Wave Elastography Research Articles

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 < .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

­ Background and objectives: 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, especially focusing on the three pathologies with the most publications: subpleural consolidations, interstitial lung diseases (ILDs), and pleural effusion.­ Methods: Originalin vivostudies published up until 12/08/2023 in the Embase, MEDLINE, or Web of Science databases were included. The QUADAS-2 tool was applied to analyse bias.­ Results:o Included studies: we found 613 records in databases searching. After duplicates removal, we screened 246 records, and finally included 18 papers.o Synthesis of the results: The average cohort sample size was 109 patients. The elastography modes most frequently used were strain (22.2%), transient elastography (TE; 22.2%), point shear-wave elastography (pSWE; 38.9%), and two-dimensional shear-wave elastography (2D-SWE; 22.2%). The possibility of a meta-analysis was ruled out because of the heterogeneity of the studies included.­ Discussion: The currently available literature indicated that pleuropulmonary ultrasound elastography produced 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.­ Other:o Funding: none.o Registration: PROSPERO № CRD42023472828.

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.

Image-guided point-shear-wave elastography: a valid and reliable technique for liver fibrotic staging.

Despite progressive implementation of image-guided point-shear wave elastography (pSWE) in guidelines as an alternative to transient elastography for the staging of fibrotic liver disease, pSWE is not widely adopted in clinical workflow. More information on reliability and validity of pSWE systems is needed. Therefore, we performed a phantom study to evaluate the validity and reliability of pSWE with ultrasound systems. Validity and reliability of pSWE measurements from three ultrasound systems were evaluated. Measurements were performed on an elasticity phantom with reference elasticities of 7 ± 1 (low) (median ± interquartile range (IQR)), 14 ± 2 (medium) and 26 ± 3 (high) kPa. Measurements were repeated in tenfold for each reference at 2, 3 and 4 cm depth. Results were considered valid when median elasticity ± IQR was between the uncertainty limits (IQR) for each reference elasticity value andreliable when IQR/median < 0.30. pSWE with the systems provided valid results for all reference elasticities and focal depths, except for overestimation of high reference elasticity at 2 and 4 cm depth for one system (41.5 ± 4.3 and 39.0 ± 1.2 kPa, respectively). Measurements were reliable with a maximum IQR/median of 0.13, well below the guideline of IQR/median < 0.30. The results support the use of pSWE as an alternative to invasive or non-image guided noninvasive techniques for liver fibrotic staging. pSWE with ultrasound systems from different vendors is valid and reliable and can therefore be implemented to optimize clinical workflow by performing imaging and elastography simultaneously.

The Effect of Steatosis on Shear-Wave Velocity and Viscoelastic Properties Related to Liver Fibrosis Progression in Rat Models

ObjectiveHepatic fibrosis has recently been evaluated using ultrasonography or magnetic resonance elastography. Although the shear wave velocity (SWV) obtained using point shear wave elastography (pSWE) provides a valuable measure of fibrosis, underlying steatosis may affect its measurement. MethodsUsing hepatic fibrosis samples, this study evaluated the effect of steatosis on the shear wave velocity of pSWE (Vs) and viscoelastic properties (assessed by dynamic mechanical analysis) of rat liver. Fifty rats with various grades of steatosis and fibrosis underwent open abdominal in vivo Vs measurements using a commercial ultrasound scanner. The mechanical properties of hepatic tissue were also characterized under ex vivo conditions using dynamic mechanical analysis and the Zener model of viscoelasticity. ResultsFibrosis and steatosis progression influenced Vs and elasticity. The SWV computed using the Zener model and Vs showed a substantial correlation (r > 0.8). Fibrosis progression increased SWV. Steatosis was also related to SWV. Steatosis progression obscured the SWV change associated with fibrosis progression. ConclusionWe conclude that steatosis progression affects the evaluation of fibrosis progression. This finding could aid discrimination of non-alcoholic steatohepatitis from non-alcoholic fatty liver disease using SWV.

Estimating reference values of parenchymal stiffness of normal pancreatic parenchyma by means of point shear wave elastography.

There are numerous imaging modalities available to describe pancreatic parenchyma. None of the broadly accepted diagnostic methods uses elasticity as an indicator of tissue damage.

Advantages and Limitations of Point Shear Wave Elastography and 2-Dimensional Shear Wave Elastography against PercutaneousLiver Biopsy for Assessing Focal Liver Lesions

BACKGROUND: Ultrasound based noninvasive techniques for the evaluation of tissue elasticity are becoming popular in practice. An accurate diagnosis of focal liver lesions (FLLs) is very important and essential for the adequate treatment and management of different conditions. AIM: The study aims to evaluate the advantages and limitations of Point Shear Wave Elastography and 2-dimensional Shear Wave Elastography against percutaneous liver biopsy for assessing focal liver lesions. METHODS: This document reviews the advantages and limitations of point shear wave elastography (pSWE) and 2-dimensional shear wave elastography (2D-SWE) against percutaneous liver biopsy for assessing focal liver lesions. RESULTS: Ultrasound elastography has shown promising results and plays an important role in the assessment of focal liver lesions but the lack of histological confirmation is a limitation, especially in cases of suspected FLLs. The Tru cut percutaneous liver biopsy has been proven as a very helpful method for an accurate histological diagnosis. The main disadvantage of this procedure is that is invasive and the complications may be life threatening. CONCLUSION: Noninvasive methods to aid clinical decisions are preferred by patients rather than liver biopsy. US elastography, in the form of pSWE, as well as 2D SWE has proved reliable for the evaluation of liver parenchyma. The investigation of pSWE and 2D-SWE for assessing the elasticity of focal liver lesions and their differentiating is still a challenging goal. Percutaneous liver biopsy provides an option for accurate histological confirmation of liver pathologies, particularly FLLs. It continues to be an important tool in the diagnosis, prognosis, and treatment of those affected with liver disorders.

Assessment of the effects of transforming growth factor beta1 (TGF-β1)-Smad2/3 on fibrosis in rat myofascial trigger points using point shear wave elastography

Background &amp; Aims Myofascial trigger points (MTrPs) are highly sensitive irritated points within a tense belt of skeletal muscle, and are the main cause of muscle pain and dysfunction. MTrPs can also cause paraesthesia and autonomic nervous dysfunction. Furthermore, long-term and chronic MTrPs can cause muscle atrophy and even disability, seriously affecting the quality of life and mental health of patients, and increasing the social and economic burden. However, to date, there have been few studies on fibrogenesis and changes in MTrPs. Therefore, this study investigated whether transforming growth factor beta1 (TGF-β1)-Smad2/3 participates in the formation of MTrPs and how it affects fibrosis using point shear wave elastography. Methods Forty Sprague‒Dawley rats were randomly divided into the MTrPs group and the control group. Blunt injury combined with eccentric exercise was used to establish an MTrPs model. Electromyography (EMG), haematoxylin and eosin (H&amp;E) staining and transmission electron microscopy (TEM) were used to verify the model. The collagen volume fraction was measured by Masson staining, the protein expression of TGF-β1 and p-Smad2/3 was measured by Western blotting (WB) and immunohistochemistry (IHC), and the shear wave velocity (SWV) was measured by point shear wave elastography. Results EMG, H&amp;E and TEM examination indicated that the modelling was successful. The collagen volume fraction and the protein expression of TGF-β1 and p-Smad2/3 were higher in the MTrPs group than in the control group. The SWV of the MTrPs group was also higher than that of the control group. These differences suggest that MTrPs may exhibit fibrosis. The correlations between the collagen volume fraction and SWV and between the collagen volume fraction and TGF-β1 were positive. Conclusion Fibrotic conditions may be involved in the formation of MTrPs. Ultrasound point shear wave elastography and assessment of TGF-β1 and p-Smad2/3 expression can reflect the degree of MTrPs fibrosis to some extent. Further exploration of the important role of TGF-β1 and Smad2/3 in the pathogenesis of MTrPs will be of great significance for clinical treatment.

Evaluation of liver and spleen stiffness measurement with shear wave elastography in brucellosis.

Human brucellosis, which is endemic in the eastern region of Turkey, infects the reticulo-endothelial system. Acute brucellosis may cause hepatomegaly or splenomegaly. The main purpose of this study was to investigate the effectiveness of the point shear wave elastography (pSWE) method in identifying and detecting liver and spleen stiffness in acute brucellosis. This case-control study included 40 patients with acute brusellosis and 60 healthy individuals as a control group. The demographic data, abdominal ultrasonography (USG) and pSWE results of the patient and control groups were evaluated. Statistical and ROC analyses were performed. The liver pSWE value was 3.8395 ± 1.171kPa in the patient group and 1.6619 ± 0.495kPa in the control group. The spleen pSWE value was 3.2431 ± 1.803kPa in the patient group and 1.3793 ± 0.622kPa in the control group. The mean liver and spleen pSWE values were statistically significantly higher in the patient group than in the control group (p < 0.001). Cut-off values were determined as 2.524 for the liver pSWE and 1.62667 for the spleen pSWE. From the AUC values (0.959, 0.903), the diagnostic performance of liver and spleen pSWE values were seen to be excellent in distinguishing between patient and control groups. The study results showed that liver and spleen stiffness were high in acute brucellosis patients and had predictive significance above certain cut-off values. It can be considered that pSWE, which evaluates liver and spleen stiffness in acute brucellosis, may provide diagnostic benefit as a reliable, non-invasive technique.

Investigating the Correlation between Liver Ultrasound pSWE and Portal Vein Hemodynamics: Preliminary Findings

Introduction:: Portal vein size and hemodynamics can be altered in patients with portal hypertension. Elastography for liver stiffness has been proposed as a potential predictor of portal hypertension. However, the relationship between liver stiffness measured using point shear wave elastography (pSWE) and portal vein diameter and Doppler parameters remains unclear. Therefore, this observational study aimed to investigate the correlation between liver ultrasound pSWE and portal vein hemodynamics in healthy participants. Methods:: Twenty-five healthy men with no underlying medical conditions and who were not on regular medications were enrolled in the study. Liver stiffness, portal vein diameter, and Doppler parameters were measured using ultrasound EPIQ Elite with a curved-array transducer (C5-1 MHz) equipped with pSWE and Doppler imaging. Real-time pSWE measurements were taken from the liver. Portal vein diameter and Doppler parameters were measured in a longitudinal view of the extra-hepatic segment. Spearman correlation was used to assess the association between liver pSWE and portal vein diameter as well as Doppler parameters, with a significance level set at &lt; 0.05. Results:: There was no significant correlation between liver stiffness and portal vein diameter (p = 0.67) or Doppler parameters, including peak systolic velocity (p = 0.89), end-diastolic velocity (p = 0.65), and resistive index (p = 0.86). Conclusion:: Our findings suggest no direct correlation between liver stiffness measured using pSWE and portal vein hemodynamics in healthy adults. Further studies are warranted to investigate the relationship between liver pSWE and the hemodynamics of portal veins in patients with liver diseases.

The Clinical Value of Multimodal Ultrasound for the Differential Diagnosis of Hepatocellular Carcinoma from Other Liver Tumors in Relation to Histopathology.

Recent advances in the field of ultrasonography offer promising tools for the evaluation of liver tumors. We aim to assess the value of multimodal ultrasound in differentiating hepatocellular carcinomas (HCCs) from other liver lesions. We prospectively included 66 patients with 72 liver tumors. The histological analysis was the reference standard for the diagnosis of malignant liver lesions, and partially for benign tumors. All liver lesions were assessed by multiparametric ultrasound: standard ultrasound, contrast-enhanced ultrasound (CEUS), the point shear wave elastography (pSWE) using shear wave measurement (SWM) method and real-time tissue elastography (RTE). To diagnose HCCs, CEUS achieved a sensitivity, specificity, accuracy and positive predictive value (PPV) of 69.05%, 92.86%, 78.57% and 93.55%, respectively. The mean shear-wave velocity (Vs) value in HCCs was 1.59 ± 0.29 m/s, which was lower than non-HCC malignancies (p < 0.05). Using a cut-off value of 1.58 m/s, SWM achieved a sensitivity of 54.76%, and 82.35% specificity, for differentiating HCCs from other malignant lesions. The combination of SWM and CEUS showed higher sensitivity (79.55%) compared with each technique alone, while maintaining a high specificity (89.29%). In RTE, most HCCs (61.53%) had a mosaic pattern with dominant blue areas corresponding to type "c" elasticity. Elasticity type "c" was 70.59% predictive for HCCs. In conclusion, combining B-mode ultrasound, CEUS, pSWE and RTE can provide complementary diagnostic information and potentially decrease the requirements for other imaging modalities.

Preliminary Investigation of Normal Pancreas Elasticity using Point Shear Wave Elastography.

Point shear wave elastography (pSWE) is used to provide quantitative information about the elasticity of the tissues. It has been used in many clinical applications to identify diseases early. This study aims to assess the suitability of pSWE to evaluate pancreas tissue stiffness and provide normal reference values for healthy pancreas tissues. This study was conducted in the diagnostic department at a tertiary care hospital between October and December 2021. Sixteen healthy volunteers (eight men and eight women) participated. Pancreas elasticity measurements were obtained in different regions of interest (head, body, and tail). Scanning was performed by a certified sonographer using Philips EPIC7 ultrasound systems (Philips Ultrasound; Bothel, WA, USA). The mean velocity of the head of the pancreas was 1.3 ± 0.3 m/s (median: 1.2 m/s), the body was 1.4 ± 0.3 m/s (median: 1.4 m/s), and the tail was 1.4 ± 0.4 m/s (median: 1.2 m/s). The mean dimension was 17 ± 3 mm, 14 ± 4 mm, and 14 ± 6 mm for the head, body, and tail. The correlation of pancreas velocity across different segments and dimensions shows no significant difference with p values of 0.39 and 0.11, respectively. This study shows that assessing the elasticity of the pancreas using pSWE is possible. A combination of SWVs measurements and dimensions could provide an early evaluation of pancreas status. Further studies including pancreatic disease patients are recommended.

ASSESSING THE ACCURACY OF FIB-4 SCORES TO POINT SHEAR WAVE ELASTOGRAPHY IN MONITORING DIFFERENT STAGES OF FIBROSIS IN NON-ALCOHOLIC LIVER DISEASE

BackgroundNon-alcoholic liver disease (NAFLD) assessment is done by measuring biochemical parameters from blood samples. However, non-invasive methods have gained significance lately. Biochemical parameters and staging of fibrosis-associated NAFLD based on the levels of biomarkers have been established procedures in the field. So, the utilization of non-invasive methods as a comparable means for fibrosis staging in NAFLD has yet to be established.&#x0D; ObjectivesTo compare the diagnostic performance of serum markers to point shear wave elastography for classifying fibrosis in NAFLD and its staging.&#x0D; Materials and MethodsData were collected by laboratory tests and point shear wave elastography. A comparison of FIB-4 indexes scores and point shear wave elastography for the staging of fibrosis in NAFLD was made based on cross-tabulation of the quantitative data obtained.&#x0D; ResultsA positive and significant correlation between FIB4 and age, ALT, AST, RBS, AST/ ALT, AST/ UL AST, APRI, AST/ Platelet count, and point shear wave elastography (PSWE). The correlation was negative and non-significant between FIB4 and Weight, Height, BMI, UL AST, TSB, and Platelet count.&#x0D; ConclusionThe study observed a positive correlation between FIB-4 and PSWE. Thus, the present study proposes the use of PSWE as a non-invasive diagnostic tool in the staging of fibrosis in NAFLD for patients with an intermediate FIB-4 score.