Shear Wave Elastography Research Articles

Radiological and biomechanical evaluation of the ulnar nerve after the percutaneous application of the medial K-wire in the extended position on supracondylar humerus fractures: Does the postoperative long arm splint position matter?

Our study aimed to evaluate and compare the changes in ulnar nerve tension and strain at different elbow positions radiologically and mechanically before and after applying the medial K-wire on the supracondylar humerus fracture cadaver model. We used ten fresh frozen cadaver upper extremity specimens to measure strain and tension on the ulnar nerve in 3 different elbow positions: elbow full extension, elbow flexion-forearm supination, and elbow flexion-forearm pronation. We employed Shear wave elastography (Siemens Acuson S3000 USG, 9L4 linear probe) and a microstrain gauge (Microstrain, Inc., Burlington) to obtain our measurements. Minimum, maximum and mean stress and strain values on the nerve and its surroundings were measured and compared statistically. The mean values of elbows with full extension are statistically lower than those in elbows with 90° flexion-forearm supination and those with 90° flexion-forearm pronation positions. Statistical evaluations were performed between all of the groups. Elbow 90° flexion-forearm pronation, both minimum and maximum and mean values were statistically higher in the group, including the specimens with Kirschner applied. The mean values in the elbow full extension and elbow 90° flexion-forearm supination positions were statistically similar in the specimens with and without the K-wire applied. Despite the numerous techniques described in the literature, there is no absolute technical method to prevent ulnar nerve damage. K-wire application to the medial epicondyle with the elbow in a slightly extended position is a technique that can be applied to reduce the risk of ulnar nerve paralysis. However, it has been reported that ulnar nerve damage can be observed in cases where a splint is placed in the 90° flexion position. We hypothesize that the position of the elbow joint in the postoperative period may contribute to ulnar nerve paralysis due to soft tissue tension and strain and as a result of changing the balance of the surrounding tissues. Our findings suggest that the long arm splint applied in elbow 90° flexion and forearm pronation position should not be preferred in the postoperative period. The maximum strain values obtained in the elbow full extension were lower, suggesting that it would be appropriate to stabilize the elbow in the extension position as much as possible postoperatively. Level of evidence: Level V.

Shear-wave elastography of canine patellar tendons in healthy dogs and the influence of stifle joint angle.

Elastography is a sonographic modality that measures tissue stiffness, a mechanical property of tissues, and a biomarker for disease. Canine musculoskeletal application to the patellar tendon has been limited to semiqualitative strain elastography. This prospective study aimed to quantitatively evaluate patellar tendon stiffness using shear-wave elastography with a color map superimposed over the tendon, a propagation map for quality control, and measurements at specific regions of interest in 16 clinically normal sedated dogs weighing 25kg or greater. Tendon stiffness using shear-wave elastography (SWE) was assessed at different stifle angles and in three regions to determine if angle and location affected stiffness. All dogs were screened with general and orthopedic exams, lateral stifle radiographs, and patellar tendon 2D ultrasound. Shear-wave elastography was performed from a long axis at various stifle angles at the proximal, middle, and distal tendon segments. Quality diagnostic SWE results varied significantly with stifle angle, and 150° of extension was the only angle found to be clinically useful based on the ease of obtaining measurable results and a quality control propagation wave. Patellar tendons were primarily stiff with a red color elastogram. The proximal and middle segments, measured at various angles, had a mean SWE velocity of 7.32±0.90m/s. Tendon stiffness did not differ along tendon length when measured in greater extension. However, stiffness decreased in the middle segment of the tendon at 150° when compared with 120°. This study establishes a quantitative baseline of normal patellar tendon stiffness to compare with pathologic states.

Combination of Different Sectional Elastography Techniques with Age to Optimize the Downgrading of Breast BI-RAIDS Class 4a Nodules.

This study aims to optimize the downgrading of BI-RADS class 4a nodules by combining various sectional elastography techniques with age. We performed conventional ultrasonography, strain elastography (SE), and shear wave elastography (SWE) on patients. Quantitative parameters recorded included age, cross-sectional and longitudinal area ratios (C-EI/B, L-EI/B), strain rate ratios (C-SR, L-SR), overall average elastic modulus values (C-Emean1, L-Emean1), five-point average elastic modulus values (C-Emean2, L-Emean2), and maximum elastic modulus values (C-Emax, L-Emax). Histopathological evaluations showed that out of 230 lesions, 45 were malignant, and 185 were benign. The sensitivity and specificity of conventional ultrasonography were 100% and 0%, respectively. In contrast, SE and SWE exhibited higher specificity but lower sensitivity. Crosssectional parameters (C-EI/B, C-SR, C-Emean1, C-Emean2, and C-Emax) outperformed their longitudinal counterparts, with C-SR and C-Emax showing the highest specificity (72.43% and 73.51%) and satisfactory sensitivity (80.00% and 88.89%). Combining age with C-SR and C-Emax significantly improved diagnostic efficiency, achieving a sensitivity of 97.78% and a specificity of 77.30%. Integrating age with C-SR and C-Emax effectively reduces unnecessary biopsies for most BI-RADS 4a benign lesions while maintaining a very low misdiagnosis rate.

Point Shear Wave Elastography for Assessment of Liver Stiffness in Normal Individuals and in Patients With Non-alcoholic Fatty Liver Disease

Point Shear Wave Elastography for Assessment of Liver Stiffness in Normal Individuals and in Patients With Non-alcoholic Fatty Liver Disease

Ultrasound monitoring of skeletal muscle wasting in critically ill patients using shear wave elastography – musclenut study sub-analysis

Ultrasound monitoring of skeletal muscle wasting in critically ill patients using shear wave elastography – musclenut study sub-analysis

The Impact of Fu's Subcutaneous Needling on Lower Limb Muscle Stiffness in Knee Osteoarthritis Patients: Study Protocol for a Pilot Randomized Controlled Trial.

Knee osteoarthritis (OA) is a leading cause of disability worldwide, with clinicians often observing increased muscle stiffness associated with joint pain and dysfunction. This study examines the impact of Fu's Subcutaneous Needling (FSN), a non-pharmacological technique, on muscle stiffness in the lower limbs of individuals with knee OA. This study protocol is a pilot, single-center, randomized controlled trial. Sixty knee OA patients will be allocated equally for FSN or electroacupuncture (EA) treatments. Interventions will be applied thrice weekly for the first two weeks and twice weekly for the subsequent two weeks for a total of ten sessions. Assessments will be conducted at baseline, post-initial session, after four weeks of intervention, and at the end of a four-week follow-up. The primary outcome will be the muscle stiffness in the lower extremities, as measured by shear wave elastography (SWE). Secondary outcomes include response rate, a reduction in the mean pain intensity on the Numerical Rating Scale (NRS) by at least two points and on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale by six points at week four compared with baseline. Weekly monitoring of the NRS and WOMAC scores will determine the rapidity of pain alleviation and functional improvement, along with 12-item short-form (SF-12) score changes from baseline to week four. This is the first standardized protocol examining the effects of FSN on lower limb muscle stiffness in patients with knee OA by SWE. We hypothesize that FSN could outperform EA in alleviating lower limb stiffness associated with knee OA. Findings will contribute to the body of knowledge regarding the efficacy of acupuncture-derived interventions in managing muscle stiffness and may guide future research directions. The trial has been registered on the Chinese Clinical Trial Registry (Registered number: ChiCTR2300073615). Registered 17 July 2023.

Shear wave elastography as a potential method for assessing muscle quality in the diagnosis of sarcopenia.

Shear wave elastography as a potential method for assessing muscle quality in the diagnosis of sarcopenia.

Elastography-based AI model can predict axillary status after neoadjuvant chemotherapy in breast cancer with nodal involvement: A prospective, multicenter, diagnostic study

Objective: To develop a model for accurate prediction of axillary lymph node (LN) status after neoadjuvant chemotherapy (NAC) in breast cancer patients with nodal involvement. Methods: Between October 2018 and February 2024, 671 breast cancer patients with biopsy-proven LN metastasis who received NAC followed by axillary LN dissection were enrolled in this prospective, multicenter study. Preoperative ultrasound (US) images, including B-mode ultrasound (BUS) and shear wave elastography (SWE), were obtained. The included patients were randomly divided at a ratio of 8:2 into a training set and an independent test set, with five-fold cross-validation applied to training set. We first identified clinicopathological characteristics and conventional US features significantly associated with the axillary LN response and developed corresponding prediction models. We then constructed deep learning radiomics (DLR) models based on BUS and SWE data. Models performances were compared, and a combination model was developed using significant clinicopathological data and interpreted US features with the SWE-based DLR model. Discrimination, calibration and clinical utility of this model were analyzed using receiver operating characteristic curve, calibration curve and decision curve, respectively. Results: Axillary pathologic complete response (pCR) was achieved in 52.41% of patients. In the test cohort, the clinicopathologic model had an accuracy of 71.30%, while radiologists’ diagnoses ranged from 64.26% to 71.11%, indicating limited to moderate predictive ability for the axillary response to NAC. The SWE-based DLR model, with an accuracy of 80.81%, significantly outperformed the BUS-based DLR model, which scored 59.57%. The combination DLR model boasted an accuracy of 88.70% and a false-negative rate of 8.82%. It demonstrated strong discriminatory ability (AUC, 0.95), precise calibration (p value obtained by Hosmer–Lemeshow goodness-of-fit test, 0.68), and practical clinical utility (probability threshold, 2.5-97.5%). Conclusions: The combination SWE-based DLR model can predict the axillary status after NAC in patients with node-positive breast cancer, and thus, may inform clinical decision-making to help avoid unnecessary axillary LN dissection.

Ultrasound shear wave elastography of the placenta: a potential tool for early detection of fetal growth restriction

BackgroundSonographic placental elastography has recently been employed as a non-invasive tool to investigate the structural alterations associated with various conditions such as pre-eclampsia, gestational diabetes and fetal growth restriction (FGR). The study was conducted based on the hypothesis that the placental elasticity might differ with varying severity of FGR and with that of appropriate for gestational age (AGA) pregnancies. MethodsThis study involved 121 pregnant women, with 54 in the normal group and 67 in the FGR group, which was defined as the fetal weight below the 10th percentile for gestational age. The FGR pregnancies were sub grouped into different stages based on the presence and extent of Doppler abnormalities. Shear-wave elastography was carried out to investigate the placental elasticity values, which were compared using the Kruskal-Wallis test. A P value of ≤0.05 was considered significant. ResultsThe placental elasticity differed significantly between pregnancies with and without FGR and among the different stages of FGR. There was a significant difference in PE (kPa) and SWV (m/s) among groups, with a p-value of 0.000001. PE and SWV in FGR pregnancies were significantly higher compared to AGA as a whole using t-test with p values of <0.0001. Doppler indices of umbilical, uterine and fetal middle cerebral arteries also correlated significantly with these. ConclusionThe study suggests that placental elasticity values reflect structural alterations associated with FGR and could serve as a valuable tool in the early detection and staging of this condition.

Predictive value of renal shear wave elastography in liver cirrhosis

BackgroundIn liver cirrhosis, prognosis is profoundly affected by renal function. This study evaluates the usefulness of renal stiffness measurement by point-shear wave elastography and renal perfusion by duplex. MethodsIn this case-control study, organ stiffness was quantified using point-shear wave elastography and duplex sonography to calculate the arterial resistive (RI) and pulsatility indices (PI) in 123 patients, including patients with liver cirrhosis with (LC+A) and without ascites (LC-A) and patients without liver cirrhosis (NLC). ResultsPI and RI were significantly increased in LC-A and LC+A compared to NLC (p<0.001) and correlated with MELD and Child Pugh scores. Point-shear wave elastography showed significantly lower renal stiffness in LC+A compared to LC-A (p<0.01) and NLC (p<0.001). Renal stiffness correlated inversely with MELD and Child Pugh scores.Reduced renal stiffness, but not PI or RI, was associated with the presence of hepatorenal syndrome (p<0.001). Reduced renal stiffness was associated with an increased risk of death due to complications of liver cirrhosis within 3 years (p<0.01). ConclusionPoint-shear wave elastography and duplex sonography correlate with progression of liver cirrhosis, but only shear wave elastography represents a valuable prognostic tool for hepatorenal syndrome and mortality in patients with liver cirrhosis.

Ultrasound Shear Wave Elastography of the Arch-Supporting Structures in Symptomatic Flatfoot: A Pilot Study.

The posterior tibial tendon (PTT), deltoid ligament, and spring ligament are often torn or attenuated in patients with progressive collapsing foot deformity. The goal of this pilot study was to measure the ultrasound shear wave velocity (SWV) of these arch-supporting structures in feet with varying degrees of deformity to improve our understanding of their role in the progression of deformity. Two observers measured the SWV of the supramalleolar and inframalleolar PTT in long and short axes, in the tibiospring portion of the deltoid ligament, and in the superomedial band of the spring ligament in 8 neutrally aligned feet, 5 asymptomatic flatfeet, and 7 symptomatic flatfeet. Each measurement was repeated 3 times both with and without an applied eversion stress. Average SWV was lower at all locations in the symptomatic flatfeet compared with normal feet, but these differences were statistically significant only for the inframalleolar PTT and the spring ligament. Externally applied stress led to an increase in the SWV of the ligaments but a paradoxical decrease in the SWV in the supramalleolar PTT. The SWV of the PTT was lower along the short axis compared with the long axis. SWV may be useful in evaluating the severity of degenerative disease of arch-supporting structures, but further study is needed before this technique can be applied clinically. Level III, case-control study.

Machine learning-based discrimination of benign and malignant breast lesions on US: The contribution of shear-wave elastography

PurposeTo build and validate a combined radiomics and machine learning (ML) approach using B-mode US and SWE images to differentiate benign from malignant solid breast lesions (BLs) and compare its performance with that of an expert radiologist. MethodsPatients with at least one BI-RADS 2–6 BL who performed breast US integrated with SWE were retrospectively included. B-mode US and SWE images were manually segmented to extract radiomics features. A multi-step feature selection process was performed and a predictive model built using the Logistic Regression algorithm. The diagnostic accuracy was evaluated with the AUC and Matthews Correlation Coefficient (MCC) metrics. The performance of the ML classifier was compared to that of an expert radiologist. Results427 Bls were included and divided into a training (286 BLs, of which 127 benign and 159 malignant) and a test set (141 BLs, of which 59 benign and 82 malignant). Of 1098 features extracted from B-mode US and SWE images, 13 were finally selected. The ML classifier showed an AUC of 0.768 and 0.746, and an MCC of 0.403 and 0.423 in the training and test sets, respectively. The performance was higher than that of the expert radiologist assessing only B-mode US images, but significantly lower when SWE images were also provided. ConclusionA ML approach based on B-mode US and SWE images may represent a potential tool in the characterization of BLs. SWE still gives its most relevant contribution in the clinical setting rather than included in a radiomics pipeline.

Effect of maneuvers, diuresis, and fluid administration on ultrasound-measured liver stiffness after Fontan.

To determine the effect of stress maneuvers/interventions on ultrasound liver stiffness measurements (LSMs) in patients with Fontan circulation and healthy controls. In this prospective, IRB-approved study of 10 patients after Fontan palliation and 10 healthy controls, ultrasound 2D shear-wave elastography LSMs were acquired at baseline and after maximum inspiration, expiration, standing, handgrip, aerobic exercise, i.v. fluid (500mL normal saline) administration, and i.v. furosemide (20mg) administration. Absolute and percent change in LSM were compared between baseline and each maneuver, and then from fluid infusion to after diuresis. Median ages were 25.5 and 26 years in the post-Fontan and control groups (p = 0.796). LSMs after Fontan were higher at baseline (2.6 vs. 1.3m/s) and with all maneuvers compared to controls (all p < 0.001). Changes in LSM with maneuvers, exercise, fluid, or diuresis were not significant when compared to baseline in post-Fontan patients. LSM in controls increased with inspiration (+0.02m/s, 1.6%, p = 0.03), standing (+0.07m/s, 5.5%, p = 0.03), and fluid administration (+0.10m/s, 7.8%, p = 0.002), and decreased 60 minutes after diuretic administration (-0.05m/s, -3.9%, p = 0.01) compared to baseline. LSM after diuretic administration significantly decreased when compared to after i.v. fluid administration at 30 minutes (-0.79m/s, -26.5%, p = 0.004) and 60 minutes (-0.78m/s, -26.2%, p = 0.017) for patients after Fontan and controls at 15 minutes (-0.12m/s, -8.70%, p = 0.002), 30 minutes (-0.15m/s, -10.9%, p = 0.003), and 60 minutes (-0.1m/s, -10.9%, p = 0.005). LSM after Fontan is higher with more variability compared to controls. Diuresis is associated with significantly decreased liver stiffness in both patients after Fontan and controls, with the suggestion of a greater effect in Fontan patients.

A Systematic Temporal Analysis of the Morphology of Tendon Healing at the Tendon-Bone Interface Post Rotator Cuff Repair as assessed by shearwave elastography ultrasound.

A Systematic Temporal Analysis of the Morphology of Tendon Healing at the Tendon-Bone Interface Post Rotator Cuff Repair as assessed by shearwave elastography ultrasound.

Do elastography values correlate with molecular subtype of breast cancer or is morphology the key player?

Objectives We evaluated the association between shear wave elastography (SWE) parameters and the molecular subtypes and other prognostic factors of breast cancer. We also examined the influence of morphological characteristics and other prognostic factors of breast cancers on elastography values. Materials and Methods This is a retrospective observational study on 148 patients with biopsy-proven 152 breast cancers who underwent both B-mode ultrasonography and SWE. The analysis involved calculating the correlation between the five quantitative parameters on SWE (mean, minimum, maximum, standard deviation, and ratio) and the molecular subtyping and other prognostic factors of breast cancer. We analyzed the influence of morphology and other prognostic factors on SWE parameters. Results The mean, minimum, and maximum values in SWE were significantly lower (P&lt;0.05) in cases where the lesion displayed non-mass abnormality, circumscribed margins, posterior acoustic enhancement, and non-ductal histopathology. Hormone positive tumors frequently exhibited spiculated margins and higher (P &lt; 0.05) elastography values, although within this category, circumscribed masses demonstrated lower elastography values compared to the remaining cases. Triple negative breast cancers often displayed circumscribed margins and lower (P &lt; 0.05) elastography values; however, among this subgroup, masses with spiculated margins exhibited higher values compared to the rest. Conclusion Our findings indicate that elastography independently do not correlate with molecular subtypes in breast cancer. Morphological features and histopathological subtypes appear to have strong influence on elastography values.

Reliability of ultrasound shear-wave elastography in assessing tensor fascia latae, gluteus medius, and iliotibial band elasticity in health individuals

Purpose: Gluteus medius (GMed), tensor fascia latae (TFL), and iliotibial band (ITB) play important roles in stabilizing the hip joint and are often prone to overuse syndromes such as greater trochanteric pain syndrome and runner’s knee. Shear-wave elastography (SWE) presents a new avenue for rapidly assessing these structures in an out-patient setting. This study aims to assess the intra- and interobserver reliability of sWE in evaluating the GMed, TFL, and ITB. Materials and Methods: Twelve healthy volunteers (6 men and 6 women) were examined by two physiatrists using SWE. To assess inter-observer reliability, both physiatrists measured the thickness, velocity, and stiffness of GMed, TFL, and proximal and distal ITB. One physiatrist repeated the same measurements under identical conditions one week later to assess intra-observer reliability. Intra-class correlation coefficients (ICC) were calculated to evaluate reliability. Results: Inter-observer measurements showed poor reliability (ICC &lt; 0.4) for all parameters, except for GMed thickness (ICC=0.412), which was moderately reliable. Intra-observer measurements showed varying degrees of reliability, with TFL thickness (ICC=0.733), ITBP thickness (ICC=0.592), ITBD velocity (ICC=0.634), and ITBD stiffness (ICC=0.701) demonstrating moderate reliability. However, no excellent ICC scores were observed across both intra- and inter-observer assessments. Conclusion: While SWE demonstrates promise in assessing hip stabilizers, its inconsistent reliability across different parameters highlights the need for further research. Comparative studies involving healthy and pathological groups are needed for better understanding of SWE’s applicability in clinical settings.

Shear Wave Elastography in Evaluating the Efficacy of Liver Microwave Ablation: An Experimental Study

Background: The effect of microwave ablation on small hepatocellular carcinoma is not significantly different from that of surgical resection. Accurate assessment of the ablation effect is crucial for ensuring the safety and effectiveness of hyperthermia. Objectives: This study aimed to explore the feasibility and accuracy of supersonic shear wave elastography (SWE) in quantitatively evaluating the microwave ablation margin of the liver. Materials and Methods: Three surgeons were each randomly assigned 4 Wuzhishan miniature pigs (WZSPs) to perform 12 ablation procedures at an ablation power of 40 W. Based on the ablation time, the lesions were divided into 15, 30, and 60-second groups. Immediately after ablation, SWE and modulus measurements were performed 5 times for each ablation lesion. The SWE data were expressed as mean ± standard deviation. Within-group and between-group comparisons were made using repeated measures analysis of variance. Results: A total of 144 effective ablations and 131 effective pathological results were obtained. Within the same ablation time, the elastic modulus increased in the surrounding normal tissue, ablation margin, and ablation center regions in a stepwise manner (P &lt; 0.01). However, in the ablation center region, the elastic modulus decreased in a stepwise manner with the shortening of ablation time [60 s (97.16 ± 14.58 kPa) &gt; 30 s (77.84 ± 9.64 kPa) &gt; 15 s (38.92 ± 3.12 kPa)], with statistically significant differences (F = 2,131.832, P &lt; 0.01). The elastic modulus of the ablation margin region at different ablation times remained between 22.68 - 23.56 kPa. Conclusion: The elastic modulus range in the ablation margin region after microwave ablation is relatively fixed. Shear wave elastography aids in the quantitative evaluation of the ablation margin region of the liver and has high practical value in monitoring and evaluating ultrasound ablation.

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.

Study on the correlation between shear wave elastography and MRI grading of meniscal degeneration

BackgroundShear Wave Elastography (SWE) offers quantitative insights into the hardness and elasticity characteristics of tissues. The objective of this study is to investigate the correlation between SWE of the menisci and MRI-assessed degenerative changes in the menisci, with the aim of providing novel reference source for improving non-invasive evaluation of meniscal degenerative alterations.MethodsThe participants in this study were selected from patients who underwent knee joint MRI scans at our hospital from February 2023 to February 2024. The anterior horns of both the medial and lateral menisci were evaluated using SWE technique. The differences in elastic values of meniscus among different MRI grades were compared. The correlation between elastic values and MRI grades, as well as various parameters, was analyzed. Using MRI Grade 3 as the gold standard, the optimal cutoff value for meniscal tear was determined. The intraclass correlation coefficient (ICC) was employed to evaluate the reliability of repeated measurements performed by the same observer.ResultsA total of 104 female participants were enrolled in this study, with 152 lateral menisci (LM) and 144 medial menisci (MM) assessed. For the male group, 83 individuals were included, with 147 LM and 145 MM evaluated. The results demonstrated statistically significant differences in the elasticity values of the menisci at the same anatomical sites across different MRI grades (P < 0.001). Within the same grade, the MM had higher elasticity values than the LM, showing a statistically significant difference (P < 0.001). The elasticity values of the menisci were higher in males compared to females. There were statistically significant positive correlations between the elasticity values of the menisci and age, BMI, and MRI grade. The ICC for repeated measurements within the observer demonstrated good reliability (> 0.79).ConclusionsThe meniscal elasticity values measured by SWE exhibit a significant positive correlation with the grades of degeneration assessed by MRI. Furthermore, the elasticity values of the meniscus are found to increase with advancing age and elevated BMI.

Shear wave elastography as a diagnostic tool in biliary atresia and liver fibrosis

BackgroundThe study aims to investigate Shear Wave Elastography's accuracy in assessing pediatric cholestasis and differentiating biliary atresia from other causes. The early diagnosis of cholestasis in newborns, when caused by true liver disease and not physiological or transient jaundice is usually eluded. To maximize the diagnostic reliability of ultrasound as an initial imaging modality to diagnose biliary atresia, ultrasound elastography has been introduced as a quantitative non-invasive sonographic technique to measure liver stiffness which is presumed to be different in biliary atresia from other cholestasis as well as follow-up liver stiffness post-Kasai operation.ResultsTen patients (34.48%) were diagnosed with cholestasis with normal/low GGT. Five patients (17.24%) were diagnosed with hepatitis, and 2 patients had syndromes (10.34%). Other causes were found in 11 patients (37.93%). Major bile duct obstruction with fibrosis/cirrhosis was the majority of findings found in biliary atresia patients (100%), most of them with mild fibrosis (40%), followed by moderate (36.67%), then marked fibrosis (13.33%) and secondary cirrhosis (10%). ROC curve analysis shows that the best cut-off value for SWE = 1.97 with a sensitivity of 75.0% and specificity of 83.5%, with positive and negative predictive values were 82.8% and 74.1%, respectively. Mean shear wave elastography was significantly higher among the biliary atresia group (median 2.86) than in non-biliary atresia (median 1.81) and control groups (median 1.64) (P < 0.001) The best cut-off value of shear wear elastography for predicting outcome in pediatric patients post-Kasai procedure was 3.55, with a sensitivity of 66.7%, specificity of 64.7%, positive and negative predictive values were 25% and 91.7% respectively, with accuracy 65%.ConclusionThe results of this study suggest that shear-wave elastography is a useful diagnostic tool for differentiating biliary atresia from other causes of cholestasis in pediatric patients, with a high sensitivity and specificity. Further studies are needed to validate the findings and determine the optimal cut-off value for shear wear elastography in clinical practice.