Sensitivity Of Shear Wave Elastography Research Articles

Erken Evre Karaciğer Fibrozisini Öngörmede Shear Wave Elastografinin Rolü

Aim: We examined the relationship between shear wave elastography (SWE) values and histopathological results in our study. Thus, we found the sensitivity of SWE in demonstrating early fibrosis. Materials and Methods: A total of consecutive 70 patients with chronic hepatitis B were prospectively evaluated. The patients included in fibrosis stages (F) 0, 1, 2, 3 and 4 according to Ishak scoring were examined with SWE. SWE measurements of F2, F3 and F4 patients who were found to have early stage fibrosis were compared with those of F0 and F1 patients. Results: The velocity+SD, and kPa+SD values in the group requiring treatment (F2, F3 and F4) were significantly higher than the group not requiring treatment (F0 and F1 )(p < 0.05). The sensitivity rate of the 1.85 cut-off value for velocity+SD was 53.8%, the positive prediction rate was 80.8%, the specificity rate was 83.3%, and the negative prediction rate was 58.1%. For kPa+SD, the cut-off value of 10.8 had a sensitivity rate of 51.3%, a positive prediction rate of 95.2%, a specificity of 96.7%, and a negative predictive rate of 60.4%. A significant correlation was observed between the fibrosis score and the kPa+SD distribution. Conclusion: SWE can differentiate the patients requiring treatment (F2, F3 and F4) from the patients not requiring treatment.

Acute Effects of Running on Shear Wave Elastography Measures of the Achilles Tendon and Calf Muscles in Professional Female Handball and Volleyball Players.

Shear Wave Elastography (SWE) is currently used to detect tissue pathologies, i.e., tendinopathy. For preventive medicine, it is important to examine the sensitivity of SWE and to investigate how stiffness measures are affected by methodological variables. The aim of this study is to examine shear wave elastography (SWE) measures in order to compare the pre- and post-running values and to determine the correlation between the shear wave speed values (m/s). SWE examinations of the Achilles tendon (AT), soleus muscle (MS) and gastrocnemius muscle (MG)) were performed in 24 healthy professional female athletes. Measurements of the shear wave speed (m/s) were taken before and after incremental treadmill running until exhaustion. Correlations were investigated using the Pearson correlation coefficient and were examined for significance using the Student's t-test. The pre- and post-exercise shear wave speed did not differ. The pre-exercise and post-exercise stiffness for MS (r = 0.613), MG (r = 0.609) and AT (r = 0.583) correlated strongly. The pre-exercise values and changes in stiffness showed a significant correlation (p < 0.001). In professional athletes, acute exercise induces different tissue stiffness changes in AT, MS and MG for each individual. Thus, exercise activity immediately prior to the SWE measurement needs to be factored in when evaluating tissue stiffness.

Effect of Anthropometric Parameters on Achilles Tendon Stiffness of Professional Athletes Measured by Shear Wave Elastography.

Shear wave elastography (SWE) is currently used to detect tissue pathologies and, in the setting of preventive medicine, may have the potential to reveal structural changes before they lead to functional impairment. Hence, it would be desirable to determine the sensitivity of SWE and to investigate how Achilles tendon stiffness is affected by anthropometric variables and sport-specific locomotion. To investigate the influence of anthropometric parameters on Achilles tendon stiffness using SWE and examine different types of sports to develop approaches in preventive medicine for professional athletes, standardized SWE of Achilles tendon stiffness was performed in 65 healthy professional athletes (33 female, 32 male) in the longitudinal plane and relaxed tendon position. Descriptive analysis and linear regression were performed. Furthermore, subgroup analysis was performed for different sports (soccer, handball, sprint, volleyball, hammer throw). In the total study population (n = 65), Achilles tendon stiffness was significantly higher in male professional athletes (p < 0.001) than in female professional athletes (10.98 m/s (10.15-11.65) vs. 12.19 m/s (11.25-14.74)). Multiple linear regression for AT stiffness did not reveal a significant impact of age or body mass index (BMI) (p > 0.05). Subgroup analysis for type of sport showed the highest AT stiffness values in sprinters (14.02 m/s (13.50-14.63)). There are significant gender differences in AT stiffness across different types of professional athletes. The highest AT stiffness values were found in sprinters, which needs to be considered when diagnosing tendon pathologies. Future studies are needed to investigate the benefit of pre- and post-season musculoskeletal SWE examinations of professional athletes and a possible benefit of rehabilitation or preventive medicine.

Diagnostic accuracy of shear wave elastography in the evaluation of solid breast lesions and its correlation with histopathology

Title: Diagnostic accuracy of shear wave elastography in evaluation of solid breast lesions & its correlation with histopathology. Background: To assess role of shear wave elastography in diagnosis of solid breast lesions with histopathological correlation. Materials and Methods: This cross-sectional analytical study was conducted in 50 patients from January 2021 to June 2022 in Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Results: Study group consisted of 50 individuals who presented to Department of Radiology for examination of breast for a solid tumor, ranging in age from 26 to 68 years. There were 27 malignant lesions among which 9 were Ductal Carcinoma insitu which is highest number seen in this study, 7 were Invasive ductal carcinoma, 6 were mucinous adenocarcinoma and 5 were Invasive lobular Carcinoma. Among 23 benign lesions, 47% were fibro adenomas followed by Mastitis (26%), Intraductal papilloma (17%), Adenosis (3%) and Intramammary lymph node. In this study sensitivity of shear wave elastography combined with USG was 95.24% & specificity was 97.37%. PPV & NPV values were 97.56% & 94.87% respectively. Mean elasticity value for predicting malignancy was 102.15 kpa & for benign was 41.12 kpa. Conclusion: A thorough grasp of the characteristics of each elastography technique enables accurate imaging and diagnosis, proving that elastography is a clinically valuable tool.

COMPARISON OF DIAGNOSTIC VALUE OF SHEAR WAVE ELASTOGRAPHY AND LIVER BIOPSY IN ASSESSING LIVER FIBROSIS

This prospective study was designed to compare the specificity and sensitivity ofshear wave elastography(SWE) and liver biopsy in liver fibrosis staging. The study was conducted at Bakhtawar Amin Trust Hospital Multan from July 2021 to July 2022. The study was conducted on 90 patients who underwent liver biopsy due to pathologies, including congenital liver diseases or as possible liver donors. An experienced radiologist performs shear wave elastography. An experienced histopathologist assessed biopsy specimens. The mean age of the patients was 30 years. Out of 90 patients, 16 (17.7%) had Hep B or C, 20 (22.2%) were liver donors, and 54 (60%) had other liver diseases. Elastography results showed mean liver stiffness in F0–F1, F2, F3, and F4 stage fibrosis to 5.48 ± .52 kPa, 8.22 ± .42 kPa, 9.56 ± .32 kPa, and 12.41 ± 2.9kPa, respectively. Results of liver biopsy and SWE were significantly correlated (p=.0001).Shear wave elastography is an effective tool for the assessment of liver fibrosis.

Comparing Myocardial Shear Wave Propagation Velocity Estimation Methods Based on Tissue Displacement, Velocity and Acceleration Data.

Shear wave elastography (SWE) is a promising technique used to assess cardiac function through the evaluation of cardiac stiffness non-invasively. However, in the literature, SWE varies in terms of tissue motion data (displacement, velocity or acceleration); method used to characterize mechanical wave propagation (time domain [TD] vs. frequency domain [FD]); and the metric reported (wave speed [WS], shear or Young's modulus). This variety of reported methodologies complicates comparison of reported findings and sheds doubt on which methodology better approximates the true myocardial properties. We therefore conducted a simulation study to investigate the accuracy of various SWE data analysis approaches while varying cardiac geometry and stiffness. Lower WS values were obtained by the TD method compared with the FD method. Acceleration-based WS estimates in the TD were systematically larger than those based on velocity (∼10% difference). These observations were confirmed by TD analysis of 32 in vivo SWE mechanical wave measurements. In vivo data quality is typically too low for accurate FD analysis. Therefore, our study suggests using acceleration-based TD analysis for in vivo SWE to minimize underestimation of the true WS and, thus, to maximize the sensitivity of SWE to detect stiffness changes resulting from pathology.

TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance?

PurposeTo assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules.Materials and methods128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05.ResultsSensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%).ConclusionStrain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.

Application of ultrasonic shear wave elastography and contrast-enhanced ultrasound in the differential diagnosis of patients with benign and malignant thyroid lesions.

Thyroid nodules are a common thyroid disorder. The aim of the present study was to observe the application value of ultrasonic shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of patients with benign and malignant thyroid lesions. Eighty-two patients with thyroid nodules (96 thyroid nodules) at our hospital were enrolled. All patients underwent ultrasonic SWE and CEUS examination. With surgical pathology as the gold standard, the Young's modulus, CEUS imaging features, and quantitative parameters were compared between the benign and malignant groups. The diagnostic efficiency of SWE, CEUS, and their combination was analyzed by receiver-operating characteristic curve (ROC). The average of the Young's modulus in the malignant group was significantly higher than that of the benign group (P<0.05). There were significant differences in the CEUS images of nodules between the benign and malignant groups in terms of boundary conditions, morphology, perfusion intensity, homogeneous enhancement, and perfusion defects (P<0.05), while there were no significant difference in initial increase time, peak intensity, time to peak, and area under the curve (P>0.05). The curve sharpness in the benign group was significantly lower than that of the malignant group (P<0.05). ROC analysis found that the diagnostic sensitivity and specificity of SWE, CEUS, and their combination were 90.1% and 81.6%, 67.8% and 75.4%, and 97.3% and 71.5%, respectively. Compared with CEUS, the sensitivity and specificity of SWE were relatively higher in the differential diagnosis of benign and malignant thyroid lesions, and a combination of both can improve the diagnostic sensitivity of SWE alone to a certain extent.

Shear wave elastography of the median nerve: A mechanical study.

Shear wave elastography (SWE) shows promise in peripheral neuropathy evaluation but has potential limitations due to tissue size and heterogeneity. We tested SWE sensitivity to elasticity change and the effect of probe position in a median nerve cadaver model. Ten specimens were used to measure median nerve elasticity under increasing loads using SWE and indentation. Measurements were compared using repeated-measures analysis of variance. Indentation and SWE-based longitudinal nerve elasticity increased with tensile loading (P < .01), showing a similar relationship. Acquisition in a transverse plane showed lower values compared with longitudinal measurements, mostly under higher loads (P = .03), as did postdissection elasticity (P = .02). Elasticity did not change when measured proximal to the carpal tunnel. Longitudinal SWE is sensitive to changes in median nerve elasticity. Measuring elasticity of peripheral nerves noninvasively could elucidate intra-neural pathology related to compression neuropathies, and proof to be of added value as a diagnostic or prognostic tool.

Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar Fasciitis

The current imaging standard for diagnosing plantar fasciitis is B-Mode ultrasound (B-US). The aim of this study was to determine the diagnostic potential of Shear Wave Elastography (SWE) and the correlation of clinical scores to elastographic parameters. Diagnostic case-control study with n = 82 plantar fascia (PF). PF were divided into three subgroups: (1) symptomatic PF (n = 39); (2) control group of unilateral asymptomatic PF (n = 23); (3) bilateral asymptomatic PF (n = 20). Reference standard for positive findings in B-US was a PF thickness greater than 4 mm. For SWE tissue elasticity (Young's modulus kPa; shear wave speed m/s) was measured at Location 1: directly at the calcaneus; Location 2: +1 cm distal of the calcaneus and Location 3: central part of the calcaneus. Sensitivity, specificity, and diagnostic accuracy as well as correlation to American Orthopaedic Foot and Ankle Score (AOFAS) and Food Functional Index (FFI) were determined. Symptomatic PF are thicker (4.2 mm, n = 39) than asymptomatic (3.0 mm, n = 43) (p < 0.001). Thickness of the PF (n = 82) correlated poorly to clinical scores (p = 0.001): FFI-pain (r = 0.349); FFI-function (r = 0.381); AOFAS (r = -0.387). Cut-off point for positive SWE finding was 51.5 kPa (4.14 m/s). Symptomatic PF (31.9 kPa, 3.26 m/s, n = 39) differ significantly from asymptomatic PF (93.3 kPa, 5.58 m/s, n = 43) with significant differences at L1 between all groups (p < 0.001). Correlation between Young's modulus (n = 82) and clinical scores was strong (p < 0.001): FFI-pain (r = -0.595); FFI-function (r = -0.567); AOFAS (r = 0.623,). B-US: sensitivity (61%), specificity (95%); SWE sensitivity (85%), specificity (83%). The combination of SWE and B-US increases the sensitivity (100%) with a diagnostic accuracy of 90%. Based on our results, we could show that SWE can improve the diagnostic accuracy in patients with plantar fasciitis compared to B-US. II.

Shear Wave Elastography of Breast Lesions: Quantitative Analysis of Elastic Heterogeneity Improves Diagnostic Performance

The aim of this study was to evaluate whether quantitative analysis of elastic heterogeneity (EH) could improve the diagnostic performance of shear wave elastography (SWE) in breast lesions. From August 2016 to August 2017, 280 patients were enrolled in this prospective study. All lesions were evaluated with the ultrasound Breast Imaging Reporting and Data System (BI-RADS) and SWE with Virtual Touch tissue imaging quantification. The shear wave velocity (SWV) of the three areas of highest stiffness and lowest stiffness within the lesions were measured to calculate the maximum SWV (SWVmax), mean SWV (SWVmean) and EH. The EH was determined as the difference between the averaged highest SWV and lowest SWV. The diagnostic performance—including the area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity of BI-RADS, EH, SWVmax and SWVmean—were analyzed. The AUC of EH, SWVmax and SWVmean were 0.963, 0.949 and 0.937, respectively. The sensitivity of EH was 93.75%, which was significantly higher than that of SWVmax (84.37%) and SWVmean (84.37%) (p < 0.001); there was no significant difference in the specificity among EH, SWVmax and SWVmean (p > 0.05). For category 4A lesions, EH predicted all the malignant lesions, while two cancers were misdiagnosed by SWVmax and SWVmean, respectively. Quantitative analysis of EH can improve the sensitivity of SWE for the differential diagnosis of breast lesions without loss of specificity.

Comparative Analysis of Diagnostic Value for Shear Wave Elastography and Real-Time Elastographic Imaging for Thyroid Nodules

Objective: To compare the diagnostic value of shear wave elastography (SWE) and real-time elastography (RTE) in the diagnosis of benign and malignant thyroid nodules. Methods: A total of 34 patients who ever received thyroidectomy in our hospital from January 2016 to January 2018 were identified. Meanwhile, all the patients received SWE and RTE before surgery, and all the diagnoses were confirmed by pathological examinations. With respect to SWE technique, the Subject Operating Characteristics (ROC) curves were drawn, in order to obtain the optimal threshold and then make differential diagnoses of benign and malignant thyroid nodules. In terms of RTE, the Rago 5 scoring method was utilized to make differential diagnoses of benign and malignant thyroid nodules. Besides, the pathological examinations after surgery could be considered as the golden standard. At last, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and RTE were calculated, respectively. Results: A total of 51 thyroid nodules were identified, and 41 nodules were benign, 10 nodules were malignant. On the basis of ROC curves, with respect to SWE, the best threshold for differential diagnosis of benign and malignant thyroid nodules is 38.3 kPa. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE were 72.7% (8/11), 85% (34/40), 82.4% (42/51), 68.4% (13/19), and 87.5% (35/40), respectively. And the diagnostic indicators of RTE were 81.8% (9/11), 87.5% (35/40), 84.3% (43/51), 73.7% (14/19), and 90.0% (36/40). The sensitivity of quasi-static elastography in differential diagnosis of benign and malignant thyroid nodules with diameter ≤1 cm was 87.5% (7/8), and the sensitivity of SWE was 50.0% (5/10). In addition, the accuracy of SWE in differential diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm was 100% (6/6), and the accuracy of RTE for this kind of thyroid nodules was 66.7% (4/6). Conclusion: Both SWE and RTE technology have good application value in differential diagnosis of benign and malignant thyroid nodules. But, SWE is preferable when making diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm, and RTE was superior in detecting benign and malignant thyroid nodules with diameter ≤1 cm.

A finite element model to study the effect of tissue anisotropy on ex vivo arterial shear wave elastography measurements

Shear wave elastography (SWE) is an ultrasound (US) diagnostic method for measuring the stiffness of soft tissues based on generated shear waves (SWs). SWE has been applied to bulk tissues, but in arteries it is still under investigation. Previously performed studies in arteries or arterial phantoms demonstrated the potential of SWE to measure arterial wall stiffness—a relevant marker in prediction of cardiovascular diseases. This study is focused on numerical modelling of SWs in ex vivo equine aortic tissue, yet based on experimental SWE measurements with the tissue dynamically loaded while rotating the US probe to investigate the sensitivity of SWE to the anisotropic structure. A good match with experimental shear wave group speed results was obtained. SWs were sensitive to the orthotropy and nonlinearity of the material. The model also allowed to study the nature of the SWs by performing 2D FFT-based and analytical phase analyses. A good match between numerical group velocities derived using the time-of-flight algorithm and derived from the dispersion curves was found in the cross-sectional and axial arterial views. The complexity of solving analytical equations for nonlinear orthotropic stressed plates was discussed.

Value of shear-wave elastography in the diagnosis of symptomatic invasive lobular breast cancer

To investigate the contribution of shear-wave elastography (SWE) in diagnosing invasive lobular breast cancer (ILC) in symptomatic patients. A retrospective case-controlled study of 52 patients with ILC and 52 patients with invasive ductal cancer (IDC), matched for age and tumour size, was performed. Breast density and mammographic and greyscale ultrasound features were graded using Breast Imaging-Reporting and Data System (BI-RADS) classification by two radiologists, blinded to SWE and pathology findings. Forty-four benign lesions were also included. The sensitivity of SWE was assessed, using a cut-off value of 50 kPa for mean elasticity. Statistical significance was evaluated using Chi-square and Chi-square for trend tests. Mean age for both ILC and IDC groups was 67 years. Mean size for ILC was 44 mm and IDC was 37 mm. The sensitivity for detection of ILC and IDC for mammography, greyscale ultrasound, and SWE were 79% versus 87%, 87% versus 98%, 94% versus 100%, respectively. SWE had significantly higher sensitivities than mammography for the detection of both ILC and IDC (p = 0.012 and p = 0.001, respectively). SWE was not significantly more sensitive than greyscale ultrasound for the detection of either tumour type. Four (8%) lobular cancers were benign/normal at both mammography and greyscale ultrasound, but suspicious on SWE. The incremental gain in sensitivity by using SWE in ILC was statistically significant compared to IDC (p = 0.01). SWE can diagnose lobular cancers that have benign/normal findings on conventional imaging as suspicious.

Quantitative comparison of transient elastography (TE), shear wave elastography (SWE) and liver biopsy results of patients with chronic liver disease.

[Purpose] The purpose of this study was to carry out a comparitive analysis of hepatic fibrosis results of the liver hardness of patients with chronic liver disease as measured by elastography (TE), shear wave elastography (SWE), and liver biopsy. [Subjects and Methods] This study was a retrospective analysis of 304 patients who underwent SWE and TE before and after liver biopsy, taken from among patients who had been checked for liver fibrosis by liver biopsy between August 2013 and August 2014. We used receiver operating characteristic (ROC) curve to prove the diagnostic significance of liver stiffness, and then analyzed the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and TE, as well as the kappa index through cross-analysis of SWE, TE, and liver biopsy. [Results] For liver hardness, the sensitivity of SWE was 84.39%, the specificity of SWE was 97.92%, the accuracy of SWE was 87.33%, the positive predictive value of SWE was 99.32%, and the negative predictive value of SWE was 63.51%. The sensitivity of TE was 94.80%, the specificity of TE was 77.08%, the accuracy of TE was 90.95%, the positive predictive value of TE was 93.97%, and the negative predictive value of TE was 80.43%. [Conclusion] It is our opinion that SWE and TE are non-invasive methods that are more effective than the invasive methods used for diagnosing liver hardness. Invasive methods cover only a section of liver tissue, and are more likely to cause side effects during biopsy.