Real-time Ultrasound Elastography Research Articles

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.

Real-time ultrasound elastographic evaluation of extraocular muscle involvement in Graves’ ophthalmopathy

ABSTRACTPurpose: To evaluate the affected extraocular muscles (EOMs) of patients with Graves’ ophthalmopathy (GO) using real-time ultrasound elastography (UE) and to compare these results with those of healthy subjects.Methods: This prospective, comparative case series included 70 eyes of 35 patients with moderate-to-severe GO with type 2 orbitopathy (myogenic variant) according to their computed tomography (CT) scans. Forty-six eyes of 23 healthy subjects were evaluated as the control group. The strain ratio of orbital fat to medial rectus was calculated as the ratio of the medial rectus to orbital fat tissue, and the strain ratio of orbital fat to lateral rectus was calculated as the ratio of lateral rectus to orbital fat tissue.Results: The strain ratio of orbital fat to medial rectus was 3.03 ± 1.25 (range: 1.05–5.07) in the GO group, and 0.54 ± 0.20 (range: 0.14–1.08) in the control group (p = .0001). The strain ratio of orbital fat to lateral rectus was 0.97 ± 0.29 (range: 0.56–1.55) in the GO group, and 0.63 ± 0.23 (range: 0.18–1.09) in the control group (p = .0001).Conclusion: By using real-time UE, we found the medial and the lateral recti of GO patients to be stiffer compared to those of healthy subjects.

Sa1735 – Baseline Bowel Stiffness on Real-Time Shear Wave Ultrasound Elastography Predicts Response to Infliximab in Patients with Crohn's Disease

Sa1735 – Baseline Bowel Stiffness on Real-Time Shear Wave Ultrasound Elastography Predicts Response to Infliximab in Patients with Crohn's Disease

Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome?

Nonalcoholic fatty liver disease is the commonest diffuse liver disease, of which women with polycystic ovary syndrome are at an increased risk. The aim of the present study was to assess the diagnostic value of the semiquantitative strain parameters of real-time ultrasound elastography for nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Thirty-five polycystic ovary syndrome patients with nonalcoholic fatty liver disease, 70 polycystic ovary syndrome patients without nonalcoholic fatty liver disease, and 70 healthy female controls of reproductive age were included. All participants underwent ultrasonic examination and semiquantitative analysis of real-time ultrasound elastography of the liver. Main semi quantitative strain parameters, such as average strain value, differed significantly among groups polycystic ovary syndrome with nonalcoholic fatty liver disease, polycystic ovary syndrome without nonalcoholic fatty liver disease, and control (87.02 ± 10.16 vs. 96.31 ± 11.44 vs. 104.49 ± 7.28, p < 0.001). Clinical and laboratory parameters differed significantly between the two subgroups with low or high average strain value. For diagnostic value of average strain value for elevated aminotransferase, the area under the curve was 0.808 (range 0.721-0.895). In multiple linear regression analysis, polycystic ovary syndrome, waist circumference, and metabolic syndrome were stand-alone independent factors associated with average strain value among subjects without nonalcoholic fatty liver disease. Semiquantitative real-time ultrasound elastography analysis could distinguish liver parenchyma alterations in patients with polycystic ovary syndrome more sensitively. The diagnostic value of the proposed method for nonalcoholic fatty liver disease need further research.

A Comparison Study of Real-Time Ultrasound Elastography and Electron Microscopy for the Assessment of Liver Damage Induced by Brain Death

The aim of this study was to investigate the specificity and sensitivity of real-time ultrasound elastography (RTE) in the evaluation of liver damage induced by brain death and the correlation with ultrastructural changes in liver tissue. Eleven RTE parameters before brain death and at 0, 3, 6 and 9 h after brain death in 12 miniature pigs were collected and analyzed, and the correlation of these parameters with electron microscopy results was explored. Six of the RTE parameters, namely, mean relative strain value within the region of interest, standard deviation of the relative strain value within the region of interest, area of low strain within the region of interest, complexity of low strain area within the region of interest, skewness and correlation, significantly differed among the time periods. Categorical data were analyzed using the χ2-test. Spearman's correlation analysis was used for evaluating correlations between RTE parameters and electron microscopy results, and the correlation coefficients (r) were calculated. Electron microscopy results revealed that liver damage gradually increased after brain death, with significant differences between 0 and 9 h (χ2 = 14.143, p value = 0.027). In addition, the six aforementioned RTE parameters significantly correlated with electron microscopy results, with the mean relative strain value within the region of interest being the strongest (r = –0.59, p value < 0.001) correlated parameter. RTE could provide preliminary assessment of liver damage induced by brain death, and correlates to ultrastructural changes in liver tissue.

The diagnostic value of elastography score and strain index for the evaluation of thyroid micronodules

Background/aim: In the general population, the frequency of thyroid micronodules is increasing, and the prevalence of malignancy is higher for such nodules. Ultrasonography findings of these nodules are neither specific nor sensitive. The aim of this study was to investigate the diagnostic value of elastography in patients with thyroid micronodules. Materials and methods: A total of 224 patients with thyroid micronodules were recruited in this prospective study. All patients underwent a thyroid fine-needle aspiration biopsy. Elastography scores (ESs) and strain indexes (SIs) were measured with real-time ultrasound elastography. Results: Malignant micronodules had higher ES and SI values than those of benign micronodules (P < 0.001). When ES was used to diagnose malignancy, scores of >3 showed sensitivity of 79.4% and specificity of 98.1%. The area under the curve (AUC) for ES was 0.888 (P < 0.001). The optimal SI cutoff value that differentiated benign from malignant micronodules was 3.06 (98% sensitivity; 91% specificity). The AUC for SI was 0.970 (P < 0.001). Conclusions: ES and SI are beneficial markers for detecting malignant thyroid micronodules. We showed that SI is better than ES when assessing the malignancy of thyroid micronodules.

Real-time ultrasound elastography evaluation of achilles tendon properties in patients with mild hemiplegic stroke after rehabilitation training.

This study aims to evaluate the Achilles tendon's properties after rehabilitation training in patients with stroke using real-time ultrasound elastography. A total of 24 patients with mild hemiplegic stroke in the past 6 to 12 months and unilateral lower limb movement disorder were prospectively enrolled. All patients accepted 9-week rehabilitation training with the same schema. The 2-dimensional elastography and real-time elastography findings in the impaired and contralateral normal Achilles tendon were measured at pretraining and at 3, 6, and 9 weeks after training, which included tendon length, thickness, elasticity score (grade 1-3), and strain ratio of fat to tendon. The functional properties, which include the 10-meter walk test and timed up-and-go scores, were evaluated before and after the 9-week training. The impaired Achilles tendon had a longer length (P = .002), lower frequency of grade 1 (P = .012), and lower strain ratio (P = .009) than the contralateral tendon before training. The impaired tendons at the third, sixth, and ninth weeks after training were compared to ones before training, respectively, which revealed shorter length, increased frequency of grade 1, and increased strain ratio. The first statistically significant changes in the length were observed at the sixth week, while such changes in elasticity score and strain ratio were observed at the ninth week. Two-dimensional elastography and real-time elastography can provide valuable imaging markers for quantitatively evaluating the Achilles tendon's properties after rehabilitation training in patients with stroke.

Clincal value of real-time ultrasound elastography in the diagnosis of thyroid nodules

Objective To explore the clinical value of real-time ultrasound elastography in the diagnosis of thyroid nodules, and to provide reference for the clinical diagnosis and treatment of patients with thyroid nodular lesions. Methods The clinical data of 62 patients with thyroid nodule occupying lesions were retrospectively analyzed.The results of real-time ultrasound elastography imaging and pathological diagnosis were compared, and the accuracy, sensitivity and specificity of real-time ultrasound elasticity imaging in the diagnosis of thyroid nodular lesions were analyzed. Results The patients with elastic grade 0, pathological examination showed follicular adenoma cystic degeneration; The patients with elastic gradeⅠ, pathological examination showed follicular hyperplastic nodules; The patients with elastic grade Ⅱ, pathological examination showed follicular gland tumor; The patients with elastic grade Ⅲ, pathological examination showed papillary adenocarcinoma; The patients with elastic grade Ⅳ, pathological examination showed papillary adenocarcinoma.In patients with elastic grade 0, 3 patients had proliferative nodules, and 5 cases were follicular adenomas.Among the patients with grade Ⅰ, 5 cases were proliferative nodules, 8 cases were follicular adenoma, 1 case of papillary adenocarcinoma; of grade Ⅱ patients, 6 cases of proliferative nodules, 14 cases of follicular adenoma, 2 cases of papillary adenocarcinoma.Among the patients with grade Ⅲ, 4 cases were follicular adenomas, and 6 cases were papillary adenocarcinomas.Among the patients with grade Ⅳ, 3 cases were follicular adenomas, 7 cases were papillary adenocarcinomas.The diagnostic accuracy of real-time ultrasound elastography was 93.5%, and the difference was not statistically significant(P>0.05). The sensitivity and specificity of real-time ultrasound elastography were 100.0% and 72.6%. Conclusion Real-time ultrasound elastography has high accuracy in the diagnosis of benign and malignant lesions of thyroid nodules, it is worthy of being widely promoted. Key words: Thyroid diseases; Ultrasonography, doppler, duplex; Diagnosis

Real-Time Shear Wave Ultrasound Elastography Differentiates Fibrotic from Inflammatory Strictures in Patients with Crohn's Disease.

The distinction of intestinal fibrosis from inflammation in Crohn's disease (CD) associated strictures has important therapeutic implications. Ultrasound elastography is useful in evaluating the degree of fibrosis in liver, but there is little evidence whether it can assess fibrosis in the bowel. We determined whether shear-wave elastography (SWE), a novel modification of elastography, quantifying tissue stiffness, could differentiate between inflammatory and fibrotic components in strictures of patients with CD. Consecutive CD patients with ileal/ileocolonic strictures who underwent SWE within 1 week to surgical resection were enrolled. The SWE value of the stenotic bowel wall was compared to the grade and severity of fibrosis and inflammation, respectively, in the resected bowel specimen. Thirty-five patients were enrolled. The mean SWE value of stenotic bowel wall was significantly higher in severe fibrosis (23.0 ± 6.3 Kpa) than that in moderate (17.4 ± 3.8 Kpa) and mild fibrosis (14.4 ± 2.1 Kpa)(P = 0.008). Using 22.55 KPa as the cutoff value in discriminating between mild/moderate and severe fibrosis, the sensitivity and specificity was 69.6 % and 91.7% with an area under the curve (AUC) of 0.822 (P = 0.002). However, no significant difference regarding mean SWE existed among different grades of inflammation. The sensitivity and specificity of bowel vascularization score on conventional ultrasound in differentiating severe inflammation from mild/moderate was 87.5 % and 57.9% with AUC of 0.811 (P = 0.002). Combining SWE and conventional ultrasound (bowel vascularization score), we propose a bowel ultrasound classification of intestinal strictures. A moderate agreement between ultrasound and pathological classification was observed (κ = 0.536, P＜0.001). This pilot study suggests that SWE is feasible and accurate in detecting intestinal fibrosis in patients with CD. After validation, combing SWE and bowel vascularization on conventional ultrasound might be applied to guide a management strategy in CD patients through defining the type of intestinal stricture. 10.1093/ibd/izy115_video1izy115.video15777734754001.

Endoscopic Ultrasound Real-Time Elastography in Liver Disease.

See the article "A Prospective Blinded Study of Endoscopic Ultrasound Elastography in Liver Disease: Towards a Virtual Biopsy" in Volume 51 on page 181.

A Prospective Blinded Study of Endoscopic Ultrasound Elastography in Liver Disease: Towards a Virtual Biopsy.

Background/AimsLiver biopsy has traditionally been used for determining the degree of fibrosis, however there are several limitations. Endoscopic ultrasound (EUS) real-time elastography (RTE) is a novel technology that uses image enhancement to display differences in tissue compressibility. We sought to assess whether liver fibrosis index (LFI) can distinguish normal, fatty, and cirrhotic liver tissue. MethodsA total of 50 patients undergoing EUS were prospectively enrolled. RTE of the liver was performed to synthesize the LFI in each patient. Univariate and multivariable analyses were performed. Chi-square and t-tests were performed for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant. ResultsAbdominal imaging prior to endoscopic evaluation suggested normal tissue, fatty liver, and cirrhosis in 26, 16, and 8 patients, respectively. Patients with cirrhosis had significantly increased mean LFI compared to the fatty liver (3.2 vs. 1.7, p<0.001) and normal (3.2 vs. 0.8, p<0.001) groups. The fatty liver group showed significantly increased LFI compared to the normal group (3.8 vs. 1.4, p<0.001). Multivariable regression analysis suggested that LFI was an independent predictor of group features (p<0.001). ConclusionsLFI computed from RTE images significantly correlates with abdominal imaging and can distinguish normal, fatty, and cirrhotic-appearing livers; therefore, LFI may play an important role in patients with chronic liver disease.

Value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients

Objective To assess the value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients. Methods Sixty-four elderly patients suspected of prostate cancer (PCA) were enrolled from December 2015 to December 2016.Sixty-four patients with 72 nodules underwent transrectal ultrasound (TRUS), contrast-enhanced transrectal ultrasound (CETRUS) and transrectal real-time tissue elastography (TRTE). A combination of systematic biopsy and suspicious site-targeted biopsy was conducted.The accuracies of different detection methods for prostate cancer were assessed against the gold standard of histological examination of prostate biopsy samples. Results Among the 72 nodules, 31 were prostatic hyperplasia, 5 were chronic prostatitis, 35 were prostatic cancer, and one was prostatic lymphoma.There were significant differences in enhancement strength, enhancement time fast-in and degree of elasticity on TRTE and CETRUS between the malignant and benign groups (χ2=28.794, 10.889, 52.898; P=0.000, 0.001, 0.000, respectively). When the 35 PCA nodules were divided into two subgroups based on the Gleason score, there were statistically significant differences in enhancement strength, homogeneity of enhancement, and enhancement time fast-in and fast-out between them (χ2=6.073, 12.315, 4.717, 18.093; P=0.048, 0.001, 0.030, 0.000, respectively). The combination of CETRUS and TRTE in diagnosing prostate nodules produced a sensitivity of 83.3%, a specificity of 86.1%, an accuracy of 84.7%, a positive predictive value of 85.7%, and a negative predictive rate of 83.8%, better than either method alone. Conclusions Multi-modal image-guided transrectal ultrasonography has an advantage in providing information on the perfusion and elasticity of prostate nodules in the elderly patients and thus has important clinical value for the diagnosis of prostate nodules. Key words: Prostatic neoplasms; Ultrasonography; Contrast media; Elasticity imaging techniques

Preliminary study of confounding factors of elastography and the application of fine-needle aspiration in thyroid nodules with indeterminate elastography

To investigate confounding factors of real-time ultrasound elastography (RTE) and to evaluate the diagnostic performance of ultrasound (US)-guided FNA for thyroid nodules with indeterminate elastography compared with conventional US. This study included 244 nodules with indeterminate elastography caused by several confounding factors (large or small size, deep location, isthmic or paratracheal location, calcification, thyroiditis, conflicting results between conventional US and RTE), and corresponding prevalences of malignancy were calculated. Additionally, conventional US and US-FNA data were collected and compared. The prevalences of malignancy of confounding factors were 74.1%, 75.0%, 73.3%, 46.2%, 27.3%, and 53.2%, respectively. Sonographic features (border, margin, echogenicity, echohomogeneity, and microcalcification) were significantly different between benign and malignant thyroid nodules (p < 0.05), and most of them exhibited good sensitivity but unsatisfactory specificity and accuracy. While US-FNA exhibited better performance with a sensitivity of 96.9%, a specificity of 99.1% and an accuracy of 98.0% in the diagnosis of malignancy. Given that indeterminate RTE is inevitable with a rather high malignant risk due to several confounding factors, our study revealed that US-FNA was a valuable tool in nodules with indeterminate elastography by increasing the detection rate of thyroid malignancy.

Evaluation of Early Kidney Damage Caused by Brain Death Using Real-Time Ultrasound Elastography in a Bama Pig Model

The aim of this study was to investigate the value of real-time tissue elastography (RTE) in the evaluation of early graft damage resulting from brain death. We performed RTE before and 0, 3, 6 and 9 h after brain death in a Bama pig model. Eleven RTE parameters were compared among time groups, and their correlations with electron microscopic findings were analyzed. Receiver operating characteristic curve analysis was used to find the RTE parameter cutoff values. The mean relative strain value within the region of interest (MEAN), standard deviation of the relative strain value within the region of interest (SD), percentage area of low strain within the region of interest (%AREA), complexity of low-strain area within the region of interest (COMP), kurtosis (KURT), skewness (SKEW), contrast (CONT) and entropy (ENT) and inverse difference moment (IDM) differed statistically significantly between groups (p < 0.05). Electron microscopy of kidney tissue revealed that irreversible damage gradually occurred with longer brain death duration and was marked at 9 h (p < 0.05). These findings correlated best with MEAN (r = 0.632, p ＜ 0.05). Receiver operating characteristic curve analysis of RTE parameters identified a cutoff value of 63.43 for MEAN for optimal diagnostic performance. RTE allows non-invasive, preliminary evaluation of early renal graft damage resulting from brain death.

Evaluation of liver damage caused by brain death with real-time ultrasound elastography on Ba-Ma pig

Objective To investigate the value of real-time ultrasound elastography (RTE) in the evaluation of liver damage caused by brain death. Methods Establish brain death model on 11 Ba-Ma pigs (either gender, weigh 30-35 kg). Ran RTE respectively before the model have been established which defined as control group, when brain death predicated, 3, 6, 9 h after brain death; one-way ANOVA test analyze of 11 parameters of different groups, correlation analysis of electronic speculum results and RTE; receiver operating characteristic (ROC) curve analyze of RTE parameters’ cut-off value. Results Among 11 parameters, the mean relative strain value within the region of interest (ROI) (MEAN), standard deviation of the relative strain value within the ROI (SD), area of low strain within the ROI (%AREA), complexity of low strain area within the ROI (COMP), skewness (SKEW), correlation (CORR) were statistically significant differences between groups (P=0.000), MEAN decreased from 117.20±8.74 to 93.30±3.76 with time (P=0.000); electronic speculum of liver tissue results show that the damage gradually irreversible with the extension of brain death time, there is significant difference between 9 h and 0 h group (P=0.027); the correlation between MEAN and electronic speculum is the highest (r=0.59, P=0.000); ROC curve analyze RTE parameters cut-off value between before and after 9 h, the critical value of MEAN is 99.82. Conclusion Liver damage of brain death gradually increased, RTE is a noninvasive method to preliminary evaluation of liver damage and has a good correlation with electronic speculum results. Key words: Real-time ultrasound elastography; Electronic speculum; Brain death animal model; Liver damage

Real-time ultrasound elastography of the Achilles tendon in patients with cerebral palsy: is there a correlation between strain ratio and biomechanical indicators?

Our aim was to comparatively investigate the strain ratio and thickness of the Achilles tendon in children with cerebral palsy (CP), and to elucidate whether there is a correlation between biomechanical features of the Achilles tendon and strain ratio. A total of 155 participants (72 CP patients and 83 healthy controls) who underwent real-time elastography of both Achilles tendons were studied. A linear transducer (4.8-11.0MHz) was used to obtain the images. Correlation analysis between age, length, and thickness of the Achilles tendon, and strain ratio (SR) was performed by means of Pearson correlation and Spearman's rho tests. Comparison of results obtained from CP patients and controls showed that the length of the Achilles tendon was shorter (p<0.001) and SR was higher (p<0.001) in CP patients. In CP patients, there was a positive correlation between SR and age and between SR and the thickness and length of the Achilles tendon (p<0.001 for all). Furthermore, the length of the tendon and age were positively associated (p<0.001). ROC analysis revealed that the cut-off value for SR was 1.89. The results of the present study demonstrated that real-time elastography can constitute a simple, practical, and noninvasive method for evaluation of the elasticity of the Achilles tendon in children with CP.

Association of Renal Elasticity and Renal Function Progression in Patients with Chronic Kidney Disease Evaluated by Real-Time Ultrasound Elastography

Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal elasticity. This study was designed to evaluate the predictive ability of renal elasticity in patients with chronic kidney disease (CKD). 148 non-CKD patients and 227 patients with CKD were recruited. 145 (38.7%) were female, 166 (73.1%) had diabetes, the mean estimated glomerular filtration rate (eGFR) was 33.9 ± 15.8 ml/min/1.73 m2 and the median urinary protein-to-creatinine ratio (UPCR) 502 (122–1491) mg/g. Patients with later stages of CKD had lower renal elasticity values, indicating stiffer kidneys (p < 0.001), and smaller kidney (p < 0.001). Renal elasticity correlated with log-transformed UPCR (β = −7.544, P < 0.001). Renal length correlated with age (β = −0.231, P < 0.001), sex (β = −3.730, P < 0.001), serum albumin level (β = −3.024, P = 0.001), body mass index (β = 0.390, P = 0.009) and eGFR (β = 0.146, P < 0.001). In fully-adjusted logistic regression model, the odds ratio (OR) per 10 unit change in renal elasticity for rapid renal deterioration was 0.928 (95% CI, 0.864–0.997; P = 0.042). The OR per 1 mm change in renal length for rapid renal deterioration was 1.022 (95% CI, 0.994–1.050; P = 0.125). Renal elasticity is associated with proteinuria and rapid renal deterioration in patients with CKD.

Ultrasound and 2D-Shear Wave Elastography Images in a Rare Case of Papillary Thyroid Carcinoma Associated with Intrathyroidal Metastases from a Colon Cancer

Intrathyroidal metastases from a colon cancer are uncommon, although the precise incidence is unknown. The coexistence of a primary thyroid malignancy with metastases from colon cancer is quite rare. Real-time shear wave ultrasound elastography 2D (2D-SWE) represents a technique that assesses the elasticity and the stiffness of different tissues. Case presentation. We report a 57-year-old female patient who was admitted in the Clinic of Endocrinology due to multinodular goiter. At presentation, the patient was recently diagnosed with pulmonary and bone lesions, being suspected for metastases. The clinical exam detected a firm multinodular goiter, with a reduced movement at swallowing. Ultrasound examination of the thyroid detected at least five nodules. One of them, located in the upper part of right thyroid lobe was hypoechoic, with infiltrative margins that overpass the thyroid capsule and absence of vascularization. Elastogram of this nodule indicated an inhomogeneous aspect with areas of high stiffness. In the upper part of left lobe another hypoechoic nodule was detected, with regular margins and perinodular vascularization. The 2D-SWE indicated low stiffness in this last nodule. The patient was operated and the pathological exam revealed a papillary thyroid carcinoma in the first nodule and a metastasis from a colon cancer in the second one. Ultrasound and 2D-SWE of this rare association is depicted in this paper, with quite different aspects of the two analyzed lesion, suggesting a different pathology.