Shear Wave Elastography Stiffness Research Articles

Correlation of shear-wave elastography stiffness and apparent diffusion coefficient values with tumor characteristics in breast cancer

We aimed to investigate the correlation between shear-wave elastography (SWE) and apparent diffusion coefficient (ADC) values in breast cancer and to identify the associated characteristics. We included 91 breast cancer patients who underwent SWE and breast MRI prior to surgery between January 2016 and November 2017. We measured the lesion’s mean (Emean) and maximum (Emax) elasticities of SWE and ADC values. We evaluated the correlation between SWE, ADC values and tumor size. The mean SWE and ADC values were compared for categorical variable of the pathological/imaging characteristics. ADC values showed negative correlation with Emean (r = − 0.315, p = 0.002) and Emax (r = − 0.326, p = 0.002). SWE was positively correlated with tumor size (r = 0.343–0.366, p < 0.001). A higher SWE value indicated a tendency towards a higher T stage (p < 0.001). Triple-negative breast cancer showed the highest SWE values (p = 0.02). SWE were significantly higher in breast cancers with posterior enhancement, vascularity, and washout kinetics (p < 0.02). SWE stiffness and ADC values were negatively correlated in breast cancer. SWE values correlated significantly with tumor size, and were higher in triple-negative subtype and aggressive imaging characteristics.

Comparison of testicular stiffness values obtained by ultrasound shear-wave elastography and magnetic resonance elastography in normal healthy volunteers

Objectives: This study aimed to contribute to the standardization of elastography by comparing stiffness values obtained from ultrasound shear wave elastography (SWE) and magnetic resonance elastography (MRE) of the testicular parenchyma in healthy volunteers. Methods: A total of 22 healthy volunteers (44 testes) were included in this study. Of the 26 cases analyzed, four were excluded from the study due to the exclusion criteria. The testicular parenchyma of the included patients was evaluated using MRE and SWE examinations. Pearson's correlation test was used to calculate the correlation between age and stiffness values, testicular volumes and stiffness values, and stiffness values from both examinations. Results: The mean SWE stiffness of the right testes was 5.560±3.1 kPa and the mean SWE stiffness of the left testes was 5.361±2.9 kPa. The mean MRE stiffness of the right testes was 6960.11±460 Pa and the mean MRE stiffness of the left testes was 6560.19±310 Pa. There was no significant correlation between SWE and MRE stiffness values (P=0.096). There was also no significant statistical correlation between SWE and MRE stiffness values and testicular volumes (P=0.17 and P=0.093, respectively). Conclusions: No statistical correlation was found between the stiffness values obtained by SWE and those obtained by MRE in the normal testicular parenchyma. Additionally, no conclusive relationship between stiffness levels, age, or testicular volume was discovered.

Novel Scoring Systems and Age-Based Hepatic Shear Wave Stiffness Cut-Offs for Improving Sonographic Diagnosis of Biliary Atresia.

To make sonographic evaluation for biliary atresia (BA) more objective and reproducible using scoring systems, and evaluate hepatic shear wave elastography (SWE) as an adjunct in sonographic diagnosis of BA. Sixty-four infants with cholestatic jaundice were enrolled between June 2016 and March 2018 in this prospective observational cohort study. Sonography and SWE was performed with SuperSonic Aixplorer system. Novel scoring systems were developed incorporating established sonographic parameters and hepatic stiffness values and analysed using SPSS software. Of the 18 patients confirmed as BA, 3 were misdiagnosed on conventional sonography (16.7%) as non-BA. Gall bladder (GB) wall irregularity and fasting GB length were the most accurate (93.8%) and most specific (97.8%) individual parameters, respectively. A significant difference was noted in the triangular cord (TC) thickness of BA and non-BA infants (p <0.001), with a high specificity of 95.6% for a 4 mm cut-off value for a positive TC sign. Comparison of hepatic SWE stiffness among age-matched groups of BA and non-BA showed significant differences (≤60d: p=0.003; >60d: p <0.001) but with a reduced accuracy (93.8%). Diagnostic accuracy of greyscale scoring system (96.9%), greyscale + elastography scoring system in ≤60 d (94.4%) and >60 d (97.8%) were better than that of conventional sonographic diagnosis (93.8%). Grey scale scoring system improves the accuracy of sonographic diagnosis of BA without any additional cost or time penalty along with making it universally reproducible. SWE has only an adjunctive role, if any, in the sonographic diagnosis of BA.

Measurement of renal congestion and compliance following intravenous fluid administration using shear wave elastography

ObjectiveUltrasound shear wave elastography (SWE) is a novel technique that may provide non-invasive measurements of renal compliance. We aimed to investigate the relationship between intravenous (IV) fluid administration and change in SWE measurements. We hypothesised that following IV fluid administration in healthy volunteers, global kidney stiffness would increase and that this increase in stiffness could be quantified using SWE. Our second hypothesis was that graduated doses of IV fluids would result in a dose-dependent increase in global kidney stiffness measured by SWE. DesignRandomised prospective study. SettingIntensive Care Unit. ParticipantsHealthy volunteers aged 18–40 years. InterventionsParticipants were randomised to receive 20 ml/kg, 30 ml/kg, or 40 ml/kg of normal saline. The volume of fluid infused was based on the actual body weight recorded. Main outcome measuresWe recorded average SWE stiffness (kPa with standard deviation of the mean), median SWE stiffness (kPa), and the interquartile range. ResultsNinety-eight percent of participants (44/45) demonstrated an increase in global kidney stiffness following administration of IV fluids. The average SWE pre fluid administration was 7.572 kPa ± 2.38 versus 14.9 kPa ± 4.81 post fluid administration (p < 0.001). In subgroup analysis, there were significant changes in global kidney stiffness pre and post fluid administration with each volume (ml/kg) of fluid administered. Average percentage change in global kidney stiffness from baseline was compared between the three groups. There was no significant difference when comparing groups 1 and 2 (197.1% increase ± 49.5 vs 216.1% ± 72.0, p ¼ 0.398), groups 2 and 3 (216.1% increase ± 72.0 vs 197.8% ± 59.9, p ¼ 0.455), or groups 1 and 3 (197.1% increase ± 49.5 vs 197.8% ± 59.9, p ¼ 0.972). ConclusionsFluid administration results in immediately visible and quantifiable changes in global kidney stiffness across all infused volumes of fluid.

Shear wave elastography ultrasound does not quantify mechanical properties of the ulnar collateral ligament of the elbow.

To validate shear wave elastography (SWE) stiffness measurements for the ulnar collateral ligament (UCL) of the elbow compared to mechanical measurements. Eleven fresh frozen human cadaveric upper extremities were evaluated by a musculoskeletal-specialized radiologist to provide SWE measurements used to calculate stiffness at 4 points along the anterior band of the UCL at various load states and flexion angles. Specimens were then dissected and optical markers were placed on the UCL to track displacement during applied force by a load frame, thereby providing measurements to calculate the mechanical stiffness. These two stiffness values were compared by ANOVA for all load states and flexion angles. Measurements of stiffness by SWE for the UCL were three orders of magnitude smaller than the true mechanical testing stiffness and no correlations between SWE and mechanical measurements of stiffness were found at 30, 60 or 90 degrees of elbow flexion (R2 = 0.004, p = 0.85; R2 = 0.001, p = 0.92; R2 = 0.15, p = 0.24 respectively). SWE stiffness was greatest near the insertion of the ligament and lowest in the mid-substance of the ligament (p = 0.0002). SWE stiffness did not correlate with mechanical measurements. Clinical utility of musculoskeletal SWE may be better defined when biomechanical properties or clinical outcomes can be correlated with SWE measurements. The ultimate clinical utility of SWE in musculoskeletal tissues may be qualitative, as demonstrated by differences throughout the length of the UCL in this study.

Evaluation of Sciatic Nerve Stiffness Using Shear Wave Elastography in Patients with Unilateral Diabetic Foot Ulcers.

To evaluate the stiffness of the sciatic nerve by shear wave elastography (SWE) and to determine whether SWE can be used to predict diabetic foot ulcer (DFU) in a patient with diabetic peripheral neuropathy (DPN). Sixteen patients (thirty-two lower limbs) with unilateral DFU were studied retrospectively. The ultrasonographic parameters including cross-sectional area (CSA) of sciatic nerve, intraneural blood flow, peak systolic velocity (Vmax) and resistive index (RI) in the intraneural artery of the sciatic nerve, and the SWE stiffness value of the sciatic nerve were measured. The examinations of arteries of the lower limbs were also performed by ultrasound. According to the presence or absence of DFU, the 32 lower limbs were divided into two groups: the DFU group and the non-DFU group. The ultrasonographic parameters were compared between these two groups. There was no significant difference (p > 0.05) between the two groups for CSA, intraneural blood flow, Vmax and RI in the intraneural artery of the sciatic nerve, and numbers of severe artery stenosis or full occlusion of the artery in the lower limbs. However, SWE stiffness values in the sciatic nerve in the DFU group are higher than the non-DFU group (p < 0.05). When the SWE stiffness values were used for prediction of DFU in patients with DPN, the area under the ROC curve (AUC) was 0.727 (95% CI: 0.541-0.868). When the best SWE stiffness value of 24.48 kPa was taken as a cutoff for prediction of DFU, the sensitivity was 62.50% (95% CI: 35.4-84.8%), and the specificity was 75% (95% CI: 47.6-92.7%). Sciatic nerve stiffness is significantly higher in lower limbs with DFU. SWE is a noninvasive imaging method that may be used to evaluate sciatic nerve stiffness, then potentially predict DFU in patients with DPN.

Advanced Ultrasound Imaging of the Brain in Neonatal Hydrocephalus Using a Rat Hydrocephalus Model

Background and Objective:Preterm infants are at risk of developing post-hemorrhagic hydrocephalus. Earlier detection and intervention via placement of an intraventricular catheter improves neurologic and cognitive outcomes. However, intraventricular catheter placement is invasive with many risks, including hemorrhage and infection. Magnetic resonance imaging (MRI) can be used to detect ventriculomegaly and suggest hydrocephalus but cannot diagnose it. MRI is also difficult to obtain in preterm infants. Shear wave elastography (SWE) is an ultrasound technique measuring tissue stiffness and could serve as a rapid, bedside technique to detect hydrocephalus. We hypothesize that SWE stiffness measurements of the brain will positively correlate to MRI-derived ventricular volumes.Methods:Rats were bred to be wild-type, heterozygous, or homozygous for a Wpk mutation causing obstructive hydrocephalus. SWE and MRI of the rats were obtained at 7 and 14 days postnatally. Stiffness was measured using the Aixplorer SWE analysis tool. Lateral ventricular volumes were measured from the T2-weighted MRI images by planimetric analysis.Results:Stiffness and ventricular volumes were compared between genotypes via Kruskal-Wallis test at 7 and 14 days. SWE comparisons were 12.75 (p &lt; 0.05) and 16.54 (p &lt; 0.001), respectively. MRI volume comparisons were 18.78 (p &lt; 0.001) and 19.01 (p &lt; 0.001), respectively. MRI volume measurements were correlated to the SWE measurements via Spearman’s Rank correlation at 7 days (r = 0.539, p &lt; 0.05), 14 days (r = 0.488, p &lt;.05), and combined (r = 0.534, p &lt; 0.001), consistent with a moderate correlation.Conclusion and Potential Impact:This study supports the hypothesis that SWE-derived brain stiffness does significantly correlate with ventricular volumes. SWE has the potential to be used as a bedside tool for detecting neonatal hydrocephalus. SWE could reduce the need for MRI exams and invasive intraventricular catheter placements, allowing for more rapid diagnosis and thus intervention for newborns with hydrocephalus.

Hamstrings load bearing in different contraction types and intensities: A shear-wave and B-mode ultrasonographic study

The main aim was to examine the load bearing of individual hamstring muscles in different contraction types and intensities, through local stiffness measurement by shear wave elastography (SWE). A secondary aim was to examine the relationship between the SWE stiffness measure and hamstrings morphology. Ten healthy males (age 22.1±4.1 years; height 173.7±5.9 cm; body mass 68.6±12.4 kg; mean ± SD) performed knee flexions on an isokinetic dynamometer at different intensities (20–70%MVC, random order) in three separate, randomized conditions: isometric (ISO), concentric (CON) and eccentric (ECC). SWE was used to measure muscle shear wave velocity (SWV) in biceps femoris long head (BFlh), semitendinosus (ST) and semimembranosus (SM) during contraction. Muscle anatomical cross-sectional area (ACSA) was measured with magnetic resonance imaging and muscle architecture with B-mode ultrasonography. Muscle SWV increased linearly with contraction intensity, but at a varying rate among muscles and contraction types. ST exhibited greater SWV than BFlh and SM in all contraction types, however, there was an upward shift in the SM SWV–torque relationship in ECC compared to ISO and CON. Strong negative correlations were found between peak ISO SWV and ST ACSA (r = -0.81, p = 0.005) and BFlh pennation angle (r = -0.75, p = 0.012). These results suggest that ST has a primary role in hamstrings load bearing in all contraction types, likely due to its morphology; however, there is evidence of increased contribution from SM in eccentric muscle actions.

Mapping of Back Muscle Stiffness along Spine during Standing and Lying in Young Adults: A Pilot Study on Spinal Stiffness Quantification with Ultrasound Imaging.

Muscle stiffness in the spinal region is essential for maintaining spinal function, and might be related to multiple spinal musculoskeletal disorders. However, information on the distribution of muscle stiffness along the spine in different postures in large subject samples has been lacking, which merits further investigation. This study introduced a new protocol of measuring bilateral back muscle stiffness along the thoracic and lumbar spine (at T3, T7, T11, L1 & L4 levels) with both ultrasound shear-wave elastography (SWE) and tissue ultrasound palpation system (TUPS) in the lying and standing postures of 64 healthy adults. Good inter-/intra-reliability existed in the SWE and TUPS back muscle stiffness measurements (ICC ≥ 0.731, p < 0.05). Back muscle stiffness at the L4 level was found to be the largest in the thoracic and lumbar regions (p < 0.05). The back muscle stiffness of males was significantly larger than that of females in both lying and standing postures (p < 0.03). SWE stiffness was found to be significantly larger in standing posture than lying among subjects (p < 0.001). It is reliable to apply SWE and TUPS to measure back muscle stiffness. The reported data on healthy young adults in this study may also serve as normative reference data for future studies on patients with scoliosis, low back pain, etc.

Association of Clinical Assessments of Hand Function and Quantitative Ultrasound Metrics in First Carpometacarpal Osteoarthritis.

Thumb carpometacarpal (CMC) osteoarthritis (OA), a degenerative condition affecting hand use, is typically evaluated through radiographs and clinical examination. Although this can determine treatment, it is difficult to evaluate functional limitations. Shear wave elastography (SWE) is a quantitative ultrasound technique that characterizes tissue stiffness. This pilot study aimed to establish data of the SWE findings in the thenar eminence muscles in patients with first CMC OA and correlate these findings with the clinical tests of hand function. This cross-sectional study correlated the SWE stiffness of thenar eminence muscles to clinical tests of hand function in patients with first CMC OA and in asymptomatic control subjects, using Spearman's correlation coefficient. Mean SWE values of the thenar eminence muscles in patients were compared with those in control subjects. The study was performed in a non-profit tertiary care hospital setting. Patients and control subjects were recruited on a volunteer basis. SWE values in the abductor pollicis brevis and flexor pollicis brevis muscles showed moderate to very strong correlation with multiple measures of hand function. Mean SWE values of the thenar eminence muscles in first CMC OA patients were lower than those in asymptomatic control subjects. Correlations between mean SWE values in the thenar eminence muscles and clinical measures of hand function suggest decreased function in subjects with less stiff thenar eminence muscles.

Shear wave elastography and microvascular ultrasound in response evaluation to calcipotriol+betamethasone foam in plaque psoriasis

Psoriasis (PsO) is a chronic skin disease. This study aims to evaluate clinical and subclinical response to calcipotriol+betamethasone foam, in patients with PsO, comparing, for the first time, data from...

Efficacy of shear-wave elastography versus dynamic optical breast imaging for predicting the pathological response to neoadjuvant chemotherapy in breast cancer

PurposeExplore the value of shear-wave elastography (SWE) parameters and dynamic optical breast imaging features for predicting pathological responses to neoadjuvant chemotherapy (NACT) in breast cancer (BC). MethodThis prospective cohort study included 91 BC patients receiving NACT. Tumor size, SWE (maximum stiffness [Emax] and mean stiffness [Emean]), blood score (BS), and oxygen score (OS) and their relative changes were collected before (t0), during (t1–t5), and after NACT (t6). The pathological response was classified according to the residual cancer burden. Relationships between tumor size, SWE stiffness, BS, and OS at t0–t6 were analyzed, and their predictive power was compared. ResultsDuring six NACT cycles, tumor size, tumor stiffness, and BS decreased, and tumor OS increased. ΔEmean (t2), E2mean, BS2, and OS2 had a greater power than other indexes for predicting a favorable response (AUC = 0.79, 0.71, 0.77, 0.78) and a resistance response (0.86, 0.74, 0.71, 0.71). For the favorable response, predictive power did not differ significantly between ΔEmean (t2), E2mean, BS2, and OS2, whereas for the resistance response, ΔEmean (t2) showed better prediction than E2mean, BS2, and OS2. ConclusionsSWE stiffness, BS, and OS exhibited good and similar performances in predicting a NACT favorable response, and SWE stiffness showed better performance than BS and OS in predicting NACT resistance. These results may provide an important reference for individualized treatment in BC patients receiving NACT.

Evaluation of plantar fasciopathy shear wave elastography: a comparison between patients and healthy subjects.

The aim of this study is to compare elasticity features between patients with plantar fasciitis (PFis) and an asymptomatic healthy control group using shear wave elastography (SWE) and to correlate SWE values with clinical scores. Consecutive patients diagnosed with PFis and asymptomatic subjects were enrolled in the present study. Both groups underwent clinical, ultrasound (US), and SWE evaluation. A plantar fascia thickness > 4mm was considered pathognomonic of PFis. SWE stiffness elasticity (Young's modulus in kPa and shear wave velocity in m/s) was measured 1cm distally from the calcaneal insertion. Correlations with VAS and the 17-Italian Foot Function Index (17-FFI) were determined. A total of 19 patients satisfied the inclusion criteria for the patient group and were enrolled in the study, and 21 healthy subjects were used as a control group. Statistically significant differences were found for shear wave velocity between the patient and the control group, with SWE findings of 3.8 (5.1; 1.5) m/s and 4.7 (4.07; 7.04) m/s, respectively (p = 0.006). Strong positive correlations were found between the SWE findings and both the pain and the functional scale (VAS: p = 0.001; FFI: p = 0.012). SWE allows quantitative assessment of the stiffness of the plantar fascia and can show PFis alterations, increasing the diagnostic performance of B-mode US. In addition, SWE shows a strong correlation with clinical scores, improving patient assessment and follow-up.

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles.

Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)-based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited. To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles. Cross-sectional study. Laboratory. A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg). The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability. Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715-0.890) except for SCM SWE stiffness (ICC = 0.554). The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.

Role of sonoelastography in assessment of axillary lymph nodes in breast cancer: a systematic review and meta-analysis

To evaluate the effectiveness of shear-wave elastography (SWE) and strain elastography (SE) for axillary lymph nodes (ALNs). PubMed, Embase, and Cochrane Library databases were searched until September 2018. Weighted mean difference was calculated for continuous variables. The accuracy of sonoelastography was assessed by calculating pooled sensitivity, specificity, area under the curve (AUC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). All data were analysed using Stata 12.0. Ten studies with 1,038 ALNs were included in the meta-analysis. Five studies evaluated the use of SE, and the other five evaluated the SWE. The SWE stiffness values of malignant ALNs were significantly higher than those of benign nodes. Both SE and SWE have relatively high specificity and sensitivity. The max stiffness in SWE showed the highest specificity (0.94; 95% confidence interval [CI], 0.81-0.98), PLR (12.1; 95% CI, 4-36.5), NLR (0.29; 95% CI, 0.12-0.69), AUC (0.94; 95% CI, 0.91-0.96), and DOR (42; 95% CI, 12-154); in contrast, the mean stiffness showed the highest sensitivity (0.80; 95% CI, 0.61-0.91). Sonoelastography demonstrated high sensitivity and specificity for differentiating between malignant and benign ALNs. The max and mean stiffness on SWE appeared to exhibit the highest accuracy. Thus, SWE is an effective accompaniment to sentinel node biopsy, and is appropriate for preoperative assessment of ALNs in the post-Z0011 era.

Ultrasound elastography correlations between anthropometrical parameters in kidney transplant recipients

Ultrasound elastography (USE) is a method to assess the stiffness of parenchymatous organs. Shear wave elastography (SWE) is considered to be the most suitable elastography method for the non-invasive kidney...

Using Ultrasound Elastography to Predict Which Pediatric HSCT Patients Will Develop Severe Sinusoidal Obstruction Syndrome

Introduction Hepatic sinusoidal obstruction syndrome (SOS) is a complication of hematopoietic stem cell transplantation (HSCT). Severe and very severe SOS is associated with multi-organ failure and has ∼60% mortality. SOS is classified into mild, moderate, severe and very severe based on new European Society for Blood and Marrow Transplantation (EBMT) criteria. Defibrotide treatment is recommended for severe and very severe patients. Objective Our primary objective was to determine if hepatic ultrasound shear wave elastography (SWE) can predict SOS severity in pediatric HSCT patients. Methods This is a multi-site prospective cohort study evaluating the use of SWE in pediatric HSCT patients (0-21 years) from 10/2015 to 3/2018 at 2 pediatric institutions. Site 1 subjects underwent 1 SWE within 10-days prior to start of conditioning regimen and at days +5 and +14 after HSCT. Site 2 enrolled subjects at the time of clinical suspicion for SOS and subjects received SWE examinations every other day up to 10 exams during their inpatient stay. We examined 11 time-varying variables including weight, hepatomegaly, ascites, SWE and various Doppler ultrasound variables as predictors of maximum EBMT criteria severity grade. We used the median to summarize the SWE values. Missing data on explanatory variables ( Results 55 subjects were enrolled. Most patients were male (n=33, 55%) with a median age of 8 (range 0-20) years. 21 (35%) patients developed SOS, 15 (25%) had severe or greater disease by EBMT criteria. Busulfan use is associated with an average increase of 0.6 in EBMT grade, and a 100 cm/s decrease in main portal vein velocity is associated with an average increase of 1.3 in EBMT grade. Hepatomegaly, ascites, and higher SWE stiffness also appear to be associated with greater SOS severity (p 1.95 m/s was 87.5% sensitive and 85% specific for severe or very severe SOS. Seven of eight patients with severe or very severe SOS had SWE >1.95 m/s two to thirteen days before the date of severe SOS grading. Conclusion In a group of 12 clinical and ultrasound variables, SWE velocity was an excellent predictor of the patient developing severe SOS. SWE was able to predict severe SOS 2 to 13 days before the EBMT criteria with 87.5% sensitivity and 85% specificity.

Prediction of pathological complete response to neoadjuvant chemotherapy for primary breast cancer comparing interim ultrasound, Shear Wave elastography and MRI

Abstract Background Prediction of pathological complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NACT) may influence planned surgical approaches in the breast and axilla. The aim of this project is to assess the value of interim shear wave elastography (SWE), ultrasound (US) and magnetic resonance imaging (MRI) after 3 cycles in predicting pCR. Methods 64 patients receiving NACT had baseline and interim US, SWE and MRI examinations. The mean lesion stiffness at SWE, US and MRI diameter was measured at both time points. We compared four parameters with pCR status: a) Interim mean stiffness ≤ or &gt; 50 kPat; b) Percentage stiffness reduction; c) Percentage US diameter reduction and d) Interim MRI response using RECIST criteria. The Chi square test was used to assess significance. Results Interim stiffness of ≤ or &gt; 50 kPat gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPat, compared to 7 of 50 (14 %) of cancers with an interim stiffness of &gt; 50 kPat, (p &lt; 0.0001) (sensitivity 59 %, specificity 91 %, PPV 71 %, NPV 86 % and diagnostic accuracy 83 %). Percentage reduction in stiffness was the next best parameter (sensitivity 59 %, specificity 85 %, p &lt; 0.0004) followed by reduction in MRI diameter of &gt; 30 % (sensitivity 50 % and specificity 79 %, p = 0.03) and % reduction in US diameter (sensitivity 47 %, specificity 81 %, p = 0.03). Similar results were obtained from ROC analysis. Conclusion SWE stiffness of breast cancers after 3 cycles of NACT and changes in stiffness from baseline are strongly associated with pCR after 6 cycles.

Use of Shear Wave Elastography in the Sonographic Triage of Thyroid Nodules: Feasibility Study in a Series of Lesions Already Selected for Fine Needle Aspiration.

The aim of this study was to evaluate the application of shear wave elastography (SWE) in the routine management of thyroid nodules, as a possible additional tool to the standard sonographic triage. A total of 248 consecutive patients scheduled for ultrasound-guided thyroid fine-needle aspiration were included in the study. The presence of a pure colloid lesion was an exclusion criterion. Absolute and relative SWE stiffness measurements on color-coded elastograms, expressed in kilopascals and meters per second, were correlated with radiologic and pathologic features. SWE values in thyroid nodules were significantly higher than normal thyroid tissue (P = .0001), proving the different elastic properties of the pathologic tissues. Regarding the radiologic characteristics of the nodules, SWE highest values were associated with the largest lesions (P = .0105) but independent from sonographic and Doppler findings. The SWE elasticity was not influenced by the characteristics of the biopsy smears. The final correlation between the SWE results and the pathologic diagnoses showed a trend in stiffness from tender tumors (follicular adenoma) to papillary thyroid carcinoma (P = .016). SWE allows the identification of nodules within normal parenchyma; however, the present study does not confirm the potential role in differentiating between benign and malignant thyroid nodules.

Role of Preoperative Testicular Shear Wave Elastography in Predicting Improvement of Semen Parameters After Varicocelectomy for Male Patients With Primary Infertility

To evaluate the role of preoperative testicular shear wave elastography (SWE) in the prediction of improvement of semen analysis parameters after subinguinal microsurgical varicocele ligation in patients with primary infertility and clinically detectable varicocele. Testicular SWE before the surgical intervention was done. Forty-eight patients were scheduled for subinguinal microsurgical varicocele ligation as a treatment option. Computer-assisted semen analysis was repeated 6 months after the intervention. At a cutoff value of 4.5 kPa, the stiffness index had a sensitivity of 86.4% and a specificity of 84.2% for semen parameter improvement after varicocelectomy. Correlation between different parameters of semen analysis and SWE showed a statistically significant negative correlation between SWE stiffness index and both sperm count (million/mL) and total motility. On the other hand, a nonsignificant negative correlation was found between SWE stiffness index and percentage of normal form. Testicular SWE is a good test that can be used in the assessment of male infertility with clinically detectable varicocele, and its results may predict semen parameter improvement after varicocelectomy. Further studies on a larger number of patients are needed to verify our results.