Real-time Tissue Elastography Research Articles

Evaluation of anorectal function using real-time tissue elastography before and after preoperative chemoradiotherapy

PurposeThis study aimed to clarify the relationship between changes in elasticity and anorectal function before and after chemoradiotherapy.MethodsThis is a single-center prospective cohort study (Department of Surgical Oncology, The University of Tokyo). We established a technique to quantify internal anal sphincter hardness as elasticity using transanal ultrasonography with real-time tissue elastography. Twenty-seven patients with post-chemoradiotherapy rectal cancer during 2019–2022 were included. Real-time tissue elastography with transanal ultrasonography was performed before and after chemoradiotherapy to measure internal anal sphincter hardness as “elasticity” (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). The relationship between the increase or decrease in elasticity pre- and post-chemoradiotherapy and the maximum resting pressure, maximum squeeze pressure, and Wexner score were the outcome measures.ResultsA decrease in elasticity was observed in 16/27 (59.3%) patients after chemoradiotherapy. Patients with and without elasticity decrease after chemoradiotherapy comprised the internal anal sphincter sclerosis and non-sclerosis groups, respectively. The maximum resting pressure post-chemoradiotherapy was significantly high in the internal anal sphincter sclerosis group (63.0 mmHg vs. 47.0 mmHg), and a majority had a worsening Wexner score (60.0% vs. 18.2%) compared with that of the non-sclerosis group. Decreasing elasticity (internal anal sphincter sclerosis) correlated with a higher maximum resting pressure (r = 0.36); no correlation was observed between the degree of elasticity change and maximum squeeze pressure.ConclusionInternal anal sphincter sclerosis due to chemoradiotherapy may correlate to anorectal dysfunction.

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.

Effects of a 4 Week Cyclic Stretching Program on Muscle Stiffness and Hardness and Jump Performance in Healthy Adults: Preliminary Results of a Randomized Controlled Trial

Category: Sports; Ankle Introduction/Purpose: In general, Static Stretching (SS) is widely used during warm-ups and cool-downs at competitive practices and events. Previous studies have shown that SS have improved muscle stiffness. On the other hand, previous studies have not shown range of motion, or vertical jump. Recently, acute effects of Cyclic Stretching (CS) have suggested to improve muscle stiffness and dynamic balance. CS is moved at a constant speed and angle using continuous passive and dynamometer-equipped exercise equipment. However, long-term CS and SS programs have been shown to improve muscle stiffness, hardness, and It is not known if muscle strength or physical performance is altered. This study aimed to examine the effects of a 4-week CS and SS program on muscle stiffness and hardness, muscle strength, and jump performance. Methods: The subjects participated 18 healthy men and were randomly assigned to a CS or SS group. Each stretching program was stretched in each condition for 2 minutes in a standing position in 5 days a week for 4 weeks. To assess muscle stiffness, muscle- tendon junction (MTJ) displacement and MTJ angle of gastrocnemius medialis (MG) were measured using ultrasonography and 20° before (pre-training) and after (post-training) conducting CS and SS program. MG hardness was measured using ultrasound real- time tissue elastography (RTE). ROM max and normalized peak torque (NPT) of ankle plantar flexor, squat jump (SJ) performance were measured in the pre- and post-training. The effects of the intervention on all outcome measures were determined using 2- way repeated-measures ANOVA with two group as a between participants factor and time (pre-training, post-training) When interaction effects were detected, post hoc comparisons were performed to test the differences in physical variables between pre- and post-training. Results: ROM max was significantly affected by time between CS and SS program (P &lt; .001, F = 26.0). MTJ displacement from 0°to 20°were significantly affected by time (P &lt; .05, F = 5.49; P &lt; .01, F = 10.26; P &lt; .01, F = 9.74). RTE from 0°to 20°were significantly affected by time (P &lt; .01, F = 13.27; P &lt; .01, F = 8.33; P &lt; .01, F = 53.52). There was significantly interaction for NPT between CS and SS program (P &lt; .01, F = 4.80). SJ were significantly affected by time (P &lt; .05, F = 5.70). Conclusion: This study examined the long-term effect of CS and SS on ROM max, muscle stiffness, NPT, and SJ. The results indicate that CS training had greater improvement than SS training in muscle strength between pre- and post-training. A significant decrease in muscle stiffness and hardness after SS was observed compared with CS. However, CS not only improves muscle stiffness and hardness as shown the effect of SS but also suggests the possibility of being a new extension method to improve muscle strength.

Could real-time sonoelastography-measured placental strain ratio (PSR) value be a soft marker for the diagnosis of intrahepatic cholestasis of pregnancy?: A case-control study and short reviews.

Diagnosis of intrahepatic cholestasis of pregnancy (ICP) is often decided upon with typical pruritus supported by elevated serum bile acid levels. However, there is confusion regarding the absolute reference range for serum bile acid . To confirm the utility of Placental Strain Ratio (PSR) measurement as a marker for the diagnosis of ICP and to reveal the extent to which it is correlated with serum bile acid concentration. A case-control study was conducted. The case group included 29 patients who were admitted to our hospital in the second or third trimester of pregnancy with typical itching and were clinically diagnosed with ICP with >10 mmol/L serum bile acid. The first 45 pregnant women were assigned to a control group. Real-time tissue elastography software was used for ultrasound assessment of all pregnant placentas. Software was used to estimate the SR values. Biochemical liver function parameters, hemograms, serum bile acid levels, and SR values were compared between these groups. PSR was found to predict the development of cholestasis with poor discrimination (area under the curve [AUC] = 0.524; 95% CI = 0.399-0.646). The optimal threshold value with the best sensitivity and specificity rates was calculated to be 0.46 PSR. ICP developed significantly more frequently in the low PSR group than in the high PSR group (60% vs 29.3%, P = .05, odds ratios [OR] = 0.276, 95% CI = 0.069-1.105). No correlation was found between the PSR and bile acid levels (rho = -0.029, P = .816). PSR values can support the diagnosis of ICP, predict serum bile acid levels, and can be used as soft markers.

Investigation of tongue hardness using ultrasound elastography in children during growth period

ABSTRACT Purpose Previous studies, the changes in tongue hardness with growth were scarcely ever described, but tongue pressure and morphology were the focus of them. Given that, we decided to use ultrasound to examine the changes in tongue hardness during growth. Materials and methods 60 paediatric patients (30 boys and 30 girls) aged 6 to 11 years (mean age, 8.5 ± 1.7 years) who visited the Department of Orthodontics, Showa University Dental Hospital were selected for the study. Tongue hardness was measured using real-time ultrasound tissue elastography. The measured values of tongue elasticity were subjected to the Shapiro – Wilk test, and QQ plot for checking the normality. Pearson’s correlation coefficient was used to confirm the significance of the relationship among the three measurements of tongue elasticity, age, sex, height, weight, BMI, body fat, tongue pressure, and hand strength. Results We confirmed that the use of ultrasound SWE and SE are valuable for the measurement of tongue elasticity. A negative correlation between age and tongue elasticity SE (extraoral) (r = −0.26, P < 0.05), body weight and tongue elasticity SE (extraoral) (r = −0.30, P =＜0.05). Conclusion It was suggested that tongue hardness changes with changes with age. The balance between the tongue and perioral muscles is affected with the position of the teeth. Perioral muscle function is closely associated with malocclusion onset, particularly during childhood when maxillofacial growth and development are rapid. Therefore, the use of ultrasonography device can aid in the evaluation of treatments to improve perioral muscle function.

Determination of the reference range for semi-quantified elasticity of healthy supraspinatus muscles using real-time tissue elastography and its clinical use in patients after rotator cuff repair

BackgroundThe quantitative assessment of healthy supraspinatus muscle elasticity may provide clinically useful preliminary information after rotator cuff repairs. We aimed to determine the reference range for supraspinatus muscle semi-quantified elasticity and describe how it can be used clinically after rotator cuff repair. MethodsThe elasticity of healthy bilateral supraspinatus muscles in 43 participants aged between 24 and 75 years (categorized into two subgroups: <50 and ≥ 50 years) was measured as a strain ratio at 0° and 60° of shoulder abduction using real-time tissue elastography. The reference and modified reference ranges calculated by excluding outliers for elasticity were determined using normal distribution methods for logarithmically transformed data. The modified reference range was applied to eight cases of rotator cuff repair. FindingsStrain ratios under and over 50 years of age were 1.63 vs. 2.21 at 0° of shoulder abduction (P = 0.028) and 0.92 vs. 1.29 at 60° of shoulder abduction (P = 0.002), respectively. Modified reference ranges for under and over 50 years of age were 0.72–4.17 and 0.98–4.50 at 0° of shoulder abduction and 0.38–1.95 and 0.56–2.76 at 60° of shoulder abduction, respectively. Among eight cases, two showed strain ratios above the reference range at 1 month postoperatively, and rehabilitation protocols were adjusted. InterpretationA strain ratio above the reference range, especially above the upper limit at 0° of shoulder abduction, may indicate increased passive stiffness of the musculotendinous unit. Clinically, the reference range has the potential to be used as a baseline after rotator cuff repairs.

Comparative Study of Muscle Hardness during Water-Walking and Land-Walking Using Ultrasound Real-Time Tissue Elastography in Healthy Young People

Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.

A Review about C-TIRADS, ACR-TIRADS, and K-TIRADS Combined with Real-Time Tissue Elastography to Diagnose Thyroid Nodules.

This study aimed to evaluate the diagnostic efficiency of the Chinese version of thyroid imaging reporting and data system (C-TIRADS), American College of Radiology (ACR)-TIRADS, and Korean (K)-TIRADS combined with real-time tissue elastography to diagnose thyroid nodules. A total of 574 thyroid nodule ultrasonographic images were retrospectively analyzed and classified based on the three TIRADS methods. The MedCale statistical software was used to construct the receiver operating characteristic (ROC) curve based on the pathological results of surgery. The diagnostic efficiency before and after assessing elastographies from the three TIRADS was compared between C-TIRADS, ACR-TIRADS, and K-TIRADS groups and within before and after TIRADS combined with elastic imaging. Furthermore, the unnecessary biopsy rates were also compared. Comparing area under ROC curve (AUC) with MEDCALC software (20.0.15, MedCalc Software Ltd., Ostend, Belgium), Delong test was used. The sensitivity and specificity were compared by STATA software (15.1, StataCorp LP, College Station, TX, USA) and Chi-square test. The rate of unnecessary biopsy was compared by SPSS software (23.0, IBM, Armonk, NY, USA) and Chi-square test. C-TIRADS, ACR-TIRADS, K-TIRADS cut-off values, and real-time tissue elastography (RTE) were 4b, 5, 5, and 3, respectively, and the areas under the ROC curve were 0.932, 0.914, 0.904, and 0.883, respectively. C-TIRADS had the highest AUC (p < 0.05) and sensitivity (p < 0.001), while ACR-TIRADS had the highest specificity (p < 0.001). After conducting a combined elastography with the three TIRADS, AUC showed increases of different degrees. Comparing TIRADS with TIRADS+RTE, the difference of C-TIRADS had statistical significance (p < 0.001), but the difference of ACR-TIRADS and K-TIRADS had no statistical significance (p > 0.05). The unnecessary biopsy rate showed decreases of different degrees. Differences between C-TIRADS and K-TIRADS were significant (p < 0.05), but in the case of ACR-TIRADS were not significant (p > 0.05). C-TIRADS, ACR-TIRADS, K-TIRA and RTE showed high diagnostic efficiency, with C-TIRADS having the highest. Real-time tissue elastography can improve TIRADS diagnostic efficiency and reduce its unnecessary biopsy rate. In this case C-TIRADS showed again the highest efficiency.

The Performance of the Uterine Artery Resistance Index following Stimulation of the Cervix in the Diagnosis of Endometriosis: A Prospective Study

Background: We speculated that stimulating the uterine cervix of patients may increase blood flow resistance of the uterine artery more significantly in women with endometriosis than those without. Accordingly, the resistance index (RI) of the uterine artery following stimulation of the cervix may offer a novel and promising non-invasive method for diagnosing endometriosis. In this prospective study, the aim was to determine the performance of the uterine artery resistance index (RI) following stimulation of the cervix in the diagnosis of endometriosis. Methods: This prospective cohort study included 270 patients with non-uterine diseases who were scheduled for laparoscopic surgery. Each patient underwent Doppler sonography for peak systolic velocity (PSV), end diastolic velocity (EDV), and RI before and after stimulation of the cervix, in addition to conventional ultrasound examination one day prior to laparoscopic surgery. The cervix was stimulated using a double convex array electronic vaginal probe for real-time tissue elastography. Results: Laparoscopic surgical evaluation revealed endometriosis in 91 (33.7%) patients. Following stimulation of the cervix, the RI of the uterine artery was significantly increased in the endometriosis group (p = 0.00), but no significant increase in the RI was observed in the control group (p = 0.45). The sensitivity and specificity of the post-stimulation RI for diagnosing endometriosis (using a cut off of 0.83) were 85.71% (95% confidence interval (CI): 76.45–91.88) and 88.83% (95% CI: 83.05–92.87), respectively. For peritoneal endometriosis (PEM), sensitivity and specificity were 86.96% (95% CI: 65.33–96.57) and 88.83% (95% CI: 83.05–92.87), respectively. The sensitivity and specificity of transvaginal ultrasonography (TVU) for diagnosing endometriosis were 63.74% (95% CI: 52.93–73.37) and 94.41% (95% CI: 89.68–97.14), respectively. The positive rate for TVU in diagnosing all endometrioses was 63.7%, and this was lower than that for the post-stimulation RI (84.6%, p = 0.001). Conclusions: Stimulation of the cervix leads to a significant decrease in uterine blood perfusion in women with endometriosis. TVU is a sensitive and specific method for the diagnosis of endometrioma, while the RI is a more sensitive parameter for diagnosing PEM than TVU. For the diagnosis of endometriosis, especially for PEM, the post-stimulation RI may prove to be a promising non-invasive diagnostic technique.

Evaluation of pelvic floor muscle elasticity in patients with overactive bladder syndrome using real-time tissue elastography

Introduction and hypothesisThe purpose of this study was to compare the muscle elasticity of the striated urethral sphincter (SUS) using real-time tissue elastography (RTE) as an evaluation of pelvic floor muscle (PFM) function between overactive bladder (OAB) patients and healthy women. MethodsThe subjects were 8 healthy middle-aged women (healthy group; age range 57–65 years) and 9 female OAB patients (OAB group; age range 42–80 years). The target sites of elastography were the striated urethral sphincter (SUS) and adipose tissue as the reference site; muscle elasticity was calculated as the strain ratio (SR) of the SUS to the reference site. Evaluations were performed at rest and during PFM contraction. The OAB group completed OAB symptom and quality of life questionnaires. The SUS SR was compared between the groups. The SUS SR at rest and during PFM contraction was compared within groups using the t-test and Wilcoxon’s test. The relationship between the questionnaire results and the SUS SR was evaluated by correlation analysis. ResultsIntergroup comparisons between the healthy and OAB groups showed no significant differences in SUS SR at rest and during PFM contraction. On intragroup comparisons, the SUS SR was significantly higher during PFM contraction than at rest in the healthy group (p = 0.011); in the OAB group, there was no significant difference in the SUS SR between rest and PFM contraction. The SUS SR was not significantly correlated with questionnaire results for OAB symptoms. ConclusionThis study shows the potential to non-invasively confirm the inability of OAB patients to correctly perform PFM contraction using RTE.

Combinational elastography for assessment of liver fibrosis in patients with liver injury.

ObjectiveWe investigated the utility of combinational elastography with point shear wave elastography (pSWE) and real-time tissue elastography (RTE) for evaluating liver fibrosis in patients with liver injury.MethodsIn this prospective single-institution study, patients scheduled for a liver biopsy to determine the presence of liver disease were enrolled. Liver fibrosis in each patient was evaluated using both shear wave velocity (Vs) shown by pSWE and the liver fibrosis index (LFI) shown by RTE, while a liver biopsy sample was obtained from the same area that was subjected to an elastography examination. Results of the latter were compared with those obtained in a histological examination.ResultsMultivariate analysis showed that Vs and LFI were significantly correlated with the liver fibrosis stage in all of the enrolled patients. Sub-analysis findings compared patients with and without non-alcoholic fatty liver disease (NAFLD) and demonstrated that Vs was significantly correlated with the liver fibrosis stage in both groups, whereas LFI was correlated with that only in the non-NAFLD patients. However, a multivariate analysis demonstrated a significant correlation between steatosis grade and LFI in the NAFLD patients.ConclusionsRTE is less useful than pSWE for assessing liver fibrosis in patients with NAFLD.

Preoperative diagnosis and prediction of microvascular invasion in hepatocellularcarcinoma by ultrasound elastography

BackgroundTo assess the values of two elastography techniques combined with serological examination and clinical features in preoperative diagnosis of microvascular invasion in HCC patients.MethodsA total of 74 patients with single Hepatocellular carcinoma (HCC) were included in this study. Shear wave measurement and real-time tissue elastography were used to evaluate the hardness of tumor-adjacent tissues and tumor tissues, as well as the strain rate ratio per lesion before surgery. According to the pathological results, the ultrasound parameters and clinical laboratory indicators related to microvascular invasion were analyzed, and the effectiveness of each parameter in predicting the occurrence of microvascular invasion was compared.Results33/74 patients exhibited microvascular invasion. Univariate analysis showed that the hardness of tumor-adjacent tissues (P = 0.003), elastic strain rate ratio (P = 0.032), maximum tumor diameter (P < 0.001), and alpha-fetoprotein (AFP) level (P = 0.007) was significantly different in the patients with and without microvascular invasion. The binary logistic regression analysis showed that the maximum tumor diameter (P = 0.001) was an independent risk factor for predicting microvascular invasion, while the hardness of tumor-adjacent tissues (P = 0.028) was a protective factor. The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the hardness of tumor-adjacent tissues, the maximum diameter of the tumor, and the predictive model Logit(P) in predicting the occurrence of MVI was 0.718, 0.775 and 0.806, respectively.ConclusionThe hardness of tumor-adjacent tissues, maximum tumor diameter, and the preoperative prediction model predict the occurrence of MVI in HCC patients.

Providing safe and effective rehabilitation by assessing supraspinatus muscle elasticity using ultrasound real-time tissue elastography after rotator cuff repair: A case series

ABSTRACT Introduction Although surgical techniques have advanced to avoid a postoperative re-tear after rotator cuff surgery, it remains unclear how to directly evaluate the risk of a re-tear. Objective To describe how muscle elasticity with real-time tissue elastography could be used to avoid re-tear in individual cases after rotator cuff repair. Case Description This case series included four patients, two per tear size (small and large/massive), with contrasting changes in muscle elasticity of the supraspinatus muscle. All patients underwent primary arthroscopic or open rotator cuff repair. The elasticity of the supraspinatus muscle was evaluated at relaxed and elongated positions of 0° and 60° shoulder abduction angles, respectively. The change in muscle elasticity at 1 month after surgery was characteristically different, and we predicted that a greater elasticity in the elongated position indicated a higher risk of re-tear. The cases with high risk underwent careful rehabilitation to avoid re-tear, and no re-tears were recorded in this report. Conclusion Our findings suggested that evaluation of muscle elasticity using real-time tissue elastography, which provides an indication of the risk of re-tear, in the clinical setting might be useful for therapists, who could adjust the intensity of rehabilitation, and for patients.

Comparison between Real-Time Tissue Elastography (HI-RTE) and Fibroscan in Assessment of Liver Fibrosis in Chronic HCV Patients

Comparison between Real-Time Tissue Elastography (HI-RTE) and Fibroscan in Assessment of Liver Fibrosis in Chronic HCV Patients

Efficacy of Real-Time Tissue Elastography (HI-RTE) for the Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis C

Efficacy of Real-Time Tissue Elastography (HI-RTE) for the Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis C

Changes in shoulder muscle activities and glenohumeral motion after rotator cuff repair: an assessment using ultrasound real-time tissue elastography.

Although rotator cuff repair is performed to restore the function of the rotator cuff muscles and glenohumeral (GH) joint motion, little has been known regarding the recovery process. The purpose of this study was (1) to investigate changes over time in activities of the supraspinatus and deltoid muscles assessed by ultrasound real-time tissue elastography (RTE) after rotator cuff repair and (2) to determine contributions of the activities of these muscles to the GH joint motion. Twenty patients after rotator cuff repair and 13 control participants were enrolled in this study. Elasticity of the supraspinatus and middle deltoid muscles were measured at rest and 30° of humerothoracic elevation in the scapular plane (scaption) by using RTE. The elasticity at 30° of scaption was normalized to that at rest in each muscle to quantify their muscle activities. In addition, the supraspinatus-to-middle deltoid (SSP/MD) ratio for the normalized elasticity was calculated. The GH elevation angle was measured with a digital inclinometer, which was calculated by subtracting the scapular upward rotation angle from 30° of scaption. For patients after rotator cuff repair, all measurements were performed at 6 weeks, 8 weeks, 3 months, and 6 months after surgery. Rotator cuff integrity was examined with magnetic resonance imaging at 6 months after surgery. Fifteen of 20 patients who remained intact at 6 months after surgery completed this study. The supraspinatus activity at 6 weeks was significantly smaller than that at 3 months (P = .006) and 6 months (P = .010). There was no significant difference in the supraspinatus activity between the patients at 3 months and the control participants (P = .586). The middle deltoid activity at 6 weeks was significantly greater than that at 6 months (P = .003). There was positive correlation between GH elevation angle and the activity of the supraspinatus relative to the deltoid at 6 weeks (r = 0.75, P = .001) and 8 weeks (r = 0.53, P = .041). The supraspinatus activity increased from 6 weeks to 3 months after surgery. The supraspinatus activity at 3 months after surgery was the same level as that in healthy individuals. On the other hand, the deltoid activity decreased from 6 weeks to 6 months after surgery. The increase in activity of the supraspinatus relative to the deltoid was likely to be related to the increase in GH elevation during postoperative at 8 weeks.

Liver fibrosis index as a novel prognostic factor in patients with pulmonary arterial hypertension.

Liver dysfunction is an important determinant of the prognosis of left heart failure patients. However, few studies have reported on cardiohepatic interactions in right heart failure patients, a condition that is an important prognostic factor in pulmonary arterial hypertension (PAH). This study aimed to evaluate the existence and extent of hepatic fibrosis and its contribution as a prognostic factor in PAH. This prospective study enrolled 60 consecutive patients with PAH in the International University of Health and Welfare Mita Hospital from June 2016 to December 2017. After the application of the exclusion criteria, 35 patients were assessed for hepatic fibrosis, using real-time tissue elastography, and for clinical deterioration. Sixteen healthy controls were also assessed for comparison. The liver fibrosis index (LFI) was significantly higher in PAH patients than in healthy controls (1.214 ± 0.047 vs. 0.911 ± 0.059, P < 0.001), suggesting that PAH patients exhibited mild liver fibrosis. However, patients with deterioration (vs. no deterioration) had significantly higher LFI values (1.507 ± 0.078 vs. 1.080 ± 0.034, P < 0.001), independent from other established liver function parameters. A receiver operating characteristic curve analysis identified that an LFI ≥ 1.275 indicated a significant probability of clinical deterioration (hazard ratio: 8.4 (95% CI 1.5-45.4, P = 0.012), independent from other known PAH prognostic factors. PAH patients may exhibit subclinical liver fibrosis associated with chronic right heart failure. The LFI can serve as both a non-invasive evaluation of liver fibrosis and a predictive marker for the deterioration of PAH patients.

Influence of fat infiltration, tear size, and post-operative tendon integrity on muscle contractility of repaired supraspinatus muscle.

BackgroundThe purpose of this study was to evaluate the effect of fat infiltration, tear size, and post-operative tendon integrity, on post-operative contractility.MethodsThirty-five patients who underwent rotator cuff repair were included. The fat infiltration, tear size, and post-operative tendon integrity were evaluated by Goutallier stage, Cofield classification, and Sugaya classification, respectively. The muscle elasticity at rest and at contraction was assessed by real-time tissue elastography pre- and one-year post-operatively. We defined the difference in elasticity between at rest and at contraction as the activity value which reflects muscle contractility.ResultsThe activity value in patients with Sugaya Type I tended to increase regardless of Cofield classification, whereas those with Sugaya Type III and IV tended to decrease. While the activity value in the patients classified as stage 1 and Type I tended to increase, patients classified as stage 2 showed decreased or constant in contractility even in those subjects classified as Type I. Stepwise multiple regression analysis showed both pre- (p = 0.004, r = -0.47) and post-operative activity values (p = 0.022, r = -0.39) to be significantly correlated only with the Goutallier stage.ConclusionMultiple regression analysis indicated only the Goutallier stage was a significant independent factor for contractility of the supraspinatus muscle. Supraspinatus muscle contractility in patients classified as Types III and IV based on the Sugaya classification tended to decrease post-operatively, while patients whose contractility increased post-operatively were characterized by having a Type I tendon integrity.

Real-Time Tissue Elastography to Evaluate Hepatic Hypoxic-Ischemic Injury Caused by Brain Death.

This study aimed to explore the potential of real-time tissue elastography (RTE) in evaluating hepatic hypoxic-ischemic injury caused by brain death. We performed RTE and biopsy for 50 donated liver. Hematoxylin-eosin staining was used to observe hepatocyte acidophilic change. Liver grafts were divided into 2 groups, one nonacidophilic change (n = 7) and the other with acidophilic change (n = 43). Correlation and difference analysis were performed for hematoxylin-eosin staining results and RTE parameters. The result indicated that 4 of the 11 RTE parameters, namely, the area of low strain within the region of interest (%AREA), contrast (CONT), inverse difference moment (IDM), and correlation (CORR) were related to hepatocytes acidophilic change (r = 0.284, P = 0.046; r = 0.349, P = 0.013; r = −0.444, P = 0.001; r = −0.381, P = 0.00). Whereas %AREA and CONT of the nonacidophilic change group were lower than that of the acidophilic change group (P < 0.05), IDM and CORR in nonacidophilic change group were higher than that of the acidophilic change group (P < 0.05); the remaining parameters were not statistically different between 2 groups (P > 0.05). Analysis of receiver operating characteristic curve indicated that the area under the curve of %AREA, CONT, IDM, and CORR were 0.75, 0.79, 0.81, and 0.77, respectively. Based on this, we concluded that the quantitative analysis parameters of RTE could preliminary assess hepatic hypoxic-ischemic injury caused by brain death.

Preoperative combi-elastography for the prediction of early recurrence after curative resection of hepatocellular carcinoma

PurposeTo estimate the prognostic value of preoperative combi-elastography for early recurrence (ER) of hepatocellular carcinoma (HCC) after radical resection. MethodsA total of 94 HCC patients undergoing hepatectomy from January to August 2019 were included. The combined elastography (ARIETTA 850, Hitachi Healthcare) was used for real-time tissue elastography and shear wave measurement analysis. Six elastography related indicators were calculated. The patients were randomly divided into a training and a validation group in a 7:3 ratio and prediction model was assessed about discrimination capability by using area under the receiver operating curve. Univariate and multivariate analyses were performed to determine the prognostic value of clinicopathological factors, laboratory tests, and elastography for HCC ER. ResultsThe Vs, E, F, and A indexes were significantly higher in patients with ER than in those without ER (P = 0.002, P = 0.002, P < 0.001, and P < 0.001, respectively). Multivariate logistic regression analysis indicated that microvascular invasion (MVI, odds ratio [OR] = 3.964, 95% confidence interval [CI] = 1.326–11.845; P = 0.010) and the F index (OR = 9.533, 95%CI = 1.921–47.296; P = 0.006) were independent predictors of ER in HCC. A ER prediction model based on laboratory tests, MVI and F index were moderate [area under curves (AUCs) in training and validation cohort were 0.829(95%CI: 0.723–0.935; P < 0.001) and 0.846 (95%CI: 0.699–0.994; P = 0.002), respectively]. ConclusionPreoperative combi-elastography analysis could be used as a potential prognostic tool for HCC ER and assist in clinical decision-making.