Elastography Research Articles

The Impact of Silent Liver Disease on Hospital Length of Stay Following Isolated Coronary Artery Bypass Grafting Surgery.

Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.5 kPa would rule out a short hospital length of stay (LOS < 6 days) following isolated coronary artery bypass grafting (CABG) surgery. Methods: A prospective observational study of one hundred sixty-four adult patients undergoing non-emergent isolated CABG surgery at a single university hospital center. Preoperative liver stiffness measured by ultrasound elastography was obtained for each participant. Multivariate logistic regression models were used to assess the adjusted relationship between LSM and a short hospital stay. Results: We performed multivariate logistic regression models using short hospital LOS (<6 days) as the dependent variable. Independent variables included LSM (< 9.5 kPa, ≥ 9.5 kPa), age, sex, STS predicted morbidity and mortality, and baseline hemoglobin. After adjusting for included variables, LSM ≥ 9.5 kPa was associated with lower odds of early discharge as compared to LSM < 9.5 kPa (OR: 0.22, 95% CI: 0.06-0.84, p = 0.03). The ROC curve and resulting AUC of 0.76 (95% CI: 0.68-0.83) suggest the final multivariate model provides good discriminatory performance when predicting early discharge. Conclusions: A preoperative LSM ≥ 9.5 kPa ruled out a short length of stay in nearly 80% of patients when compared to patients with a LSM < 9.5 kPa. Preoperative liver stiffness may be a useful metric to incorporate into preoperative risk stratification.

Shear wave trajectory detection in ultra-fast M-mode images for liver fibrosis assessment: A deep learning-based line detection approach

Stiffness measurement using shear wave propagation velocity has been the most common non-invasive method for liver fibrosis assessment. The velocity is captured through a trace recorded by transient ultrasonographic elastography, with the slope indicating the velocity of the wave. However, due to various factors such as noise and shear wave attenuation, detecting shear wave trajectory on wave propagation maps is a challenging task. In this work, we made the first attempt to use deep learning methods for shear wave trajectory detection on wave propagation maps. Specifically, we adopted five deep learning models in this task and evaluated them by using a well-acknowledged metric based on EA-Angular-Score (EAA) and task-specific metric based on Young s-Score (Ys) in the line-detection field. Furthermore, we proposed an end-to-end framework based on a Transformer and Hough transform, named Transformer-enhanced Hough Transform (TEHT). It took a wave propagation map as input image and directly output the slope of the shear wave trajectory. The framework extracts multi-scale local features from wave propagation maps, employs a deformable attention mechanism for feature fusion, identifies the target line using the Hough transform’s voting mechanism, and calculates the contribution of each scale through channel attention. Wave propagation maps from 68 patients were utilized in this study, with manual annotation performed by a rater who was trained as a radiologist, serving as the reference value. The evaluation revealed that the SLNet model exhibited F-measure of EA and Ys values as 40.33 % and 40.72 %, respectively, while the TEHT model showed F-measure of EA and Ys values as 80.96 % and 98.00 %, respectively. TEHT yielded significantly better performance than other deep learning models. Moreover, TEHT demonstrated strong concordance with the gold standard, yielding R2 values of 0.967 and 0.968 for velocity and liver stiffness, respectively. The present study therefore suggests the application of the TEHT model for assessing liver fibrosis owing to its superiority among the five deep learning models.

Elastography of the Male Pelvic Region-Perspectives on Malignant Lesions.

Ultrasound elastography is widely used to assess tissue stiffness for lesion characterization, including differentiation between benign and malignant lesions. This study focuses on the use of elastography in the male pelvis, including the prostate, testicles, and rectum, by comparing elastography types (shear wave and strain). This article provides a summary of the existing literature on the use of elastography in the male pelvic region and outlines the clinical perspective. Ultrasound elastography is a good technique for evaluating and monitoring lesions in the male pelvic region.

Soft tissue elasticity at teeth and implant sites. A novel outcome measure of the soft tissue phenotype.

To assess ultrasonographic tissue elasticity at teeth and implant sites and its variation after peri-implant soft tissue augmentation with a connective tissue graft (CTG). Twenty-eight patients, each contributing with one clinically healthy dental implant exhibiting a soft tissue dehiscence (PSTD), were included. Implant sites were augmented with CTG and monitored over 12 months. Ultrasonographic strain elastography, expressed as strain ratios (SR1, SR2, and SR3, respectively) was assessed at baseline, 6-, and 12-month, and compared with the corresponding contralateral homologous natural tooth. SR1 assessed the strain/elasticity of the midfacial coronal portion of the soft tissue in comparison to the natural tooth crown/implant-supported crown, SR2 evaluated the strain of the midfacial coronal soft tissue in relation to the one of the alveolar mucosa, while SR3 depicted the strain of the midfacial soft tissue in relation to the interproximal soft tissue on the transverse ultrasound scan. SR1 in natural dentition and at implant sites was 0.20 ± 0.08 and 0.30 ± 0.14, respectively (p = .002), indicating that the coronal portion of the soft tissue around teeth is generally more elastic than its counterpart around dental implants. Soft tissue augmentation with CTG promoted an increased stiffness of the midfacial coronal portion of the soft tissue over 12 months (p < .001 for SR1, SR2, and SR3). Strain ratios at the 12-month time points were significantly higher than the values observed at 6 months (p < .001). Regression analysis demonstrated that strain elastography ratios in natural dentition were significantly associated with keratinized gingiva width, and gingival thickness. At implant sites, SR1 was significantly associated with keratinized mucosa width and mucosal thickness (p < .001 for both correlations), SR2 was significantly associated with keratinized mucosa width (p = .013), and SR3 was significantly associated with the surgical technique performed in combination with CTG (p = .022). Ultrasound strain elastography captures and quantifies tissue elasticity and its changes after soft tissue augmentation. A different baseline tissue elasticity was observed between teeth and dental implants in the most coronal aspect of the soft tissue. The main factors affecting tissue elasticity-related outcomes were the keratinized tissue width, and mucosal thickness.

Reflected shear wave computed tomography for elasticity imaging of 3D cell cultures using a single-element transducer

Shear wave elasticity imaging (SWEI) has long been used to quantify tissue stiffness in clinical diagnoses. In comparison with conventional bulk-based measurement methods, SWEI offers the distinct advantage of nondestructive sampling, thereby enabling the spatiotemporal monitoring of stiffness variations. However, applying SWEI to assessing millimeter-scale three-dimensional (3D) cell environments has faced limitations despite its potential in mechanobiology, and the existing techniques are insufficient for imaging inhomogeneous media environments. In this study, we investigated a computed tomography technique specifically designed for reflected SWEI (called R-SWCT) by rotational scanning in a sample using a 20-MHz ultrasound single-element transducer. We focused on samples containing a single inclusion with higher stiffness than the surrounding medium, mimicking the situation of a tumor sphere embedded in a 3D gel. Our method reconstructs the stiffness distribution using a curve-fitting method, wherein coefficients of Gaussian curves are fitted to the wavefronts of simulated signals. This reconstruction method yielded coefficients that closely approximated the wavefronts obtained experimentally, with a maximum difference between the measured and predicted shear wave speeds of only 0.1 m/s for phantom samples and 0.2 m/s for cell samples. The system and methodologies proposed in this research have demonstrated the feasibility of employing R-SWCT to study the remodeling dynamics of a cell group within its surrounding matrix in an in vitro setting. This noninvasive method also facilitates an exploration of how irradiation dosage used in radiation therapy can induce temporal alterations in the shear wave speed in 3D cancer cell cultures.

Seeing Beyond the Surface: Superior Performance of Ultrasound Elastography over Milan Ultrasound Criteria in Distinguishing Fibrosis of Ulcerative Colitis.

Colonic fibrosis has important clinical implications in ulcerative colitis [UC]. Ultrasound imaging has emerged as a convenient and reliable tool in diagnosis of inflammatory bowel disease. We aimed to explore the potential use of ultrasound to evaluate UC fibrosis. Consecutive UC patients who had proctocolectomy from July 2022 to September 2023 were enrolled in the study. Patients underwent bowel ultrasound examination and ultrasound elastography imaging prior to surgery. Milan ultrasound criteria [MUC] were calculated and bowel wall stiffness was determined using two mean strain ratios [MSRs]. Degree of colonic fibrosis and inflammation was measured upon histological analysis. Receiver operating characteristic [ROC] analysis was used to evaluate the performance of ultrasound-derived parameters to predict fibrosis. In all, 56 patients were enrolled with 112 segments included in analysis. The median fibrosis score was 2 [0-4] and the median Geboes score was 5 [0-13] and these two scores were significantly correlated [p < 0.001]. The muscularis mucosa thickness was significantly higher in moderate-severe fibrosis than none-mild fibrosis [p = 0.003] but bowel wall thickness was not [p = 0.082]. The strain ratios [p < 0.001] and MUC [p = 0.010] were significantly higher in involved than non-involved segments. The strain ratios were correlated with fibrosis score [p < 0.001] but not MUC [p = 0.387]. At ROC analysis, mean strain ratio 1 [MSR1] had an area under the curve [AUC] of 0.828 [cutoff value 3.07, 95% CI 0.746-0.893, p < 0.001] to predict moderate-severe fibrosis. Ultrasound elastography imaging could predict the degree of colonic fibrosis in UC. Application of this technique could help disease monitoring and decision making in UC patients.

Diagnostic value of combined ultrasound contrast and elastography for differentiating benign and malignant thyroid nodules: a meta-analysis

The diagnostic value of contrast-enhanced ultrasound combined with ultrasound elastography for benign and malignant thyroid nodules is still controversial, so we used meta-analysis to seek controversial answers. The PubMed, OVID, and CNKI databases were searched according to the inclusion and exclusion criteria. The literature was selected from the establishment of each database to February 2024. The QUADAS-2 tool assessed diagnostic test accuracy. SROC curves and Spearman's correlation coefficient were made by Review Manager 5.4 software to assess the presence of threshold effects in the literature. Meta-Disc1.4 software was used for Cochrane-Q and χ2 tests, which be used to evaluate heterogeneity, with P-values and I2 indicating heterogeneity levels. The appropriate effect model was selected based on the results of the heterogeneity test. Stata18.0 software was used to evaluate publication bias. The diagnostic accuracy of contrast-enhanced ultrasound combined with ultrasound elastography for benign and malignant thyroid nodules was evaluated by calculating the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, DOR, and area under the SROC curve. A total of 31 studies included 3811 patients with 4718 nodules were analyzed. There is no heterogeneity caused by the threshold effect, but there is significant non-threshold heterogeneity. Combined diagnostic metrics were: sensitivity = 0.93, specificity = 0.91, DOR = 168.41, positive likelihood ratio = 10.60, and negative likelihood ratio = 0.07. The SROC curve area was 0.97. Contrast-enhanced ultrasound and elastography show high diagnostic accuracy for thyroid nodules, offering a solid foundation for early diagnosis and treatment.Trial registration. CRD42024509462.

Application of two-dimensional shear wave elastography ultrasound in diagnosis of breast cancer

Objective: To describe characteristics of 2D ultrasound and two-dimensional shear wave elastography (2D-SWE) breast tumors. Determinated the combined value of 2D-SWE and 2D ultrasound in diagnosis breast cancer. Subject and method: 107 female patients with breast tumors were assigned 2D ultrasound, measured shear wave velocity (SWV) internal tumor by 2D-SWE method, classified according to BIRADS 2013 and WFUMB guildes 2015. Compared with the histopathological biopsy results after surgery. Results: 107 female patients with 46 benign breast tumors, 61 malignant breast tumors. The mean SWV intenal malignant breast tumors 6.6 ± 1.7 m/s were higher than benign breast tumors 3.8 ± 1.2 m/s. The SWV cutoff point internal tumors in diagnosis breast cancer was 5.1 m/s with Se = 91.8%, Sp = 80.4%, AUC-ROC = 0.91. The combined 2D ultrasound and 2D-SWE in diagnosis breast cancer had Se = 90.2%, Sp = 84.8%, good concordance with histopathological biopsy results after surgery Kappa = 0.75. Conclusion: 2D-SWE improved the specificity of 2D ultrasound in diagnosis breast cancer by upgrading or downgrading the BIRADS classification based on tumors stiffness characteristics. Key words: Elastography, cancer, breast.

CSP2023: 384 - Using ultrasound elastography techniques to assess conservative interventions for musculoskeletal stiffness: a systematic review and meta-analysis

CSP2023: 384 - Using ultrasound elastography techniques to assess conservative interventions for musculoskeletal stiffness: a systematic review and meta-analysis

Diagnostic accuracy of Non Invasive Imaging “Ultrasound Elastography” in Breast Carcinoma in Patients with Pathological Nipple Discharge Taking Histopathology as Gold Standard.

Diagnostic accuracy of Non Invasive Imaging “Ultrasound Elastography” in Breast Carcinoma in Patients with Pathological Nipple Discharge Taking Histopathology as Gold Standard.

Shear Wave Ultrasonographic Elastography in Pediatric Spleens and Its Role in Differential Diagnosis.

Shear wave elastography (SWE) has become popular in clinical practice for many diseases. However, there is not adequate research on spleen-related diseases. This study aimed to investigate the potential of quantitative values obtained through SWE in evaluating spleen pathologies in the pediatric population and to demonstrate its performance to differentiate splenomegaly-related diseases. The research group retrospectively included children with pathological diagnoses related to the spleen from November 2016 to April 2021, and they were categorized into three groups, including portal hypertension (PH), benign lymphoid hyperplasia (BLH), and malignant infiltration (MI). Spleen sizes and parenchymal stiffness were also calculated for each group. Subsequently, mean spleen stiffness in each group was compared with normal values within the same age group. In total, 2781 children (1379 children for the study group; 1402 children for the control group) were enrolled in the study. The highest stiffness was observed in the PH group, which is statistically higher than others (p < 0.05). Although the mean spleen stiffness in the group with BLH was higher than the control and MI group, the difference was not statistically significant (p = 0.08). The mean stiffness in the group with MI was significantly lower than both the control group (p = 0.005) and PH (p = 0.01). In conclusion, using SWE in the differential diagnosis of etiologies causing splenomegaly could make an important contribution.

Impact of ultrasound elastography in evaluating Bethesda category IV thyroid nodules with histopathological correlation.

Fine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules investigated through FNA, with reported malignancy rate in a wide range of 10-40%. The recommended treatment is either surgical or risk additional molecular testing before surgery. However, a large number of nodules belonging to this category (60-80%) are observed to be benign after surgical excision, which can put the patient at risk of unnecessary surgical morbidity. This study aimed to assess the diagnostic performance of conventional ultrasound, the ACR TI-RADS score and elastography in cases of Bethesda IV cytology on FNA. We evaluated ninety-seven consecutive cases with Bethesda category IV results on FNA by using conventional B-mode ultrasound, qualitative strain or shear-wave elastography (Hitachi Preirus Machine, Hitachi Inc., Japan and Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) and all nodules were classified according to the ACR TI-RADS system. Conventional ultrasound was used to categorize the nodules as potentially malignant based on the following features: hypoechogenicity, inhomogeneity, a taller than wide shape, irregular margins, presence of microcalcifications, an interrupted thyroid capsule and suspicious cervical lymph nodes. Elastography classified nodules with increased stiffness as suspicious for malignancy. We considered pathology results as the gold standard diagnosis, finding that 32 out of 97 nodules were carcinomas (33%) and 65 out of 97 were benign nodules (67%). The benign group included twenty cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Finally, we compared ultrasound data with pathology results, which showed that nineteen out of the 32 malignant nodules presented with increased stiffness on elastography (p=0.0002). On conventional ultrasound, we found that microcalcifications (p=0.007), hypoechogenicity and irregular margins (p=0.006) are features which can distinguish between benign and malignant nodules with statistical significance. Integrating elastography as a parameter of the ACR TI-RADS score in the evaluation of Bethesda category IV nodules showed a sensitivity of 90.62% in detecting thyroid cancer cases (p=0.006). We can conclude that elastographic stiffness as an addition to high risk features observed on conventional ultrasound improves the detection of malignant nodules in cases with Bethesda IV cytology.

Evaluation of Carotid Stiffness in Metabolic Syndrome by Real-Time Shear Wave Elasticity Imaging and Ultrafast Pulse Wave Velocity

ObjectiveThis study utilized real-time shear wave elasticity imaging (SWE) and ultrafast pulse wave velocity (ufPWV) to assess carotid arterial stiffness, aiming to predict atherosclerosis risk in patients with metabolic syndrome (MS). MethodsIn this study, 181 patients with metabolic syndrome (MS group) were compared with 73 healthy adults. The MS group was divided into three groups: MS I group: CIMT was normal (CIMT < 1.0 mm, no plaque, n = 61); MS II group: CIMT thickening (1.0 mm ≤ CIMT<1.5 mm, no plaque, n = 39); MS III group: plaque group (CIMT ≥ 1.5 mm, plaque, n = 81). Concurrently, the group of 73 healthy individuals was designated as the control set (NC). Parameters assessed include carotid intima-media thickness (CIMT), elastic modulus values of the carotid artery's anterior and posterior walls (Mean, Max, Min), pulse wave velocity at systole's commencement (PWV-BS), and pulse wave velocity at systole's termination (PWV-ES). Differences, distribution characteristics, and correlations across these groups were analyzed. ResultsA significant association was found between PWV-BS, PWV-ES, and arteriosclerosis severity, with these factors gaining importance as arteriosclerosis progressed. Notably, PWV-ES differences were significant across the four groups (p < 0.05). Both MS III and MS II groups exhibited higher PWV-ES values compared to the MS I group and controls. Statistically significant differences were observed between MS III, MS II, and MS I groups relative to the control group (p < 0.05). Additionally, the Mean, Max, and Min values of the anterior and posterior carotid walls in the MS III group surpassed those of the other groups. ConclusionReal-time shear wave elasticity imaging and ultrafast pulse wave velocity are valuable tools for assessing atherosclerosis risk in MS patients. These non-invasive, safe, and reproducible imaging techniques can quantitatively evaluate the stiffness of the common carotid artery's wall, offering important insights into cardiovascular risk assessment.

Application of ultrasound shear wave elastography in tumors of head and neck region – a preliminary study and literature review

&lt;b&gt;Introduction:&lt;/b&gt; Ultrasound (US) scanning is one of the primary modalities in diagnostic imaging of the head and neck region. Shear wave elastography (SWE) is an ultrasound technique that facilitates objective measurements of the stiffness of the examined tissues. Additional data obtained from SWE can increase the diagnostic value of ultrasound scans in clinical practice.&lt;b&gt;Materials and methods:&lt;/b&gt; A retrospective analysis of SWE examinations as performed in patients with head and neck tumor in the period of 2021 through 2022 is presented. The obtained SWE measurements were referenced against the results of histopathological or cytological examinations.&lt;b&gt;Results:&lt;/b&gt; SWE scans were acquired in 101 patients. In 62 patients, major salivary gland lesions were examined to reveal 7 malignant neoplasms, 49 benign neoplasms, and 6 inflammatory lesions. Lymph nodes were examined in 31 patients to reveal 11 cases of reactive lymph nodes, 12 metastases of malignant neoplasms, and 8 cases of lymphoma. Eight tumors of other nature and location were also examined to reveal 2 malignant neoplasms, 5 benign neoplasms, and 1 inflammatory infiltrate within the area of large vessels. Based on the results, SWE was concluded to be a useful tool for differentiation between metastatic and reactive lymph nodes. In salivary gland lesions, the measurements of tissue stiffness are particularly useful in the differential diagnosis of the most common non-malignant tumors.&lt;b&gt;Conclusions:&lt;/b&gt; Shear wave elastography is a valuable adjunct to ultrasound imaging. Further studies on a larger group of patients with diverse pathologies are required to identify cutoff points for tissue stiffness coefficients for different types of lesions.

3D Ultrasound Shear Wave Elastography for Musculoskeletal Tissue Assessment Under Compressive Load: A Feasibility Study.

Given its real-time capability to quantify mechanical tissue properties, ultrasound shear wave elastography holds significant promise in clinical musculoskeletal imaging. However, existing shear wave elastography methods fall short in enabling full-limb analysis of 3D anatomical structures under diverse loading conditions, and may introduce measurement bias due to sonographer-applied force on the transducer. These limitations pose numerous challenges, particularly for 3D computational biomechanical tissue modeling in areas like prosthetic socket design. In this feasibility study, a clinical linear ultrasound transducer system with integrated shear wave elastography capabilities was utilized to scan both a calibrated phantom and human limbs in a water tank imaging setup. By conducting 2D and 3D scans under varying compressive loads, this study demonstrates the feasibility of volumetric ultrasound shear wave elastography of human limbs. Our preliminary results showcase a potential method for evaluating 3D spatially varying tissue properties, offering future extensions to computational biomechanical modeling of tissue for various clinical scenarios.

Role of Ultrasound Elastography in Evaluating Suspicious Thyroid Nodules

Role of Ultrasound Elastography in Evaluating Suspicious Thyroid Nodules

Endometrial Elasticity is an Ultrasound Marker for Predicting Clinical Pregnancy Outcomes after Embryo Transfer.

Endometrial elasticity is a potential new marker for assessing endometrial receptivity and pregnancy outcomes based on endometrial thickness and type. Currently, little research has been conducted on the elasticity of the endometrium using shear wave elasticity imaging (SWEI). This study aimed to explore whether endometrial elasticity is an ultrasound marker for predicting clinical pregnancy outcomes after embryo transfer. A total of 245 infertile women underwent ultrasonography before embryo transfer at the Peking University Third Hospital. We compared the endometrial elasticity and sub-endometrial blood flow rate using SWEI in the groups with different pregnancy outcomes. Trends in clinical pregnancy outcomes across the quartiles of endometrial elasticity in the fundus of the uterus (E1) were assessed. Logistic regression analysis was performed to obtain odds ratios for clinical pregnancy outcomes based on the quartiles of E1, with or without adjusting for potential confounding variables. Women in the clinical pregnancy group had higher E1 values and sub-endometrial blood flow rates in the uterine fundus than those in the non-pregnancy group. Women in the highest quartile of E1 had the most favorable clinical pregnancy rates. Endometrial elasticity measured using SWEI is a promising ultrasound marker for predicting clinical pregnancy outcomes after embryo transfer.

Characterizing Changes in Abdominal Aortic Aneurysm Principal Wall Strain Using Ultrasound Elastography

Characterizing Changes in Abdominal Aortic Aneurysm Principal Wall Strain Using Ultrasound Elastography

Ultrasound Elastography: Methods, Clinical Applications, and Limitations: A Review Article

Ultrasound is a highly adaptable medical imaging modality that offers several applications and a wide range of uses, both for diagnostic and therapeutic purposes. The principles of sound wave propagation and reflection enable ultrasound imaging to function as a highly secure modality. This technique facilitates the production of real-time visual representations, thereby assisting in the evaluation of various medical conditions such as cardiac, gynecologic, and abdominal diseases, among others. The ultrasound modality encompasses a diverse range of modes and mechanisms that serve to enhance the methodology of pathology and physiology assessment. Doppler imaging and US elastography, in particular, are two such techniques that contribute to this expansion. Elastography-based imaging methods have attracted significant interest in recent years for the non-invasive evaluation of tissue mechanical characteristics. These techniques utilize the changes in soft tissue elasticity in various diseases to generate both qualitative and quantitative data for diagnostic purposes. Specialized imaging techniques collect data by identifying tissue stiffness under mechanical forces such as compression or shear waves. However, in this review paper, we provide a comprehensive examination of the fundamental concepts, underlying physics, and limitations associated with ultrasound elastography. Additionally, we present a concise overview of its present-day clinical utilization and ongoing advancements across many clinical domains.

Multifidus atrophy and/or dysfunction following lumbar radiofrequency ablation: A systematic review.

Lumbar medial branch nerve radiofrequency ablation (LRFA) is an interventional procedure used to treat chronic lumbar facet joint pain. Because the medial branch nerves also innervate the multifidus muscle, it has been proposed that LRFA may pose a risk of multifidus atrophy and/or dysfunction. However, the quality and level of evidence to answer this clinical question have not been established. Therefore, this review aimed to systematically appraise the literature to discern whether the prevailing evidence substantiates the hypothesis in question. A systematic review compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to evaluate the quality and level of evidence of studies reporting functional and/or structural changes in the multifidus muscle following LRFA. Only five cohort studies met inclusion criteria. Two studies assessed changes in multifidus function following LRFA with confirmed denervation at electromyography and significant reduction in multifidus shear modulus with ultrasound shear wave elastography. Of the four studies that evaluated changes in multifidus structure with magnetic resonance imaging following LRFA, two demonstrated a decrease in cross-sectional area or an increase in fat infiltration, one demonstrated no change, and one revealed an apparent increase. Given the destructive nature attributed to LRFA, some degree of multifidus atrophy and/or dysfunction may be plausible, albeit with a very low certainty that relies on a restricted body of literature of modest quality and with a presence of high bias. There is a paucity of studies discussing the potential association between LRFA and multifidus atrophy and/or dysfunction. In light of the shortage of high-quality studies and the absence of standardized protocols to assess both changes in the structure and function of the multifidus subsequent to LRFA, there is a pressing need for more prospective studies with a high methodological rigor to comprehensively address and answer this enduring debate in clinical practice.