Real-time Shear Wave Elastography Research Articles

The utility of two-dimensional real-time shear wave elastography for assessing liver fibrosis in patients with chronic hepatitis C virus infection.

Two-dimensional shear wave elastography (2D-SWE) is a new ultrasound-based elastography method to evaluate liver fibrosis in the daily practice. However, the utility of 2D-SWE among the other liver fibrosis markers is unclear. We enrolled 141 consecutive patients with hepatitis C virus infection, 66 men and 75 women (median age, 67 years), who underwent liver biopsy and 2D-SWE (LOGIQ E9, GE Healthcare, Wauwatosa, WI, USA). We compared the diagnostic accuracy of the 2D-SWE with those of magnetic resonance elastography (MRE; MR-Touch, GE Healthcare, Milwaukee, WI, USA), Mac-2 binding protein glycosylation isomer (M2BPGi), fibrosis-4 index (FIB-4) and platelet counts (PLT), using the histologic METAVIR scoring as the reference standard. The areas under the receiver operating characteristics curves (AUROCs) of 2D-SWE, MRE, M2BPGi, FIB-4 and PLT for ≥F2, ≥F3 and F4 were 0.86, 0.88, 0.79, 0.81 and 0.77; 0.92, 0.93, 0.86, 0.87 and 0.83; and 0.91, 0.97, 0.85, 0.85 and 0.82, respectively. For diagnosing ≥F2 and ≥F3, the AUROCs of 2D-SWE and those of MRE showed no significant differences, and both 2D-SWE and MRE showed significantly higher AUROCs than the other markers. For diagnosing F4, the AUROC of MRE was significantly higher than those of other fibrosis markers. 2D-SWE has an excellent diagnostic accuracy equivalent to that of MRE for assessing significant (≥F2) and severe (≥F3) fibrosis. MRE demonstrated a higher AUROC than 2D-SWE, but this last one has advantages such as lower cost, fewer contraindications and greater ease of performance than MRE.

A new method to quantify penile erection hardness: real-time ultrasonic shear wave elastography.

BackgroundAn important indicator of penile erectile function is erection hardness (EH), which is currently evaluated by the semi-quantitative erectile hardness score (EHS). EH increases continuously during the course of an erection, so although it is statistically a continuous variable, the EHS is a grade variable. We propose a new method for real-time quantitative measurement of penile EH using ultrasonic shear wave elastography (SWE).MethodsThe study group comprised 40 patients with erectile dysfunction (ED) and 20 normal controls who all underwent real-time SWE to measure tissue stiffness (Young’s modulus, YM) of the penile corpus cavernosum and tunica albuginea during erection, at rest and at different EH grades induced by intracavernosal injection (ICI) of prostaglandin. The examiner gently placed the high frequency probe on the ventral penis and got the two-dimensional longitudinal US image of penis, then switched to SWE mode, the appropriate region of interest (ROI) was selected, then a 3–5 mm circle (“Q-box”) was automatically set to by machine to measure the SWE of the corpus cavernosum and tunica albuginea on the left side.ResultsIn both the ED patients and normal controls, YM slightly decreased in the corpus cavernosum during erection but the stiffness of tunica albuginea increased significantly with increasing EH (resting: 21.66±4.21 kPa, grades 1–4: 32.61±4.27, 54.86±8.69, 128.02±20.66, and 223.23±23.61 kPa, respectively). Because EH grades 1 and 2 clinically predicted failure to complete sexual intercourse, and EH grades 3 and 4 predicted ability, the cutoff point for the YM of the tunica albuginea to evaluate whether sexual intercourse could be completed was 81.60 kPa.ConclusionsOur data demonstrated that tunica albuginea stiffness, not corpus cavernosum stiffness, provided a good clinical imaging index indicator for evaluating penile EH. The tunica albuginea stiffness changed continuously during penile erection, which could be measured quantitatively by SWE. Compared with the EHS, measuring the YM of the penile tunica albuginea using SWE is a new and objective technique for quantitatively assessing EH. Because of its objective and quantifiable characteristics, measuring YM enables more accurate evaluation of the effect on EH of various treatments for ED.

SAT272 - Two-dimensional real-time shear wave elastography and risk for de novo hepatocellular carcinoma in patients with advanced chronic liver disease

SAT272 - Two-dimensional real-time shear wave elastography and risk for de novo hepatocellular carcinoma in patients with advanced chronic liver disease

Elastography improves accuracy of early hepato-biliary complications diagnosis after allogeneic stem cell transplantation.

Significant morbidity and mortality have been associated with liver complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Causes and consequences of these hepato-biliary complications are various and might be life-threatening. A high misdiagnosis rate has been reported because of a weak correlation between clinical, laboratory and imaging data. Liver elastography, a liver stiffness measure, is able to assess liver fibrosis and portal hypertension in most liver diseases, but data after allo-HSCT are scarce. Our aim was to determine the interest of sequential liver stiffness measurements for the diagnosis of early hepatic complications after allo-HSCT. Over a 2-year time period, 161 consecutive adult patients were included and 146 were analyzed. Ultrasonography and elastography measurements were performed before transplantation, at day+7 and day+14 by three different experienced radiologists unaware of the patients’ clinical status. Eightyone (55%) patients had liver involvements within the first 100 days after allo-HSCT. Baseline elastography was not predictive for the occurrence of overall liver abnormalities. A significant increase in two-dimensional real-time shearwave elastography (2D-SWE) was found in patients with sinusoidal obstruction syndrome (SOS). Fifteen patients (10%) fulfilled European Society for Blood and Marrow Transplantation (EBMT) score criteria and twelve (8%) reached Baltimore criteria for SOS diagnosis, but only six (4%) had a confirmed SOS. 2D-SWE at day+14 allowed early detection of SOS (AUROC=0.84, P=0.004) and improved sensibility (75%), specificity (99%) and positive predictive value (60%) over the Seattle, Baltimore or EBMT scores. A 2D-SWE measurement above 8.1 kPa at day+14 after allo-HSCT seems a promising, non-invasive, and reproducible tool for early and accurate diagnosis of SOS.

Extended Screening for Cystic Fibrosis-related Liver Disease Including Elastography in Children and Adolescents.

Advances in treatment of cystic fibrosis (CF) have increased survival and thereby prevalence of patients with liver disease, making chronic liver disease one of the major complications of CF. We describe the prevalence of liver fibrosis, portal hypertension, and liver decompensation by extended screening for cystic fibrosis-related liver disease (CFLD) including ultrasound, elastography, and an extended panel of biochemical markers. A cross sectional study of CFLD in all pediatric CF patients (1-18 years) from the Copenhagen CF Center. Screening for liver disease included physical examination, biochemical analysis, Vibration-Controlled Transient Elastography (FibroScan), conventional ultrasound, and Real-Time Shear Wave elastography (SWE). Patients were scored according to Williams ultrasound scoring scale (WUSS) within 6 months. A total of 84 consecutive patients (male sex 46.4%, median age 10.4 years) were included. Eight patients (9.5%) had both ≥2 abnormal results of sonographic methods and ≥2 abnormal biochemical results and were in this study categorized as having manifest CFLD. Manifest CFLD patients were significantly older and had a higher mean value of APRI, but no differences in gender, z-height, z-weight, z-BMI, FEV1%, or mean value of bilirubin or albumin were found. In total, 8 patients (9.5%) in this pediatric CF population were categorized as having CFLD according to both biochemical and sonographic tests. Consistency was found among the results of FibroScan and SWE. We suggest WUSS and either FibroScan or SWE, combined with GGT as diagnostic markers for CFLD.

Throwing can Increase the Stiffness of the Scalene Muscle

Objectives:Thoracic outlet syndrome (TOS) has been reported as a set of symptoms due to the compression of the brachial plexus and subclavian vessels in the region of the thoracic outlet1. As a type of TOS, scalenus anticus syndrome involves the compression of the brachial nerves as they pass through the interval surrounded by the anterior and middle scalene muscles, and the first rib bone or cervical rib2. Recently, exercise-induced TOS is becoming more common in athletes, especially for those who perform repetitive overhead and hyperabduction maneuvers with upper limbs, such as baseball players. However, the effect of throwing on the stiffness of the scalene muscles is unknown. Thus, the purpose of this study was to quantitatively measure the stiffness of the scalene muscles using real-time shear wave elastography (SWE). The stiffness of scalene muscles was hypothesized to increase for the throwing side of baseball players.Methods:Thirty college baseball players (age range 19 to 21 years) were included for this study. Ultrasonic SWE with a 2-10 MHz linear array probe transducer (Aixplorer; SuperSonic Imagine, Aix-en-Provence, France) was used to assess the stiffness of the anterior and middle scalene muscles. Each participant was sited. The measurements were performed in two arm positions; 1) adducted and neutral rotation of the shoulder 2)90 degree of abduction and external rotation of shoulder with elbow flexed to simulate a clinical examination known as Roos test3. In both of the arm positions, the transducer was positioned just superior to the clavicular bone, parallel to its axis. Transducer was moved superiorly and tilted to visualize the superior surfaces of the anterior and middle scalene muscles parallel to the surface of the fifth cervical nerve simultaneously (Figure 1A). In this position, shear wave elastography was performed to measure the elasticity of each scalene muscle as its stiffness. Each muscle was divided into superior and deep areas. In both areas of each muscle, three 3mm-diameter circles were set to measure the elasticities of the scalene muscles and its averaged data in each area was defined as each stiffness (Figure 1B). A repeated-measures analysis of variance (ANOVA) was used to compare the elasticity of superior and deep areas in anterior and middle scalene muscles in throwing and non-throwing side. Values of p<0.05 were considered statistically significant.Results:For the throwing side, higher stiffness was found in the deep part of the middle scalene muscle compared to the superior and deep parts of the anterior scalene muscle with an adducted and neutrally rotated shoulder (p=0.0433). Moreover, the muscle stiffness was significantly higher in the superior and deep part of the middle scalene muscle than in the superior and deep parts of anterior scalene muscle in an abducted and externally rotated position of shoulder (p =0.00187). Meanwhile, no significant difference was found in the anterior and middle scalene muscles for the non-throwing side in both arm positions.Conclusion:In professional athletes with TOS who experienced surgical treatment, moderate to severe hypertrophy of the anterior scalenus muscles has been reported to be found4. Meanwhile, although the stiffness of the scalene muscles can be also related to the compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet, its quantitative measurements in the scalene muscles has not been reported. In this study, at throwing side, the muscle stiffness significantly increased in the superior area of middle scalene muscle in throwing side. While no contribution was identified in the scalene muscles at non-throwing side. As a result, repeat throwing motion can increase the stiffness of the middle scalene muscle. As a result, the brachial plexus and/or the subclavian artery could be compressed at the interscalene triangle. Throwing athletes with TOS should be treated, considering the stiffness of the middle scalene muscle, even conservative or surgical treatment. Our study was the first study to evaluate the effects of throwing on the stiffness of the scalene muscles in throwing athletes. Repetitive throwing motion can affect the stiffness of middle scalene muscle. Reduction of the middle scalene muscle should be considered to treat throwing athlete who has TOS.Figure 1.

Anterior knee pain after total knee arthroplasty: A multifactorial analysis.

Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP. In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters-including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity-were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used. In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle (p = 0.021), a thinner inlay (p = 0.041), and a lower position of the patella (p = 0.041) were associated with AKP. Although no correlation with AKP was found (p = 0.346, resp. p = 0.154), we observed significantly decreased Young's modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee (p < 0.001). In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.

Role of real-time shear-wave elastogarphy in differentiating hepatocellular carcinoma from other hepatic focal lesions.

Hepatocellular carcinoma (HCC) has an increasing incidence worldwide, and is considered the second cause of cancer-related death. The aim of the study is to assess the usefulness of real-time shear-wave elastography in differentiating HCC from other hepatic focal lesions. The current study was conducted on 110 patients in addition to 10 healthy subjects, divided into four groups as follows: liver cirrhosis, HCC, hepatic focal lesions other than HCC, and control. Demographic, laboratory and imaging data were collected and then elastographic assessment of the hepatic focal lesions and the surrounding liver parenchyma using elastograph point quantification (ElastPQ) (iU22x MATRIX, Philips) was done. ElastPQ (iU22x MATRIX, Philips) has shown its ability to differentiate between HCC and cystic focal lesions, HCC and cholangiocarcinoma, and HCC and focal nodular hyperplasia (FNH). Cystic lesions demonstrated lower stiffness in comparison to HCC; however, cholangiocarcinoma and FNH demonstrated higher stiffness in comparison to HCC. ElastPQ was unable to differentiate between stiffness in both 'HCC and hemangioma' and 'HCC and metastatic focal lesions'. ElastPQ showed that HCC, cystic focal lesions, and cholangiocarcinoma had lower stiffness in comparison to their surrounding liver parenchyma, whereas FNH had higher stiffness in comparison to the surrounding liver parenchyma. ElastPQ showed that the surrounding liver parenchyma of the HCC group has the highest stiffness amongst all studied hepatic focal lesions surrounding liver parenchyma. 'Point' shear-waves elastography (ElastPQ; Philips iU22x MATRIX, Philips) is a noninvasive, quantitative and nonradiating method for evaluation of tissue elasticity, and is helpful in differentiating HCC from other hepatic focal lesions.

Shear-wave elastography of the testicle: potential role of the stiffness value in various common testicular diseases

To assess the value and efficacy of real-time shear-wave elastography (SWE) of normal testicular parenchyma and various common testicular diseases in clinical practice. SWE was undertaken in 338 patients (mean age: 43.2±17.2 years, range 17-78 years) comprising normal testicles (n=358), testicular microlithiasis (n=40), and various testicular diseases (n=208) and the stiffness was recorded. The final diagnosis was correlated with the clinical context, long-term follow-up, or histopathology. Statistical evaluation was performed to provide a stiffness threshold for pathological diagnosis. The mean size of testicular lesions was 2.6±1.5 cm (range: 10-42 mm). The mean Young's modulus value for normal testis was recorded at 4.55±2.54 kPa. Whatever the stage of microlithiasis, a higher statistically significant stiffness value was recorded. For acute orchitis, the mean stiffness value was slightly higher, but not statistically significantly. The testicular tumoural processes presented a median stiffness value of 21.02 kPa with a cut-off of 16.1 kPa. Fibrosis presented the highest median stiffness value of 30.03 kPa with a cut-off of 26.3 kPa. By analysing the distribution of the different pathological groups, the difference was statistically significant between fibrosis and tumoural processes (p=0.001). SWE is a feasible technique in the exploration of the testicular parenchyma. SWE values can be used to differentiate testicular fibrosis from a tumoural process with confidence.

Application value of conventional ultrasound and real-time shear wave elastography in patients with type 2 diabetic polyneuropathy

PurposeTo explore the application value of conventional ultrasound and real-time shear wave elastography (SWE) to the tibial nerve (TN) and the common peroneal nerve (CPN) in diabetic peripheral neuropathy (DPN). Materials and methodsThirty-three healthy volunteers, 33 diabetic patients without DPN, and 30 diabetic patients with DPN were enrolled in this study. The anteroposterior diameter (APD), the cross-sectional area (CSA), and the perimeter of the TN and the CPN were measured by conventional ultrasound, and the stiffness of the nerves was measured by SWE. ResultsThe conventional ultrasound parameters and stiffness of the TN in patients with DPN were significantly larger than those of the other two groups (P < 0.01). The conventional ultrasound parameters of the CPN were significantly higher in patients with DPN than in the other two groups (P < 0.01).The patients with DPN demonstrated a greater stiffness of the CPN compared to the control group (P < 0.05). The comparison of all parameters for the left and right TNs and CPNs among the three groups showed no significant difference. The area under the curve (AUC) of TN stiffness for the diagnosis of DPN was significantly greater than that of conventional ultrasound parameters. ConclusionThe conventional ultrasound parameters and the stiffness of the TN and the CPN were significantly higher in patients with DPN. The stiffness of the TN could better diagnose DPN than conventional ultrasound parameters. In short, conventional ultrasound and SWE of nerves are of good application value in the diagnosis of DPN.

Diagnostic performance of conventional ultrasound and quantitative and qualitative real-time shear wave elastography in musculoskeletal soft tissue tumors

BackgroundTo explore the feasibility to identify malignant musculoskeletal soft tissue tumors using real-time shear wave elastography (rtSWE).MethodsOne hundred fifteen musculoskeletal soft tissue tumors in 92 consecutive patients were examined using both conventional ultrasonography (US) and rtSWE. For each patient, the rtSWE parameters including maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), standard deviation of the elasticity (Esd), and rtSWE image pattern were obtained. Eighty-one histopathologically confirmed tumors from 73 patients were subjected to analysis.ResultsThe 81 lesions included in the study were histopathologically classified as malignant (n = 21) or benign (n = 60). The statistically significant differences between benign and malignant lesions were found in conventional US characters including size, depth, margin, echogenicity, mass texture, and power Doppler signal. Meanwhile, the significant differences were also found in quantitative rtSWE findings including Emax, Emean, Emin, and Esd values and in qualitative rtSWE parameter named rtSWE image pattern. Multivariate analysis showed that infiltrative margin (OR, 4.470), and size (OR, 1.046) were independent predictors for malignancy in US findings, while Esd value (OR, 9.047) was independent predictors for malignancy in quantitative rtSWE parameters. Areas under the ROC curve (Azs) for US features, Esd value, and rtSWE image pattern were 0.851, 0.795, and 0.792, respectively.ConclusionsConventional US and quantitative and qualitative rtSWE parameters are useful for malignancy prediction of musculoskeletal soft tissue tumors. rtSWE can be used to supplement conventional US to diagnose musculoskeletal soft tissue tumors.

Diagnostic value of shear wave sonoelastography in differentiation of benign from malignant thyroid nodules

PurposeTo study the efficacy of shear wave elastography (SWE), using both qualitative and quantitative methods, alone and in conjunction with other B-mode features. Method117 patients with 123 nodules were studied both by conventional ultrasonography and SWE. Size, echogenicity, margins, internal calcification (micro- or macro-calcification), composition, shape and color Doppler were assessed for each nodule. The elasticity was assessed both qualitatively and quantitatively. Velocity in the ROI (Region of Interest) was calculated in the stiffest portions for 3 times, and maximum and mean velocity were obtained. ROC curve was analyzed to calculate the best cut-off value of the SWV (Shear Wave Velocity). Univariate logistic regression was used to examine the maximum and mean SWV as discrete variables and the results were compared to key variables of conventional US (Ultrasound) features. Result123 nodules in 117 patients were evaluated. Poor margins, hypoechogenicity, micro-calcification, color Doppler grades III and IV, color map grades IV and V, maximum and minimum velocity had significant correlation with malignancy. The highest Nagelkerke R2 belonged to maximum and mean velocity (R2 = 41.2 and 39 respectively) which propose them as the strongest predictors of malignancy. The best cut-off point for differentiation of benign from malignant nodules was 3.63 m/s for maximum velocity (sensitivity of 90 %, specificity of 78.2 %,) and 3.44 m/s for mean velocity (sensitivity of 90 %, specificity of 76.4 %). ConclusionThe Real-time SWE is a promising test for the preoperative malignancy risk stratification of patients and maximum velocity has the strongest predictive value for both conventional and elastography variables.

The role of real-time shear wave elastography in the diagnosis of idiopathic nephrotic syndrome and evaluation of the curative effect.

To evaluate the use of real-time shear wave elastography (SWE) in the assessment of renal elasticity and the efficacy of steroid treatment in adult idiopathic nephrotic syndrome (INS). This study included 120 patients with INS. Patients were divided into steroid-sensitive and steroid-resistant groups. Renal biopsy was performed. Thirty healthy subjects were recruited as controls. Young's modulus (YM) of the renal parenchyma was measured by SWE. The YM values in each group were compared using glomerular sclerosis index (GI) and renal interstitial fibrosis (RIF). The YM values were significantly different between the INS and control groups, as well as between the steroid-sensitive and steroid-resistant groups (P < 0.05). Higher YM values were associated with steroid sensitivity. The area under the receiver operating characteristic curve for the YM value in the INS group vs. control group was 0.871 (95% CI 0.815-0.927) and in the steroid-resistant group vs. control, and steroid-sensitive groups was 0.836 (95% CI 0.765-0.908). The corresponding cut-off values were 7.96 and 10.73m/s, with 81.7% and 86.0% sensitivities, 93.3% and 77.9% specificities, and Youden index 0.750 and 0.639, respectively. Spearman correlation analysis showed that the YM value in the renal parenchyma was positively correlated with GI (r = 0.631, P < 0.05) and RIF (r = 0.606, P < 0.05). SWE technology is a potential method for non-invasive quantitative measurement of renal parenchyma stiffness to determine the pathological changes of INS renal parenchyma and evaluate the effectiveness of steroid therapy.

Application value of real-time shear wave elastography in differential diagnosis of testicular torsion.

To evaluate the clinical value of real-time shear wave elastography (SWE) in differential diagnosis of testicular torsion and acute orchiditis. During a 3-year period, 14 cases of testicular torsion and 16 cases of acute orchiditis met the inclusion criteria. Young's modulus maximum hardness (Emax) of testicular capsule region, middle testicular parenchyma, warped spermatic segment or inferior spermatic segment was measured in each group. SWE "stiff ring sign" of testis refers to the appearance of a red ring in the testicular capsule area and "stiff knot sign" of spermatic cord refers to the appearance of a red knot in the lower segment of the spermatic cord. Emax value of the testicular capsule in the torsion group was higher than in the acute inflammation group (138.76±58.27 vs 16.40±4.71 kPa, p=0.0001). Emax value in the middle parenchyma of the testis showed no statistically significant difference between groups (p=0.053). Emax value in the twisted spermatic segment was higher than that in the lower spermatic segment with acute inflammation (166.61±60.07 vs 14.14±4.93, p=0.0001). In the torsion group, 12 testicular capsule areas showed "stiff ring sign" and all twisted segments of spermatic cord showed "stiff knot sign" but no signs were found in the inflammatory group. "Stiff ring sign" of testis, "stiff knot sign" of spermatic cord, high stiffness of the testicular capsule and in the twisted spermatic segment are the typical SWE findings of testicular torsion, with important clinical value in the differential diagnosis of testicular torsion and acute orchiditis.

Accuracy of real-time shear wave elastography in staging hepatic fibrosis: a meta-analysis

BackgroundChronic liver disease (CLD) is an important cause of morbidity and mortality and can lead to hepatic fibrosis. This study was conducted to evaluate the diagnostic value of real-time shear wave elastography (SWE) in the assessment of hepatic fibrosis.MethodsA systematic search of databases was performed for publications on SWE during the period between 2010 and 2017. The identified studies were analyzed using Meta-disc 1.4 software to integrate and analyze the data.ResultsEleven studies comprising 1560 patients were included for analysis. The pooled sensitivity, specificity and diagnostic odds ratio were 0.85 (95% CI: 0.82–0.87), 0.79 (95% CI: 0.76–0.82) and 30.81 (95% CI: 16.55–57.34), respectively for patients with a Metavir-score of ≥ F2; 0.87 (95% CI: 0.84–0.91), 0.84 (95% CI: 0.82–0.87), 41.45 (95% CI:18.25–94.45), respectively for patients with ≥ F3; 0.88(95% CI: 0.83–0.91), 0.91 (95% CI: 0.89–0.92), 67.18 (95% CI:30.02–150.31), respectively for patients with ≥ F4. The areas under the receiver operating characteristic curve of the three groups were 0.9147, 0.9223 and 0.9520, respectively.ConclusionsOur work demonstrates that SWE is highly accurate for detecting and staging hepatic fibrosis.

Effect of thunder-fire moxibustion combined with vibration training on low back pain of primary osteoporosis

To compare the therapeutic effect of thunder-fire moxibustion combined with vibration training and simple vibration training on low back pain of primary osteoporosis by Young's modulus of ultrasonic wave, and seek an objective evaluating method. A total of 60 patients were randomized into an observation group and a control group, 30 cases in each one. The patients in the two groups were treated with vibration training using whole body vibration treatment bed. In the observation group, thunder-fire moxibustion was applied at Yaoyangguan (GV 3), Mingmen (GV 4), Ganshu (BL 18), Shenshu (BL 23) and Dachangshu (BL 25). The treatment was given once every other day, 3 times a week for 4 weeks. The visual analogue score (VAS), real-time shear wave elastography (RTSWE) and medical outcomes study 36-item short-form hearth survey (SF-36) were used to evaluate pain intensity, multifidus muscle tone (Young's modulus) and quality of life before treatment, after 4-week treatment and 1 month after treatment. Compared before treatment, the VAS scores, Young's modulus of multifidus muscle and 5 dimensions of SF-36 (physical condition, body pain, general health, social function and mental health) after 4-week treatment and 1 month after treatment were significantly improved in the two groups (all P<0.05), the physiological role in the observation group after 4-week treatment and 1 month after treatment were improved (both P<0.05). In the observation group, the VAS scores, Young's modulus of multifidus muscle and 3 dimensions of SF-36 (physiological role, body pain and general health) after 4-week treatment and 1 month after treatment were superior to the control group (all P<0.05). The therapeutic effect of thunder-fire moxibustion combined with vibration training is superior to simple vibration training in relieving low back pain intensity and multifidus muscle tone, and improving quality of life for primary osteoporosis. RTSWE technique can be an objective examination method to evaluate pain.

Diagnostic performance on multiple parameters of real-time ultrasound shear wave elastography for evaluating nonalcoholic fatty liver disease: A rabbit model.

To study the diagnostic value of real-time ultrasound shear wave elastography (US-SWE) in evaluating the histological stages of nonalcoholic fatty liver disease (NAFLD) in a rabbit model. Twenty-one 8-week-old rabbits were fed a high-fat, high-cholesterol diet (experimental groups), and seven rabbits were fed a standard diet (control group). All rabbits underwent real-time US-SWE at various time points to document the histological stages of NAFLD. We categorized the histological stages as normal, NAFL, borderline nonalcoholic steatohepatitis (NASH), and NASH. We measured the elastic modulus of the liver parenchyma and analyzed the diagnostic efficacy of real-time US-SWE using the area under receiver operating characteristic curve (AUC) for the four histological stages. The mean, minimum, and maximum elastic modulus increase for NAFL, borderline NASH, and NASH. For the mean, minimum, and maximum elastic modulus, AUCs are 0.891 (95% confidence interval [CI]: 0.716-0.977), 0.867 (95% CI: 0.686-0.965), and 0.789 (95% CI:0.594-0.919) for differentiating normal liver from liver with NAFLD, respectively; AUCs are 0.846 (95% CI: 0.660-0.954), 0.818 (95% CI: 0.627-0.937), and 0.797 (95% CI:0.627-0.913) for differentiating normal liver or liver with NAFL from liver with borderline NASH or NASH, respectively; AUCs are 0.889 (95% CI: 0.713-0.976), 0.787 (95% CI: 0.591-0.918), and 0.895 (95% CI:0.720-0.978) for differentiating liver with NASH from liver with lower severity NAFLD or normal liver, respectively. Real-time US-SWE is an accurate, noninvasive technique for evaluating the histological stages of NAFLD by measuring liver stiffness. We recommend using the mean elastic modulus to differentiate the histological stages, with the minimum and maximum elastic modulus as valuable complements.

Treating Chronic Hepatitis B Liver Fibrosis with a Combination of Biejiaruangan Compound Tablet and Entecavir with the aid of Real-time Shear Wave Elastography

The aim of the present study was to observe clinical effect of the combination of Biejiaruangan compound tablet and entecavir under the assistance of real-time shear wave elastography for treating chronic hepatitis B liver fibrosis. About 180 patients who had been treated for chronic hepatitis B liver fibrosis at the Second Hospital of Yinzhou were enrolled. The real-time shear wave elastography was applied. The patients were randomized into the research group and the control group, each containing 90 patients. The control group was treated with entecavir, while the research group was treated with a combination of Biejiaruangan compound tablet and entecavir. The therapeutic efficacy was compared between both groups. Patients’ liver stiffness was obviously decreased after treatment (p<0.05). The research group had better hepatic function index than the control group (p<0.05). Moreover, a greater decrease in the hepatic fibrosis index and abdominal ultrasonography was observed in both groups after treatment, compared to those before therapy. The therapeutic efficacy of the research group was significantly better as well (p<0.05). For treating chronic hepatitis B liver fibrosis, a combination of Biejiaruangan compound tablet and entecavir with the aid of real-time shear wave elastography could achieve good clinical efficacy as well as significantly improve the therapeutic efficiency.

Impact of hemodialysis on liver stiffness measured with real-time two-dimensional shear wave elastography.

The impact of hemodialysis on liver stiffness is still unclear. The aim of the study was to assess liver fibrosis by real-time two-dimensional shear wave elastography (RT 2D-SWE) and to quantify the influence of net fluid withdrawal on liver stiffness during one hemodialysis session. The second aim was to investigate the influence of systolic blood pressure and time spent on dialysis (in years) on liver stiffness measurements. This before/after hemodialysis (HD) study in agroup of end stage renal disease (ESRD) patients was carried out with patients on regular HD. Measurements of liver stiffness were done using RT 2D-SWE directly before and after a hemodialysis session. In this study 27 patients with mean age 69.4 ± 14.75 years were included. Mean net fluid withdrawal volume per session was 2874.07 ± 778.35 ml. Mean pre-HD and post-HD liver stiffness measurements were 8.15 kPa (95% confidence interval, CI 7.61-8.68) and 6.70 kPa (95% CI 6.10-7.30 kPa), respectively. Mean liver stiffness reduction was 1.448 ± 1.14 kPa. The amount of fluid removed correlated with the decline in liver stiffness values after HD (ρ = 0.523, P = 0.003). There was apositive but statistically not significant correlation between time spent in HD and liver stiffness (ρ = 0.151, P = 0.623) CONCLUSION: Liver stiffness significantly declined after one session of HD. The change in liver stiffness was strongly correlated with the amount of net fluid withdrawal. Random liver stiffness measurements (LSM) by RT 2D-SWE does not precisely show the degree of fibrosis, Furthermore, it is presumed that postdialysis liver stiffness values likely reflect the real degree of liver fibrosis.

Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: A cross-sectional controlled study with real-time two-dimensional shear wave elastography

ObjectiveTo explore the significance of the association between treatment with methotrexate (MTX) and liver stiffness in rheumatoid arthritis (RA) patients. MethodsWe enrolled 140 consecutive RA patients under MTX treatment (MTX-treated RA; mean treatment duration: 6.2 years; mean MTX cumulative dose: 4.67 g), 33 RA patients naive to MTX (MTX-naive RA) and 100 age and sex-matched healthy blood donors (HD). Liver stiffness was assessed by real time two-dimensional shear wave elastography, with values ≥7.1 Kilopascals (kPa) defining significant liver fibrosis. ResultskPa values in HD (4.32 ± 0.7) were lower than that in MTX-naive RA (4.92 ± 0.8) and MTX-treated RA (4.85 ± 0.9, p < .0005 for trend). On the contrary, the difference in kPa between MTX-naive and MTX-treated RA was not significant (p = .89). Similarly, liver stiffness was not significantly different across strata of cumulative MTX dose (4.95 ± 0.7 kPa in MTX <1 g, 4.90 ± 1.1 kPa in MTX 1–3 g and 4.80 ± 0.9 in MTX >3 g, p = .610). Significant liver fibrosis was diagnosed in 4 patients in the MTX-treated RA (highest kPa value = 7.6; no liver function test abnormalities or clinical signs of hepatic failure) and in none in both the MTX-naive RA and HD groups (p = .145). ConclusionLiver stiffness values, although within the normal range, are significantly higher in RA patients vs. controls, irrespective of MTX treatment. RA patients taking MTX do not have a higher prevalence of significant liver fibrosis when compared to MTX naive RA patients and the general population.