Shear Wave Elastography Evaluation Research Articles

Shear-Wave Elastography of the Achilles tendon: reliability analysis and impact of parameters modulating elasticity values.

Shear wave elastography (SWE) has seen many advancements in Achilles tendon evaluation in recent years, yet standardization of this technique is still problematic due to the lack of knowledge regarding the optimal way to perform the examination. The purpose of this study was to evaluate the effects of ankle position, probe frequency and physical effort on the shear modulus of the Achilles tendon, but also to determine the intra and inter-observer reliability of the technique. 37 healthy volunteers were included; SWE protocol was performed by two examiners. We analyzed the shear modulus of the tendon with the ankle in neutral, maximum dorsiflexion and maximum plantar flexion using two different high frequency probes. Afterwards, the subjects performed a brief physical exercise and SWE measurements were repeated. The L18-5 probe showed the highest ICC values (ICC = 0.798, 95% CI 0.660-0.880, p < 0.001) when positioned at 2cm from the calcaneal insertion with the ankle in a neutral state. Conversely, utilizing the same L18-5 probe at 1cm from the insertion during maximum plantar flexion of the ankle resulted in the lowest ICC (ICC = 0.422, 95% CI 0.032-0.655, p = 0.019). Significant variations in elasticity values were noted among different ankle positions and probe types, while no significant changes in elasticity were observed post-physical exercise. Ankle position and probe frequency are factors that influence elasticity values of the Achilles tendon. An ankle position between 10 and 20 degrees of plantar flexion is the most suitable for SWE evaluation. However, more research focusing on Achilles tendon SWE is essential due to the challenges encountered in standardizing this region.

Multiparametric ultrasound-based assessment of overt hyperthyroid diffuse thyroid disease.

Hyperthyroidismis a prevalent condition affecting global populations, with an overall prevalence of 1.2%. Our research aimed to establish a systematic diagnostic approach using multiparametric ultrasound (MPUS) to diagnose hyperthyroid diffuse thyroid disease (DTD). We conducted a retrospective study from June 2021 to June 2023 at a specialized endocrinology center in Timisoara, Romania, enrolling subjects presenting with clinical hyperthyroidism. Using the Mach 30 Aixplorer ultrasound equipment, evaluations were performed initially in B-mode US, followed by Color Doppler and Spectral Doppler measurements, and finally, 2D Shear wave elastography (SWE). From the 218 patients analyzed, the diagnosis of DTD with hyperthyroidism was confirmed through biochemical assessment, subgrouping various pathologies such as subacute thyroiditis, Graves' disease, painless thyroiditis, Hashimoto's thyroiditis, iatrogenic, as well as healthy controls. In the first step, B-mode hypoechogenicity had an AUC of 0.951 for DTD detection. In the second step, the peak systolic velocity differentiated Graves' disease with a median of 42.4 cm/s and an AUC of 1. Lastly, the third step consisted of SWE evaluation, revealing a mean elasticity index in the SAT subgroup significantly higher from other subgroups (p<0.001) with an AUC of 1. Our study offers a step-by-step evaluation algorithm for DTD diagnosis, with a very good overall diagnostic performance (AUC of 0.946).

PB0445 Ultrasound Shear Wave Elastography Evaluation of Acute Deep Vein Thrombosis as a Predictor for Thrombus Resolution

PB0445 Ultrasound Shear Wave Elastography Evaluation of Acute Deep Vein Thrombosis as a Predictor for Thrombus Resolution

Evaluation of levator ani muscle elasticity after vaginal delivery and cesarean section using shear wave elastography

PurposeThe risk of pelvic floor muscle injury is commonly considered to be higher in vaginal than in cesarean delivery. This study aimed to compare levator ani muscle (LAM) elasticity after vaginal and cesarean delivery using shear wave elastography (SWE).MethodsPostpartum women who underwent a single SWE evaluation 1 month after their first delivery were divided into vaginal and cesarean delivery groups. The elastic moduli of both sides of the LAM were measured in a horizontal section and compared between the groups. In addition, a subgroup analysis was performed to compare LAM elasticity according to the delivery method within the vaginal delivery group—normal vaginal delivery, episiotomy, and operative vaginal delivery.ResultsSixty-two women were included (vaginal delivery, n = 47; elective cesarean section, n = 15). Multiple regression analysis revealed that the LAM elastic modulus was significantly lower in the vaginal delivery group than in the cesarean delivery group (right LAM: 44.2 vs. 72.7 kPa, p = 0.0036; left LAM 40.4 vs. 82.7 kPa, p < 0.0001). In the subgroup analysis, the right LAM elastic modulus was significantly lower in the operative vaginal delivery subgroup than in the normal vaginal delivery subgroup (p = 0.0131). However, there was no significant difference in the left LAM elastic modulus between the three subgroups.ConclusionLAM elasticity was significantly lower after vaginal delivery than after cesarean delivery. Furthermore, the elasticity of the right LAM was lower after operative vaginal delivery than after normal vaginal delivery. SWE has the potential to provide an objective quantitative assessment of postpartum pelvic floor muscle recovery.

Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas.

Simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants. In total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher's exact test was used to compare independent groups, and Spearman's correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values. The B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas). As the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas.

2D Shear wave elastography for evaluation of renal cortex and medulla: stiffness values in healthy children.

To evaluate renal cortical and medullary stiffness using 2D Shear-wave elastography (SWE) in healthy children. In this IRB approved prospective study, we measured the stiffness of cortex and medulla of children (4months-17years) at the upper pole, mid pole, and lower pole in bilateral kidneys. The median (IQR) values of renal cortex in <1year age group was 8.7 (5.7-11.7) kPa for right and 8.7 (4.2-14.1) kPa for the left side. For 1-5years age group, it was 7.3 (5.3-10) kPa for the right and 8.9 (6-12.3) kPa for the left side. For >5years, it was 7.4 (5.3-11.2) kPa for the right and 9.6 (6.2-12.7) kPa for the left side. The median (IQR) values of renal medulla in <1year age group was 7.1 (5.1-12.5) kPa for right and 6.8 (4-10.6) kPa for the left side. For 1-5years age group, it was 7.2 (4.9-9.7) kPa for the right and 6.9 (5.6-9.9) kPa for the left side. For >5years, it was 6.8 (5.1-9.6) kPa for the right and 7 (5-10.2) kPa for the left side. The differences in the elasticity values amongst these groups were statistically insignificant (p>0.05). There was a significant correlation between SWE values of cortex and medulla of right kidney (ρ=0.64) and of left kidney (ρ=0.61), respectively. SWE values of renal cortical and medullary stiffness in healthy children do not correlate with age. There is a significant correlation between SWE values of cortex and medulla of the kidneys in healthy children.

Shear wave elastography evaluation of kidneys in children with familial mediterranean fever.

Familial Mediterranean fever (FMF) is an autosomal recessive disorder. Typical clinical manifestations are self-limiting attacks of recurrent fever, abdominal pain, arthralgia, and chest pain due to aseptic polyserositis. Renal involvement is common in FMF patients. Shear wave elastography (SWE) is a noninvasive method that provides the measurement of tissue stiffness. In this study, we aimed to show that SWE can be used as an adjunctive method for evaluating renal involvement in children with FMF. Our study group consists of 79 pediatric FMF patients and 79 control individuals. The study was planned prospectively. The variables, such as age, height, weight, and body mass index (BMI) of the patient and control groups, were kept in a similar way in order not to be affected by the differences. The right and left kidney sizes, parenchymal thicknesses, and SWE values in both groups were compared. The parenchymal stiffness degrees of the kidneys were quantified by shear modulus values in kilopascals. In our study, no statistically significant difference was found between the control and patient groups in terms of the right and left kidney longitudinal dimensions, transverse dimensions, and parenchymal thicknesses. When the kidneys were evaluated in terms of the right and left kidney stiffness values, the stiffness values in the patient group were significantly higher in both kidneys compared with those in the control group (P < 0.001). SWE can be a noninvasive quantitative imaging method that can be used to evaluate kidney involvement by detecting changes in kidney stiffness in children with FMF.

Factors influencing the Shear Wave Elastography evaluation of the patellar tendon.

There is no clear standardization for tendon Shear Wave Elastography (SWE), and data regarding the factors that influence the correctness of evaluation are scarce. We aimed to determine the intra- and interobserver agreement in patellar tendon SWE, and to establish the influence of various factors on elasticity values. We recruited 37 healthy volunteers; SWE of the patellar tendon was performed by two examiners. The following factors were analyzed: probe frequency, degree of joint flexion, size of region of interest (ROI), distance of the color box from the probe footprint, utilization of coupling gel as standoff, and the effect of physical exercise on elastic modulus values. Highest overall interobserver [k=0.767, 95%CI (0.717-0.799), p<0.001] and intraobserver agreement [k=0.920 (0.909-0.929) for examiner 1, k=0.891 (0.875-0.905) for examiner 2] was obtained with the knee in the neutral position, using the L18-5 probe. With the knee flexed at 30º and 45º, the elasticity values were higher compared to the neutral position (p<0.001). With the probe immersed in 0.25 and 0.50 cm coupling gel, the median values were lower compared to the probe placed on the skin (p=0.001, p=0.018). The ROI dimensions and the placement of the SWE box at the level of the skin or at 0.5 cm below skin did not significantly influence the elastic modulus. After physical exercise, the elasticity values decreased in the proximal and middle portion of the tendon (p=0.002, p<0.001). The best results obtained in patellar tendon SWE were with the knee in neutral position, in the proximal or middle tendon, after 10 minutes of relaxation and with the probe placed directly on the skin with minimal pressure. The size and position of ROI do not significantly influence the examination.

Diagnostic efficiency on ultrasound shear wave elastography in evaluation of steatosis severity for non-alcoholic fatty liver disease: a rat model

BackgroundThe pathological feature of steatosis affects the elasticity values measured by shear wave elastography (SWE) is still controversial in non-alcoholic fatty liver disease (NAFLD). The aim of this study is to demonstrate the influence of steatosis on liver stiffness measured by SWE on a rat model with NAFLD and analyze feasibility of SWE for grading steatosis in absence of fibrosis.MethodsSixty-six rats were fed with methionine choline deficient diet or standard diet to produce various stages of steatosis; 48 rats were available for final analysis. Rats underwent abdominal ultrasound SWE examination and pathological assessment. Liver histopathology was analyzed to assess the degree of steatosis, inflammation, ballooning, and fibrosis according to the non-alcoholic fatty liver disease activity score. The diagnostic performance of SWE for differentiating steatosis stages was estimated according to the receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was conducted to determine clinical usefulness and the areas under DCA (AUDCAs) calculated.ResultsIn multivariate analysis, steatosis was an independent factor affecting the mean elastic modules (B = 1.558, P < 0.001), but not inflammation (B = − 0.031, P = 0.920) and ballooning (B = 0.216, P = 0.458). After adjusting for inflammation and ballooning, the AUROC of the mean elasticity for identifying S ≥ S1 was 0.956 (95%CI: 0.872–0.998) and the AUDCA, 0.621. The AUROC for distinguishing S ≥ S2 and S = S3 was 0.987 (95%CI: 0.951–1.000) and 0.920 (95%CI: 0.816–0.986) and the AUDCA was 0.506 and 0.256, respectively.ConclusionsSteatosis is associated with liver stiffness and SWE may have the feasibility to be introduced as an assistive technology in grading steatosis for patients with NAFLD in absence of fibrosis.

Sedative effect with the combination of butorphanol and midazolam on two-dimensional shear wave elastography of pancreas and kidney in healthy dogs

To evaluate the sedative effect of a combination of butorphanol and midazolam on 2-D shear wave elastography (SWE) of the kidneys and pancreas in dogs. 8 clinically healthy dogs. We conducted a 2-D SWE examination of the bilateral kidneys and the pancreas before and after IV of 0.2 mg/kg butorphanol and 0.1 mg/kg midazolam in each dog. We performed 2-D SWE on the left kidney via a subcostal approach with the dog in right lateral recumbency, on the right kidney via the intercostal approach with the dog in left lateral recumbency, and on the right lobe of the pancreas via the subcostal approach. Subsequently, the pancreas and kidney shear wave velocities (SWV) pre- and postsedation were compared. On qualitative evaluation using color mapping, the pancreas and kidneys showed a homogeneous blue-to-green color in pre- and post-sedation 2-D SWE. There was no significant difference in SWV pre- and post-sedation in the pancreas and kidneys. Intravenous administration of a combination of 0.2 mg/kg butorphanol and 0.1 mg/kg midazolam did not change the 2-D SWE of the pancreas and kidneys significantly. The combination of butorphanol and midazolam can be used in healthy dogs for 2-D SWE evaluation of the pancreas and kidneys, especially when the patient is uncooperative during the examination.

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.

Elasticity evaluation of the plantar fascia: A shear wave elastography study involving 33 early-stage plantar fasciopathy subjects.

Background: Plantar fasciopathy, the most common foot condition seen in elderly and athletic populations, can be diagnosed and differentially diagnosed with imaging modalities such as ultrasound shear wave elastography (SWE). However, standard guidelines for ultrasound elastography of the plantar fascia are lacking. The purpose of this study was to determine the impact of the region of interest (ROI) on the evaluation of the plantar fascia elasticity and confirm the screening accuracy of SWE in the early-stage of plantar fasciopathy. Methods: This was an observational case‒control study involving 50 feet of 33 early-stage plantar fasciopathy subjects (the plantar fasciopathy group) and 96 asymptomatic feet of 48 healthy volunteers (the non-pain group). Clinical information, including age, gender, height, weight, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Scale score (AOFAS), and the symptom duration, were recorded. All participants underwent both conventional ultrasound and SWE evaluation. The plantar fascia elastic parameters included SWEsingle-point, calculated with a single-point ROI set at the greatest thickness of the plantar fascia, and SWEmulti-point, calculated by multipoint ROIs set continuously from the origin at the calcaneus to about 2cm from the calcaneal origin. Results: The plantar fasciopathy group presented a higher VAS score (median [IQR), 4.00 (3.00) vs. 0.00 (0.00), p < 0.001] and lower AOFAS score [median (IQR), 79.50 (3.00) vs. 100.00 (10.00), p < 0.001] than the non-pain group. The median plantar fascia thickness of the plantar fasciopathy group was significantly greater than that of the non-pain group [median (IQR), 3.95 (1.37)mm vs 2.40 (0.60)mm, p < 0.001]. Abnormal ultrasound features, including echogenicity, border irregularities, and blood flow signals, were more prominent in the plantar fasciopathy group than in the non-pain group (29% vs. 0%, p < 0.001; 26% vs. 1%, p < 0.001; 12% vs. 0%, p < 0.001, respectively). Quantitative analysis of the plantar fascia elasticity revealed that the difference between the value of SWEsingle-point and SWEmultipoint was significant [median (IQR), 65.76 (58.58) vs. 57.42 (35.52)kPa, p = 0.02). There was a moderate and significant correlation between the value of SWEsingle-point and heel pain. However, there was no correlation between the value of SWEmultipoint and heel pain. Finally, we utilized the results of SWEsingle-point as the best elastic parameter reflecting clinical heel pain and found that SWEsingle-point could provide additional value in screening early-stage plantar fasciopathy, with an increase in sensitivity from 76% to 92% over conventional ultrasound alone. Additionally, compared with conventional ultrasound and SWE, the use of both improved the accuracy of screening for plantar fasciopathy. Although there were no significant differences in the negative predictive value of conventional ultrasound, SWE, and their combination, the positive predictive value when using both (90.20%) was significantly greater than that when using conventional ultrasound (74.50%) or SWE alone (76.50%). Conclusion: The plantar fascia elastic parameter calculated with single-point ROIs set at the greatest thickness of the plantar fascia is positively correlated with fascia feel pain. Single-point analysis is sufficient for the screening of the early-stage plantar fasciopathy using SWE. SWEsingle-point may provide additional valuable information for assessing the severity of plantar fasciopathy.

Shear wave elastography evaluation of cats with chronic kidney disease.

Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of life and financial implications for therapy. Currently staging and identification of CKD is limited by diagnostic testing such as creatinine and urine-specific gravity, which do not change until late in the disease course. Other methods to evaluate CKD would be valuable in the clinical setting. Shear wave elastography is one novel ultrasound method, which has shown promise in identifying increases in tissue stiffness and identifying CKD in people. As CKD is often histologically characterized by tubulointerstitial fibrosis, shear wave elastography has the potential to identify CKD and differentiate between stages of CKD in cats. This prospective observational case-control study with 78 cats found no difference in shear wave velocities between groups (P=0.33), a contradictory finding to one prior publication. There was no effect of weight (P=0.65), nor the presence of mineralization (P=0.31) or infarction (P=0.52) on cortical shear wave velocities. There was a significant effect of age on shear wave velocity (P=0.018) where velocities increased with age. The intraclass correlation coefficient was only moderate (0.62). Possible reasons for the difference in results between our work and that published prior, include differences in methodology and differences in instrumentation. Variability in measurements in our population may be due to the effects of respiratory motion or limitations in shear wave elastography software. As such, shear wave elastography is not currently recommended as a tool to evaluate CKD in cats and further work is necessary.

Intelligent multi-modal shear wave elastography to reduce unnecessary biopsies in breast cancer diagnosis (INSPiRED 002): a retrospective, international, multicentre analysis

BackgroundBreast ultrasound identifies additional carcinomas not detected in mammography but has a higher rate of false-positive findings. We evaluated whether use of intelligent multi-modal shear wave elastography (SWE) can reduce the number of unnecessary biopsies without impairing the breast cancer detection rate. MethodsWe trained, tested, and validated machine learning algorithms using SWE, clinical, and patient information to classify breast masses. We used data from 857 women who underwent B-mode breast ultrasound, SWE, and subsequent histopathologic evaluation at 12 study sites in seven countries from 2016 to 2019. Algorithms were trained and tested on data from 11 of the 12 sites and externally validated using the additional site's data. We compared findings to the histopathologic evaluation and compared the diagnostic performance between B-mode breast ultrasound, traditional SWE, and intelligent multi-modal SWE. ResultsIn the external validation set (n = 285), intelligent multi-modal SWE showed a sensitivity of 100% (95% CI, 97.1–100%, 126 of 126), a specificity of 50.3% (95% CI, 42.3–58.3%, 80 of 159), and an area under the curve of 0.93 (95% CI, 0.90–0.96). Diagnostic performance was significantly higher compared to traditional SWE and B-mode breast ultrasound (P < 0.001). Unlike traditional SWE, positive-predictive values of intelligent multi-modal SWE were significantly higher compared to B-mode breast ultrasound. Unnecessary biopsies were reduced by 50.3% (79 versus 159, P < 0.001) without missing cancer compared to B-mode ultrasound. ConclusionThe majority of unnecessary breast biopsies might be safely avoided by using intelligent multi-modal SWE. These results may be helpful to reduce diagnostic burden for patients, providers, and healthcare systems.

2D shear wave elastography in evaluation of prognostic factors in breast cancer.

To evaluate the reproducibility of the 2D shear wave elastography (2D-SWE) method and to identify the prognostic factors of breast lesions. In this prospective study, 44female patients were consecutively included from January 2020 to September 2021. All patients showing visible masses at B-mode ultrasound underwent to clinical evaluation, followed by qualitative and quantitative 2D-SWE by two different operators with over 15-year and 2-year experience, respectively. Subsequently, patients underwent to surgical treatment after core needle biopsy. Reproducibility of qualitative and quantitative 2D-SWE was evaluated by Cohen's kappa and intraclass correlation coefficient (ICC). Clinical, imaging, and histopathological data and 2D-SWE evaluations were analysed with Spearman's rank correlation test. The mean age of the patients was 55years ± 12. The mean histological and ultrasound tumour size of were 23.1mm ± 13.2 and 17.2mm ± 10.2, respectively. The interobserver agreement showed a good reproducibility limited to the qualitative evaluation colour maps (Cohen's kappa = 0.603) and to the quantitative evaluation E ratio (ICC = 0.771). Correlation analysis between the ultrasound and 2D-SWE values and the clinical-pathological parameters showed a significant relationship between E ratio and Elston-Ellis grading (P < 0.030) and between tumour size and Elston-Ellis grading (P < 0.041). The 2D-SWE has shown good reproducibility among operators with different experience. It could be a promising tool in the evaluation of some prognostic factors in ultrasound visible breast cancer.

Two-Dimensional Shear Wave Elastography Evaluation of Post-transplantation Complications in Pediatric Receipt: A Retrospective Cohort.

BackgroundThe 20-year survival rate in pediatric patients after liver transplantation (LT) was no more than 70%. Hepatic fibrosis is one of the principal factors affecting the long-term prognosis. Imaging evaluation was the first-line examination for pediatric liver graft assessment. However, the sensitivity and specificity were insufficient. Thus, two-dimensional shear wave elastography (2D-SWE) was performed to evaluate liver graft stiffness and complication in post-transplant pediatric receipt.Materials and MethodsIn this retrospective cohort, 343 pediatric recipients who underwent liver graft biopsy in our tertiary LT center were recruited between June 2018 and December 2020. The 2D-SWE evaluation, laboratory examination, routine post-transplant biopsy, and hepatic pathological assessment were performed.ResultsNinety-eight of the 343 pediatric patients were included according to the protocol. The Liver Stiffness Measurements (LSM) value of 2D-SWE was significantly elevated in post-transplant fibrosis (p < 0.0001). The LSM value of patients with post-transplant biliary complications (p < 0.0001) and biopsy-proven rejection (BPR, p = 0.0016) also rose compared to regular recovery patients. Concerning the sensitivity and specificity of 2D-SWE in diagnosing liver graft fibrosis, the area under the ROC curve (AUC) was 88%, and the optimal cutoff value was 10.3 kPa.ConclusionPediatric LSM by 2D-SWE was efficient. Routine 2D-SWE evaluation could be optimal to predict significant liver graft fibrosis.

Shear wave elastography in evaluation of carotid elasticity in the type 2 diabetes mellitus patients with nonalcoholic fatty liver disease

Shear wave elastography in evaluation of carotid elasticity in the type 2 diabetes mellitus patients with nonalcoholic fatty liver disease

Contribution of shear wave elastography in evaluation of the deltoid in reverse shoulder arthroplasty: reproducibility study and preliminary results

The current difficulty of reverse shoulder arthroplasty (RSA) is soft tissue management, and adequate deltoid tensionand at present there is no consensus and available tools (X-ray, MRI, EMG) remain difficult to apply in clinical follow-up.The objective of this study was (1) to determine reliability and feasibility of deltoid elasticity assessment using ultrasound elastographyand (2) to assess the change of deltoid stiffness after RSA by comparing shear wave speed (SWS) between healthyand RSA shoulders. Twenty-six healthy (native shoulder, painless and complete range of motion)subjects and twelve patients with RSA were included. Two independent investigators performed 3 measurements on each segment.Measurements were bilateral. Anterior segment was also evaluated at 45° and 60° of passive abduction. Reliability andfeasibility have been assessed (ISO5725-standard). Coefficient of measurements variation was less than 6.1% and0.13 m/s. In the healthy group, SWS was not significantly different between anterior and middle segments; however, the SWSof the posterior segment was significantly lower than others (p<0.0001). In abduction position, compared to the rest position,SWS of the anterior segment decreased at 45° abduction (p=0.0003) and increased at 60° abduction (p<0.0001). Variability ofmeasurement was higher in the RSA group. No significant difference was found between the SWS measurement of the operatedand non-operated side. SWS measurements of the operated side of the anterior and middle segment were significantlyhigher compared to the healthy group. In abduction position, compared to rest position, no difference in SWS of the anteriorsegment was found at 45° abduction (p=0.71) and nor at 60° abduction (p=0.75). This study demonstrated feasibilityand reliability of shoulder assessment with shear wave elastography. Reference values for asymptomatic patients canalready be used in future studies on shoulder pathology and surgery.

Abstract PD11-05: Intelligent shear-wave elastography to reduce unnecessary biopsies in breast cancer diagnosis (INSPiRED 002): An international, multicenter analysis

Abstract Background: Breast ultrasound identifies additional carcinomas not detected in mammography, but has a higher rate of false-positive findings which result in more unnecessary breast biopsies. Shear-Wave Elastography (SWE), an ultrasound technique used to quantify the stiffness of a lesion, showed promising results to improve the diagnostic performance of B-mode breast ultrasound but also to miss some cancers. As the stiffness of a lesion is found to be influenced by individual patient characteristics, incorporation of lesion stiffness in more individualized assessments may be key to the problem of reducing unnecessary breast biopsies without impairing the breast cancer detection rate. Thus, in this study, we evaluated whether an intelligent algorithm incorporating traditional SWE values as well as other patient and clinical variables (hereafter “intelligent SWE”) could reduce the number of unnecessary breast biopsies without impairing the breast cancer detection rate compared to traditional SWE and B-mode breast ultrasound for patients with suspicious breast lesions. Methods: We trained, tested, and validated machine learning algorithms using patient, clinical, ultrasound, and SWE information to classify breast masses. We used international, multicenter data from 857 women with BI-RADS 4 breast masses at 12 study sites in 7 countries. Patients underwent B-mode breast ultrasound, SWE, and subsequent histopathologic evaluation. 10-fold cross-validation was used to train and test the algorithms on data from 11 of the 12 sites which were further validated using the additional site’s data. The results of B-mode breast ultrasound, traditional SWE, and intelligent SWE were compared to the gold standard of histopathologic evaluation. We calculated sensitivity, specificity, and AUROC and used McNemar tests to test for significant differences in diagnostic performance. Results: The mean age was 49.5 years (SD 16.3) and 42.2% breast masses (n=362 of 857) were found to be malignant as confirmed by histopathology. In the external validation set (n=285), traditional SWE showed a significantly higher diagnostic performance compared to B-mode breast ultrasound (P &amp;lt; 0.001), whereas intelligent SWE outperformed both B-mode breast ultrasound and traditional SWE (P &amp;lt; 0.001). The neural network algorithm showed a significantly higher diagnostic performance compared to the Logistic Regression with Elastic Net Penalty (P = 0.004). The neural network algorithm achieved a sensitivity of 100% (95% CI 97.1 to 100%, 126 of 126) and a specificity of 50.3% (95% CI 42.3 to 58.3%, 80 of 159); the number of unnecessary biopsies were reduced by 50.3% (79 vs. 159) without missing any cancer compared to B-mode breast ultrasound. Model-agnostic variable importance plots to provide insights into the model predictions showed that the three most important variables for intelligent SWE were patient age followed by Shear-Wave velocity and orientation of the lesion (parallel vs. not parallel) in B-mode ultrasound. Conclusion: This is the first evidence which suggests that the majority of false-positive breast biopsies could be safely avoided by using intelligent SWE without impairing breast cancer detection rates. These results may be helpful in their ability to reduce treatment burden for patients, providers, and healthcare systems. Trial registration: NCT02638935. Funding: Siemens Medical Solutions USA, Inc Diagnostic Performance ComparisonB-mode Breast UltrasoundTraditional Shear-Wave ElastographyIntelligent Shear-Wave Elastography – Logistic Regression with Elastic Net PenaltyIntelligent Shear-Wave Elastography – neural networkAUROC – value (95% CI)–0.84 (0.79-0.89)0.93 (0.90-0.95)0.93 (0.90-0.96)Sensitivity – % (95% CI); no.100% (97.1-100%); 126 of 12697.6% (93.2-99.5%); 123 of 126100% (97.1-100%); 126 of 126100% (97.1-100%); 126 of 126Specificity – % (95% CI); no.0% (0.0-2.3%); 0 of 15923.9% (17.5-31.3%); 38 of 15936.5% (29.0-44.5%); 58 of 15950.3% (42.3-58.3%); 80 of 159Negative predictive value – % (95% CI); no.–92.7% (80.1-98.5%); 38 of 41100% (93.8-100%); 58 of 58100% (95.5-100%); 80 of 80Positive predictive value – % (95% CI); no.44.2% (38.4-50.2); 126 of 28550.4% (44.0-56.8%); 123 of 24455.5% (48.8-62.1%); 126 of 22761.5% (54.4-68.2%); 126 of 205 Citation Format: André Pfob, Chris Sidey-Gibbons, Richard G. Barr, Volker Duda, Zaher Alwafai, Corinne Balleyguier, Dirk-André Clevert, Sarah Fastner, Christina Gomez, Manuela Goncalo, Ines Gruber, Markus Hahn, André Hennigs, Chi Ho, Panagiotis Kapetas, Sheng-Chieh Lu, Juliane Nees, Ralf Ohlinger, Fabian Riedel, Matthieu Rutten, Benedikt Schaefgen, Anne Stieber, Riku Togawa, Mitsuhiro Tozaki, Sebastian Wojcinski, Cai Xu, Geraldine Rauch, Joerg Heil, Michael Golatta. Intelligent shear-wave elastography to reduce unnecessary biopsies in breast cancer diagnosis (INSPiRED 002): An international, multicenter analysis [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD11-05.

Factors associated with the elasticity of asymptomatic carotid plaques in hypertension Tibetan population.

Hypertension is a major risk factor for coronary, cerebrovascular, and the greatest cause of stroke. Half of stroke events are the result of cerebrovascular atherosclerosis, including carotid plaques. It is of major importance to detect which plaques are vulnerable, even though not yet ruptured. Due to the particularity of the Tibetan population, this study evaluated the elasticity of asymptomatic carotid plaques in Tibetan hypertension patients using shear wave elastography (SWE) and explored associated risk factors. A total of 91 Tibetan patients were divided into normotension, grade 1-2, and grade 3 hypertension groups based on the level of blood pressure. All subjects underwent common duplex ultrasonic examination and SWE evaluation for carotid plaques. Elasticity of carotid plaque was assessed by Young's modulus. The final analysis included 126 plaques as representative plaques according to Total Plaque Risk Score. The mean and maximum Young's modulus in the grade 3 hypertension group were smaller, and more plaques with irregularity surface compared with the other two groups (p < 0.05). Multivariate regression analysis showed drinking butter tea (β = -0.220, p = 0.009; β = -0.240, p = 0.004, respectively) was the independent factor associated with mean and maximum Young's modulus. SWE is feasible for measurement of Young's modulus of carotid plaques. Plaques in the grade 3 hypertension group were more likely to become vulnerable ones. In hypertension Tibetan patients, drinking butter tea was an independent factor associated with mean and maximum Young's modulus of asymptomatic carotid plaque.