Role Of Elastography Research Articles

Role of elastography in the differentiation of thyroid versus parathyroid lesions

Role of elastography in the differentiation of thyroid <i>versus</i> parathyroid lesions

Role of Elastography in Differentiating Malignant and Benign Thyroid Nodules using FNAC as a Reference Standard

Objective: To determine the efficacy of elastography in differentiating between malignant and benign thyroid nodules, using fine needle aspiration cytology (FNAC) as the reference standard. Methodology: This cross-sectional study was conducted at the Radiology Department of Nishtar Hospital, Multan, from January 2023 to December 2023. A total of 180 patients with one or more solid thyroid nodules diagnosed on conventional ultrasound were enrolled in the study. After obtaining consent, all patients underwent strain elastography under standard protocol, and the findings were compared with cytological results. Sensitivity was calculated using the formula: True Positives / (True Positives + False Negatives). Specificity was calculated as: True Negatives / (True Negatives + False Positives). Positive predictive value (PPV) was calculated as: True Positives / (True Positives + False Positives). Negative predictive value (NPV) was calculated as: True Negatives / (True Negatives + False Negatives). Diagnostic accuracy was determined using the formula: (True Positives + True Negatives) / (True Positives + True Negatives + False Positives + False Negatives). All these values were calculated using a 2x2 contingency table. Results: The study included a total of 180 patients with an average age of 46.38±12.21 years, 76.1% of whom were male and 23.9% female. Among the patients, 9.4% had malignant thyroid nodules, while 90.6% had benign nodules as determined by elastography and confirmed by FNAC. In terms of diagnostic accuracy, 13 patients were true positives (both positive on cytology FNAC and ultrasound elastography), whereas 7 patients were false positives (negative on cytology FNAC but positive on ultrasound elastography). Conclusion: Elastography has high efficacy in differentiating malignant from benign thyroid nodules and can potentially replace fine needle aspiration cytology (FNAC).

SDMS CME Credit – The Role of Elastography in Diagnosing Endometrial Pathology

SDMS CME Credit – The Role of Elastography in Diagnosing Endometrial Pathology

The Role of Elastography in the Evaluation of Disease Activity in Inflammatory Bowel Diseases

The Role of Elastography in the Evaluation of Disease Activity in Inflammatory Bowel Diseases

The Role of Elastography in Reducing Unnecessary Biopsies in BI-RADS 4a and 4b Breast Lesions

The Role of Elastography in Reducing Unnecessary Biopsies in BI-RADS 4a and 4b Breast Lesions

The Role of Elastography in Diagnosing Endometrial Pathology

Objective: The aim of this review was to provide a summary of literature and research on the use of elastography and its effectiveness in diagnosing endometrial pathology. Materials and Methods: An online database search produced 16 research articles. Inclusion criteria consisted of ultrasound elastography of benign and malignant endometrial pathology. Priority was given to articles focused on endometrial hyperplasia, polyps, and endometrial carcinoma. Results: The difference in stiffness between endometrial carcinoma and benign endometrial pathology, including lesions and hyperplasia, is statistically significant. High rates of sensitivity and specificity are seen in using elastography to determine endometrial carcinoma from a benign endometrial pathology. Conclusion: Elastography can provide valuable information to aid in diagnosing endometrial carcinoma. Currently, the standard of care for diagnosing endometrial pathology is 2D ultrasound imaging with tissue sampling and histology. Elastography imaging of the endometrium offers the opportunity to diagnose endometrial pathology without invasive tissue sampling procedures. While this exciting development offers great potential, there must be universal, consistent approaches and studies of subgroups to be considered the standard of care.

Poor correlation of 2D shear wave elastography and transient elastography in Fontan-associated liver disease: A head-to-head comparison.

Fontan-associated liver disease (FALD) is a long-term complication of the Fontan procedure. Guidelines recommend elastography, but the utility of transient elastography (TE) and two-dimensional shear wave elastography (2D SWE) is unknown. We aimed to evaluate the relationship between TE and 2D SWE in FALD. This prospective cohort study included 25 patients managed in a specialist clinic between January 2018 and August 2021. Trained clinicians performed 2D SWE (GE Logiq-E9) and TE (FibroScan 503 Touch) on the same day under the same conditions. Laboratory, echocardiography, and imaging data were collected. The atrioventricular systolic-to-diastolic duration (AVV S/D ratio) was calculated as a measure of cardiac diastolic function. We analyzed 40 paired measurements. Median age was 22 years. Median liver stiffness measurement (LSM) was 15.4 kPa (12.1-19.6) by TE and 8.0 kPa (7.0-10.3) (P = 0.001) by 2D SWE. There was weak correlation between the modalities (r = 0.41, P = 0.004). There was no correlation between time since Fontan and LSM by TE (r = 0.15, P = 0.19) or 2D SWE (r = 0.19, P = 0.13). There was no difference in LSM irrespective of whether sonographic cirrhosis was present or absent by TE (17.4 kPa [15.9-23.6] vs. 14.9 kPa [12.0-19.4], respectively, P = 0.6) or 2D SWE (9.0 kPa [2.8-10.5] vs. 8.0 kPa [6.7-10.1], P = 0.46). There was no correlation between AVV S/D ratio and LSM by TE (r = 0.16, P = 0.18) or 2D SWE (r = 0.02, P = 0.45). In FALD, TE and 2D SWE are poorly correlated. LSM by either modality was not associated with known risk factors for liver fibrosis or Fontan function. Based on these data, the role of elastography in FALD is uncertain.

The role of elastography in the assessment of thyroid nodules in acromegaly.

Nodular thyroid disease is a frequent finding seen in patients with acromegaly. Ultrasound-elastography (US-E) appears to be a helpful tool for the diagnosis of thyroid cancer. The aims of this study were to evaluate thyroid nodules in acromegaly and to assess the diagnostic accuracy of US-E in detecting thyroid cancer in this population. US-E was applied to 166 nodules detected in 102 acromegalic patients and to 105 nodules found in 95 nonacromegalic subjects. The lesions were classified according to the elasticity scores (ES) as soft (ES 1-2) or hard (ES 3-4). : Mean age was 55.1 ± 12.47 years [59 (58%) women]. The prevalence of hard nodules (ES 3 and 4) was significantly higher in the group of acromegalic patients than in control subjects (48% to 20%, p < 0.001). Mean ES was higher in patients with acromegaly (2.45 to 2.22, p: 0.001), however, the mean strain index (SI) was similar between groups (1.53 to 1.65, p: 0.204). Thyroid nodules in acromegaly patients have a higher elasto score and the prevalence of hard nodules is higher in active disease. However, increased stiffness of nodules by US-E in patients with acromegaly does not seem to estimate the malignancy of the nodules.

The Role of Elastography in Predicting the Grade of Mammary Ductal Carcinoma

Background: Elastography is an imaging technique which has been used in the last decades and its role in breast masses characterization is well established. However, its value for predicting breast cancer grading is yet to be studied. Objective: To determine the role of strain elastography in the prediction of the grade of mammary ductal carcinoma. Methods: A cross sectional study enrolled 44 female patients with Breast Imaging Reporting and Data System (BI-RADS) Category 5 breast mass. Complete B-mode and elastographic ultrasound examination of the breast was performed with evaluation of the elastoscore and strain ratio. Correlation with the detailed histopathological report was done for cases that were proved to be ductal type breast carcinoma. Results: Significant correlation was found between the speculated outline of the tumor and grade III tumor (p=0.03). Breast tumors with higher Elastography/B mode size ratio (&gt;1) and with high elasticity score (score 5) were significantly associated with grade III (p=0.02). The mean strain ratio of masses was significantly higher among grade III breast tumors (p&lt;0.001). Conclusion: Elastography is a helpful non-invasive tool that has the potential for predicting breast ductal carcinoma grade and by such predicting the prognosis. Keywords: Breast ductal carcinoma, strain elastography, ductal carcinoma grades Citation: Said TTM, Sheet AT, Nuaman BN. The role of elastography in predicting the grade of mammary ductal carcinoma. Iraqi JMS. 2022; 20(2): 233-238. doi: 10.22578/IJMS.20.2.10

In Search of an Imaging Classification of Adenomyosis: A Role for Elastography?

Adenomyosis is a complex and poorly understood gynecological disease. It used to be diagnosed exclusively by histology after hysterectomy; today its diagnosis is carried out increasingly by imaging techniques, including transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). However, the lack of a consensus on a classification system hampers relating imaging findings with disease severity or with the histopathological features of the disease, making it difficult to properly inform patients and clinicians regarding prognosis and appropriate management, as well as to compare different studies. Capitalizing on our grasp of key features of lesional natural history, here we propose adding elastographic findings into a new imaging classification of adenomyosis, incorporating affected area, pattern, the stiffest value of adenomyotic lesions as well as the neighboring tissues, and other pathologies. We argue that the tissue stiffness as measured by elastography, which has a wider dynamic detection range, quantitates a fundamental biologic property that directs cell function and fate in tissues, and correlates with the extent of lesional fibrosis, a proxy for lesional "age" known to correlate with vascularity and hormonal receptor activity. With this new addition, we believe that the resulting classification system could better inform patients and clinicians regarding prognosis and the most appropriate treatment modality, thus filling a void.

Liver Disease Assessment in Children with Fontan and Glenn Surgeries for Univentricular Hearts—The Role of Elastography and Biochemical Fibrosis Markers

Background: Children born with single-ventricle hearts require surgery in order to survive. Liver fibrosis is a known complication of Fontan surgery for univentricular hearts. Methods: In this study on 13 post-Fontan and 21 post-Glenn patients, we used elastography (shearwave and transient elastography) as well as serum biochemical fibrosis markers to evaluate the degree of liver fibrosis in comparison to 32 controls. Results: The mean Emedian and Vmedian values determined by shear wave elastography in the Fontan Group were significantly higher than the controls (4.85 kPa vs. 3.91 kPa and 1.25 m/s vs. 1.12 m/s, respectively). Fontan patients had significantly increased Fibrotest, Actitest, AST-to-Platelet Ratio index, ALT and GammaGT levels compared to controls. For post-Glenn patients, the mean Emedian and Vmedian values were similar to healthy controls, whereas the Fibrotest, Actitest and AST-to-Platelet Ratio index were significantly increased. Using transient elastography, we found significantly higher values for Emedian and Vmedian in Fontan patients compared to Glenn patients. Conclusions: Elastography and biochemical fibrosis markers are valuable non-invasive tools for screening and monitoring liver fibrosis in patients with Fontan and Glenn interventions.

The role of elastography in course of endobronchial ultrasound in the determination of lymph node rigidity: a retrospective study

article: The role of elastography in course of endobronchial ultrasound in the determination of lymph node rigidity: a retrospective study - Minerva Respiratory Medicine 2022 March;61(1):1-5 - Minerva Medica - Journals

Update on the role of elastography in liver disease.

The diagnosis of liver fibrosis and the assessment of its severity are important to provide appropriate management, to determine the prognosis or the need for surveillance. Currently, for fibrosis staging, liver stiffness measurement (LSM) with the shear wave elastography (SWE) techniques is considered a reliable substitute for liver biopsy in several clinical scenarios. Nonetheless, it should be emphasized that stiffness value is a biomarker of diffuse liver disease that must be interpreted taking into consideration anamnesis, clinical and laboratory data. In patients with diffuse liver disease, it is more clinically relevant to determine the likelihood of advanced disease rather than to obtain an exact stage of liver fibrosis using a histologic classification. In this regard, a 'rule of five' for LSMs with vibration-controlled transient elastography (VCTE) and a 'rule of four' for LSMs with the acoustic radiation force impulse (ARFI)-based techniques have been proposed. In patients with advanced chronic liver disease (CLD), the risk of liver decompensation increases with increasing liver stiffness value. SWE has been proposed as a tool to predict the risk of death or complications in patients with CLD. LSM by VCTE combined with platelets count is a validated non-invasive method for varices screening, with very good results in terms of invasive procedures being spared. ARFI-based techniques also show some promising results in this setting. LSM, alone or combined in scores or algorithms with other parameters, is used to evaluate the risk of hepatocellular carcinoma occurrence. Due to the high prevalence of CLD, screening the population at risk is of interest but further studies are needed.

The Role of Elastography in Fibroadenoma of the Breast and Differentiating it from its Mimics

Abstract Background Fibroadenomas are one of the most common benign diseases of the breast varying in number and size in all quadrants of the breast. Less than 2% of lesions with the typical ultrasound features of a fibroadenoma, are found to be malignant on biopsy. Aim of the Work To evaluate the diagnostic performance of combined ultrasonography and strain elastography and to compare the imaging characteristics of fibroadenomas with other benign and malignant mimics and assess the results by histopathological characteristics. Patients and Methods Type of Study: Cross-sectional study. Study Setting: The study was conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months (From March 2020 till September 2020). Study Population: Female Patients with breast lumps. Results Ultrasound elastography combined with B-mode ultrasonography had shown variable degrees of sensitivity and specificity. However, in our study it showed high sensitivity and specificity as compared to other studies. The most reliable tool in our study was the strain ratio having the highest sensitivity and specificity. Conclusion Strain elastography combined to B-mode sonography improves the diagnostic performance of differentiating benign from malignant well circumscribed breast lesions with an additional benefit of preventing unnecessary biopsies and speeding up the diagnosis of malignant lesions instead of follow up of the patient for early diagnosis of malignancies.

The usefulness of elastography in the evaluation and management of adult men with varicocele: A systematic review

ABSTRACT Objective To review the role of elastography in the evaluation and decision-making of adult, infertile men with varicocele. Methods A systematic search using the terms (Elastography) AND (Varicocele), (Stiffness) AND (Varicocele), (Elastography) AND (Male infertility) was performed in Pubmed/Medline. Studies reporting a) elastographic characteristics in varicocele-bearing comparing to normal testicles, and b) the correlation of elastography with varicocele grading, parameters of spermatogenesis, and outcomes of varicocele treatment were selected. Exclusion criteria were animal, adolescents, abstracts, and non-English language studies. Results In total, 453 articles were identified; 11 eligible studies were selected. Several modalities were used (shear wave elastography, strain elastography, quasistatic ultrasound elastography, acoustic radiation force impulse). Varicocele-bearing testicles have significantly different stiffness and elasticity in comparison to normal and non-varicocele testicles. Although not in full agreement, elastography readings are correlated with semen parameters. Conflicting results were reported regarding grading as most of the studies failed to demonstrate a significant correlation. Shear wave elastography showed a significant correlation with the improvement in semen parameters after varicocelectomy, but the association with pregnancy rates is unknown. Finally, no studies were identified comparing elastography with other modalities. Conclusions Elastography can detect changes in the architecture of varicocele-bearing testicles. Although the role of the modality in grading is uncertain, elastography showed a meaningful correlation with spermatogenesis parameters. Importantly, elastography readings could predict the improvement in semen parameters after varicocelectomy which is useful in terms of decision-making in infertile men with varicocele. Abbreviations ARFI: acoustic radiation force impulse; CDUS: colour Doppler ultrasonography; DWI: diffusion-weighted imaging; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SWE: shear wave elastography; VC: varicocele

Role of multiparametric ultrasound in testicular focal lesions and diffuse pathology evaluation, with particular regard to elastography: Review of literature.

Ultrasound is the main requested technique for the assessment of traumatic, vascular, neoplastic, and inflammatory testicular pathology. Moreover, the role of ultrasound has broadened over the years along with the introduction of new techniques, such as contrast enhanced ultrasound and ultrasound elastography. An updated representation of the pre-existing Literature evidence for multiparametric ultrasound imaging with particular regard to elastography, in the evaluation of focal and diffuse testicular pathologies, has been presented. The search was performed in PubMed, Cochrane, EMBASE, Web of Science and Scopus databases from the earliest available article (1977) until January 2021. Based on the evidence of the Literature, the current role of US imaging for focal and diffuse testicular pathologies has been reported and illustrated, with emphasis on examination technique, classification, and pitfalls. Multiparametric Ultrasound has a recognized role for testicle focal and diffuse disease. Elastography is nowadays recognized as an essential part of the multiparametric ultrasound examination. However, in the setting of testicular pathology this method showed some promising results in the setting of varicocoele and for focal lesions characterization. In the remaining field its role is still under debate. B-mode ultrasound and color Doppler ultrasound have been for a long time the diagnostic gold standard for testicular pathologies. The introduction of both contrast enhanced ultrasound and elastography in the last two decades has brought to the emergence of the multiparametric ultrasound concept. These methods are currently able to increase diagnostic confidence especially for testicular lesions characterization, with different relevance depending on the pathology under consideration. Multiparametric ultrasound testis assessment, with specific regard to elastography is nowadays recommended for focal and diffuse disease evaluation. Further and larger studies are however needed to validate these results and to understand if the role of elastography in testicular pathology may be broadened.

The role of elastography in non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and its prevalence is even higher in patients with risk factors such as type 2 diabetes and obesity. Liver biopsy is the gold standard for diagnosis of non-alcoholic steatohepatitis (NASH), particularly for the assessment of fibrosis stage that is a key prognostic factor. Noninvasive methods for assessment of liver fibrosis are a huge need in contemporary hepatology in order to stratify patient's risk of advanced and progressive liver disease. In this perspective different imaging techniques have been developed in last decades and showed high performance in liver fibrosis evaluation. Strengths and weaknesses of all imaging methods are summarized in this review.

Elastography—A Bona Fide Non-Invasive Method for Assessing Non-Alcoholic Fatty Liver Disease in Children

Pediatric obesity has become a major public health problem worldwide, resulting in a wide spectrum of systemic complications. Liver disease associated with obesity, also known as nonalcoholic fatty liver disease (NAFLD), is currently the most common chronic liver condition in children. Therefore, its timely and proper diagnosis is essential for preventing further development of cirrhosis. Multiple studies focused on identifying the most accurate non-invasive diagnostic method for liver fibrosis or cirrhosis. Although liver biopsy remains the gold-standard in terms of this hepatopathy, elastography methods emerged as a relatively reliable alternative to liver biopsy. Thus, recent studies revealed the great importance of these non-invasive methods not only in diagnosing pediatric NAFLD, but also in its staging. MRE is commonly considered to have a greater accuracy than ultrasound-based elastography methods, but with lower availability and higher costs. Ultrasound-based elastography methods (transient elastography (TE), p-SWE, and 2-dimensional shear wave elastography (2D-SWE)) were proved to have similar accuracy in NAFLD staging. Nevertheless, multiple confounding factors account for potential challenges when using elastography for liver stiffness measurement, such as age, obesity itself (i.e., BMI), transaminase levels, or portal flow. A potential solution for facing these challenges might be represented by a complex approach based on the combination between elastography, clinical and laboratory findings. Although the studies that assessed the role of elastography in pediatric NAFLD staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy. Therefore, elastography might become a cornerstone in staging pediatric NAFLD.

Study of role of elastography in the evaluation of breast lesions

Study of role of elastography in the evaluation of breast lesions

The role of elastography in alcoholic liver disease: fibrosis staging and confounding factors, a review of the current literature.

Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the USA population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD. A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included. According to reported data, patients with aspartate aminotransferase (AST)>100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values >5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e. active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad-hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate. We hope that our review article may serve as a reference point in the prospect of futures guidelines.