Shear Wave Elastography Technique Research Articles

Does shear wave elastography technology provide better value for the assessment of perianal fistulizing Crohn’s disease?

Magnetic resonance imaging is the gold standard compared other clinical findings. But shear wave elastography technique combined with endoscopic ultrasound can evaluate the degree of fibrosis of fistula tissue in Crohn’s disease patients. This topic is highly relevant to the current discourse, especially for It shows a certain degree of innovation and practicality and is worthy of study and popularization.

Body Habitus vs. Hepatic Steatosis: Understanding the Drivers of Non-Diagnostic Shear Wave Elastography

PurposeShear Wave Elastography (SWE) is frequently non-diagnostic in obese patients, a key cohort at risk for liver disease. Subcutaneous fat and hepatic steatosis are suspected drivers, but their relative contribution is unknown. We compare ultrasound-guided attenuation parameter (UGAP), a marker of steatosis, body mass index (BMI), and skin-to-liver capsule distance (SCD) to predict non-diagnostic SWE. Materials and MethodsThis IRB approved, single center retrospective study included adults with SWE and diagnostic UGAP exams between June and December 2023. Fasting patients were imaged in supine position with right arm abducted, via an intercostal window during neutral breath hold. The median of 10 measurements in the right lobe was analyzed for SWE and UGAP. SWE measurements were ≥ 2 cm from the capsule while UGAP depth was fixed at 4 cm from the probe. Exams were considered non-diagnostic for SWE (measured in m/s) if the Interquartile Range/Median Ratio (IQR/M) was > 15% or if diagnostic measurements could not be obtained. UGAP IQR/M > 30% or complete measurement failure was considered non-diagnostic. Univariate Receiver Operating Characteristic (ROC) curves compared UGAP (dB/cm/MHz), BMI (kg/m2), and SCD (mm) prediction of non-diagnostic SWE by the DeLong test. Results87 participants (48 male) with mean age of 54.7 ± 15.7 years were analyzed. UGAP [OR: 1.63 per 0.1 dB/cm/MHz, p=0.02, AUC=0.66], BMI [OR: 1.23, p<0.001, AUC=0.77], and SCD [OR: 1.27, p<0.001, AUC=0.81) were predictors of non-diagnostic SWE. UGAP prediction of non-diagnostic SWE was similar in subgroups with the measurement region at least 1 cm (OR: 1.64, n = 68), and 2 cm (OR: 1.54, n = 16) from the liver capsule. UGAP was a worse predictor than SCD (p = 0.04), while not significantly different than BMI (p = 0.15). BMI and SCD did not differ in predicting non-diagnostic SWE (p = 0.44). ConclusionOur small preliminary study demonstrated that body habitus and hepatic attenuation, a marker of steatosis, both contribute to non-diagnostic SWE exams, however body wall thickness is the key driver. This informs patient selection for SWE exams and guides future research to mitigate these technical shortcomings. Clinical Relevance/ApplicationPatients with hepatic steatosis and large body habitus are at increased risk of non-diagnostic ultrasound shear wave elastography (SWE) exams. These patients, particularly those with increased body wall thickness, may benefit from liver fibrosis evaluation with alternative approaches following an initial non-diagnostic SWE exam. Researchers working to improve SWE technique should pay particular attention to mitigating attenuation and phase aberration from the body wall as this is the key driver of non-diagnostic exams.

Quantitative Ultrasound and Ultrasound-Based Elastography for Chronic Liver Disease: Practical Guidance, From the AJR Special Series on Quantitative Imaging.

Quantitative ultrasound (QUS) and ultrasound-based elastography techniques are emerging as non-invasive effective methods for assessing chronic liver disease. They are more accurate than B-mode imaging alone and more accessible than MRI as alternatives to liver biopsy. Early detection and monitoring of diffuse liver processes such as steatosis, inflammation, and fibrosis play an important role in guiding patient management. The most widely available and validated techniques are attenuation-based QUS techniques and shear-wave elastography techniques that measure shear-wave speed. Other techniques are supported by a growing body of evidence and are increasingly commercialized. This review explains general physical concepts of QUS and ultrasound-based elastography techniques for evaluating chronic liver disease. The first section describes QUS techniques relying on attenuation, backscatter, and speed of sound. The second section discusses ultrasound-based elastography techniques analyzing shear-wave speed, shear-wave dispersion, and shear-wave attenuation. With an emphasis on clinical implementation, each technique's diagnostic performance along with thresholds for various clinical applications are summarized, to provide guidance on analysis and reporting for radiologists. Measurement methods, advantages, and limitations are also discussed. The third section explores developments in quantitative contrast-enhanced and vascular ultrasound that are relevant to chronic liver disease evaluation.

Application of Shear Wave Elastography in the Diagnosis and Evaluation of Cervical Cancer

Background: Our goal was to add an auxiliary examination method for the detection of cervical cancer, and to further explore its application value in clinical staging and treatment. Methods: Shear wave elastography (SWE) technique was used to examine the cervical hardness of patients, and the maximum, mean and minimum values of elastic modulus were recorded, with differences being compared. The area under the receiver operating characreristic (ROC) curve and diagnostic efficacy of elastic modulus were compared with Medcalc software. The differences of elastic modulus values under different parameters were compared in the cervical cancer group. Results: The mean, maximum and minimum values of the cervical cancer group were all the highest, and the differences were statistically significant. The area under the ROC curves were 0.925, 0.909 and 0.873, respectively. For the mean and maximum values, the Youden indexes were 0.79 and 0.72, the positive likelihood ratios were 21.74 and 19.97, and the negative likelihood ratios were 0.18 and 0.25. The optimal cut-off point was 82.2 kilpoascal (kPa) for maximum value and was 66.5 kPa for mean value. Elastic modulus were all significantly different according to International Federation of Gynecology and Obstetrics (FIGO) stages and tumor lesion size. Also, elastic modulus of cervical cancer patients before and after radiotherapy were statistically significant. Conclusions: SWE technology has an application value in the detection of cervical cancer. The mean and maximum values have higher diagnostic accuracy. SWE technology also has potential clinical application value in the clinical staging and treatment of cervical cancer, but further studies with larger sample sizes are needed.

EVALUATION OF FOCAL BREAST LESIONS USING ULTRASOUND ELASTOGRAPHY

Breast lesions pose a significant diagnostic challenge, necessitating advanced imaging techniques for accurate characterization. Ultrasound elastography, including strain and shear wave methods, offers promising diagnostic capabilities for distinguishing between benign and malignant breast lesions. Objective: This study aimed to evaluate the effectiveness of ultrasound elastography in characterizing focal breast lesions and to compare the diagnostic performance of strain and shear wave elastography techniques. Methods: A prospective observational study was conducted, enrolling 200 women aged 18 and older with focal breast lesions detected on conventional ultrasound. Participants underwent both strain and shear wave elastography. Lesion characteristics, including stiffness scores and echogenicity, were documented. Histopathological analysis was performed on biopsied lesions to confirm diagnoses. Diagnostic accuracy metrics were calculated for both elastography techniques, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The average age of participants was 52 ± 10 years. Most lesions were solid (70%), with an average size of 22 mm. Shear wave elastography exhibited higher stiffness scores (average 4.5) than strain elastography (average 3.2). Diagnostic accuracy for benign lesions showed a sensitivity of 85% and specificity of 90% with elastography. For malignant lesions, sensitivity was 90% and specificity was 85%. The ROC curve analysis indicated the superior performance of shear wave elastography with an AUC of 0.85 compared to 0.80 for strain elastography. Conclusion: Ultrasound elastography, particularly shear wave elastography, demonstrates high diagnostic accuracy in characterizing breast lesions, providing valuable support in clinical decision-making.

Understanding confounding factors allows for accurate interpretation of liver stiffness measurements by ElastQ, a novel 2D shear wave elastography technique.

Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) or two-dimensional shear wave elastography (2D-SWE) is recommended to assess the risk of liver fibrosis and advanced chronic liver disease. Even though both techniques measure liver stiffness, their numerical results often diverge. Confounders and reliability criteria for 2D-SWE have not been systematically investigated. We prospectively recruited participants with paired LSM by VCTE and the novel 2D-SWE technique ElastQ (Philips) in three European tertiary centers. The following parameters were recorded: sex, age, body mass index (BMI), etiology, laboratory markers of liver damage and function, as well as cholestasis, LSM by VCTE and controlled attenuation parameter (CAP), interquartile range (IQR)/median for VCTE-LSM and ElastQ-LSM, and the skin-to-liver capsule distance. We included 840 participants: 447 (53.2%) males; median age 57.0 [IQR:19.0] years; median BMI 25.4 [6.0] kg/m2; median VCTE-LSM 7.25 [9.2] kPa; median ElastQ-LSM 6.7 [5.4] kPa. On uni- and multivariable modeling (adjusted for LSM), we found that the discrepancy increased with liver stiffness and markers of disease severity. Skin-to-liver capsule distance and BMI affected VCTE-LSM more compared to ElastQ-LSM and significantly increased the discordance between the two measurements. The discrepancy of ElastQ-LSM to VCTE-LSM increases with liver stiffness and disease severity. BMI and skin-to-liver capsule distance increase the discrepancy between VCTE- and ElastQ-LSM but affect ElastQ-LSM less. The quality criterion IQR/median ≤ 30% indicates reliable ElastQ-LSM.

The significance of ultrasonographic characteristics in the comprehensive radiological assessment of «high risk» carotid stenoses

Background. The prevalence of asymptomatic carotid stenosis (ACS) requires the existence of an algorythm to identify patients at risk of ischemic stroke. Assessment of carotid atherosclerotic plaque (AP) based on its morphology and composition in addition to the quantitative parameter «stenosis» is possible using a complex of radiological studies including ultrasonographic ones, that can be deepened by new ultrasound techniques. Purpose – define ultrasonographic criteria for vulnerable carotid plaque based on evaluation of plaque characteristics using current ultrasonic techniques. Materials and methods. The study is based on the analysis of data obtained from 105 patients aged 41 to 84, diagnosed with stenosis of the internal carotid artery (ICA) according to ultrasonography (US). Examination methods – clinical, duplex US with the inclusion of shear wave elastography (SWE) and superb microvascular imaging (SMI) techniques to assess plaque stiffness and plaque microvascularisation; brain MRI, MSСT angiography (MSCTA), statistical. Two age-matched group were formed: a group with symptomatic carotid stenosis (SCS), 55 patients, and a group with asymptomatic carotid stenosis (ACS), 50 patients. Results. Statistically significant differences in the groups of patients with and without stroke were determined according to the following parameters of carotid plaques: quantitative criteria – maximum thickness (p = 0,02), with an AP thickness of more than 3.5 mm, the risk of stroke increases 2.2 times (p = 0,03), stenosis degree according to the NASCET protocol (p = 0,01 in the right ICA), plaque stiffness indicator according to SWE data (p = 0,001); qualitative criteria – type of plaque echogenicity according to the Gray-Weale classification (p = 0,001), presence of microvascularization according to SMI data (p = 0,04). Correlation of AP stiffness indicators according to SWE and MSCTA data (ρ = 0,60; р = 0,004) was established, as well as between AP stiffness according to SWE data and echo- type of AP (τ = 0,56; р = 0,006). Conclusions. Determination of plaque thickness greater than 3.5 mm, low plaque stiffness according to SWE data, the presence of microvascularization according to SMI data it is advisable to add to the complex of radiological assessment of carotid stenosis with a high risk of ischemic events, in addition to the standard US criteria of stenosis degree and AP echo-type.

Assessment of testicular stiffness in fertile dogs with shear wave elastography techniques: a pilot study.

Ultrasound of the testes is important in the evaluation of breeding dogs, and recently advanced techniques such as Shear Wave Elastography (SWE) have been developed. This study focused on evaluation of normal testicular stiffness in healthy and fertile male dogs, employing both qualitative (2D-SWE) and quantitative (pSWE, 2D-SWE) techniques. Nineteen dogs of various medium-large breeds aged 3.39 ± 2.15 years, and with a history of successful reproduction were included after clinical, B-mode and Doppler ultrasound of testes and prostate, and semen macro and microscopic evaluations. pSWE involved square regions of interest (ROIs) placed at six different points in the testicular parenchyma, while 2D-SWE depicted stiffness with a color scale ranging from blue (soft) to red (stiff), allowing a subsequent quantification of stiffness by the application of 4 round ROIs. The results showed a mean Shear Wave Speed (SWS) of 2.15 ± 0.39 m/s using pSWE, with lower values above the mediastinum compared to below, and in the center of the testis compared to the cranial and caudal poles. 2D-SWE demonstrated a uniform blue pattern in the parenchyma, and a mean SWS of 1.65 ± 0.15 m/s. No significant differences were found between left and right testes, above and below the mediastinum, or among breeds. No correlations were observed between mean SWS and body condition score, age, testicular and prostatic volume. Weight was positively correlated with mean SWS only by 2D-SWE. By performing semen analysis and enrolling only healthy and fertile adult dogs, we ensured both structural and functional integrity of the testes. This pilot study represents a valuable baseline data for testicular stiffness by both pSWE and 2D-SWE with a Mindray US machine in medium-large sized healthy and fertile dogs, pointing out the potential role of SWE in the non-invasive fertility assessment and management of breeding dogs.

Continuous Shear Wave Elastography for Liver Using Frame-to-Frame Equalization of Complex Amplitude.

This study addresses a crucial necessity in the field of noninvasive liver fibrosis diagnosis by introducing the concept of continuous shear wave elastography (C-SWE), utilizing an external vibration source and color Doppler imaging. However, an application of C-SWE to assess liver elasticity, a deep region within the human body, arises an issue of signal instability in the obtained data. To tackle this challenge, this work proposes a method involving the acquisition of multiple frames of datasets, which are subsequently compressed. Furthermore, the proposed frame-to-frame equalization method compensates discrepancies in the initial phase that might exist among multiple-frame datasets, thereby significantly enhancing signal stability. The experimental validation of this approach encompasses both phantom tests and in vivo experiments. In the phantom tests, the proposed technique is validated through a comparison with the established shear wave elastography (SWE) technique. The results demonstrate a remarkable agreement, with an error in shear wave velocity of less than 4.2%. Additionally, the efficacy of the proposed method is confirmed through in vivo tests. As a result, the stabilization of observed shear waves using the frame-to-frame equalization technique exhibits promising potential for accurately assessing human liver elasticity. These findings collectively underscore the viability of C-SWE as a potential diagnostic instrument for liver fibrosis.

The therapeutic effects of ADSCs on photoaging of skin induced by UVB irradiation.

Skin photoaging affects appearance and is associated with a variety of skin diseases, even skin cancer. Therefore, the prevention and treatment of skin photoaging is very important. However, there is a lack of effective evaluation methods, so it is an urgent problem to explore a comprehensive, non-invasive and in vivo evaluation method. Adipose-derived mesenchymal stem cells (ADSCs) are widely used to improve skin conditions as easier to obtain and positive effects. Recently, as the development of ultrasound technology, skin ultrasound has been widely used. Changes in skin layer and structure can be observed by high-frequency ultrasound (HFUS). In addition, Shear wave elastography (SWE) technology can be used to monitor the change of skin hardness. However, it is necessary to further explore the ultrasound parameters in interpreting histological changes. We simulate the progression and treatment process of human skin photoaging by using UVB-induced nude mice skin photoaging model and ADSCs injection. The analysis of the degree and therapeutic effect of skin photoaging was conducted by HFUS, SWE and to verify with histopathology. Our study aims to clarify the value of HFUS combined SWE techniques in evaluating the degree and therapeutic efficacy of skin photoaging, which provides theoretical basis for diagnosis and treatment evaluation systems.

Prognostic value of liver stiffness in patients hospitalized for acute decompensated heart failure: a meta-analysis

PurposeHeart failure (HF) is a major health problem affecting millions of people worldwide. In the latest years, many efforts have been made to identify predictors of poor prognosis in these patients. The aim of this systematic review and meta-analysis was to enlighten the correlation between liver stiffness (LS), assessed by Shear Wave Elastography techniques, and HF, particularly focusing on the prognostic value of LS on cardiovascular outcomes.MethodsWe searched the PUBMED databases (up to May 1st, 2023) for studies that enlightened the correlation between LS and cardiovascular outcomes in patients hospitalized for acute decompensated heart failure (ADHF). We performed a meta-analysis to estimate the efficacy of LS in predicting the prognosis of patients with ADHF.ResultsWe analyzed data from 7 studies, comprising 677 patients, that assessed the prognostic value of LS in predicting cardiovascular outcomes in patients hospitalized for ADHF. The pooled analysis showed that increased liver stiffness was associated with higher risk of adverse cardiac events (hazard ratio 1.07 [1.03, 1.12], 95% CI).ConclusionIncreased LS is associated with poor prognosis in patients hospitalized for HF and might help effectively identify those patients at high risk for worse outcomes.

Evaluation of common carotid artery wall stiffness by shear wave elastography in smokers and non-smokers.

Smoking is one of the most important preventable causes of cardiovascular diseases. Vascular disease caused by smoking is associated with vascular endothelial damage, platelet aggregation, and adhesion. In our study, we examined the effect of chronic smoking on vessel wall stiffness in smokers and control group by measuring carotid artery wall stiffness by shear wave ultrasonography. Sixty-two smokers of similar ages and genders, and 67 people who never smoked in the last ten years were included as the control group in this cross-sectional study. Arterial wall stiffness over the common carotid arteries of all participants was measured by shear wave elastography (SWE). In addition, each patient's blood pressure, fasting blood glucose, body mass index (BMI), HDL and LDL cholesterol measurements were recorded. Arterial wall stiffness values in smokers were found to be statistically significantly higher than in non-smokers. The mean of SWE measurements of the smokers was 47.3 ± 6.2 kPa, and that of the control group was 42.9 ± 4 kPa. The mean values of HDL and LDL of the smokers were 46.9 ± 5.6 mg/dL and 147.3 ± 9.3 mg/dL, respectively, and those of the control group were 50.3 ± 5.1 mg/dL and 136.9 ± 5.9 mg/dL. The LDL cholesterol values were statistically significantly higher in smokers compared to the control group, and HDL cholesterol values were statistically significantly lower in smokers. In our study, the arterial wall stiffness values measured by the SWE technique were higher in smokers than non-smokers.

Signal detrending in elastographic wave data with large motion artifacts through a 2D Whittaker smoother

A variety of advanced shear wave elastography techniques require the measurement of frequency-resolved phase velocity to properly characterize wave signals where factors such as tissue viscosity or guided wave effects are present. However, when applying these techniques in a dynamic environment where extrinsic motion cannot be limited, nonlinear and nonstationary trends can be expected in the motion signal used for phase velocity estimation. Because such extrinsic motion signals can contaminate a broad range of frequencies, they can produce significant errors in the phase velocity estimates. In this study, we propose a spatiotemporal detrending approach for elastography wave motion signals built from a 2D Whittaker smoother. This smoother has its origins in nonparametric regression and is well suited for fitting nonlinear curves of arbitrary shape. The resulting detrending filter was applied to Lamb wave signals from clinical ultrasound bladder vibrometry measurements. We found that the proposed detrending filter allowed for phase velocity estimates to be made in acquisitions that are otherwise be too corrupted by large motion. This works was supported by a grant from the NIH (DK131685)

Clinical Applicability of Ultrasound Shear Wave Elastography in Patients under Hypoglossal Nerve Stimulation Therapy

Relationship between stiffness of genioglossi (GG) and geniohyoidei (GH) muscles under electric hypoglossal nerve stimulation therapy (HNS) in relation to success of therapy was investigated with additional special focus on tongue movement. Patients and Methods: Clinical and sleep laboratory parameters of a cohort of 18 patients with known shear wave velocity (SWV) data of the ipsilateral and contralateral musculi GG and GH (sGG, sGH and nGG, nGH) before and under HNS therapy were analyzed. The SWV was already determined using the ultrasonic shear wave elastography (US-SWE) technique. Results: Median Epworth Sleepiness Scale (ESS) was 8 (IQR 12), median baseline Apnoe–Hypopnoe Index (AHI) 31.65 (IQR 25.1), median AHI under HNS therapy 16.3 (IQR 20.03). Therapy success: 9/18 patients (AHI during therapy &lt; 15/h). There was no significant difference in SWV (sGG, sGH, nGG and nGH) between therapy responders and non-responders during therapy. Also, no difference could be seen with respect to the difference and increase in SWV values without and with stimulation. Examination of SWV values (sGG, sGH, nGG, nGH during stimulation, difference of SWV values stimulation − no stimulation, increase factor of SWV) revealed a significant negative correlation between the AHI under therapy and the measured SWV of the musculus GH of the contralateral side during stimulation (−0.622, p = 0.006). Patients with bilateral protrusion of the tongue differed regarding to therapy success in increase in SWV in sGG (p = 0.032). Tongue protrusion to contralateral: A significant difference between patients with AHI during therapy &lt; 15/h in SWV values at sGG without stimulation (p = 0.021) was seen, with also a correlation to the current AHI under therapy (p = 0.047) and the change factor of the AHI (p = 0.015). Conclusion: Stiffness of the target muscle does not appear to be an isolated measure of the success of HNS therapy. This observation may have implications for future decision-making processes in the process of titrating electrical therapy parameters. But the technique of US-SWE may be useful for future research of the neurophysiology of the tongue and OSA phenotyping.

The potential role of combined shear wave elastography and superb microvascular imaging for early prediction the pathological response to neoadjuvant chemotherapy in breast cancer.

The potential role of shear wave elastography (SWE) and superb microvascular imaging (SMI) for early assessment of treatment response to neoadjuvant chemotherapy (NAC) in breast cancer remains unexplored. This study aimed to identify potential factors associated with the pathological response to NAC using these advanced ultrasound techniques. Between August 2021 and October 2022, 68 patients with breast cancer undergoing NAC were recruited. Patients underwent conventional ultrasonography, SMI, and SWE examinations at baseline and post-2nd cycle of NAC. Maximum tumor diameter (Dmax), maximum elastic value (Emax), peak systolic velocity (PSV), and resistance index (RI) at baseline and the rate of change of these parameters post-2nd cycle were recorded. After chemotherapy, all patients underwent surgery. Using the Miller-Payne's grade, patients were categorized into response (grades 3, 4, or 5) and non-response (grades 1 or 2) group. Parameters were compared using t-tests at baseline and post-2nd cycle. Binary logistic regression analysis was used to identify variables and their odds ratios (ORs) related to responses and a prediction model was established. ROC curves were drawn to analyze the efficacy of each parameter and their combined model for early NAC response prediction. Among the 68 patients, 15(22.06%) were categorized into the non-response group, whereas 53(77.94%) were categorized into the response group. At baseline, no significant differences were observed between the two groups (p>0.05). Post-2nd cycle of NAC, rates of change of Emax, PSV and RI (ΔEmax, ΔPSV and ΔRI) were higher in responders than non-responders (p<0.05). Binary logistic regression analysis revealed that ΔEmax (OR 0.797 95% CI, 0.683-0.929), ΔPSV (OR 0.926, 95%CI, 0.860-0.998), and ΔRI (OR 0.841, 95%CI, 0.736-0.960) were independently associated with the pathological response of breast cancer after NAC. The combined prediction model exhibited higher accuracy in the early evaluation of the response to NAC (AUC 0.945, 95%CI, 0.873-1.000). SWE and SMI techniques enable early identification of tumor characteristics associated with the pathological response to NAC and may be potentially indicative of an effective response. These factors may eventually be used for the early assessment of NAC treatment for clinical management.

The diagnostic performance of salivary gland ultrasound elastography in Sjögren's syndrome and sicca symptoms: a systematic review and meta-analysis.

To systematically evaluate the diagnostic performance of ultrasound elastography (USE) in distinguishing primary Sjögren's syndrome (pSS) from healthy/disease controls. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for published literature on USE for diagnosing pSS. Bivariate random effects models were used to calculate the pooled sensitivity and specificity of USE. To determine the factors influencing heterogeneity, meta-regression and subgroup analyses were performed to assess country, diagnostic criteria, imaging mechanisms, shear wave elastography techniques, measurement location, control group category, and patient age. Publication bias was assessed using the asymmetry of the Deeks funnel plot. Fifteen articles covering 816 patients and 735 control participants were included. USE showed a pooled sensitivity of 0.80 (95% CI: 0.71-0.87) and specificity of 0.87 (95% CI: 0.78-0.92). Meta-regression and subgroup analyses revealed that shear wave elastography techniques, measurement location, and patient age were significant factors that affected study heterogeneity (p < 0.05). Elastography performs better in diagnosing patients aged ≤ 51years compared to patients aged > 51years. There was no significant publication bias. USE demonstrates high accuracy in differentiating between pSS and healthy/disease control groups. Ultrasound elastography, as a non-invasive and cost-effective technique, can be used to distinguish primary Sjögren's syndrome from disease/healthy control groups by measuring the stiffness of salivary glands. • Ultrasound elastography is an acceptable technique for the diagnosis of primary Sjögren's syndrome. • The pooled sensitivity and specificity of ultrasound elastography for diagnosing primary Sjögren's syndrome were 0.80 and 0.87, respectively. • In patients aged ≤ 51years with primary Sjögren's syndrome, ultrasound elastography showed good diagnostic performance.

Multisample Ultrasound Point Shear Wave Elastography of the Liver: Repeatability and Agreement With Conventional Point Shear Wave Elastography.

To characterize the technical performance of a multisample ultrasound point shear wave elastography (pSWE) technique that allows 15 individual measurements of liver stiffness in a single acquisition. In 56 overweight and obese adults, research ultrasound examinations were performed using conventional pSWE and multisample pSWE (Sequoia; Siemens Healthineers). Five independent measurements were acquired with the conventional technique over five consecutive breath holds (5C1 and DAX transducers). A single multisample acquisition (DAX transducer) of up to 15 unique measurements was acquired during a single breath hold. All imaging was performed before (baseline) and after a "coffee break" (repeat). Median liver stiffness measurements between techniques and between baseline and repeat imaging were compared using Pearson correlation (r) and intra-class correlation (ICC) coefficients. Mean participant age was 33.7 ± 11.4 years; 40 participants were female. There was high correlation between conventional pSWE measurements obtained using the 5C1 and DAX transducers at baseline (r = .75 [95% CI: 0.61-0.85], P < .0001) and repeat (r = .88 [95% CI: 0.78-0.92], P < .0001). There was moderate agreement between conventional pSWE measurements obtained using the 5C1 and DAX transducers at baseline (ICC = 0.69 [95% CI: 0.52-0.81]), and good agreement at repeat (ICC = 0.81 [95% CI: 0.65-0.90]). There was moderate correlation (r = .59 [95% CI: 0.39-0.74], P < .0001) and moderate agreement (ICC = 0.58 [95% CI: 0.38-0.73]) between baseline conventional and multisample pSWE measurements acquired using the DAX transducer; there was high correlation (r = .73 [95% CI: 0.57-0.83], P < .0001) and moderate agreement (ICC = 0.72 [95% CI: 0.56-0.82] between techniques at repeat. There was moderate correlation (r = .65 [95% CI: 0.46-0.78], P < .0001) and moderate agreement (ICC = 0.64 [95% CI: 0.45-0.77]) between baseline and repeat multisample pSWE measurements. Multisample pSWE, allowing up to 15 measurements in a single breath hold, showed moderate to high correlation and moderate agreement with conventional pSWE.

Two-dimensional shear wave elastography (ElastQ) accurately rules out liver fibrosis and rules in advanced chronic liver disease across liver disease etiologies: a prospective multicenter study.

This study evaluated ElastQ, a two-dimensional shear wave elastography (2D-SWE) technique, for the non-invasive assessment of liver fibrosis risk using liver stiffness measurement (LSM). The aim was to determine its diagnostic accuracy and establish LSM cutoffs for clinical risk stratification. A prospective multicenter study was conducted, employing vibration-controlled transient elastography (VCTE) as a reference standard. The statistical analysis utilized Pearson correlations and Lin concordance correlation coefficients, diagnostic areas under the curve (AUCs), and 90%-specific rule-in and 90%-sensitive rule-out ElastQ cutoffs. The study included 875 patients at risk for liver disease, of whom 816 (376 women, 46.1%; median age, 57.0 years [interquartile range, 19.0]) had successful and reliable VCTE- and ElastQ-LSMs. The median LSM was 13.0 kPa (range, 2.0 to 75.0 kPa) for VCTE and 6.6 kPa (range, 2.9 to 26.5 kPa) for ElastQ. The correlation between VCTE-LSM and ElastQ-LSM was adequate for VCTE-LSM <15 kPa (Pearson r=0.63) but lower for VCTE-LSM ≥15.0 kPa (Pearson r=0.27). VCTE-LSM indicated no fibrosis risk (<5.0 kPa) in 178 cases (21.8%), gray zone (5.0-9.9 kPa) in 347 cases (42.5%), and advanced chronic liver disease (ACLD; ≥10.0 kPa) in 291 cases (35.7%). The diagnostic AUC for ElastQ-LSM was 0.82 for fibrosis risk and 0.90 for ACLD. The clinically relevant ElastQ cutoffs for ruling out fibrosis risk and ruling in compensated ACLD (cACLD) were <5.0 kPa and ≥9.0 kPa, respectively. ElastQ 2D-SWE enables accurate, non-invasive assessments of liver fibrosis and cACLD risk. In clinical practice, ElastQ-LSM <5.0 kPa rules out fibrosis, while ElastQ-LSM ≥9.0 kPa rules in cACLD.

Comparison between Two-Dimensional and Point Shear Wave Elastography Techniques in Evaluating Liver Fibrosis Using Histological Staging as the Reference Standard: A Prospective Pilot Study.

Evaluation of hepatic fibrosis is essential to prevent liver-related morbidity and mortality. Although various types of ultrasound shear wave elastography (SWE) have been used and validated, there are limited studies on the relatively newer technique, two-dimensional SWE (2D-SWE). Therefore, this study aimed to compare the diagnostic performances of 2D-SWE and point SWE (p-SWE) for evaluating liver fibrosis using histology as the reference standard. To measure liver stiffness (LS) values, 87 patients underwent 2D-SWE and p-SWE using the same machine. Technical failures and unreliable measurements were also evaluated. The diagnostic performances of 2D-SWE and p-SWE were compared using area under the receiver operating characteristic (AUROC) curve analysis. No technical failures were observed in either method; however, unreliable measurements were less frequent in 2D-SWE (1/87 [1.1%]) than in p-SWE (8/87 [9.2%]) (p < 0.001). The AUROC of the LS values of 2D-SWE were significantly higher than those of p-SWE for diagnosing significant fibrosis (0.965 vs. 0.872, p = 0.022) and cirrhosis (0.994 vs. 0.886, p = 0.042). In conclusion, 2D-SWE is more reliable and accurate than p-SWE for diagnosing hepatic fibrosis.

A Case-Control Study of 40 Patients with Piriformis Muscle Syndrome to Evaluate Diagnostic Findings Using Two-Dimensional Ultrasound and Shear Wave Elastography.

BACKGROUND Piriformis muscle syndrome (PMS) is a neuropathy caused by compression of the sciatic nerve by the piriformis muscle. This case-control study included 40 patients with PMS and aimed to evaluate the diagnostic findings using two-dimensional ultrasound and shear wave elastography (SWE), as non-invasive and cost-effective diagnostic methods. MATERIAL AND METHODS In order to evaluate the value of two-dimensional ultrasound diagnosis, a new imaging technique called shear wave elastography (SWE) was used in the screening of PMS, with a total of 40 PMS patients and 40 healthy individuals participating in our study. We analyzed the correlation and area under the curve (AUC) of changes in thickness (mm) and Young's modulus (kpa) of the bilateral piriformis muscle (PM). RESULTS We found that PM thickness and Young's modulus on the lesion sides were significantly higher in PMS patients than in controls (P<0.05). Also, we determined that there was a positive correlation between PM thickness and Young's modulus (r=0.454, P<0.05). Using two-dimensional ultrasonic diagnosis and the SWE technique, a specificity of 95.8% and sensitivity of 78.8% were demonstrated in the clinical diagnosis of PM. CONCLUSIONS Two-dimensional ultrasound with SWE technology has demonstrated its superior sensitivity and specificity in diagnosing PMS in the clinic.