Shear Wave Elastography Imaging Research Articles

Emerging Role of Quantitative Ultrasound-Based Imaging Techniques for Characterizing Rotator Cuff Tears: A Scoping Review

Rotator cuff myosteatosis following cuff tears is very common and one of the most important prognostic factors in clinical management. Quantitative ultrasound-based imaging techniques (QUBIT) are frequently used along with magnetic resonance imaging (MRI) to evaluate rotator cuff fatty degeneration. However, the examination of rotator cuff tissue integrity by QUBIT is lacking a standardized imaging protocol and procedural methodologies. In this scoping review, we synthesized the current state of QUBIT against the reference imaging modalities in patients with rotator cuff tears. The literature search was extracted from 963 studies, with 22 studies included in the final review in accordance with the preferred reporting items for systematic reviews and meta-analyses extensions for scoping reviews. The selected studies included human participants and focused on measuring at least one prognostic or diagnostic factor using ultrasonography-based imaging with reference to MRI. The findings suggest both conventional B-mode ultrasound and shear wave elastography imaging were comparable to MRI-based imaging techniques for the evaluation of fatty infiltration and rotator cuff tear characterization. This review establishes guidelines for reporting shoulder-specific QUBIT aimed at developing a standardized imaging protocol. The objective was to enhance the diagnostic and prognostic capabilities of QUBIT in the clinical setting.

A single-center, retrospective, cross-sectional study comparing the number of non-diagnostic measurements ratio in the pSWE and SSI ultrasound elastography methods.

The point shear wave elastography and supersonic shear imaging methods were compared regarding incorrect measurements during the liver examinations. A report-based, single-center, retrospective analysis of 425 liver elastography examinations was performed. A lower success ratio was observed for the point shear wave elastography method, as well as the older and obese patients pre-dominated in non-diagnostic studies. In our center experience, it is easier to obtain diagnostic data using the supersonic shear imaging method. However, further investigation of the subject is needed.

The Utility of Quantitative Parameters of Shear-Wave Elastography to Predict Prognostic Histologic Features of Breast Cancer.

In this study, we aimed to investigate the correlation of stiffness values of shear-wave elastography (SWE) and histopathological prognostic factors in patients with breast cancer. Between January 2021 and June 2022, SWE images of 138 core-biopsy proven breast cancer lesions from 132 patients were retrospectively reviewed. Histopathogic prognostic factors, including tumor size, histologic grade, histologic type, hormone receptor positivity, human epidermal growth factor receptor (HER2) status, immunohistochemical subtype and Ki-67 index were documented. Elasticity values including mean and maximum elasticity ( Emean and Emax ) and lesion-to-fat ratio ( Eratio ) were recorded. The association between histopathological prognostic factors and elasticity values were assessed using Mann-Whitney U and Kruskal-Wallis test, and multiple linear regression analysis. Tumor size, histological grade, and Ki-67 index were significantly associated with the Eratio ( P < 0.05). Larger tumor size and higher Ki-67 index also showed significantly higher Emean and Emax values ( P < 0.05). However, hormone receptor positivity, HER2 status, and immunohistochemical subtype were not significantly associated with elasticity values ( P > 0.05). Multivariate logistic regression analysis revealed that tumor size was significantly associated with Emean , Emax , and Eratio values ( P < 0.05). A high Ki-67 index was also significantly associated with high Eratio values. Larger tumor size and higher Ki-67 index are independently associated with high Eratio values. Preoperative SWE may improve the performance of conventional ultrasound in predicting prognosis and treatment planning.

The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications.

The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.

Value of clinical features combined with multimodal ultrasound in predicting lymph node metastasis in cervical central area of papillary thyroid carcinoma.

To explore the clinical features, multimodal ultrasound features and multimodal ultrasound imaging features in predicting lymph node metastasis in the central cervical region of papillary thyroid carcinoma. A total of 129 patients with papillary thyroid carcinoma (PTC) confirmed by pathology were selected from our hospital from September 2020 to December 2022. According to the pathological results of cervical central lymph nodes, these patients were divided into metastatic group and non-metastatic group. Patients were randomly sampled and divided into training group (n = 90) and verification group (n = 39) according to the ratio of 7:3. The independent risk factors for central lymph node metastasis (CLNM) were determined by least absolute shrinkage and selection operator and multivariate logistic regression. Based on independent risk factors to build a prediction model, select the best diagnostic effectiveness of the prediction model sketch line chart, and finally, the line chart calibration and clinical benefits were evaluated. A total of 8, 11 and 17 features were selected from conventional ultrasound images, shear wave elastography (SWE) images and contrast-enhanced ultrasound (CEUS) images to construct the Radscore of conventional ultrasound, SWE and CEUS, respectively. After univariate and multivariate logistic regression analysis, male, multifocal, encapsulation, iso-high enhancement and multimodal ultrasound imaging score were independent risk factors for cervical CLNM in PTC patients (p < 0.05). Based on independent risk factors, a clinical combined with multimodal ultrasound feature model was constructed, and multimodal ultrasound Radscore were added to the clinical combined with multimodal ultrasound feature model to form a joint prediction model. In the training group, the diagnostic efficacy of combined model (AUC = 0.934) was better than that of clinical combined with multimodal ultrasound feature model (AUC = 0.841) and multimodal ultrasound radiomics model (AUC = 0.829). In training group and validation group, calibration curves show that the joint model has good predictive ability for cervical CLNM of PTC patients; The decision curve shows that most of the net benefits of the nematic chart are higher than those of clinical + multimodal ultrasound feature model and multimodal ultrasound radiomics model within a reasonable risk threshold range. Male, multifocal, capsular invasion and iso-high enhancement are independent risk factors of CLNM in PTC patients, and the clinical plus multimodal ultrasound model based on these four factors has good diagnostic efficiency. The joint prediction model after adding multimodal ultrasound Radscore to clinical and multimodal ultrasound features has the best diagnostic efficiency, high sensitivity and specificity, which is expected to provide objective basis for accurately formulating individualized treatment plans and evaluating prognosis.

Abstract 2396: Longitudinal monitoring of stromal stiffness predicts immune escape in preclinical hepatocellular carcinoma

Abstract Background/Objectives: Increased tumor stiffness enhances disease progression and aggressiveness in several cancers. Stiffer extracellular tumor matrix hinders T cell trafficking and promotes immune escape. The interplay between liver tumor mechanical properties and hepatocellular immune cell landscape has not been fully investigated. The aim of our study is to correlate tumor stiffness quantified with shear wave elastography and tumor-infiltrating lymphocyte accumulation using a syngeneic orthotopic rat model of hepatocellular carcinoma (HCC). Methods: Rat hepatoma cell line McA-RH7777 were implanted in the left liver lobe of Buffalo rats. Maximum tumor size and stiffness were evaluated 3 weeks after implantation (baseline) and weekly for 14 days using ultrasound. The maximum tumor size of each rat was evaluated on transverse view of B-mode ultrasound. The elasticity of each rat was evaluated by shear wave elastography (SWE), and SWE measurements were obtained at the maximum tumor size in m/s. A circular region of interest was put manually on the SWE images to calculate tumor stiffness. SWE was performed 3 times for each rat at each time point, and the mean value of tumor stiffness was used for analysis. After 14 days, tumors were harvested for histology and immune cell isolation. Isolated cells were stained with CD3, CD4, CD8, CD25, CD45, CD103, CD161, CD279 (PD-1), FOXP3, IL17A, and INF-g and submitted to spectral cytometry. Results: Shear wave speed at baseline and at 14 days ranged from 1.95 to 3.07 m/s and from 2.25 to 3.26 m/s, respectively. The rate of longitudinal increase or decrease in tumor stiffness measured by SWE is inversely correlated with intratumoral infiltration of CD45+/CD3+, CD3+/CD8+ T cells and IFN-producing CD3+/CD8+ T cells (P=0.015, r=-0.62[-0.857, -0.15], P&amp;lt;0.01, r=-0.74[-0.913, -0.346], P=0.02, r=-0.6[-0.859, -0.107]). Intratumoral CD3+/CD4+ T cells did not significantly correlate with the rate of change in stiffness but did correlate with the rate of change in tumor size measured by B-mode ultrasound (P=0.03, r=-0.58[-0.850, -0.0730]). Conclusion: Our results confirm previous reports of immune escape in stiffer solid tumors in the context of HCC. Findings suggest that longitudinal monitoring of tumor stiffness can be useful for the assessment of immune cell infiltration. Citation Format: Kiyoyuki Minamiguchi, Andrea Cortes, Patricia Da Costa Lopez, Malea Williams, Simone Anfossi, Marites Melancon, Rony Avritscher. Longitudinal monitoring of stromal stiffness predicts immune escape in preclinical hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2396.

Predicting Malignancy of Thyroid Micronodules: Radiomics Analysis Based on Two Types of Ultrasound Elastography Images

To develop a multimodal ultrasound radiomics nomogram for accurate classification of thyroid micronodules. A retrospective study including 181 thyroid micronodules within 179 patients was conducted. Radiomics features were extracted from strain elastography (SE), shear wave elastography (SWE) and B-mode ultrasound (BMUS) images. Minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms were used to select malignancy-related features. BMUS, SE, and SWE radiomics scores (Rad-scores) were then constructed. Multivariable logistic regression was conducted using radiomics signatures along with clinical data, and a nomogram was ultimately established. The calibration, discriminative, and clinical usefulness were considered to evaluate its performance. A clinical prediction model was also built using independent clinical risk factors for comparison. An aspect ratio ≥ 1, mean elasticity index, BMUS Rad-score, SE Rad-score, and SWE Rad-score were identified as the independent predictors for predicting malignancy of thyroid micronodules by multivariable logistic regression. The radiomics nomogram based on these characteristics showed favorable calibration and discriminative capabilities (AUCs: 0.903 and 0.881 for training and validation cohorts, respectively), all outperforming clinical prediction model (AUCs: 0.791 and 0.626, respectively). The decision curve analysis also confirmed clinical usefulness of the nomogram. The significant improvement of net reclassification index and integrated discriminatory improvement indicated that multimodal ultrasound radiomics signatures might work as new imaging markers for classifying thyroid micronodules. The nomogram combining multimodal ultrasound radiomics features and clinical factors has the potential to be used for accurate diagnosis of thyroid micronodules in the clinic.

Crosstalk analysis of comb detection for measuring shear wave propagation

Applications, such as shear wave elastography and Doppler imaging, require high frame rates. Plane wave compounding (PWC) is widely used for these applications. Comb detection was proposed to combine the high frame rate of PWC and the high signal quality of focused beam scanning. Comb detection transmits multiple focused beams simultaneously to increase the frame rate. These comb beams are scanned laterally to cover the whole region-of-interest. The simultaneous multiple transmission of focused beams causes crosstalk between neighboring beams. Transmit crosstalk is related to the pressure field of transmit beams, and receive crosstalk is determined by the beam profile of receive beamforming. In this study, we varied f-number (F/N) and apodization window and measured their effects on crosstalk based on the pressure field and an arterial wall simulation using Field II. For transmit design, transmit apodization with a Hamming window significantly reduced crosstalk compared to a rectangular window and transmit F/N had little impact on the crosstalk. Regarding receive beamforming, a Hamming window led to lower crosstalk than the rectangular window and F/N from 1 to 5 suppressed crosstalk to below 30 dB. The effects of crosstalk in shear wave motion data from phantom experiments were also analyzed. Comb detection showed less motion artifact than PWC in phantom experiments.

Liver fibrosis processing, multiclassification, and diagnosis based on hybrid machine learning approaches

&lt;span lang="EN-US"&gt;The cirrhosis and cirrhosis-related problems are connected to the degree of fibrosis in the liver. The purpose of this paper is to propose an automated method for identifying liver fibrosis using ultrasound shear wave elastography (700) images that is based on a hybrid machine learning approach using a convolutional neural network (CNN) with two types of classifier (SoftMax and support vector machine (SVM)). The dataset gathered from hospitals is used in the training and testing phases of the model. The objective is to develop a hybrid machine learning model that can classify images based on their stage of fibrosis. The suggested system comprises three stages. The first is the preprocessing step, which starts with countor detection and continues with the "contrast limited adaptive histogram equalization (CLAHE)" technique to show the properties of liver tissue. In the second step, the CNN algorithm was utilized, which was based on several images to extract deep features and identify shear wave elastography (SWE) samples. In the third step, SVM and SoftMax functions are used to classify liver fibrosis. A five-class model (normal, F1, F2, F3, and F4) was developed. The result illustrates how successfully the CNN-SoftMax and CNN-SVM classifiers classified liver fibrosis in the test dataset, with 97.18% and 98.59% accuracy, respectively.&lt;/span&gt;

Intraoperative shear-wave elastography and superb microvascular imaging contribute to the glioma grading

BackgroundTo explore the diagnostic value and feasibility of shear wave elastography and superb microvascular imaging in the grading diagnosis of glioma intraoperatively. Materials and methodsForty-nine patients with glioma were included in this study. B-mode ultrasonography, Young's modulus in shear-wave elastography (SWE) and vascular architecture in superb microvascular imaging(SMI) of tumor tissue and peritumoral tissue were analyzed. Receiver operating characteristic(ROC) curve analysis was used to evaluate the diagnostic effect of SWE. Logistic regression model was used to calculate the prediction probability of HGG diagnosis. ResultsCompared with LGG, HGG was often characterized by peritumoral edema in B mode (P < 0.05). There was a significant difference in Young's modulus between HGG and LGG; the diagnostic threshold of HGG and LGG was 13.05 kPa, the sensitivity was 78.3%, and the specificity was 76.9%. The vascular architectures of the tumor tissue and peritumoral tissues of HGG and LGG were significantly different (P < 0.05). The vascular architectures of peritumoral tissue in HGG often characterized by distorted blood flow signals surrounding the tumor (14/26,53.8%); in the tumor tissue, HGG often presents as dilated and bent vessels(19/26,73.1%). The elasticity value of SWE and the tumor vascular architectures of SMI were correlated with the diagnosis of HGG. ConclusionIntraoperative ultrasound (ioUS), especially SWE, and SMI are beneficial for the differentiation of HGG and LGG and may help optimize clinical surgical procedures.

Convolutional neural network based on automatic segmentation of peritumoral shear-wave elastography images for predicting breast cancer.

Our aim was to develop dual-modal CNN models based on combining conventional ultrasound (US) images and shear-wave elastography (SWE) of peritumoral region to improve prediction of breast cancer. We retrospectively collected US images and SWE data of 1271 ACR- BIRADS 4 breast lesions from 1116 female patients (mean age ± standard deviation, 45.40 ± 9.65 years). The lesions were divided into three subgroups based on the maximum diameter (MD): ≤15 mm; >15mm and ≤25 mm; >25mm. We recorded lesion stiffness (SWV1) and 5-point average stiffness of the peritumoral tissue (SWV5). The CNN models were built based on the segmentation of different widths of peritumoral tissue (0.5mm, 1.0mm, 1.5mm, 2.0mm) and internal SWE image of the lesions. All single-parameter CNN models, dual-modal CNN models, and quantitative SWE parameters in the training cohort (971 lesions) and the validation cohort (300 lesions) were assessed by receiver operating characteristic (ROC) curve. The US + 1.0mm SWE model achieved the highest area under the ROC curve (AUC) in the subgroup of lesions with MD ≤15 mm in both the training (0.94) and the validation cohorts (0.91). In the subgroups with MD between15 and 25mm and above 25mm, the US + 2.0mm SWE model achieved the highest AUCs in both the training cohort (0.96 and 0.95, respectively) and the validation cohort (0.93 and 0.91, respectively). The dual-modal CNN models based on the combination of US and peritumoral region SWE images allow accurate prediction of breast cancer.

A Novel Nomogram Based on Imaging Biomarkers of Shear Wave Elastography, Angio Planewave Ultrasensitive Imaging, and Conventional Ultrasound for Preoperative Prediction of Malignancy in Patients with Breast Lesions.

Several studies have demonstrated the difficulties in distinguishing malignant lesions of the breast from benign lesions owing to overlapping morphological features on ultrasound. Consequently, we aimed to develop a nomogram based on shear wave elastography (SWE), Angio Planewave Ultrasensitive imaging (Angio PLUS (AP)), and conventional ultrasound imaging biomarkers to predict malignancy in patients with breast lesions. This prospective study included 117 female patients with suspicious lesions of the breast. Features of lesions were extracted from SWE, AP, and conventional ultrasound images. The least absolute shrinkage and selection operator (Lasso) algorithms were used to select breast cancer-related imaging biomarkers, and a nomogram was developed based on six of the 16 imaging biomarkers. This model exhibited good discrimination (area under the receiver operating characteristic curve (AUC): 0.969; 95% confidence interval (CI): 0.928, 0.989) between malignant and benign breast lesions. Moreover, the nomogram also showed demonstrated good calibration and clinical usefulness. In conclusion, our nomogram can be a potentially useful tool for individually-tailored diagnosis of breast tumors in clinical practice.

Passive muscle stiffness is correlated with the intramuscular adipose tissue in young individuals.

We investigated the relationship between intramuscular adipose tissue (IntraMAT) and muscle stiffness (passive and mechanical) and lengthening in young individuals, hypothesizing that (1) passive muscle stiffness is negatively correlated with the IntraMAT content, and (2) the IntraMAT content is negatively correlated with mechanical changes in muscle stiffness and fascicle length during passive dorsiflexion. Twenty men and women (20.3 ± 1.3years) participated in this study. Axial T1-weighted magnetic resonance imaging was performed at the thickest point of the medial gastrocnemius (MG) to measure the IntraMAT cross-sectional area (CSA) and muscle tissue CSA (units; cm2). The shear wave velocity (SWV) and fascicle length at the three ankle joint angles, namely 15° with plantarflexion (PF15), 0° with neutral position (NP), and 15° with dorsiflexion (DF15), were measured as parameters of muscle stiffness (unit; m/s) and lengthening (unit; cm) using ultrasound shear wave elastography and B-mode imaging. We further calculated the changes in SWV and fascicle length from PF15 to NP and from NP to DF15 as mechanical muscle stiffness and lengthening, respectively. There was a relationship between IntraMAT CSA and absolute SWV at DF15 (r = -0.47, P < 0.05). Further, a relationship was observed between IntraMAT CSA and change in SWV and fascicle length from NP to DF15 (r = -0.47 and r = 0.59, P < 0.05); whereas no relationship was observed between changes in fascicle length and muscle SWV (r = -0.23, P = 0.33). These results may indicate biomechanical and/or physiological associations between IntraMAT CSA and passive muscle stiffness.

Multimodal ultrasound-based carotid plaque risk biomarkers predict poor functional outcome in patients with ischemic stroke or TIA

BackgroundCarotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.MethodsThis study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.ResultsSMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59, P = 0.041) and 0.51 (95% CI 0.31–0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95).ConclusionIntraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Evaluating the stage of deep vein thrombosis: the diagnostic accuracy of shear wave elastography and super-microvascular imaging.

Assessing the age of deep vein thrombosis (DVT) is crucial for guiding treatment approaches. Two-dimensional shear-wave elastography (2D-SWE) and super-microvascular imaging (SMI), as emerging techniques for tissue elasticity assessment and intrathrombus microvascular analysis, are pivotal for accurate thrombus age determination. This research endeavors to classify DVT into acute, subacute, and chronic ages utilizing these imaging methods. The study is a prospective, single-center, inpatient investigation that utilized convenience sampling for participant recruitment. Patients with a symptom duration of <6 months who were found to have lower-extremity DVT on ultrasound (US) between January 2021 and March 2022 after craniocerebral trauma (CT) or bone injury (BI) operations were included in this study. Participants were divided into three groups based on the duration of DVT, measured from the first diagnosis of thrombosis by US to the follow-up with 2D-SWE and SMI: acute (≤14 days), subacute (15-30 days), and chronic (31 days to 6 months) All patients underwent 2D-SWE and SMI using an Aplio i700 Ultrasound System equipped with a PLT-1005BT line array probe. Diagnostic performance was assessed using the area under the receiver operating characteristic (ROC) curve. The maximum value of the elastic modulus for DVT (DVT_Emax), the mean value of the elastic modulus for DVT (DVT_Emean), and SMI's flow distribution scoring pattern for DVT (SMI_scoring) emerged as significant predictors for acute and chronic, with high area under the ROC curve (AUC) of acute [AUC (95% confidential interval): 0.95 (0.89-0.97), 0.96 (0.91-0.98), 0.93 (0.88-0.97) in 39 patients] and chronic [AUC (95% confidential interval): 0.88 (0.81-0.93), 0.94 (0.88-0.97), 0.91 (0.84-0.95) in 51 patients], respectively. However, these indices had lower efficacy for subacute prediction [AUC (95% confidential interval): 0.51 (0.42-0.60), 0.54 (0.46-0.63), 0.53 (0.44-0.62), in 47 patients]. Combining DVT_Emean with SMI_scoring improved performance in predicting subacute: 0.90 (0.83-0.94) than related features alone. Both 2D-SWE and SMI can be used to assess acute and chronic DVT in patients with CT and BI after surgeries. This combination is a promising adjunctive technique for identifying the subacute phase of DVT in these patients.

Comparison of the fibrosis degree using acoustic radiation force impulse elastography and diffusion-weighted magnetic resonance imaging in chronic hepatitis cases.

The aim of this study was to investigate the correlation of fibrosis stages in cases of chronic hepatitis by comparing shear wave elastography and diffusion-weighted magnetic resonance imaging. A total of 46 chronic hepatitis patients with an age range of 20-50 years were classified into three groups based on their fibrosis stages. Comparison group 1: the presence of fibrosis (S0 and S1≤); comparison group 2: the presence of significant fibrosis (≤S2 and S3≤); and comparison group 3: the presence of cirrhosis (≤S4 and S6). Shear wave velocities were measured by acoustic radiation force impulse elastography. Diffusion-weighted magnetic resonance imaging was performed on a 3.0 Tesla MRI device. In comparison group 1 (S0 and S1≤), the area under the curve, sensitivity, and specificity of acoustic radiation force impulse values were 0.784, 87, and 60%, respectively, while these values were 0.718, 80, and 66%, respectively, for apparent diffusion coefficient . In comparison group 2 (≤S2 and S3≤), the area under the curve, sensitivity, and specificity of acoustic radiation force impulse values were 0.917, 80, and 86%, respectively, and the apparent diffusion coefficient values were 0.778, 90, and 66%, respectively. In comparison group 3, the area under the curve, sensitivity, and specificity of acoustic radiation force impulse values were 0.977, 100, and 95%, respectively. There was no statistically significant difference between the apparent diffusion coefficient values of the cases in the three groups (p=0.132). Noninvasive methods are gaining importance day by day for staging hepatic fibrosis. Acoustic radiation force impulse elastography was evaluated as a more reliable examination than diffusion-weighted magnetic resonance imaging in revealing the presence of fibrosis, determining significant fibrosis, and diagnosing cirrhosis.

Changes in pectoralis major stiffness and thickness following radiotherapy for breast cancer: A 12-month follow-up case series

Radiotherapy (RT) is a common and often essential treatment for breast cancer, but has been associated with pectoralis major (PM) muscle fibrosis and atrophy. In an initial prospective evaluation, we assessed muscle stiffness and muscle thickness of the sternocostal and clavicular regions of the PM with ultrasound shear wave elastography and B-mode imaging. Changes in PM muscle stiffness and thickness following RT can be detected within the first twelve months of RT completion. These parameters may potentially be useful for screening of patients who would benefit from post-RT physical therapy. Further studies with larger sample sizes that include patients who receive nodal radiation are necessary to confirm these findings.

Dose- and time-dependent effects of collagenase clostridium histolyticum injection on transverse carpal ligament elastic modulus and thickness in vitro.

A potential treatment for carpal tunnel syndrome is to biochemically alter the mechanical properties of the transverse carpal ligament (TCL) through Collagenase Clostridium Histolyticum (CCH) injection. The purpose of this study was to determine the time- and dose-dependent effects of CCH injection on TCL elastic modulus and thickness. Nine TCLs were dissected from cadaveric hands for this study. CCH doses of 50U, 100U, 150U, 200U, and 250U were injected into five points on the TCL, respectively. B-mode and shear wave elastography images were taken of each injection point using robot-assisted ultrasound imaging immediately after injection, as well as 2, 4, 6, 8, and 24 hours after injection. TCL thickness and mean shear wave speed were measured for each CCH dose at each time point. CCH doses of 200U and 250U decreased shear wave speed by 18.70% and 30.01% (p<0.05), respectively, after 24 hours. CCH doses of 150U, 200U, and 250U decreased TCL thickness by 7.28%, 10.97%, and 14.92%, respectively, after 24 hours (p<0.05). Our findings suggest that CCH injection may be effective in degrading TCL tissue, with higher doses of CCH resulting in greater tissue degradation up to 24 hours after injection.

Evaluation of Accuracy of Shear Wave Elastography and Superb Microvascular Imaging Methods in Diagnosis of Piriformis Syndrome: A Preliminary Study.

Piriformis syndrome is a neuromuscular disease resulting from sciatic nerve compression caused by an abnormal condition in the piriformis muscle. Superb microvascular imaging (SMI) is a new ultrasound imaging technique that visualizes low-velocity and small-diameter blood vessel flow. In our prospectively designed study, we aimed to evaluate the accuracy of diagnosis of piriformis syndrome with innovative methods such as shear wave elastography (SWE) and SMI. Thirty-two patients diagnosed with unilateral piriformis syndrome were accepted to the statistical stage. The side without symptoms was considered the "unaffected side." Bilateral piriformis muscles were examined by ultrasonography. Muscle thickness was determined on gray scale, stiffness on SWE and vascularity characteristics on power Doppler and SMI by two independent radiologists. Piriformis muscle stiffness on the non-pathological (unaffected) side was measured by SWE as 18.27 ± 7.301 kPa, and the mean stiffness on the pathological side was 29.70 ± 10.095 kPa. Pathological side muscle stiffness was significantly higher (p < 0.05). Using innovative methods such as SWE and SMI in addition to conventional ultrasonography as much as possible in our daily practice and research helps us in making the correct diagnosis in piriformis syndrome.

Evaluation of Ultrasound Based Point Shear Wave Elastography for Diagnosis of Inflammatory Pancreatic Diseases

Introduction: A variety of imaging techniques exists for the diagnosis of pancreatic disorders. None of the broadly accepted diagnostic methods, uses elasticity as an indicator of tissue damage. A well-known fact is that pathological changes influence tissue stiffness and elasticity. US elastography in its different modalities has been widely used for evaluation and characterization of multiple abdominal structures. Point Shear Wave Elastography (pSWE) particularly has been reported to be highly effective in various clinical diagnostic applications. However, data on the role of pSWE in a deep-seated organ like pancreas is scarce. Objective: To prospectively assess the diagnostic value of abdominal US elastography in the form of point shear wave elastography (pSWE) in characterizing and differentiating between normal pancreatic parenchyma and chronic pancreatitis. To establish a cut off value for the diagnosis of chronic pancreatitis. To investigate the influence of certain independent variables and the severity of pancreatitis on the acquired results. Patients Twenty five patients diagnosed with chronic pancreatitis who visited the Department of Gastroenterology in University Hospital Kaspela, between December 2020 and August 2021, for diagnosis and/or treatment and twenty eight individuals with no evidence of pancreatic disorder, admitted at the hospital during the same period of time, were included in the study. Based on the clinical symptomatic criteria, diagnostic imaging and histological findings, patients were divided into chronic pancreatitis (CP) and healthy pancreatic parenchyma group. Methods: The ultrasound based point Shear Wave Elastography (pSWE) imaging techniques were applied. A total of five measurements was obtained in each segment of the gland. The depth of region of interest (ROI) was also recorded. Design Prospective single-center study. Results: The mean shear wave speed (SWS) values of the entire pancreatic parenchyma were 1.71m/s, 1.15m/s for the chronic pancreatitis and the normal pancreatic parenchyma respectively. With a cut off value of 1.43m/s, sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Ac) of 89.7%, 95.2%, 94.59%, 90.91% and 92.59% respectively were calculated for the diagnosis of chronic pancreatitis. Neither the independent variables researched, nor the severity of disease, defined according to the Cambridge score, proved to have statistically significant reflection on the SWS in patients with CP. Conclusion: pSWE established considerably higher SWS in patients with chronic pancreatitis, therefore it may be successfully adopted as a diagnostic modality in patients with chronic inflammatory pancreatic disorders. External factors have minor effect on the results obtained, suggesting that the technique is highly objective. High SWS were obtained both in patients with discrete structural abnormalities (Cambridge 2) and advanced forms of pancreatitis (Cambridge 4), which points that pSWE may be utilized as differential diagnostic method in cases in which other imaging techniques provide equivocal and inconclusive results.