Shear Wave Sonoelastography Research Articles

Effectiveness of two-dimensional shear-wave sonoelastography in the diagnosis and follow-up of infantile hypertrophic pyloric stenosis

IntroductionWe sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS).Materials and MethodsTwenty-three infants were included in the study, 13 in the IHPS group and 10 in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values.ResultsNo differences were found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylorus in the IHPS group was four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month.Conclusions2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.

Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

A Study of Serial Shearwave Sonoelastography (SWE) Using Supersonic Imaging in Early Renal Post - Transplant Period

BACKGROUND&#x0D; Ultrasound elastography is a novel technique in ultrasound that quantifies the tissue stiffness in organs and recently has emerged as a tool in complementing the evaluation of renal allograft function. The pathological processes underlying the graft dysfunction cause the changes in elasticity of the graft tissue. This change in elasticity is detected and imaged using elastography. US-based elastography is now a noninvasive complementary tool in addition to the existing laboratory and Doppler-based parameters in the evaluation of renal allograft dysfunction.&#x0D; METHODS&#x0D; The present prospective cohort study was conducted in the Department of Radiology, Malabar Institute of Medical sciences, Kerala, India from January 2019 to June 2020.&#x0D; RESULTS&#x0D; Renal allograft parenchymal stiffness by shearwave sonoelastography correlated positively with S. creatinine (p &lt;0.001) and RI (p &lt;0.001) and inversely correlated with eGFR (p&lt;0.001). There was no correlation between the SWE values and BMI of the recipient. There was no correlation between the SWE values and age of the donor and between the SWE values and age of the patient.&#x0D; CONCLUSIONS&#x0D; The renal parenchymal stiffness by shearwave elastography showed positive correlation with serum creatinine and RI values and inverse correlation with eGFR which reflected the functional status of the renal allograft. The renal allografts with graft dysfunction were found to have higher SWE values than the stable renal allografts. The renal parenchymal stiffness can help to differentiate stable allografts and graft with allograft dysfunction, hence may be used as a reliable tool in addition to the existing laboratorical and Doppler based parameters in predicting allograft dysfunction. The cut-off value for differentiating stable renal allografts and renal allografts with dysfunction was found to be 14.32 kpa. There was no correlation between shear wave elastography values with the BMI of the recipient and age of the donor.

Assessing thickness and stiffness of superficial/deep masticatory muscles in orofacial pain: an ultrasound and shear wave elastography study

Introduction Sonoelastography has been increasingly used for non-invasive evaluation of the mechanical features of human tissues. The interplay between orofacial pain and regional muscle activity appears clinically paramount, although only few imaging studies have investigated this association. Using shear wave sonoelastography (SWS), this study ascertained whether orofacial pain induced alterations in the stiffness of superficial and deep masticatory muscles. Methods All participants were systematically evaluated for oral/facial-related conditions, including the area and intensity of pain. SWS was applied to measure the stiffness of the bilateral masseter, temporalis, and lateral pterygoid muscles. The association between orofacial pain and muscle stiffness/thickness was investigated using a generalized estimating equation for adjusting the influence of age, sex, laterality, and body mass index on muscle thickness/stiffness. Results A total of 98 participants were included in the present study: 48 asymptomatic controls, 13 patients with unilateral pain, and 37 patients with bilateral orofacial pain. The reliability, quantified by the intraclass correlation coefficient for muscle stiffness measurement, ranged from 0.745 to 0.893. Orofacial pain at the individual muscle level was significantly associated with masseter muscle stiffness. A trend of increased stiffness (p = 0.06) was also observed in relation to the painful side of the temporalis muscle. No significant correlation was identified between the numeric rating scales for pain and stiffness measurements. Conclusions SWS provides reliable stiffness measurements for the superficial and deep masticatory muscles. The ipsilateral masseter and temporalis muscles might be stiffer than those on the side without orofacial pain. Future studies using the present sonoelasotography protocol can be designed to investigate the stiffness changes in the target muscles after interventions.

Clinical correlation of 2D shear wave elastography findings in children with type 1 diabetes mellitus without autoimmune thyroiditis.

The aim of study was to evaluate the 2D shear wave sonoelastography (SWE) findings of the thyroid gland in children with type 1 diabetes mellitus (T1DM) with normal gray-scale findings and without thyroid autoimmunity (AIT) and obtain data that will be useful for the early detection of glandular involvement. The study included 46 T1DM patients (mean age: 11.28±3.3years) and 46 healthy children (mean age: 12.01±3.8years) as the control group. The thyroid gland mean elasticity value was obtained as kPa and compared in groups. A correlation was investigated between elasticity values and age at diabetes, serum free T4, thyroid stimulating hormone (TSH), anti-thyroglobulin, anti-tissue peroxidase, and hemoglobin A1c values. No difference was found between T1DM patients and the control group in the thyroid 2D SWE evaluation (the median kPa value: 17.1 (10.2) in the study group and 16.8 (7.0) in the control group) (p=0.15). No significant correlation was found between 2D SWE kPa values and age at diagnosis, serum free T4, TSH, anti-thyroglobulin, anti-tissue peroxidase, and hemoglobin A1c levels in T1DM patients. Our study showed that the elasticity of the thyroid gland in T1DM patients without AIT was not affected differently from that of the normal population. If 2D SWE isused in routine follow-up in T1DM patients before the development of AIT, we think that it will be useful in the early detection of thyroid gland affections and AIT, and long-term comprehensive studies in this direction will contribute to the literature.

Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study.

The thoracolumbar fascia (TLF) may be a pain generator, given its rich innervation. Structural and biomechanical changes have also been documented in adults with chronic non-specific low back pain (LBP). Myofascial techniques (MFTs) are commonly used in manual therapy and are hypothesized to reduce tissue stiffness and pain. However, evidence for these effects is limited. The objective of this study was to evaluate the immediate effects of a standardized MFT compared to a simulated MFT on: (1) the stiffness of the TLF and erector spinae muscles (shear-wave sonoelastography), (2) the thickness of the TLF (B-mode ultrasound), and (3) pain intensity (numerical rating scale). Forty-nine participants with chronic non-specific LBP were included in a randomized before-and-after experimental study. Outcome measures were collected before (T0) and immediately after the intervention (T1). Pain intensity was also assessed on day two (T2) and seven (T7). The MFT group showed a significant decrease in left erector spinae muscle stiffness and left TLF thickness compared to the simulated group. In addition, there was a significant reduction in pain intensity in the MFT group compared to the simulated group at T1 and T2. The results of this study suggest that MFT results in immediate tissue changes and transient pain reduction in patients with LBP.

Sono-elastography findings of supraspinatus tendon in supraspinatus tendinopathy and tear: comparison study with magnetic resonance imaging

BackgroundRotator cuff disorders are the main causes of chronic shoulder instability and pain. Diagnostic imaging is important to guide treatment decisions with magnetic resonance imaging, which is considered the reference standard for rotator cuff evaluation. Sono-elastography is a noninvasive and reliable ultrasound technique that provides qualitative as well as quantitative assessment of tendon quality through alteration in the tissue composition before alteration in tendon echogenicity or thickness on the conventional US.PurposeTo assess the role of shear wave sonoelastography in the evaluation of supraspinatus tendon abnormalities.To assess the association between SWE and grades of tendon abnormalities on MRI (the standard imaging in the evaluation of rotator cuff abnormalities).ResultsThe shear wave velocity (SWV) was notably low (reduced tendon stiffness) in patients with supraspinatus tendinopathy and tear (mean SWV for the supraspinatus tendon in cases of tendinopathy/tear was 3.91 m/s with a standard deviation of 0.67, while the mean SWV for normal supraspinatus tendons was 6.93 m/s with a standard deviation 0.57), and a significant difference was found in SWV values between cases and controls (P < 0.001).Also, there were significant differences between the patients with different grades of tendon abnormalities (P < 0.001), with a highly significant inverse correlation observed between the measured SWV and grades of tendon abnormalities on MRI (P < 0.001).ConclusionsSonoelastography showed tendon softening in supraspinatus tendinopathy and tear with a good correlation to the MRI, making it a reproducible and low-cost imaging modality that can be a complementary tool to the US in the evaluation of shoulder disorders, especially when MRI is not allowed.

The sono-elastography evaluation of the immediate effects of neurodynamic mobilization technique on median nerve stiffness in patients with carpal tunnel syndrome

ObjectivesThe stiffness of median nerve increases in carpal tunnel syndrome (CTS) even at mild stage of syndrome which could be regarded as a diagnostic criterion. The aim of this study was to evaluate the immediate effects of neurodynamic technique on median nerve stiffness and cross-sectional area (CSA) at wrist and elbow in individuals with CTS. Material and methodsIt was a quasi-experimental study. Twenty patients were recruited for this study. They were included if aged 18–65 years and diagnosed with CTS based on electrodiagnostic and clinical findings. The exclusion criteria were previous surgeries at wrist or elbow. Patients were assessed by shear wave sono-elastography before and immediately after one session of neurodynamic mobilization technique (NDM). The primary outcome measure was the stiffness of the median nerve at wrist and the secondary outcomes were nerve stiffness at elbow and CSA of nerve at wrist and elbow. ResultsMedian nerve stiffness and CSA decreased significantly at wrist immediately after a session of NDM. These parameters also decreased at elbow but were not statistically significant. ConclusionOne session of NDM reduced the stiffness and CSA of median nerve at wrist in patients with CTS as detected by sono-elastography verifying that sono-elastography is able to quickly detect the immediate biomechanical changes of the median nerve.

Liver elasticity assessment after biliary drainage in patients with extrahepatic cholestasis by shear wave sono-elastography (SWE)

BackgroundExtrahepatic cholestasis that is caused by benign and malignant diseases has been reported to influence liver elasticity, independent of liver fibrosis. Shear wave sono-elastography is a novel noninvasive ultrasound-based tool to assess liver stiffness that is indirectly measured by the propagation velocity of ultrasound waves within the liver parenchyma. The aim of our study is to explore the impact of extrahepatic cholestasis on liver elasticity assessed by sono-elastography.MethodsThis is the prospective cohort study of 80 patients with obstructive jaundice. Liver elasticity was measured before biliary drainage (day 0), with measures repeated 2 days (day 2) and seven days (day 7) after biliary drainage. Then, correlation with serum bilirubin and serum liver enzymes values was done.ResultsThe studied patients with extrahepatic cholestasis (38 males and 42 females with mean age ± SD of 45.8 ± 14.6 years) referred to our department for biliary drainage. All underwent liver elasticity measurement by real-time shear wave sono-elastography before biliary drainage with the highest value of mean elasticity (± SD) 8.44 kPa (± 3.02) and then repeated on day 2 with mean elasticity 6.82 kPa (± 2.77), followed by maximum improvement of liver stiffness on day 7 with mean elasticity 4.8 kPa (± 1.80), coincided with improvement of cholestatic laboratory levels.ConclusionsThis study confirmed improvement of liver stiffness, measured by sono-elastography, after biliary drainage in patients with extrahepatic biliary obstruction.

A shear-wave sonoelastography investigation of calf muscle pump biomechanics in patients with chronic venous disease and healthy controls

Background: chronic venous disease (CVD) is a common progressive disorder with incompetence of calf muscle pump due to weakness and ankle mobility abnormality is an important etiological factor in CVD, but the biomechanical properties of calf muscle pump are remain unknown. ObjectivesThe purpose of the present study was to evaluate group differences between the biomechanical properties changes of the medial gastrocnemius muscle (GM) and its fascias in participants with CVD and healthy controls. MethodsIn this case-control study, thirty patients with CVD in three equal groups (mild: C1 – C2, moderate: C3 – C4, severe: C5 – C6) and 20 healthy subjects in a control group participated. The medial GM and its fascias shear modulus (stiffness) were measured using a shear-wave sonoelastography in rest and active dorsiflexion positions of ankle joint. ResultsThe results of variance (ANOVA) analysis showed a significant difference in shear wave elastography (SWE) value between the groups for medial GM and its fascias at rest and active dorsiflexion of the ankle joint (P < 0.05). There was a statistically significant increase in SWE value of the medial GM and its fascias in moderate (c3-c4) and severe CVD groups (C5–C6) compared to the control and mild (C1–C2) CVD groups. A positive correlation was discovered between disease grades and the medial GM and its fascias SWE in patients with CVD ranging between r = 0.846 to 0.891; P < 0.001. ConclusionAn alteration stiffness in calf myofascial pump as compared to control group indicated an impaired myofascial biomechanics. Calf myofascial SWE may be valuable information in the diagnosis and follow-up processes of patients with CVD.

401.7: Non-Invasive Assessment of Renal Allograft Fibrosis by Shearwave Elastography: A Radiological – Pathological Correlation Analysis.

Background & objectives: Currently, renal allograft biopsy is the only reliable tool available to detect fibrosis in the transplanted kidney. However, it is an invasive procedure and is associated with complications. Therefore, a non-invasive tool to detect renal allograft fibrosis is needed. This study sought to evaluate the usefulness of SWE in the quantitative measurement of renal allograft fibrosis and to correlate shear-wave sonoelastography measurements with histological findings, resistive index, serum creatinine level and estimated glomerular filtration rate (eGFR) obtained with the CKD-EPI. Methods: A cross-sectional study of 110 renal transplant patients. Patients were classified as having stable allograft and allograft dysfunction based on clinical parameters. Only patients with allograft dysfunction underwent renal allograft biopsy. SWE assessment was done by a single radiologist using the same ultrasound machine to quantify allograft fibrosis in kPa. Renal allograft biopsies were interpreted by the same pathologist according to the 2019 Banff classification. The potential correlation between SWE scores and Banff classification was performed in allograft dysfunction group. The receiver operating characteristic curves were drawn to evaluate the likelihood of differentiation. Results: 66 patients had allograft dysfunction and 44 patients had stable allograft function. Mean parenchymal stiffness measured values in stable allograft and allograft dysfunction were 14.20±4.50 kPa and 16.54±5.42 kPa respectively.Mean parenchymal stiffness showed a significant negative correlation with eGFR (r= -0.317, p= 0.001) and a positive correlation with serum creatinine level (r= 0.256; p= 0.007). There was a significant correlation between the Banff grade of IFTA and the mean SWE score, (p= 0.003).The correlation of resistive index was insignificant when compared to the mean SWE score (r= 0.058, p= 0.547). The area under the curve was higher and significant at IFTA grading ≥ 2 (AUC- 0.801, p < 0.0001) when compared it with IFTA grading 0 (AUC–0.523, p= 0.831) and 1 (AUC-0.551, p= 0.431).The sensitivity was 86% and specificity was 73% in the differentiation of stable graft from graft dysfunction with moderate to severe fibrosis (cut-off value, 16.15 kPa). The sensitivity was 85% and specificity was 67% in the differentiation of graft dysfunction with grade 2/3 IFTA from graft dysfunction with grade 0/1 IFTA (cut-off value, 16 kPa). This means that shear wave elastography effectively detects moderate to severe fibrosis in the allograft. The severity of fibrosis increased with the increase in transplant vintage with statistical significance (p <0.001). Conclusions: Renal allograft parenchymal stiffness quantified by shear-wave elastography showed a significant correlation with allograft fibrosis graded by Banff classification. SWE can differentiate between mild fibrosis and moderate-to-severe fibrosis with high accuracy. The inverse correlation of parenchymal stiffness with eGFR and positive correlation with serum creatinine level show that shear-wave sonoelastography may reflect the functional status of the renal allograft. Therefore, shear wave elastography can be used as a noninvasive tool to assess renal allograft fibrosis and is better than the resistive index. Key words: elastography, SWE, renal allograft biopsy, renal transplant, allograft fibrosis.

Summary of Meta-analyses of Studies Considering Lesion Size Cut-off Thresholds for The Assessment of Eligibility for FNAB and Sonoelastography and Inter- and Intra-observer Agreement in Estimating the Malignant Potential of Focal Lesions of The Thyroid Gland.

Thyroid cancer is a tumour with a steadily increasing incidence. It accounts for 7% to 15% of focal lesions detected by ultrasound, depending on age, gender and other factors affecting its occurrence. Fine-needle aspiration biopsy is an essential method to establish the diagnosis but, in view of its limitations, sonoelastography is seen as a non-invasive technique useful in differentiating the nature of lesions and monitoring them after fine-needle aspiration biopsy. This paper presents a literature review on the role of both sonoelastographic techniques (relative strain sonoelastography, shear wave sonoelastography) to assess the deformability of focal thyroid lesions. Ultrasound examination is a relatively subjective method of thyroid imaging, depending on the skills of the examiner, the experience of the centre, and the quality of equipment used. As a consequence, there are inconsistencies between the results obtained by different examiners (inter-observer variability) and by the same examiner (intra-observer variability). In this paper, the authors present a review of the literature on inter-observer and intra-observer variability in the assessment of individual features of ultrasound imaging of focal lesions in the thyroid. In addition, the authors report on an analysis of cut-off thresholds for the size of lesions constituting the basis for fine-needle aspiration biopsy eligibility assessment. The need to diagnose carcinomas up to 10 mm in diameter is highlighted, however a more liberal approach is recommended in terms of indications for biopsy in lesions associated with a low risk of malignancy, where, based on consultations with patients, active ultrasound surveillance might even be considered.

Methods of Masseter and Temporal Muscle Thickness and Elasticity Measurements by Ultrasound Imaging: A Literature Review.

The positive correlation between changes in the morphology of masseter and temporal muscles and some disorders, inclines diagnosticians to search for an effective method of assessing muscle thickness and elasticity. Ultrasound imaging, as a relatively simple and cheap method, seems to be a useful diagnostic tool. The aim of this study was to present the existing ultrasound imaging methods in the assessment of the elasticity and thickness of the masseter and temporal muscles. The literature review has been done with a focus on the accurate description of the masseter and/or temporal muscle examination by ultrasonography imaging methods. Articles were categorized into two groups. The first group included articles in which muscle thickness was assessed by ultrasound imaging. The second group concerned the elasticity aspect of mentioned muscles. It is difficult to achieve an objective protocol of masseter and temporal thickness assessment by ultrasonography and there is no method that has been fully verified in terms of reliability. The shear-wave sonoelastography revealed higher-level reliability of masseter muscle elasticity than strain sonoelastography. During the shear-wave sonoelastography, the effect of scan plane in relation to masseter muscle pennation and the day-to-day variation were statistically significant. With regard to elasticity of temporal muscle, further research is needed. This review has shown that there is a limited number of methods for masseter and temporal muscle thickness and elasticity measurements by ultrasonography. All procedures (methods) were not fully verified in terms of reliability and agreement. Thus, it is still necessary to develop standardized procures to assess thickness and elasticity of the masseter and temporal muscles with appropriate reliability and accuracy.

The current value of quantitative shear wave sonoelastography in parotid gland tumors.

The preoperative differentiation between salivary gland tumor entities using computed tomography, magnetic resonance imaging (MRI) and ultrasound (US) is still limited. Biopsies are often regarded as indispensable for properly characterizing these various lesions. The aim of this study was to analyze the value of acoustic radiation force impulse (ARFI) sonoelastography as an US differentiation tool when examining parotid gland (PG) lesions. We included 104 patients with PG masses in this study, employing two different US devices using quantitative ARFI-sonoelastography (Siemens Acuson-S3000, n=59; Siemens Acuson-Sequoia, n=45). The ability of sonoelastographic measurements to differentiate between different neoplasms was compared and analyzed for both US machines. Quantitative shear wave sonoelastography is limited in its ability to reliably differentiate between tumor entities of the PG as a stand-alone parameter. Measurement results were unsystematically distributed and not transferable between the two US devices. A significant differentiation of benign and malignant lesions was not possible with either US machine (S3000: P=0.770, Sequoia: P=0.382). A differentiation between pleomorphic adenomas (PA) and Warthin tumors was only possible with the Acuson S3000 system (P=0.001, Spearman-Rho =0.492, sensitivity 73.9%, specificity 65.0%). A reliable identification and differentiation of PG tumors as well as clinical treatment decisions cannot be made with the sole use of ARFI-sonoelastography. The results emphasize the device-dependence and high error-proneness of this US technique when examining lesions of the PG.

Shear wave elastography in transplant kidney and its correlation with renal doppler parameters and eGFR

Chronic allograft nephropathy is the most common cause of graft failure and is characterized by interstitial fibrosis and tubular atrophy, this study evaluated the role of shear-wave sonoelastography in the differentiation of stable renal allograft from allograft dysfunction & establish the correlation of parenchymal stiffness values with resistive index (RI), serum creatinine level, estimated glomerular filtration rate (eGFR). A prospective study of 40 patients who had undergone renal transplantation was conducted between October 2018 and July 2020. Patients were classified as having stable allograft and allograft dysfunction on the basis of clinical parameters practised in our institution. Receiver operating characteristic curve were drawn to obtain a cut off value with maximum sensitivity and specificity. Pearson’s correlation was used to evaluate different renal parameters and their correlation with the shear wave elastography (SWE) value. In this study 27 patients had graft dysfunction and 13 had stable graft. Use of the threshold value of 8.23kPa for SWE resulted in a sensitivity of 70% and specificity of 100% for the differentiation of stable allograft from allograft dysfunction. Parenchymal stiffness showed inverse correlation with eGFR (r = -.756, P

Effectiveness of ultrasonography and shear wave sonoelastography in Sjögren syndrome with salivary gland involvement.

PurposeThis study investigated the effectiveness of major salivary gland ultrasonography (MSGUS) using a new grading system and shear wave elastography (SWE) in evaluating the major salivary glands of patients with Sjögren syndrome (SjS).MethodsThis prospectively-designed cross-sectional study included 49 SjS patients and 49 healthy controls. Major salivary glands were examined with gray-scale ultrasonography and SWE. A new grading system for salivary glands was developed using MSGUS findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGUS and shear wave velocity (SWV) values were investigated. The MSGUS grading system and SWV values were evaluated together by logistic regression analysis. A cutoff value of SWE for salivary glands was determined.ResultsThe sensitivity, specificity, PPV, and NPV of MSGUS were 69.4%, 73.5%, 72.3%, and 70.6% for the submandibular gland and 69.4%, 65.3%, 66.7%, and 68.1% for the parotid gland, respectively. The mean SWV values of the parotid and submandibular glands were significantly higher in SjS patients than in controls (P<0.05). The sensitivity, specificity, PPV, and NPV for the submandibular gland (cutoff, 1.95 m/s) and the parotid gland (cutoff, 2.39 m/s) were 69.4%, 52%, 59.1%, and 63% and 82.7%, 83.7%, 83.5%, and 82.8%, respectively. Adding SWE to the parotid gland grading system increased the sensitivity and specificity (sensitivity, 82.7%; specificity, 83.7%).ConclusionEvaluating the salivary glands using MSGUS with a new grading system and SWE may contribute to the diagnosis of SjS. The combination of MSGUS and SWE may be a promising tool for diagnosing SjS.

Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions

ObjectivesChanges in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions.MethodsLongitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices; two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2).ResultsSE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa.ConclusionsStrain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated.

Estimation of Hepatic Elasticity by Shear Wave Sonoelastography among Asymptomatic Individuals in a Tertiary Level Hospital.

Shear wave elastography is currently most widely used method for determining the elasticity of liver. Liver fibrosis, final common pathway of chronic liver disease, is associated with increased liver stiffness. This study aimed to obtain normal liver elasticity in Nepalese population, as it can be used as reference in future for determination of elasticity in abnormal liver. Quantitative prospective study was done in 132 individuals with normal liver function tests. Shear wave elastography was done to measure elasticity of both lobes of liver and thus obtained values were also correlated with age, gender and fatty changes in liver. Forty seven out of 132 individuals had fatty liver. Mean elasticity of liver was 4.40±0.60 kPa with range of 3.12-6.62 kPa. There was no significant difference between mean elasticity of right and left lobe of liver. No significant correlation was found between mean liver elasticity with age and gender. There was statistically significant difference in the mean elasticity between non-fatty and fatty liver (p=0.041). The study established normal elasticity of liver in Nepalese population and this reference can be used to obtain abnormal liver elasticities.

Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue.

Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane—transverse vs. longitudinal—on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results.

Application of Shear Wave Sonoelastography in the Differential Diagnosis of Extra- and Intra-Thyroidal Ectopic Thymic Tissue.

The ultrasound (US) pattern of intrathyroidal ectopic thymus (IET) can resemble papillary thyroid carcinoma (PTC) while the extrathyroidal ectopic thymus (EET) can mimic pathological lymph nodes. Recently, the usefulness of strain elastography (SE) was demonstrated in the differential diagnosis, however this method has several limitations. The aim of the current study was to assess the usefulness of shear wave elastography (SWE) in this field. The US, SE, and SWE were performed in 31 children with 53 ectopic thymuses (ETs) and quantitative values of SWE parameters were calculated, so as to generate potential normative values of ET elasticity and of the shear wave ratio (SWR). The mean SWRIET was 0.89 ± 0.21 and the mean shear wave stiffness (SWS) was 7.47 ± 1.93 kPa. The mean SWREET was 0.84 ± 0.15 and the mean SWSEET was 11.28 ± 2.58 kPa. The results have proven that the stiffness of ETs is lower or equal to the thyroid’s. SWE was demonstrated to be a useful diagnostic method for ET evaluation. Therefore, the application of SWE in ET diagnosis allows more accurate evaluation of ET-like lesions and, in many cases, allows one to avoid invasive procedures, simultaneously providing a precise monitoring method based on combined US and SWE evaluation.