Real-time Ultrasound Elastography Research Articles

Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article

Adenomyosis is a common gynecological problem characterized by the growth of endometrial glands and stroma within the myometrium. Previously, the definitive diagnosis of adenomyosis was made through histopathology after a hysterectomy. However, in the last two decades, several uterine-sparing treatment options have emerged, including High-Intensity Focused Ultrasound (HIFU), which has become a promising option. HIFU is a non-invasive local thermal ablation technique that can be performed via ultrasound or MRI guidance. Additionally, “Laparoscopic uterine artery occlusion with uterus sparing pelvic plexus block and partial adenectomy for adenomyosis” has become a popular option. While conventional adenomyomectomy carries a high risk of recurrence and uterine rupture, some novel surgical techniques have been described to mitigate these complications and preserve future fertility. There are also “new surgical techniques of laparoscopic resection of adenomyoma under real-time intraoperative ultrasound elastography guidance”. Diagnostic imaging techniques such as transvaginal ultrasound, MRI, and hysteroscopic evaluation have revolutionized the diagnosis of adenomyosis and opened up possibilities for conservative treatment options. Hysteroscopy can be used for direct visualization and biopsy collection, though it is not the first-line treatment option. With the increasing incidence of adenomyosis and the desire for fertility preservation among younger patients, there is a growing need for effective uterine-sparing treatments. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 55-58

Associations of Real-Time Ultrasound and Strain and Shear Wave Elastography with Gastrointestinal Organs: A Systematic Review.

Ultrasound elastography is gaining attention for its diagnostic potential across various medical fields, and its physical properties make it valuable in modern clinical medicine. However, its specific attributes, especially in the context of recent medical advancements, remain relatively unexplored. This study aimed to identify instrument-specific characteristics and applications of real-time ultrasound elastography, shear wave elastography, and strain elastography, particularly within gastroenterology. Following PRISMA guidelines, the study examined elastography articles on databases like PubMed, resulting in 78 included articles. Data on patient demographics, organ involvement, specificity, sensitivity, accuracy, positive predictive value, and negative predictive value were extracted. Statistical analysis involved SPSS version 21, with significance set at p < 0.05. The majority of patients were male (50.50%), with a mean age of 42.73 ± 4.41 years. Shear wave elastography was the most prevalent technique (48.7%), and liver investigations were predominant in gastroenterology (34.6%). Gastrointestinal applications showed higher sensitivity, positive predictive value, and negative predictive values (p < 0.05) but lower specificity (p < 0.05). Real-time ultrasound elastography exhibited increased specificity, accuracy, and predictive values (p < 0.05). Ultrasound elastography appears more accurate and effective in gastroenterological settings. Nonetheless, its performance depends on instrument-specific and operator-dependent factors. While promising, further studies are necessary to ascertain optimal utilization in both gastrointestinal and non-gastrointestinal conditions.

Upper trapezius muscle elasticity in cervical myofascial pain syndrome measured using real-time ultrasound shear-wave elastography.

Myofascial pain syndrome (MPS) is a common cause of neck pain, which is a global public health problem. Because MPS does not present morphological changes within lesioned muscles, there are no imaging diagnostic criteria for this condition. In this study, we evaluate elasticity changes in upper trapezius muscles most frequently involved in cervical MPS using real-time ultrasound shear-wave elastography, and we examine their potential diagnostic value. We consecutively enrolled 109 right posterior neck pain patients for this prospective study. Of these, 51 were diagnosed with MPS and 58 with non-MPS in the right side of their neck. Among MPS patients, 19 fell into the 1-3 range (mild pain) for pain scores on the visual analog scale (VAS), 25 fell into the 4-6 range (moderate pain), and 7 into the 7-10 range (severe pain). MPS was diagnosed by two independent clinicians using the diagnostic criteria proposed by Simons et al. Using real-time ultrasound shear-wave elastography, we measured right trapezius mean shear-wave velocity (SWVmean). The midpoint of the line between the foramen magnum and the end of the right acromion served as measuring point. Regions of interest were scaled to span 0-8.0 m/s. Trapezius SWVmean was significantly higher in MPS patients compared with non-MPS patients (P<0.001). Stratified analysis of MPS patients according to pain severity revealed similar trapezius SWVmean between mild pain and non-MPS patients (P=0.324), however SWVmean was higher in moderate and severe pain MPS patients compared with non-MPS patients (P<0.001). The area under the curve (AUC) value for upper trapezius SWVmean in MPS patients was 0.791 (95% CI: 0.703-0.863). Corresponding sensitivity and specificity values were 86.27% (95% CI: 73.7-94.3%) and 62.07% (95% CI: 48.4-74.5%). Stratified analysis of MPS patients by pain severity produced the following AUC values for trapezius SWVmean in MPS patients with mild, moderate, and severe pain: 0.578 (95% CI: 0.460-0.690), 0.899 (95% CI: 0.814-0.955), and 0.983 (95% CI: 0.914-0.999), respectively. Elasticity changes and increased stiffness in the trapezius occur in cervical MPS patients with moderate and severe pain. The SWVmean parameter reflecting trapezius muscle elasticity may be valuable for successful screening of cervical MPS, especially in patients with moderate and severe pain.

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.

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.

Application of Real-Time Ultrasound Elastography Combined with Prostate Calcification in Differential Diagnosis of Prostate Cancer.

This study aimed to explore the clinical and differential diagnostic value of real-time ultrasound elastography combined with transabdominal prostate calcification in prostate cancer (PCa). This study retrospectively analysed the clinical pathological data of 97 patients with PCa and 105 patients with benign prostatic hyperplasia (BPH) diagnosed by postoperative pathology in our hospital from May 2020 to May 2021; Comparatively analysed the clinical data of the two groups, including the elastic strain ratio, elastic image compression index, types of prostate calcification and calcification diameter; And used logistic regression analysis to screen out the independent risk factors for identifying PCa and BPH. No significant difference in age, body weight, body mass index, location of calcification and calcification diameter was observed between the two groups (p > 0.05), and overt differences in elastic strain ratio, elastic image compression index, types of calcification, and testosterone were found between the PCa group and BPH group (p < 0.05). Logistic regression analysis showed that the elastic strain ratio, elastic image compression index and types of calcification were independent risk factors for identifying PCa (p < 0.05). The area under curve value of combined diagnosis under receiver operating characteristic curve was as high as 0.756 (95% CI: 0.691-0.813), with a sensitivity of 67.60% and a specificity of 76.30%. A certain correlation is observed amongst elastic strain ratio, elastic image compression index, types of prostate calcification and the occurrence and development of PCa. The application of real-time ultrasound elastography combined with the detection of transabdominal prostate calcification in clinical diagnosis can improve the detection rate of PCa, which has an important clinical application value.

Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study.

This study aimed to examine the clinical characteristics of 11 patients undergoing laparoscopic adenomyomectomy guided by intraoperative ultrasound elastography and this technique's feasibility. Eleven patients undergoing laparoscopic adenomyomectomy using ultrasound elastography for adenomyosis at Kawasaki Medical School Hospital in Okayama, Japan between March 2020 and February 2021 were enrolled. Operative outcomes included operative time, operative bleeding, resected weight, operation complications, percent change in hemoglobin (Hb) values, and uterine volume pre- and postoperatively. Dysmenorrhea improvement was evaluated by changes in visual analog scale (VAS) scores pre- and 6- and 12-months postoperatively. The median operative time and bleeding volume was 125 min (range, 88-188 min) and 150 mL (10-450 mL), respectively. The median resected weight was 5.0 g (1.5-180 g). No intraoperative or postoperative blood transfusions or perioperative complications were observed. The median changes in uterine volume, Hb value, and VAS score were -49% (-65 to -28%), -3% (-11 to 35%), and -80% (-100 to -50%), respectively. The median follow-up period post-surgery was 14 months (7-30 months). Adenomyosis recurrence was not observed in the patients during the follow-up period. Laparoscopic adenomyomectomy using ultrasound elastography guidance is minimally invasive and resects as many adenomyotic lesions as possible.

Analysis of Mechanism of Action of Cuprous Oxide Nanoparticles in Treatment of Cervical Cancer under Real-time Ultrasound Elastography.

It aimed to explore the adoption value of cuprous oxide nanoparticles (Cu2O NPs) in the clinical treatment of cervical cancer under the evaluation of real-time ultrasound elastography. In this experiment, the solution of Cu2O NPs was synthesized and used in 90 selected mouse models of cervical cancer. It was found that Cu2O NPs can significantly control the reproduction of various types of cervical cancer cells, effectively stopping the cycle of cervical cancer cell lines in the G1/G0 phase. In addition, the tumor weight of 0.25g in the Cu2O NPs group was notably lighter than that of 1.1g in the control group. The weight change of the mouse was 21g compared with 15g of the cis-dichlorodiamine platinum (CDDP) group, and it was proved that Cu2O NPs were less cytotoxic to the body and have few side effects. Moreover, real-time ultrasound elastography showed that there were 26 cases with a tumor elasticity score no less than 2 in the Cu2O NPs group, accounting for 87%, which was better than that of the CDDP group (17 cases, 57%), and the difference was substantial (P<0.05). The shear wave velocity of Cu2O NPs (1.46±0.48 m/s) was also lower than that (1.73±0.62 m/s) of the CDDP group, which suggested that the tumor body hardness of mice in the Cu2O NPs group was lower, and the difference was considerable (P<0.05). In short, Cu2O NPs had good functions such as inhibiting the proliferation and spread of tumor cells and blocking the cell cycle. Moreover, the toxic and side effects of the drug were slight, and it was an ideal new type of treatment for cervical cancer.

Diagnostic efficacy of ultrasound, ultrasound elastography and magnetic resonance imaging for breast lesions

Background: The present study was conducted for comparing the diagnostic efficacy of ultrasound, ultrasound elastography and magnetic resonance imaging for breast lesions. Materials &amp; methods: A total of 100 subjects were enrolled. Complete demographic details and clinical details of all the subjects were enrolled. All the patients were subjected to B-mode USG assessment. US Elastography was also done. The two-dimensional USG was followed by Real Time ultrasound elastography. The stiffness of the lesion was evaluated. All patients were placed prone on a 0.5 Tesla MRI scanner equipped with a dedicated breast surface coil. The lesion was categorized as benign, probably benign, malignant and probably malignant. Fine needle aspiration cytology (FNAC) or biopsy was performed and the specimen was evaluated cytologically/histopathologically to confirm the diagnosis. All the results were recorded and analysed by SPSS software. Results: Sensitivity and specificity of USG was 78.6 percent and 86.2 percent respectively. Sensitivity and specificity of Elastography was 89.5 percent and 92.6 percent respectively. Sensitivity and specificity of MRI was 96.2 percent and 93.1 percent respectively. Conclusion: MRI was most sensitive and most specific followed by USG elastography.

Comparison of diagnostic efficacy of ultrasound, ultrasound elastography and magnetic resonance imaging for breast lesions

Study aimed to evaluate and compare the performance of ultrasound, ultrasound elastography and magnetic resonance imaging in the diagnosis of breast cancer & its differentiation from benign lesions Material & Method: This cross-sectional observational study was conducted at department of Radiodiagnosis, Era’s Lucknow Medical college. The study was conducted for 18 month from January 2019 to june 2020. Patients detected with breast lesions and willing to be part of study were included in the study. The patients with cystic nodules and non-consenting patients were excluded from the present study. All the patients were subjected to B-mode USG assessment followed with Real Time ultrasound Elastography and 0.5 Tesla MRI scan. Fine needle aspiration cytology (FNAC) or biopsy was performed and the specimen were evaluated cytologically/histopathologically to confirm the diagnosis Result: Histopathologically, 18 (36%) cases were diagnosed as malignant and remaining 32 (64%) were diagnosed as benign. Among 18 malignant cases, maximum (n=11) were intraductal carcinoma (NOS), followed by well-differentiated intraductal carcinoma (n=6) and invasive lobular carcinoma (n=1) respectively. Among 32 benign cases, maximum (n=20) were fibroadenoma, followed by breast abscess (n=3), galactocele, intraductal papilloma and simple cyst (n=2 each). There was 1 case each diagnosed as fibroadenolipoma, fibrocystic and phyllode respectively. Diagnostic efficacy of USG in terms of sensitivity, specificity, positive and negative predictive value was 77.8%, 87.5%, 77.8% and 87.5% respectively. The accuracy of USG diagnosis was 84%. Diagnostic efficacy of USG elastography in terms of sensitivity, specificity, positive and negative predictive value was 83.3%, 96.9%, 93.8% and 91.2% respectively. The accuracy of elastography diagnosis was 92%. Diagnostic efficacy of MRI in terms of sensitivity, specificity, positive and negative predictive value was 94.4%, 90.6%, 85.0% and 96.7% respectively. The accuracy of MRI diagnosis was 92%. Conclusion: In low-resource settings, USG elastography can emerge as a suitable alternative to MRI in diagnosis of malignant breast masses with highly appreciable positive and negative predictive values. Study Design: Observational Study.

Reliability and discriminative validity of real-time ultrasound elastography in the assessment of tissue stiffness after calf muscle injury

ObjectiveTo investigate the reliability and discriminative validity of real-time ultrasound elastography (RTE) measures of soft-tissue elasticity after calf muscle tear. DesignCross-sectional, intra/inter-examiner reliability and comparative validity study. SettingDepartment of Physical Therapy. ParticipantsTwenty-one recreational athletes were included and examined 6 weeks after sustaining a grade I-II calf musculature tear. Main outcome measuresSoft-tissue elasticity was measured by two experienced assessors using RTE assessments in both the longitudinal and transverse planes of the athletes’ injured and uninjured calf muscles. Elasticity was estimated by using the strain ratio (SR), which was calculated by dividing the strain (displacement) value taken at the medial gastrocnemius-soleus myotendinous junction (reference) by the strain value taken at the centre of the injury (index) as visualized on B-mode sonogram. Intra- and inter-observer reliability was estimated calculating intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). Differences in elasticity between injured and healthy legs were assessed using t-tests or Wilcoxon tests for repeated measures. ResultsAll RTE assessments in both planes showed ICC values ranging from 0.77 to 0.95 and SEM values ranging from 0.72 to 0.99. Additionally, RTE enabled both assessors to determine differences in elastic properties between injured and control legs (p < 0.001). ConclusionRTE measures of calf muscles demonstrated good reliability and were able to differentiate injured from non-injured muscle tissue. RTE may provide a fast and objective measure in sports medicine to improve the detection of risk factors for muscle injury related to alterations of the mechanical behaviour of soft tissues during healing process.

Real-time Ultrasound Elastography in the Differential Diagnosis of Benign and Malignant Thyroid Nodules

Abstract Background: Elastosonography is a promising noninvasive technique that developed in recent years for evaluating thyroid nodules. It assesses nodule stiffness or displacement depending on the applied force to differentiate malignant from benign thyroid nodules. Objectives: The aim of this study was to evaluate the diagnostic utility of real-time ultrasound (US) elastography in the differentiation the benign from malignant thyroid nodules. Patients and Methods: A prospective study was carried out on 40 patients attending the US unit/radiology in Al-Imamein Al-Kadhimein Medical City in Baghdad, Iraq, from September 2018 to August 2019. All patients were examined by B-mode US, color Doppler, and real-time elastography by Voluson-E6 US machine. Final diagnoses were obtained from histological and/or cytological evaluation. Results: The mean age of 40 patients was 43.7 ± 11.7 years, with a range of 25–70 years. Twenty-eight (70%) of them were female and 12 (30%) were male. Of the 40 lesions, 34 (85%) were benign and 6 (15%) were malignant lesions. Malignant thyroid nodules were significantly hypoechoic, with irregular margin, taller than wider, showed microcalcification, and exhibited a significant increase in vascularity with varying rates of sensitivity and specificity. Orientation (taller than wider) was the most US predictive pattern of malignancy with sensitivity, specificity, and accuracy of 66.7%, 100%, and 92.5%, respectively. The mean ± standard deviation of the strain ratio (SR) of all nodules was 2.7 ± 2.1 (range: 0.4–13.5) with significant result. The optimal SR cutoff value was &gt;2.5 and showed to have a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 67%, a negative predictive value of 100%, and an accuracy rate of 90%. Conclusion: Elastosonography can assist in the differential diagnosis of malignant and benign thyroid nodules, as strain elastosonography improves the diagnostic performance in differentiating the benign and malignant thyroid nodules. SR is higher in malignant than benign nodules.

The Diagnostic Value of Ultrasound Elastography and Colour Doppler Ultrasonograhy in Predicting Malignancy in Intermediate Thyroid Nodules

Abstract Background: Nodules of thyroid gland are very common and the majority of them are benign. Sonography has many favorable features, such as detection of non-palpable nodules, estimation of size and volume of the nodule and guidance for Fine Needle Biopsy (FNB). High-resolution ultrasound is very sensitive in detection of thyroid nodules, enabling dif-ferentiation of solid and fluid-containing lesions. Indeterminate and non diagnostic patterns represent the main limitation of Fine Needle Aspiration (FNA) cytology of thyroid nodules, clinical and echographic features can poorly predictive of malignancy. The newly developed real-time Ultrasound Elas-tography (USE) has been applied to differentiate malignant from benign lesions. Aim of Study: To evaluate indeterminate thyroid nodules by US elastography and colour Doppler study. Material and Methods: In this study, 73 cases were in-cluded from which 57 cases were benign and 16 cases were malignant. The cases were subjected to complete U/S, Doppler examination, Micro pure imaging and US elastography the results were compared to U/S guided FNAC. Results: The most predictive combined ultrasound features are disappearing halo sign with the appearance of dots of micro calcifications and by colour Doppler ultrasound marked intra nodular and absent or slight peri nodular blood flow represented with malignant nodules more than benign, the combination of US elastography with US findings clears that hypoechogenicity/score 4-5 was the most predictive of malig-nancy with sensitivity 80% and specificity 100%; and accuracy 93.4%. Conclusion: US-elastography combined with colour Dop-pler US, has rapid and easy performance and can help to identify nodules of thyroid gland that are likely seems to be malignant.

Real-time and High Quality Ultrasound Elastography Using Convolutional Neural Network by Incorporating Analytic Signal.

Convolutional Neural Networks (CNN) have been extensively used for many computer vision applications including optical flow estimation. Although CNNs have been very successful in optical flow problem, they have been rarely used for displacement estimation in Ultrasound Elastography (USE) due to vast differences between ultrasound data and computer vision images. In USE, a main goal is to obtain the strain image which is the derivative of the axial displacement in axial direction; therefore, a very accurate displacement estimation is required. Radio Frequency (RF) data is needed to obtain accurate displacement estimation. RF data contains high frequency contents which cannot be downsampled without significant loss of information, in contrast to computer vision images. We propose a novel technique to utilize LiteFlowNet for USE. For the first time, we incorporate analytic signal to improve the quality of the displacement estimation. We show that this network with the designed inputs is more suitable for USE compared to more complex networks such as FlowNet2. The network is adopted to our application and it is compared with FlowNet2 and a state-of-the-art elastography method (GLUE). The results show that this network performs well and comparable to GLUE. Furthermore, not only this network is faster and has lower memory footprint compared to FlowNet2, but also it obtains higher quality strain images which makes it suitable for portable and real-time elastography devices.

Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients

BackgroundMuscle weakness following critical illness is the consequence of loss of muscle mass and alteration of muscle quality. It is associated with long-term disability. Ultrasonography is a reliable tool to quantify muscle mass, but studies that evaluate muscle quality at the critically ill bedside are lacking. Shear wave ultrasound elastography (SWE) provides spatial representation of soft tissue stiffness and measures of muscle quality. The reliability and reproducibility of SWE in critically ill patients has never been evaluated.MethodsTwo operators tested in healthy controls and in critically ill patients the intra- and inter-operator reliability of the SWE using transversal and longitudinal views of the diaphragm and limb muscles. Reliability was calculated using the intra-class correlation coefficient and a bootstrap sampling method assessed their consistency.ResultsWe collected 560 images. Longitudinal views of the diaphragm (ICC 0.83 [0.50–0.94]), the biceps brachii (ICC 0.88 [0.67–0.96]) and the rectus femoris (ICC 0.76 [0.34–0.91]) were the most reliable views in a training set of healthy controls. Intra-class correlation coefficient for inter-operator reproducibility and intra-operator reliability was above 0.9 for all muscles in a validation set of healthy controls. In critically ill patients, inter-operator reproducibility and intra-operator 1 and 2 reliability ICCs were respectively 0.92 [0.71–0.98], 0.93 [0.82–0.98] and 0.92 [0.81–0.98] for the diaphragm; 0.96 [0.86–0.99], 0.98 [0.94–0.99] and 0.99 [0.96–1] for the biceps brachii and 0.91 [0.51–0.98], 0.97 [0.93–0.99] and 0.99 [0.97–1] for the rectus femoris. The probability to reach intra-class correlation coefficient greater than 0.8 in a 10,000 bootstrap sampling for inter-operator reproducibility was respectively 81%, 84% and 78% for the diaphragm, the biceps brachii and the rectus femoris respectively.ConclusionsSWE is a reliable technique to evaluate limb muscles and the diaphragm in both healthy controls and in critically ill patients.Trial registrationThe study was registered (ClinicalTrial NCT03550222).

The value of conventional sonography and ultrasound elastography in decision-making for thyroid nodules in different categories of the Bethesda system for reporting thyroid cytopathology.

The aim of this study was to evaluate the diagnostic value of conventional sonography and ultrasound elastography for thyroid nodules of each Bethesda category and to analyze their potential role in the corresponding management decision. This retrospective study included 557 thyroid nodules diagnosed by conventional ultrasound (US) and real-time ultrasound elastography (RTE) before fine-needle aspiration (FNA) from 458 patients. The US, RTE, and cytological results were collected and analyzed according to different Bethesda categories. Differences in the distribution of sonographic features between groups were evaluated by the Chi-square test or Fisher exact test. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional US and RTE for the diagnosis of malignant nodules in each category were then calculated and analyzed. The diagnostic accuracy of the comprehensive US diagnosis in all categories stayed at a relatively high level from 78.4% to 88.6%, and good specificities ranging from 77.3% to 100% were revealed in all Bethesda categories. As to RTE, the diagnostic accuracies in categories I-IV stayed at a relatively low level ranging from 44.6% to 65.6% except for better performance in categories V and VI (85.2%, 89.1%). Besides, the accuracies of comprehensive US (85.2%, 88.6%) and RTE (85.2%, 89.1%) is relatively low compared to the corresponding cytological diagnoses in categories V and VI. Conventional US is complementary to FNA for providing additional hints especially in categories I-IV for further clinical managements, while RTE failed to provide useful diagnostic information in general.

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.

Sex Differences in Iliotibial Band Strain under Different Knee Alignments.

Increased strain of the iliotibial band (ITB) is a plausible contributing factor for the development of iliotibial band syndrome (ITBS). Although several studies have found relationships between the strain of the ITB and kinematic factors during running, the associations of the ITB strain with knee alignment and sex, which are considered intrinsic factors, are not well understood. To clarify the sex differences in the ITB strain between genu varum and normal knee alignments in different postures. Observational cross-sectional study. Laboratory research within a university. Forty-four healthy recreational athletes (21 men and 23 women) volunteered for this study and were divided into four groups by sex and knee alignment: men with genu varum alignment, men with normal knee alignment, women with genu varum alignment, and women with normal knee alignment. An ultrasound real-time elastography (RTE) unit was used for distal ITB strain measurements in weight bearing and for different non-weight-bearing: neutral, knee flexion, hip adduction, and hip adduction with knee flexion. Gender information and the intercondylar distance data were collected to divide the participants into two groups. Main Outcome was the ITB strain (strain ratio) measured by the RTE. There were no significant differences in neutral and hip adduction postures among the four groups. However, during weight-bearing, the women's genu varum group (6.91 ± 1.69; Mean ± SD) exhibited greater strain than both the men's normal group (3.50 ± 1.04, P = .005) and the women's normal group (4.42 ± 1.42, P = .048). In addition, there were significant positive correlations between the intercondylar distance and the ITB strain during weight-bearing (r = 0.315, P = .037). The women's genu varum group exhibited a higher ITB strain during weight-bearing, which may be related to the high incidence of ITBS in women athletes. Furthermore, the changes in alignment and muscle activities during weight-bearing could influence the strain of the ITB. III.

The liver fibrosis index is superior to the APRI and FIB-4 for predicting liver fibrosis in chronic hepatitis B patients in China

BackgroundThe purpose of this study was to prospectively investigate the value of real-time ultrasound elastography (RTE) for the diagnosis of liver fibrosis (LF) in patients with chronic hepatitis B (CHB), to correlate the elastography findings with the histologic stage of LF and to compare RTE findings with those from noninvasive tests of LF calculated using laboratory blood parameters.MethodsLiver biopsies, laboratory blood testing, and RTE were performed in 91 patients with CHB. The LF index (LFI) was calculated using a multiple linear regression equation involving 11 parameters, which represented the degree of LF. The higher the LFI is, the greater the degree of LF.ResultsThe mean aspartate aminotransferase-to-platelet ratio index (APRI) and the mean fibrosis index based on four factors (FIB-4) were significantly different for the 5 stages of LF, respectively. The APRI (r = 0.43, P = 0.006), FIB-4 (r = 0.51, P = 0.012) and LFI (r = 0.562, P = 0.004) were correlated with the stages of LF. For discriminating stage F0 from F1, only the LFI had significant power (P = 0.026) for predicting stage F1. For discriminating stage F4 from F3, only the LFI had statistically significant power (P = 0.024) in predicting stage F4. The areas under the receiver operating characteristic curves (AUCs) of the LFI for diagnosing significant, advanced LF and liver cirrhosis were significantly higher than those of the APRI and FIB-4, and the LFI had better sensitivity and specificity.ConclusionsThe LFI calculated by RTE is reliable for the assessment of LF in patients with CHB and has better discrimination power than the APRI and FIB-4.

Quantitative Analysis of Ultrasound Tissue Diffusion Elastography in The Diagnosis of Benign and Malignant Prostate Lesions.

This study aims to evaluate the value of quantitative analysis of ultrasound real-time tissue diffusion elastography in the diagnosis of benign and malignant prostate lesions. From March 2010 to June 2013, 52 patients suspected with prostate cancer based on laboratory or clinical test results and underwent prostate biopsy in our hospital were enrolled into this study. The age of these patients ranged between 45-82 years, with an average age of 67.2 ± 6.8 years. All patients underwent transrectal real-time ultrasound elastography (TRTE) before biopsy. A total of 63 prostate nodules were detected, and the 11 elastic characteristic quantities of these nodules were quantitatively analyzed via tissue diffusion quantitative analysis. The results of ultrasonography were compared with the results of operation and pathology. Among these 11 characteristic quantities, which include the mean (MEAN) and standard deviation (SD), blue area ratio (AREA%), complexity (COMP), kurtosis (KURT), skewness (SKEW), contrast (CONT), equality (ENT), entropy (IDM), consistency (ASM) and correlation (CORR), except for COMP and CORR, the differences in other nine characteristic quantities between benign and malignant prostatic nodules were statistically significant (P<0.05). Among these, the AREA% and MEAN had the highest correlation, which were 0.791 and -0.791, respectively. The Youden's index (sensitivity and specificity) of AREA% in the ROC curves was the highest, the cutoff value was 80.65% for the diagnosis of prostate cancer, sensitivity was 87.9%, and specificity was 96.6%. Quantitative analysis of ultrasound real-time tissue diffusion elastography is helpful in the diagnosis of benign and malignant prostate lesions, provides a relatively accurate evaluation method in clinical practice, and has broad application prospects.