Value Of Shear Wave Elastography Research Articles

P0388 Can intestinal ultrasound guide us in the treatment of inflammatory bowel disease?

Abstract Background Intestinal Ultrasonography (IUS) is a useful method for monitoring inflammatory bowel disease. The role of Shear Wave Elastography (SWE) and the relationship with other parameters indicating activity are not yet well understood. Methods The aim was to describe the ultrasound characteristics observed in a cohort of patients with Crohn’s disease (CD) and the changes in therapeutic attitude derived from the results of this imaging test. To evaluate the usefulness of SWE in patients with intestinal strictures to detect fibrosis in comparison with analytical and ultrasound parameters of inflammatory activity. We conducted a single-center, retrospective, observational study of a baseline study including IUS examinations performed in CD patients between May 2022 and February 2023. Results We included 63 IUS in CD patients (60.9% male; mean age 43 ± 17 years). The mean HBI-score was 2.77 (± 2.6). A change in therapeutic approach was made in 32.8% of cases following IUS. Stricture was found in 22 IUS (34.9%), with a mean length of 5.6 ± 2.59 cm. Fat wrapping was observed in 40.9% of cases, and loss of wall stratification in 9.1%. Median SWE of the stricture was 9.05. Calprotectin is directly related to the Limberg scale (p<0.001) and indirectly with the SWE value (p<0.05). Inverse correlation between Limberg scale and SWE value (p<0.05) was observed. Conclusion intestinal ultrasonography facilitates a proactive monitoring in CD because immediate changes in therapeutic approach can be made. The combination of the Limberg scale and the SWE value allow the definition of intestinal strictures. Comparative studies are needed to clarify the usefulness in predicting the degree of fibrosis.

P0540 Assessment of Metabolic-Associated Liver Disease in Patients with Crohn’s Disease in Long-Term Remission

Abstract Background Previous studies have shown that patients with Crohn’s disease(CD) have an increased risk of metabolic liver disease(MASLD) even in the absence of cardiovascular risk factors. This increased prevalence is attributed to the inflammatory bowel activity itself. However, there is less evidence on whether CD could be an independent risk factor for MASLD in patients in long-term remission Methods A cross-sectional study was conducted, including two cohorts: one of patients with CD in deep remission and another of healthy controls. All participants underwent blood tests, abdominal ultrasound with shear wave elastography(SWE) and FibroScan®. Additionally, CD patients were evaluated to determine clinical, biochemical, and radiological remission(using intestinal ultrasound). Only patients with CD in clinical remission for at least one year, and not receiving immunosuppressive or biological treatments, were included. Patients with clear predisposing risk factors to metabolic liver disease(such as corticosteroid treatment or diabetes) were excluded Results 47 patients were included: 29 controls(61.7%) and 18 with CD in remission(38.3%). The baseline characteristics are summarized in Table1. Regarding the CD remission: Harvey index median was 0(IQR 0-1). Faecal calprotectin mean was 38.8 µg/g(IQR 20.7-57.4), C-reactive protein mean was 0.6mg/dL(IQR 0.5-2.1), and intestinal ultrasound showed normal bowel wall thickness in all patients. The lipid and liver profile is presented in Table2. Considering all included patients, regardless of the presence of steatosis, Fibroscan values were significantly higher in the control group compared to CD patients, although there were no advanced fibrosis in either group(4.9kPa vs 4.1kPa,p=0.04). This was consistent with SWE data(4.3 kPa vs 4.15 kPa), although this difference did not reach statistical significance(p=0.58). ATI values were 0.54 in controls vs 0.58 in CD patients(p=0.38). Considering only patients with steatosis, there was no greater prevalence of steatosis among patients with CD(23.5%) compared to controls(20.8%),p=0.84. By ultrasound, all cases were classified as mild steatosis, except for one patient who was reported as severe, belonging to the CD group. In our sample, among patients with steatosis, those with CD were more frequently diagnosed with dyslipidaemia(75%) compared to controls(0%),p=0.018. Fibroscan values were lower in patients with CD and steatosis(3.9kPa) compared to controls(5.3kPa),p=0.26. Similar to SWE (4.02kPa vs 4.56kPa, p=0.43) and ATI(0.73 vs 0.69,p=0.74) values Conclusion In our experience, there is no increased prevalence of MASLD in CD in the absence of activity, and when present, it may be secondary to underlying cardiovascular risk factors, as in our case was dyslipidaemia

Elastographic evaluation for fatty liver disease in north Indian children and adolescents with type 1 diabetes.

The prevalence and predisposing factors to metabolic dysfunction-associated fatty liver disease (MAFLD) in children with type 1 Diabetes (T1D) living in developing countries are unknown. A cross-sectional study was conducted in children with T1D. The presence of liver fat and tissue stiffness were assessed by ultrasonography and shear-wave elastography (SWE), respectively. The SWE values were correlated to body mass index (BMI), glycemic control, disease duration, and gamma-glutamyl transferase (GGT). Healthy non-obese children (n=36) were recruited as controls. One hundred children with T1D were grouped (Group A-C) according to the disease duration (<5, 5-10, and >10 years, respectively). The mean diabetes duration and glycated hemoglobin were 5.9±4.0 years and 8.2±0.55 %, respectively. The mean SWE values were significantly higher in the patient groups compared to controls (5.07±0.67, 5.27±0.65, 5.16±0.50, vs. 4.80±0.82 kPa, p-value 0.006). The liver stiffness based on SWE showed a positive but weak relationship with BMI, diabetes duration, glycemic control, and GGT levels. A significantly higher number of children with T1D had MAFLD [9(20 %), 7(24.1 %), 7(26.9 %), vs. 1(3 %), p-value <0.001] based on ultrasonography. Children with T1D showed higher liver stiffness values than controls. A weakly positive relationship of liver stiffness was observed with BMI, duration of diabetes, glycemic control, and serum GGT. Approximately one-fourth of children with diabetes showed sonographic evidence of hepatic steatosis. Larger studies are needed to ascertain the effects of obesity, diabetes duration, and metabolic control on the prevalence and progression of MAFLD in children with T1D.

Minimum 24-Month Outcomes of Minimally Invasive Paratenon Protection Repair vs Open Giftbox Repair of Ruptured Achilles Tendon.

The paratenon has been shown to promote Achilles tendon healing, but the evidence supporting the role of paratenon protection technique in Achilles tendon repair is sparse. We retrospectively assessed the results of a paratenon-sparing repair technique vs an open giftbox repair of Achilles tendon ruptures. Patients with Achilles tendon rupture who underwent surgical treatment at our hospital between January 2015 and August 2021 were retrospectively reviewed. Among them, 61 patients underwent surgical repair using the minimally invasive paratenon protection technique (MI group) and 67 patients using the open repair giftbox technique (OR group). The postoperative rehabilitation protocol was identical in both groups. The operation time, complication rate, length and cross-sectional area (CSA) of Achilles tendon, shear wave elastography (SWE), CSA of the calf triceps muscle, isokinetic strength, Achilles tendon Total Rupture Score (ATRS), and the Victorian Institute of Sports Assessment-Achilles (VISA-A) score were compared between the 2 groups. The average follow-up time was 40.0 ± 10.2 months. The operation time and complication rate in the MI group were significantly lower than in the OR group (P < .001, P = .031). The ATRS score (P = .015), VISA-A score (P = .002), isokinetic strength (60 degrees/second: P = .006; 180 degrees/second: P = .036), SWE values (P = .007), and CSA of Achilles tendon (P = .043) in the MI group were significantly higher than the OR group. SWE values were significantly positively correlated with the ATRS score (r = 0.294, P < .001) and the VISA-A score (r = 0.304, P < .001). And a significant negative correlation was found between Achilles tendon extension length and peak torque (60 degrees/second: r = -0.309, P < .001; 180 degrees/second: r = -0.218, P = .013). Compared with the open repair giftbox technique, the minimally invasive paratenon protection technique was associated with likely marginally clinically significant improved clinical outcome scores, greater isokinetic strength, and better mechanical properties of the Achilles tendon.

Shear Wave Elastography in AV Fistula Thrombosis: Differentiating Thrombus Age and Assessing Clinical Outcomes of Balloon Angioplasty.

To evaluate the role of shear wave elastography (SWE) in distinguishing acute from subacute thrombi in thrombosed arteriovenous fistulas (AVFs) and explore the relationship between thrombus stiffness and outcomes of balloon angioplasty. This retrospective study included 44 dialysis patients with thrombosed AVFs from June 2022 to June 2024. Patients underwent Doppler ultrasound and SWE to assess thrombus age, followed by balloon angioplasty. Based on ultrasound findings and clinical history, patients were classified into acute and subacute thrombus groups. SWE was used to measure thrombus stiffness (kPa values). Procedural outcomes, including technical and clinical success, and primary and secondary patency, were compared between groups. The study included 23 patients with acute and 21 with subacute thrombus. SWE measurements (average, median, and maximum kPa) were significantly higher in subacute thrombi (P < .001). A strong positive correlation existed between thrombus age and kPa values (r = .770, r = .727, r = .835). Receiver operating characteristic analysis showed SWE could effectively distinguish acute from subacute thrombi, with an average cut-off of 31.733 kPa (sensitivity: 90.5%, specificity: 73.9%). No significant correlation was found between SWE values and procedural outcomes (P > .05). SWE is a promising tool for assessing thrombus age in AVF thrombosis, effectively differentiating between acute and subacute thrombi. Although it did not predict procedural success, SWE could complement existing imaging for improved thrombus characterization and treatment planning.

Evaluation of renal elasticity by shear wave elastography in children with Familial Mediterranean Fever.

Familial Mediterranean Fever (FMF) is a genetic disorder that can cause kidney damage. Shear wave elastography (SWE), a non-invasive method, was used to evaluate the decrease in renal tissue elasticity as a predictive parameter for amyloidosis. This study aimed to examine the changes in renal elasticity in patients with FMF using the renal SWE measurement method. The present study included 50 pediatric patients diagnosed with FMF. The median SWE values of both kidneys were compared between the groups. Acute phase reactants were also evaluated. The SWE measurements (for the left kidney p = 0.007, for the right kidney p = 0.06) and proteinuria levels (p < 0.001) of the patient group were found to be higher than those of the control group. No correlation was observed between the disease activity score and the SWE measurements. Erythrocyte sedimentation rate (p < 0.001), C-reactive protein (p < 0.001) and urine protein/creatinine ratio (p < 0.001) were significantly higher in the remission period compared to the control group, whereas estimated glomerular filtration rate was found to be low in the patient group (p < 0.001), which was considered as an indicator that subclinical inflammation continued in the course of the disease. The acute phase reactants were elevated in patients with FMF even in the remission period which indicates that the disease is constantly active and have the potential to cause damage in all organs and tissues. It is thought that this subclinical inflammation may also contribute to increased tissue stiffness, which may serve as a predictor for the development of amyloidosis.

Role of multi-parametric ultrasonography for the assessment and monitoring of functional status of renal allografts with histopathological correlation.

The study focuses on the use of multi-parametric ultrasound [gray scale, color Doppler and shear wave elastography (SWE)] to differentiate stable renal allografts from acute graft dysfunction and to assess time-dependent changes in parenchymal stiffness, thereby assessing its use as an efficient monitoring tool for ongoing graft dysfunction. To date, biopsy is the gold standard for evaluation of acute graft dysfunction. However, because it is invasive, it carries certain risks and cannot be used for follow-up monitoring. SWE is a non-invasive imaging modality that identifies higher parenchymal stiffness values in cases of acute graft dysfunction compared to stable grafts. To assess renal allograft parenchymal stiffness by SWE and to correlate its findings with functional status of the graft kidney. This prospective observational study included 71 renal allograft recipients. Multi-parametric ultrasound was performed on all patients, and biopsies were performed in cases of acute graft dysfunction. The study was performed for a period of 2 years at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, a tertiary care center in north India. Independent samples t-test was used to compare the means between two independent groups. Paired-samples t-test was used to test the change in mean value between baseline and follow-up observations. Thirty-one patients had experienced acute graft dysfunction at least once, followed by recovery, but none of them had a history of chronic renal allograft injury. Mean baseline parenchymal stiffness in stable grafts and acute graft dysfunction were 30.21 + 2.03 kPa (3.17 + 0.11 m/s) and 31.07 + 2.88 kPa (3.22 + 0.15 m/s), respectively; however, these differences were not statistically significant (P = 0.305 and 0.252, respectively). There was a gradual decrease in SWE values during the first 3 postoperative months, followed by an increase in SWE values up to one-year post-transplantation. Patients with biopsy-confirmed graft dysfunction showed higher SWE values compared to those with a negative biopsy. However, receiver operating characteristic analysis failed to show statistically significant cut-off values to differentiate between the stable graft and acute graft dysfunction. Acute graft dysfunction displays higher parenchymal stiffness values compared to stable grafts. Therefore, SWE may be useful in monitoring the functional status of allografts to predict any ongoing dysfunction.

Changes in Liver Shear Wave Elastography of Preterm Infants during Hospitalization.

Liver evaluation is essential in preterm infants because of exposure to hepatotoxic drugs, the effects of parenteral nutrition, and their organ immaturity. The clinical significance of shear wave elastography (SWE) which measures tissue elasticity, is unclear in preterm infants. For SWE application to liver evaluation in preterm infants, we examined the postnatal course and factors associated with changes. We prospectively measured liver SWE values every other week in 37 preterm infants born at 23 to 35 weeks gestation and 12 term infants born after 36 weeks gestation. The median early postnatal liver SWE value was 1.22 (interquartile range, 1.19-1.26) m/s. The correlations of liver SWE values with gestational age and birth weight were r = -0.18 (p = 0.23) and r = -0.21 (p = 0.157), respectively. The median liver SWE values from birth to 36 to 38 postmenopausal weeks were 1.22 (1.17-1.24) m/s at <28 weeks gestation (n = 9), 1.21 (1.18-1.25) m/s at 28 to 29 weeks gestation (n = 11), 1.24 (1.21-1.28) m/s at 30 to 31 weeks gestation (n = 8), and 1.21 (1.20-1.24) m/s at ≥32 weeks gestation (n = 9). There was no change over time in any gestational age group (p = 0.158). The median liver SWE values were 1.22 (1.17-1.25) m/s (n = 10) and 1.22 (1.19-1.25) m/s (n = 27) for small- and appropriate-for-gestational-age infants, respectively (p = 0.93). The correlations of abnormally high serum concentrations of direct bilirubin (>1.0 mg/dL) and alanine aminotransferase (>12 IU/L) with liver SWE values were r = 0.37 (p = 0.041) and r = 0.21 (p = 0.35), respectively. Liver SWE values may be useful for the evaluation of liver damage with cholestasis in preterm infants because they remain constant regardless of gestational age and birth weight and do not change over time or with a deviation of body size. · Liver SWE was prospectively performed in preterm infants.. · Liver SWE was constant until term regardless of gestational age or birth weight.. · Liver SWE values of preterm infants ranged from 1.2 to 1.3 m/s.. · For preterm infants, elevation of liver SWE values reflected cholestasis.. · Liver SWE may become the new standard for liver evaluation in preterm infants..

Evaluation of Ex Vivo Shear Wave Elastography of Axillary Sentinel Lymph Nodes in Patients with Early Breast Cancer.

Background: The pretherapeutic assessment of axillary lymph node status is crucial in staging early breast cancer patients, significantly influencing their further treatment and prognosis. According to current guidelines, patients with clinically unsuspicious axillary status regularly undergo a biopsy of sentinel lymph nodes (SLNs), whereby metastasis is detected in up to 20% of cases. In recent years, the use of shear wave elastography (SWE) has been studied as an additional ultrasound tool for the non-invasive assessment of tumors in the breast parenchyma and axillary lymph nodes. Previous studies (examining the axilla in patients) have shown that metastases have significantly higher SWE values than benign nodes. Methods: This study aims to evaluate whether SWE can differentiate between tumor-free and metastatic-affected SLN ex vivo, i.e., by examining the pathological specimen. SWE was performed ex vivo on SLN specimens and compared with final histopathological results. Results: A total of 168 SLNs from 105 patients were measured using ex vivo SWE and subjected to standard histopathological processing. In this group, 17 metastases in 17 patients (16.19%) were detected. Tumor-free SLNs had a mean velocity of 1.33 ± 0.23 m/s, while metastatic nodes showed a mean velocity of 1.35 ± 0.29 m/s (p = 0.724). There was no significant difference in ex vivo SWE between benign and malignant SLNs in this population. Conclusions: Contrary to previous studies, this study did not find SWE effective in differentiating lymph node metastases. Further research is needed to clarify SWE's potential role in axillary staging.

The Added Diagnostic Value of Shear Wave Elastography to Differentiate between Benign and Malignant Musculoskeletal Soft Tissue Tumors

The Added Diagnostic Value of Shear Wave Elastography to Differentiate between Benign and Malignant Musculoskeletal Soft Tissue Tumors

Value of Shear Wave Elastography in the Evaluation of Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major global public health problem with eventual progression to end-stage renal disease which tends to increase kidney stiffness. Shear wave elastography (SWE) is a recently developed ultrasound based technique which can be used to assess tissue stiffness noninvasively. The aim of this study was to evaluate the potential diagnostic value of SWE to assess renal parenchymal stiffness in CKD and its correlation with estimated glomerular filtration rate (eGFR), which may be used as a marker for detecting and staging CKD. The study protocol was approved by the Institutional ethics Committee at Kasturba medical college, Manipal and written informed consent was obtained from all participants. The study included 93 control subjects and 108 patients with CKD. SWE imaging was performed to assess renal cortical stiffness, as measured by the Young's modulus (YM). Correlations between SWE and conventional ultrasound parameters with age, serum creatinine, eGFR and serum urea were analysed using Pearson's correlation coefficient (p ≤ 0.05) and receiver operating characteristic (ROC) curves were derived. The diagnostic performance of SWE correlated with serum creatinine levels and eGFR. We found a statistically significant difference in kidney stiffness values between healthy individuals and CKD patients. The Spearman correlation coefficient revealed moderate negative linear correlation between the YM measurements and eGFR. We obtained a YM measurement cut-off value of 4.43 kPa, a value less than or equal to this suggested a no diseased kidney. This yielded sensitivity and specificity of 92.6% and 80.6%, respectively, with an AUROC of 0.92. Our results demonstrated that shear wave elastography may provide a low-cost, non-invasive method for the morphological assessment and progression of the disease status in chronic kidney disease patients with CKD.

Measurement properties of shear wave elastography for evaluating rotator cuff muscle stiffness: a systematic review.

Literature assessing elasticity in rotator cuff (RC) muscles with shear wave elastography (SWE) is growing but little is known about the overall measurement properties. However, this information is crucial before implementation in research or practice. The objective of this review was first, to systematically investigate the evidence regarding reliability and validity of rotator cuff (RC) muscles shear wave elastography (SWE). Second, to summarize measurement protocols to support uniformity and standardization of SWE methodology. A literature search was conducted using Medline (PubMed), Web of Science and Embase. Included studies reported measurement properties of reliability, validity and/or responsiveness of SWE to evaluate RC muscle stiffness in subjects without and with musculoskeletal shoulder pain. Methodological quality was rated with the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. The level of evidence was determined using a best-evidence synthesis approach. Forty-two articles were included. Studies assessing reliability (n=29) had a moderate level of evidence (LoE) for positive ratings of intratester reliability for Supraspinatus (SS), Infraspinatus (IS) and Teres minor (Tm) and intertester reliability for SS and IS. A limited LoE for positive ratings was implied for intertester reliability of Tm and unknown LoE for negative ratings for day-to-day variability of SS. Studies reporting on convergent validity (n=13) showed inconsistent correlation between SWE and other outcomes. Studies assessing discriminant validity (n=18) showed higher SWE in shoulder patients but not in frozen shoulder and RC tears. Studies reporting on responsiveness (n=10) showed decreased SWE values 1-2 months postop RC repair and after stretching. Although RC muscle SWE measurements showed overall moderate reliability, few studies used appropriate reliability study designs and protocols. The evidence regarding convergent validity, discriminant validity, and responsiveness is inconsistent, underscoring the need to improve measurement procedures and explore day-to-day reliability. SWE is a potentially valuable technique for RC muscle assessment. However, future high quality methodological research with reliability and validity as a primary focus is needed to better understand its applicability in clinical practice.

Assessing the diagnostic and therapeutic value of submandibular gland elastography in patients with immunoglobulin G4-related sialadenitis.

: To investigate the utility of shear wave elastography values (SWE) in differentiating IgG4-related submandibular sialadenitis (IgG4-RSS) from healthy individuals and in monitoring the response to glucocorticoid treatment. : Patients with IgG4-RSS who underwent ultrasound between 2017 and 2023 were included. Gland size, border, internal echo pattern, vascularity, and SWE were measured. These parameters were compared with those of the healthy controls, and before and after treatment. Thirty-one glands from 16 patients were analysed. All glands had a nodular shape; the nodular hypoechoic was the most prevalent pattern, followed by the diffuse hypoechoic; the reticular was the least common. Most glands had rich vascularity, whereas two glands had minimal vascularity. The depth (mean 18 mm) and SWE (mean 3.57 m/s) were significantly higher in IgG-RSS (P=0.003 and <0.001, respectively) than in the healthy controlsNine glands from five patients were enrolled to evaluate the treatment response. After treatment, the margins became smoother and all glands showed a reduction in size, hypoechoic area, and vascularity. The mean SWE decreased from 3.56 m/s to 2.50 m/s with a significant difference between pre- and post-treatment (P= <0.001). The SWE is useful for diagnosing IgG4-RSS and assessing the effectiveness of treatment.

The feasibility study of shear wave elastography in the diagnosis of erectile dysfunction

The aim of this study was to explore the value of Shear wave elastography (SWE) in evaluating vascular and nonvascular erectile dysfunction. In this study, erectile dysfunction (ED) patients enrolled (n = 114) received SWE and Doppler ultrasonography (PCDU) exams. The peak systolic velocity (PSV) and end-diastolic velocity (EDV) were used as the classification standard. The performance of the SWE was assessed with the receiver operating characteristic curve, sensitivity and specificity. The rigidity alterations of corpus cavernosum penis with age was also investigated. SWE values of corpus cavernosum penis (CCP) before intracavernosal injection (ICI) negatively correlated with age of patients in vascular ED group (r = -0.288, P < 0.05). In erectile or flaccid state, the SWE value of vascular ED was significantly larger than non-vascular ED. When the cut-off value for SWE values of CCP 0.88 m/s in erectile state and 2.32 m/s in flaccid state, the areas under the receiver operating characteristic (ROC) curve were 0.700 (sensitivity: 77.78%, specificity: 60.00%) and 0.612(sensitivity: 68.52%, specificity: 51.67%) in erectile or flaccid state, respectively. This study provides preliminary evidence that SWE in flaccid state could be non-invasive methods used to moderate predict vascular ED.

Doppler ultrasound imaging and shear wave elastography for evaluation of interstitial fibrosis/tubular atrophy in IgA nephropathy.

The purpose of this study was to explore the value of Doppler ultrasound imaging and shear wave elastography (SWE) in evaluating renal interstitial fibrosis/tubular atrophy (IFTA). During April 2019 and November 2023, biopsy-proven IgA nephropathy (IgAN) patients were enrolled in our study. Conventional ultrasound, Doppler ultrasound imaging and SWE measurements were performed, and related parameters were collected. According to the Oxford classification of IgAN, interstitial fibrosis/tubular atrophy (T) lesions were grouped into T0, T1 and T2 group. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic accuracy of SWE in identifying IFTA. A total of 100 IgAN patients were enrolled in the final cohort. 67 patients were in the T0 group, and 33 patients were in the T1/T2 group. The average SWE values were 42.17 ± 9.11kPa in the T0 group and 36.83 ± 10.32kPa in the T1/T2 group (p = 0.01). Multivariate logistic regression revealed that the SWE value and end diastolic velocity (EDV) of the interlobar artery were found to be independent risk factors for IFTA. For the diagnosis of IFTA, the area under the ROC curve (AUC) of SWE alone was 0.652, whereas the AUC of SWE in combination with the EDV was 0.807 (p = 0.008). The combination of Doppler ultrasound imaging and SWE measurements could improve the diagnostic performance of quantitative assessment of IFTA in IgAN patients.

Quantified Deltoid Muscle Stiffness Can Predict Improved Muscle Strength for Elevation Following Reverse Shoulder Arthroplasty.

Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). Methods: Sixty-five patients who underwent RSA over a 12-month follow-up period were included. Patient characteristics and clinical and radiologic measurements were recorded. Preoperatively and at 3, 6, 9, and 12 months after surgery, deltoid muscle stiffness and muscle strength for scapular-plane abduction were sequentially measured using SWE and a portable dynamometer. In each quarterly period (3-6, 6-9, and 9-12 months), patients were assessed for an improvement in muscle strength and separated into two groups: improved and non-improved. To assess the risk of lack of improvement in each quarterly period, the variables were compared between the groups. Results: Improvement in muscle strength was observed in 52 patients (80%) at 3-6 months, 46 patients (71%) at 6-9 months, and 39 patients (60%) at 9-12 months. Notably, SWE measurements at the beginning of each period showed significantly greater values in the non-improved group than in the improved group during the subsequent quarterly period. A receiver operating characteristic (ROC) curve analysis suggested that SWE values >45.1-50.0 kPa might be associated with a lack of muscle strength improvement over 3 months with 73-87% specificity and 73-85% sensitivity. Conclusions: Our study demonstrated that increased deltoid muscle stiffness negatively correlated with an improvement in muscle strength following RSA. According to our results, a postoperative assessment with SWE may be useful for not only improving muscle strength after RSA but also facilitating postoperative improvement by preventing excessive stiffness in the deltoid muscle.

Improving the diagnostic strategy for thyroid nodules: a combination of artificial intelligence-based computer-aided diagnosis system and shear wave elastography.

Thyroid nodules are highly prevalent in the general population, posing a clinical challenge in accurately distinguishing between benign and malignant cases. This study aimed to investigate the diagnostic performance of different strategies, utilizing a combination of a computer-aided diagnosis system (AmCAD) and shear wave elastography (SWE) imaging, to effectively differentiate benign and malignant thyroid nodules in ultrasonography. A total of 126 thyroid nodules with pathological confirmation were prospectively included in this study. The AmCAD was utilized to analyze the ultrasound imaging characteristics of the nodules, while the SWE was employed to measure their stiffness in both transverse and longitudinal thyroid scans. Twelve diagnostic patterns were formed by combining AmCAD diagnosis and SWE values, including isolation, series, parallel, and integration. The diagnostic performance was assessed using the receiver operating characteristic curve and area under the curve (AUC). Sensitivity, specificity, accuracy, missed malignancy rate, and unnecessary biopsy rate were also determined. Various diagnostic schemes have shown specific advantages in terms of diagnostic performance. Overall, integrating AmCAD with SWE imaging in the transverse scan yielded the most favorable diagnostic performance, achieving an AUC of 72.2% (95% confidence interval (CI): 63.0-81.5%), outperforming other diagnostic schemes. Furthermore, in the subgroup analysis of nodules measuring <2 cm or 2-4 cm, the integrated scheme consistently exhibited promising diagnostic performance, with AUCs of 74.2% (95% CI: 61.9-86.4%) and 77.4% (95% CI: 59.4-95.3%) respectively, surpassing other diagnostic schemes. The integrated scheme also effectively addressed thyroid nodule management by reducing the missed malignancy rate to 9.5% and unnecessary biopsy rate to 22.2%. The integration of AmCAD and SWE imaging in the transverse thyroid scan significantly enhances the diagnostic performance for distinguishing benign and malignant thyroid nodules. This strategy offers clinicians the advantage of obtaining more accurate clinical diagnoses and making well-informed decisions regarding patient management.

Pancreatic Shear Wave Elastography in Pediatrics with Type I DM

Abstract Background Type I diabetes milletus (DM) is one of the most prevalent autoimmune diseases in the pediatric age group. It is characterized by pancreatic inflammation in the early stages due to autoimmune destruction of the insulin producing beta cells with subsequent fibrosis in the late stages. Conventional gray-scale ultrasonography can provide detailed information about the bio- mechanical structure of tissues when used with the new method of elastography. As tissues affected by a variety of pathologic processes display different mechanical features, stiffness differences may be used to differentiate diffuse diseases or focal lesions. Objective To assess the role of pancreatic shear wave elastography (SWE) in children with type I diabetes in comparison to control subjects. Methods A cross-sectional study over the course of 6 months from March 2023 till September 2023. It included 41 cases with laboratory proven type I DM on insulin therapy and 41 age and gender matched non-diabetic controls referred to our department from the outpatient pediatric clinics for and abdominal ultra-sonography. C-peptide and HbA1C of the cases were measured. Conventional B-mode ultrasonography and pancreatic SWE were performed using the General Electric Logiq P9 ultrasound system. Results Conventional B-mode abdominal ultra-sonography together with pancreatic shear wave elastography were done to the entire study group. There was no significant difference by B-mode noted between the study subjects regarding echogenicity and homogeneity. Shear wave elastography (SWE) values of the diabetic cases and non-diabetic controls were compared and revealed a significant difference between both groups being faster in the cases than in the control group with p-value &amp;lt;0.05. Shear wave elastography values of the cases were compared to each other in respect to their disease duration, age, C-peptide levels and HBA1C levels and there was a statistically significant positive correlation between SWE, disease duration and age with p-value &amp;lt;0.001, while there was statistically significant negative correlation between mean of SWE and level of C-peptide with p-value &amp;lt;0.001. There was no significant correlation with HbA1c with p-value 0.116. Conclusion Type I DM affects pancreatic tissue stiffness as evident by the difference in the mean SWE values of the diabetic cases and the non-diabetic controls. Pancreatic SWE changes significantly in correlation to disease duration, age and C-peptide. Hence, SWE might serve as a new promising non-invasive imaging modality for monitoring and following up type 1 diabetes in children.

Spleen shear wave elastography measurements do not correlate with histological grading of liver fibrosis in Fontan physiology: a preliminary investigation.

Elevated spleen stiffness may be seen in patients with portal hypertension due to cirrhosis. In patients with Fontan physiology, elevated liver stiffness has been shown to correlate poorly with liver fibrosis. It is unknown whether spleen stiffness may instead serve as a surrogate marker of liver fibrosis in these patients. To compare spleen stiffness determined by shear wave elastography (SWE) with histological findings of an ultrasound-guided liver biopsy in patients who had undergone Fontan palliation as a potential surrogate for Fontan-associated liver disease. This was an IRB-approved single-center, retrospective study. Patients with Fontan palliation who had undergone both a spleen SWE study and a percutaneous liver biopsy between 2016 and 2020 were included. Biopsy, performed during cardiac catheterization, within 3months of the SWE was required for inclusion. Using Kruskal-Wallis tests, spleen stiffness was compared with three liver biopsy scoring methods: Ishak, METAVIR, and congestive hepatic fibrosis score (CHFS). When available, Pearson's correlation was also used to compare collagen deposition determined using Sirius Red stain (%SR) with SWE values. A P-value < 0.05 was considered statistically significant. Twenty-two patients (15 males) were included in the study, with a median age of 17years (IQR is 14.8-20.5years; age range: 7years to 30.2years). The median spleen stiffness was 2.94m/s (IQR: 2.57-3.61m/s; range: 1.48-4.27m/s). The median Fontan pressure was 11mm Hg (IQR: 10-13.3mm Hg; range: 7-19mm Hg) obtained within a median of 10days (IQR: 1-41days) of SWE. Splenic stiffness did not correlate with the extent of fibrosis determined by histology (all P > 0.05). There was also no statistically significant correlation between the %SR staining and SWE-determined spleen stiffness (Pearson's correlation of 0.165, P = 0.59, n = 13). In this preliminary study, SWE spleen stiffness values did not correlate with biopsy-determined scoring of liver fibrosis in patients with Fontan physiology.

The value of shear wave elastography combined with red blood cell distribution width in evaluating arterial erectile dysfunction

PurposeA retrospective study was conducted to determine the value of shear wave elastography (SWE) and red blood cell distribution width (RDW) in the diagnosis of various forms of erectile dysfunction (ED).MethodsWith the method of Nocturnal Penile Tumescence and Rigidity (NPTR) and the screening method of Color Duplex Doppler Ultrasound (CDDU), hematological data were collected from 131 individuals, among whom 24 are with psychogenic ED, 48 are with non-arterial ED(NAED) and 59 are with arterial ED(AED) with erectile dysfunction. SWE value of penile corpus cavernosum(CCP) and cavernous arterial flow velocity were measured before (flaccid state) and after (erect state) intracavernous injection (ICI) in all patients.ResultsAmong the AED patients and other types of ED patients, there were statistically significant differences in the abridged five-item International Index of Erectile Function (IIEF-5), red blood cell distribution width-coefficient of variation (RDW-CV), red blood cell distribution width-standard deviation (RDW-SD), and SWE values (all P < 0.01). In the AED patients, the IIEF-5 scores had a significant negative relationship with RDW-CV, RDW-SD, and SWE values, with SWE values having the strongest correlation. (p < 0.001, r=-0.638).ConclusionThe combination of RDW level and SWE value demonstrated the greatest performance in diagnosing AED, according to the receiver-operator characteristic(ROC) curve analysis (AUC = 0.870, p < 0.0001, cut-off value of 0.75, sensitivity of 74.6%, specificity of 91.7%).RDW and SWE value may develop into an incredibly simple, practical tool for predicting and diagnosing AED.Trial registrationretrospectively registered.