Real-time Strain Elastography Research Articles

The Application Value of Using Semiquantitative and Quantitative Parameters in Multimodal Ultrasound to Distinguish Between Benign and Malignant BI-RADS 4 Lesions.

This study aims to explore the value of real-time strain elastography (RTE) and contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast BI-RADS 4 lesions. It collected 85 cases (totaling 85 lesions) diagnosed with breast BI-RADS 4 through routine ultrasound from October 2020 to December 2022 in Huangshan City People's Hospital. All lesions underwent RTE and CEUS examination before surgery, and the ImageJ software was used to measure the periphery of lesion images in the enhancement peak mode and grayscale mode to calculate the contrast-enhanced ultrasound area ratio. The diagnostic capabilities of single-modal and multimodal ultrasound examination for the malignancy of breast BI-RADS 4 lesions were compared using the receiver operating characteristic curve; the Spearman correlation analysis was adopted to evaluate the correlation between multimodal ultrasound and CEUS area ratio. As a result, among the 85 lesions, 51 were benign, and 34 were malignant. The areas under the curve (AUCs) of routine ultrasound (US), US + RTE, US + CEUS, and US + RTE + CEUS were 0.816, 0.928, 0.953, and 0.967, respectively, with the combined method showing a higher AUC than the single application. The AUC of the CEUS area ratio diagnosing breast lesions was 0.888. There was a strong positive correlation (r = 0.819, P < 0.001) between the diagnostic performance of US + RTE + CEUS and the CEUS area ratio. In conclusion, based on routine ultrasound, the combination of RTE and CEUS can further improve the differential diagnosis of benign and malignant lesions in breast BI-RADS 4.

Endoscopic ultrasonography in diagnosis of digestive diseases. Review of clinical cases

Endoscopic ultrasound (EUS) is a high-tech ultrasound examination that simultaneously combines the options of endoscopic and ultrasound diagnosis of diseases of the gastrointestinal tract, pancreas, bile ducts and liver. The advantages of endoscopic ultrasound over traditional transabdominal ultrasound are that the ultrasound transducer can be guided directly through the lumen of the gastrointestinal tract to the object under visual control. The EUS is the method of choice for the study of submucosal lesions in the upper gastrointestinal tract. It is the most accurate method for the detection and diagnosis of submucosal formations due to its high sensitivity, specificity, is used as the next research method after endoscopy and can provide information about the origin, size, borders, homogeneity, as well as the choice of treatment method: endoscopic or surgical one. A more important application of EUS is the determination of the stage of malignant neoplasms of the gastrointestinal tract, as it determines the treatment and predicts the disease. And the real-time strain elastography, which allows analyzing the stiffness of tissues, helps in this. The high accuracy of this study allows for the differential diagnosis of benign and malignant neoplasms. The article presents cases of examination of patients with submucosal neoplasms of the stomach who were treated in the SI “Institute of Gastroentero­logy of the National Academy of Medical Sciences of Ukraine”.

Application of Real-Time Sound Touch Elastography for Evaluating Chronic Kidney Disease of Transplanted Kidneys

If chronic allograft nephropathy can be detected early and treated, the long-term survival rate of the transplanted kidney may be effectively improved. To compare the application value of real-time sound touch elastography (STE), strain elastography, and color Doppler flow imaging in evaluating chronic kidney disease of transplanted kidneys. A total of 101 patients with renal transplantation were divided into a normal group (serum creatinine <134 mol/L, 58 patients) and a chronic allograft nephropathy group after renal transplantation over 6 months (serum creatinine >134 mol/L, 43 patients). The maximum elastic modulus (Emax) was determined, and receiver operator characteristics were used to compare the diagnostic efficacy of STE ultrasound. Emean, Emax, B/A (the strain rate of the internal oblique muscle tissue/the strain rate of the central renal cortex) of cortical standard strain ratio in strain elastography, and resistance index (RI) between normal and chronic allograft nephropathy groups have statistical significance (P < .05). Emax is superior to B/A and arcuate artery RI in the chronic cortex in the diagnosis of renal dysfunction, and the area under the receiver operator characteristics curve is 0.88. The estimated glomerular filtration rate was negatively correlated with renal cortex Emax, B/A, and arcuate artery RI, among which Emax was the strongest (r=- 0.713, P < .001). The renal cortical Emax cut-off was 30.95 kPa, the sensitivity was 92%, the specificity was 88%, and the accuracy was 88%. The STE technique to evaluate chronic renal dysfunction after renal transplantation is more sensitive than traditional strain-type elastography and hemodynamic parameters, with renal function decline, renal cortex Emax, renal cortical B/A, and arcuate artery RI gradually increased, and renal cortex Emax was particularly obvious.

Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions.

Endoscopic ultrasonography (EUS) has become an established method in diagnostic and therapeutic procedures in gastroenterology; however, it has recently gained a growing role in hepatology. To evaluate the role of EUS features, strain elastography (SE), and EUS-tissue acquisition in diagnosing hepatic focal lesions (HFLs) that could affect further management. This cross-sectional study included 215 patients with pancreatic, biliary, or gastrointestinal malignancies referred for EUS examination. HFLs were identified in 43 patients (20%), and EUS-guided tissue acquisition was performed from these lesions. EUS features were highly sensitive (100%) but much less specific (57%) in diagnosing HFLs; the overall accuracy was 94%. Real-time elastography was also very sensitive (97%) but less specific (67%) in diagnosing HFLs; however, the overall accuracy was 92%. EUS tissue acquisition was extremely sensitive (100%) and specific (100%), with a 100% overall diagnostic accuracy. The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs. EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.

Early Prediction of Gestational Diabetes Mellitus Using Placental Strain Elastography and Subcutaneous Adipose Tissue Thickness.

The aim of this study is to investigate the efficacy of placental strain ratio values measured by real-time sonoelastography and maternal subcutaneous adipose tissue thickness measured by two-dimensional ultrasonography in predicting gestational diabetes mellitus in the first trimester. The population of the study consisted of the first 210 consecutive singleton pregnant women who applied for routine first-trimester screening between the 11th and 14th week of gestation.B-mode subcutaneous adipose tissue thickness sonography and real-time placental strain elastography scanning were performed.All patients underwent 75 g oral glucose tolerance test between the 24th and 28th week of gestation. American Diabetes Association criteria were used in the diagnosis of gestational diabetes mellitus. It was observed that body mass index (p<0.001), first-trimester fasting blood sugar (p<0.001), subcutaneous adipose tissue thickness (p<0.001), and placental strain ratio value (p<0.001) affected the development of gestational diabetes mellitus statistically. The multivariate analysis shown that subcutaneous adipose tissue thickness (odds ratio=1.271, 95% CI=1.142-1.416, p<0.001) and placental strain ratio value (odds ratio=3.664, 95% CI=1.927-6.969, p<0.001) were the independent risk factors affecting the development of gestational diabetes mellitus. The findings of this study indicated a positive correlation between 75 g oral glucose tolerance test application and first trimester subcutaneous adipose tissue thickness and placental strain ratio. Using the cut-off values of>11.5 mm for subcutaneous adipose tissue and>0.986 for placental strain ratio, the development of gestational diabetes mellitus may be predicted in the early weeks of pregnancy.

Convolutional Neural Network-Based Speckle Tracking for Ultrasound Strain Elastography: An Unsupervised Learning Approach

Accurate and computationally efficient motion estimation is a critical component of real-time ultrasound strain elastography (USE). With the advent of deep-learning neural network models, a growing body of work has explored supervised convolutional neural network (CNN)-based optical flow in the framework of USE. However, the above-said supervised learning was often done using simulated ultrasound data. The research community has questioned whether simulated ultrasound data containing simple motion can train deep-learning CNN models that can reliably track complex in vivo speckle motion. In parallel with other research groups' efforts, this study developed an unsupervised motion estimation neural network (UMEN-Net) for USE by adapting a well-established CNN model named PWC-Net. Our network's input is a pair of predeformation and postdeformation radio frequency (RF) echo signals. The proposed network outputs both axial and lateral displacement fields. The loss function consists of a correlation between the predeformation signal and the motion-compensated postcompression signal, smoothness of the displacement fields, and tissue incompressibility. Notably, an innovative correlation method known as the globally optimized correspondence (GOCor) volumes module developed by Truong et al. was used to replace the original Corr module to enhance our evaluation of signal correlation. The proposed CNN model was tested using simulated, phantom, and in vivo ultrasound data containing biologically confirmed breast lesions. Its performance was compared against other state-of-the-art methods, including two deep-learning-based tracking methods (MPWC-Net++ and ReUSENet) and two conventional tracking methods (GLUE and BRGMT-LPF). In summary, compared with the four known methods mentioned above, our unsupervised CNN model not only obtained higher signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) for axial strain estimates but also improved the quality of the lateral strain estimates.

Sonoelastographic evaluation of salivary gland lesions with clinicopathological association

Sonoelastography is a comparatively new and developing technology in the field of salivary gland imaging. Nevertheless, it has the potential to distinguish between various types of lesions by calculating the degree of strain-related deformation under the externally applied force. With this background, the present study was undertaken to evaluate the role of sonoelastography in characterising salivary gland lesions as benign or malignant.&#x0D; The aim: To evaluate and characterize salivary Gland lesions on the Gray scale and Colour doppler ultrasonography and sonoelastography and to correlate these findings with the clinico-pathological diagnosis.&#x0D; Methodology: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College &amp; Research Centre, Moradabad (U.P.), from Aug 2021 to Nov 2022. All patients referred to the radiology department for imaging with clinical suspicion of having salivary gland lesions were enrolled in the study and evaluated on the SIEMENS ACUSON S3000 machine. Gray scale USG was done first to assess various morphological features of lesions, and then a Doppler assessment was done to determine vascularity within the lesion. Subsequently, real-time strain elastography (eSie touch) was performed to assess the tissue stiffness. The elastogram image of the detected lesions was evaluated using colour coding ranging from blue (soft) through green (intermediate/average hardness) and red (hard). After strain elastography, shear wave elastography of the lesion was also performed using Virtual Touch Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) software. The sonographic findings were correlated with histopathological diagnosis. The acquired data were subjected to statistical analysis using the software SPSS version 20. Sensitivity, specificity, PPV and NPV were calculated for conventional ultrasound techniques alone &amp; in combination with elastography.&#x0D; Results: Out of the 50 salivary gland lesions included in the study, 44 (88 %) were benign, whereas 6 (12 %) were malignant on cytology. The age of the study population ranged from 16 to 75 years, with a mean age of 38.82 years. Pleomorphic adenoma (60 %) was the most frequent lesion, followed by Warthin's tumour (28 %). The Conventional USG showed 66.67 %, sensitivity, 52.27 %, specificity, 16.00 %, PPV, 92.00 % NPV and 54.00 % accuracy in differentiating benign from malignant lesions while USG- Elastography combined showed higher diagnostic performance with 83.33 %, sensitivity, 79.55 %, specificity, 35.71 % PPV, 97.22 % NPV and 80.00 %, accuracy. The specific cut-off scores for the sonoelastography score, eSie touch, VTQ, and VTIQ were also determined to diagnose a lesion as malignant or benign, and the difference was found to be statistically significant.&#x0D; Conclusions: Sonoelastography alone cannot be solely relied upon to distinguish between malignant &amp; benign salivary gland abnormalities. However, it can be combined with conventional USG for better differentiation and characterization of these lesions

Sonoelastographic Evaluation of Pelvic Adnexal Masses and its Association with Clinicopathological Findings at a Tertiary Care Centre in Western Uttar Pradesh, India

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&amp;RC), Moradabad, Uttar Pradesh, India, for a period of 18 months (January 2020 to June 2021) and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. The youngest patient was 16-year-old and eldest was 70 years and the mean age of the study population was 36.35 years. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses.

REAL-TIME strain elastography: Applications in musculoskeletal system

BackgroundStrain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy. ObjectivesTo assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE. Materials and methodsA prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years. Statistical analysis of distribution, mean, associations, sensitivity, specificity, area under Receiver Operating Characteristic curve (AUROC) for B-mode, ES, SR combined B-mode/CE and their comparison was done. ResultsSignificant association was noted between SR in muscles and tendons with sex. Significant correlation was noted between ES/SR with B-mode. CE and B-mode had 100% and 52.4% sensitivity respectively for diagnosing diffuse pathologies. For differentiating benign and malignant masses sensitivity, specificity, and diagnostic accuracy of B-mode was 71.43%, 86.36% and 82.76%; of SR was 71.43%, 90.91% and 86.21%; of Combined B-mode with CE was 100%, 90.91% and 93.1% respectively. Elastographic pattern had highest diagnostic accuracy and largest AUROC. ConclusionCE as a screening test had higher diagnostic accuracy, supporting need for standardizing it for clinical use in MSK. EUS being a widely available, fast and affordable modality, can aid follow up of chronic MSK pathologies, response to medication, physiotherapy and surgery and mitigate the need for MRI.

Differentiation of benign and malignant superficial soft tissue lesions using real-time strain elastography

To evaluate benign and malignant cutaneous-subcutaneous lesions using real-time strain elastography (RTSE) and to compare the findings with histopathologic results. Over a period of 10 months, 72 patients (38 with benign and 34 with malignant cutaneous and subcutaneous lesions) were prospectively included in this study. Elasticity patterns and strain ratios were examined for each lesion. Lesions were evaluated in 4 groups as yellow-red (soft; pattern-1), green-yellow (moderate; pattern-2), blue-green (hard; pattern-3) and blue (hardest; pattern-4). The stiffness of the lesions was displayed with strain ratios by comparing of a nearby reference tissue. The recorded images were compared with histopathologic findings. On sonoelastograms, considering patterns 1-2 as benign and patterns 3-4 as malignant, the sensitivity, specificity, and positive and negative predictive values for the differentiation of malignant from benign lesions were 100%, 68.5%, 74%, and 100%, respectively. Considering a cut-off value of the strain ratio as > 3.05, the sensitivity, specificity, and positive and negative predictive values were 91%, 89%, 88%, and 92%, respectively. The area under the curve (AUC: 0.972) showed the excellent ability of strain elastography to differentiate benign and malignant lesions. RTSE is an important imaging tool to differentiate benign and malignant superficial soft tissue lesions. Our results suggest that RTSE can be used to predict malignancy since malignant lesions are more confidentially diagnosed than benign superficial soft tissue lesions on elastograms.

Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography

BackgroundFine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography.MethodsRetrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated.ResultsEighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1–2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001).ConclusionsIrregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.

Assessment of diagnostic efficiency of real-time strain elastography by using the median nerve stiffness at females with carpal tunnel syndrome

elastography in relation to carpal tunnel syndrome (CTS) and to show the relationship between electromyography (EMG) and sonographic cross-sectional area measurements.&#x0D; Materials and Methods: The patients with paresthesia of the median nerve distrubition lasting at least for 3 months were included. A total of 23 female patients’s of CTS and 25 healthy female volunteers’ wrist in which one median nerve existed included that of 36 CTS and 46 healthy wrists. The patients had clinical signs and their EMG test confirmed the diagnosis. The patients median nerve along its course on the wrist was applied strain elastography at three points of the radioulnar joint, scaphoidpsiform junction and hamate bone. &#x0D; Results: The EMG findings, strain elastogragraphy ratios and the CSA of the median nerve were found to be correlated significantly. The median nerve strain ratio in elastography was significantly increased in the CTS patients compared to the control group. &#x0D; Conclusion: Sonoelastography promises to be a useful method for the diagnosis of CTS.

Real time strain elastography for differentiation of solid renal masses

Objective: The aim of this study was to investigate the diagnostic performance of real time strain elastography for evaluation of solid renal masses. Material and methods: Forty two patients who were incidentally detected solid renal masses underwent Real Time Strain Elastography. Strain index value was detected for each lesion by dividing ROI of lesion to ROI of adjacent renal cortex. Strain index values and color encoding patterns of lesions and renal parenchyma were obtained. Mean strain index values and color encoding patterns for benign and malignant lesions were compared. Also by using ROC curve, cut-off value was obtained and diagnostic performance of method was evaluated. Results: Any statistically significant difference of mean ages of patients was not found. Mean strain index value of malignant lesions were significantly higher than benign lesions. When cut-off value for strain index ratio was taken 0.3, high diagnostic performance was obtained for differentiation of solid renal masses as benign or malignant. Conclusion: Real time strain elastography can be useful for differentiation of solid renal masses as malignant or benign.

Utility of ultrasound strain elastography to differentiate benign from malignant lesions of the breast

Background:The purpose of this study was to determine the utility and diagnostic performance of strain elastography (SE) in differentiating benign from malignant lesions of the breast.Methods:In this prospective study, 50 palpable breast masses in 50 patients were examined by mammography, B-mode ultrasound (US) and SE. Lesions were categorized using Breast Imaging Reporting and Data System (BIRADS) scoring based on mammographic and sonographic features. Elasticity scores were assessed on a five-point scale based on the distribution of strain, and the lesion size on SE imaging and B-mode (elasticity imaging/B mode [EI/B] ratio) was compared. Findings were correlated with the BIRADS assessment and diagnostic performance of sonoelastography was evaluated taking histopathology as reference standard.Results:Histopathology revealed 29 (58%) malignant and 21 (42%) benign lesions. Infiltrative ductal carcinoma and fibroadenoma were the most common malignant and benign lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE was 100%, 76.1%, 85.2%, 100%, and 90%, respectively. Higher elasticity score was significantly associated with malignant histopathology (P < 0.00001). The mean EI/B ratio for malignant lesions was 1.36 ± 0.24 while that of benign lesions was 1.03 ± 0.30 (P = 0.000).Conclusion:Real-time SE of the breast, with its superior sensitivity and specificity, could provide improved characterization of benign and malignant breast masses compared with mammography and conventional US. Due to greater diagnostic accuracy, SE can be an effective adjunctive tool to B-mode US in predicting malignancy of breast, as well as in reducing the need for biopsies in benign breast lesions.

The value of real-time strain elastography in the assessment of diffuse thyroid pathology

The value of real-time strain elastography in the assessment of diffuse thyroid pathology

Role of Transrectal Ultrasound Elastography in the Diagnosis of Prostate Carcinoma.

Background:The purpose of this study was to evaluate the diagnostic value of transrectal real- time strain elastography (RTE) in identifying prostatic carcinoma (PCa).Methods:60 patients suspected of having PCa based on abnormal digital rectal examination and raised prostate specific antigen levels underwent transrectal ultrasound (TRUS), color Doppler (CD) and RTE. Elastograms were scored on a five point scale based on distribution of strain in relation to hypoechoic area on TRUS. Twelve core systematic biopsy as well as targeted biopsy was performed from suspicious areas on TRUS and RTE. Diagnostic performance of sonoelastography was evaluated using histopathology as reference standard.Results:Histopathology revealed cancer in 28 out of 60 patients (47%) studied. Gleason score ranged from 6 to 9. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TRUS in detecting prostate cancer were 78.57%, 81.25%, 78.57%, and 81.25%, respectively. On CD evaluation 87.5% (n = 28) of benign lesions showed symmetric, radial flow compared to 14.3% (n = 4) of malignant lesions (P < 0.0001). The sensitivity and specificity of RTE was 89.29% and 56.25% with PPV and NPV being 58.13% and 82.35%, respectively. Higher elastography score was found to be significantly associated with malignant histopathology (P = 0.004). Cancer detection rate with RTE was greater for tumors with higher Gleason score.Conclusion:RTE was found to have better sensitivity than TRUS as well as combination of TRUS and CD. Although less specific, RTE can be an effective adjuvant tool to TRUS for guidance of biopsy and improve detection rate of PCa.

Accuracy of transrectal strain elastography in detection of prostate cancer

Background: Elastography has emerged as a boon in aiding diagnosis of various neoplastic conditions. Strain elastography helps in differentiating hard lesions from the normal tissue on a real-time basis and targeting biopsies of the same described by other authors in various conditions. We assess a series of cases for the detection of prostate cancer using strain elastography of prostate. Aims: The aim of this study was to assess the accuracy of transrectal strain elastography in diagnosis of prostate cancer. Materials and Methods: This is an observational cross-sectional, prospective study. Transrectal strain elastography was performed using a C-10 3 v endocavity probe with elastography software and was compared against biopsy results on 25 adult male patients with raised prostate-specific antigen levels. Statistical significance of qualitative data across two study groups was tested using the Chi-square test or Fisher's exact test. The entire data were analyzed using SPSS version 16.0, Inc., Chicago, software for Microsoft Windows. Results: Ten (40%) out of 25 patients demonstrated carcinoma prostate, 14 patients had benign prostatic hyperplasia, and 1 had prostatic abscess. Transrectal real-time elastography scores in patients with carcinoma patient were higher than those of benign conditions, i.e., 3 and 4 scores with accuracy of 92%, sensitivity of 85.7%, and specificity of 94.4%. Conclusions: The overall accuracy of strain elastography was 92%, which enhanced the diagnostic yield in prostate carcinoma. Real-time strain elastography is a highly sensitive and specific technique for diagnosing prostatic carcinoma and guiding the prostate biopsy.

Evaluation of Normal and Varicocele-Bearing Testes Using Real-time Strain Elastography.

To evaluate testes in patients with varicocele using real-time strain elastography and to correlate the results with the patients' clinical, seminal, and hormonal profiles. Fifty patients with left varicocele and 20 age-matched control participants were included in the study. All participants were evaluated via a historical interview, clinical examination, including testicular volume and varicocele grade, hormonal assay (total and free testosterone, luteinizing hormone, and follicle-stimulating hormone), computer-assisted semen analysis, and testicular assessment using real-time strain elastography to define the strain ratio and elasticity score. Testicular volume and sperm parameters were significantly lower (P < .001), whereas the follicle-stimulating hormone level, strain ratio, and elasticity score were significantly higher (P < .01; P < .001; P < .001, respectively), in the varicocele group. Other hormone levels in the endocrine profile were not significantly different between the groups. Significant negative correlations were found between the elasticity score and testicular volume and the percentage of normal forms (P = .029; P = .005). The varicocele grade showed significant positive correlations with both the strain ratio and elasticity score (P < .001). Strong correlations were found between real-time strain elastography and the testicular volume, varicocele grade, and sperm morphologic characteristics. Real-time strain elastography is a simple, noninvasive investigative modality that can potentially be used to study the structure and function of the testicular tissue in varicocele.

Differentiation of Inflammatory From Fibrotic Ileal Strictures among Patients with Crohn's Disease Based on Visual Analysis: Feasibility Study Combining Conventional B-Mode Ultrasound, Contrast-Enhanced Ultrasound and Strain Elastography

The aim of this pilot study was to assess prospectively the feasibility of conventional B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) combined with real-time strain elastography (SE) in the differentiation of inflammatory from fibrotic ileal strictures among patients with Crohn's disease (CD) based on visual analysis. Twenty non-consecutive patients (15 male and 5 female; mean age ± standard deviation, 40.2 ± 10.22 y) with CD and stricture of the terminal ileal loop were scanned by conventional B-mode US and CEUS and, subsequently, by real-time SE. Two independent readers visually classified each bowel stricture as fibrotic or inflammatory based on conventional B-mode US, CEUS, SE, individually and then for all techniques combined. All techniques combined had a higher (p < 0.05) sensitivity (reader 1, 9/20 [45%]; reader 2, 7/20 [35%]), specificity (reader 1, 5/20 [25%]; reader 2, 8/20 [40%]) and diagnostic accuracy (reader 1, 14/20 [70%]; reader 2, 15/20 [75%]) and higher (p < 0.05) area under the receiver operating characteristic curve (reader 1, 0.953; reader 2, 0.921) than individual techniques. Inter-reader agreement was fair for conventional B-mode US (k = 0.46) and CEUS (k = 0.39), moderate for SE (k = 0.6) and fair for all techniques combined (k = 0.38). Conventional B-mode US and CEUS, in combination with SE, may improve differentiation of inflammatory from fibrotic ileal strictures among patients with CD based on visual analysis.

The Value of Contrast-Enhanced Ultrasonography Combined with Real-Time Strain Elastography in the Early Diagnosis of Prostate Cancer

To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection. Patients with serum prostate-specific antigen (PSA) levels of ≥4.0 ng/ml were prospectively enrolled between June 2014 and December 2016. 153 prostate nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CETRUS and RTSE before a biopsy. Multivariate logistic regression models were established for CETRUS, and CETRUS combined with RTSE to diagnose prostate malignancy. The diagnostic performances of CETRUS, RTSE, and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The multivariate logistic regression for CETRUS combined with RTSE showed that enhanced strength, enhanced uniformity, and elasticity scores were the independent predictors of prostate malignancy. The area under the ROC curve of CETRUS combined with RTSE (0.921±0.023) was higher than that of CETRUS and RTSE (0.88±0.029 and 0.80±0.038, respectively; both p<0.05). Moreover, the sensitivity, accuracy and negative predictive value of CETRUS combined with RTSE were 92.1%, 86.2%, and 84.6%, respectively. The omission diagnostic rate of CETRUS combined with RTSE (7.9%) was reduced. And the diagnostic accuracy of CETRUS combined with RTSE was significantly higher than that of CETRUS and RTSE (p<0.05). While the diagnostic accuracy of CETRUS was close to the RTSE, the difference was not statistically significant (p>0.05). The combined RTSE with CETRUS approach significantly improved the sensitivity and overall accuracy for correctly identifying prostate cancer.