Shear Wave Elastography Research Articles

Diagnosis and management of Canine Renal Cell Carcinoma with special reference to Shear Wave Elastography

This report focuses on the diagnosis and surgical management of unilateral renal cell carcinoma in a 7-year-old male intact German Shepherd dog. The dog was presented with fever, haematuria, inappetence, infrequent bouts of emesis, and progressive weight loss. Palpation revealed a hard, round mass in the right cranial abdomen. A presumptive diagnosis of unilateral renal neoplasm was made based on clinical signs, haematobiochemical analysis, and radiography. B-mode ultrasound examination demonstrated an enlarged right kidney extending up to the ventral midline. The kidney exhibited heterogenous echotexture, loss of renal architecture, and only a small healthy portion at the caudal pole. Point Shear Wave Elastography analysis revealed elevated values both in terms Shear Wave Velocity (m/sec) and Young’s Modulus Stiffness Value (kPa), indicating the presence of renal malignancy. To treat the condition, unilateral nephroureterectomy was performed under general anaesthesia. Histopathological examination confirmed the diagnosis of renal cell carcinoma. Consequently, it can be concluded that B-mode ultrasonography, Point Shear Wave Elastography, and nephroureterectomy played crucial roles in the successful diagnosis and surgical management of unilateral renal cell carcinoma.

Changes in hamstrings’ active stiffness during fatigue tasks are modulated by contraction duration rather than intensity

Despite the increase in research of hamstring stiffness through the use of ultrasound-based shear wave elastography, the active stiffness of biceps femoris long head (BFlh) and semitendinosus (ST) muscles under fatigue conditions at various contraction intensities has not been sufficiently explored. This study aimed to compare the effects of knee flexor’s isometric contraction until exhaustion performed at 20% vs. 40% of maximal voluntary isometric contraction (MVIC), on the active stiffness responses of BFlh and ST. Eighteen recreationally active males performed two experimental sessions. The knee flexors’ MVIC was assessed before the fatiguing task, which involved a submaximal isometric contraction until failure at 20% or 40% of MVIC. Active muscle stiffness of the BFlh and ST was assessed using shear wave elastography. BFlh active stiffness remained relatively unaltered at 20% of MVIC, while ST active stiffness decreased from ≅ 91% contraction time (55.79 to 44.52 kPa; p < 0.001). No intramuscular stiffness changes were noted in BFlh (36.02 to 41.36 kPa; p > 0.05) or ST (63.62 to 53.54 kPa; p > 0.05) at 40% of MVIC session. Intermuscular active stiffness at 20% of MVIC differed until 64% contraction time (p < 0.05) whereas, at 40% of MVIC, differences were observed until 33% contraction time (p < 0.05). BFlh/ST ratios were not different between intensities (20%=0.75 ± 0.24 ratio vs. 40%=0.72 ± 0.32 ratio; p > 0.05), but a steeper increase in BFlh/ST ratio was found for 20% (0.004 ± 0.003 ratio/%) compared to 40% (0.001 ± 0.003 ratio/%) of MVIC (p = 0.003). These results suggest that contraction duration could play a major role in inducing changes in hamstrings’ mechanical properties during fatigue tasks compared to contraction intensity.

Hepatocellular Cancer Surveillance in Patients with Advanced Chronic Liver Disease

BackgroundPatients with advanced chronic liver disease (ACLD) are at high risk of developing hepatocellular carcinoma (HCC). Therefore, biannual surveillance is recommended. This large-scale multicenter study aimed to stratify the risk of HCC development in ACLD.MethodsFrom 3016 patients with ACLD screened in 17 European and Chinese centers, 2340 patients with liver stiffness measurement (LSM) determined using different techniques (two-dimensional shear-wave elastography [2D-SWE], transient elastography, and point shear-wave elastography) and with different disease severities were included. Cox regression was used to explore risk factors for HCC. We used these data to create an algorithm, named PLEASE, but referred to in this manuscript as “the algorithm”; the algorithm was validated in internal and two external cohorts across elastography techniques.ResultsHCC developed in 127 (5.4%) patients during follow-up. LSM by 2D-SWE (hazard ratio: 2.28) was found to be associated with developing HCC, alongside age, sex, etiology, and platelet count (C-index: 0.8428). We thus established the algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×109/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Within 2 years, with a median follow-up of 13.7 months, patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%).ConclusionsOur algorithm stratified patients into two groups: those at higher risk of developing HCC and those at lower risk. Our data provide equipoise to test the prospective utility of the algorithm with respect to clinical decisions about screening patients with ACLD for incident HCC. (Funded by the German Research Foundation and others; ClinicalTrials.gov number, NCT03389152.)

Non-Invasive Ultrasound Diagnostic Techniques for Steatotic Liver Disease and Focal Liver Lesions: 2D, Colour Doppler, 3D, Two-Dimensional Shear Wave Elastography (2D-SWE), and Ultrasound-Guided Attenuation Parameter (UGAP).

We conducted a comprehensive literature review to evaluate the efficacy of combining two-dimensional shear wave elastography (2D-SWE) and ultrasound-guided attenuation parameter (UGAP) in assessing the risk of progressive metabolic dysfunction-associated steatohepatitis (MASH). This narrative review explores the applications of liver ultrasound in diagnosing metabolic liver diseases, focusing on recent advancements in diagnostic techniques for steatotic liver disease (SLD). Liver ultrasound can detect a spectrum of SLD manifestations, from metabolic dysfunction-associated liver disease (MASLD) to fibrosis and cirrhosis. It is also possible to identify inflammation, hepatitis, hepatocellular carcinoma (HCC), and various other liver lesions. Innovative ultrasound applications, including elastography and UGAP, can significantly enhance the diagnostic capabilities of ultrasound in accurately interpreting liver diseases. Understanding the pathogenesis of liver diseases requires a thorough analysis of their etiology and progression in order to develop sound diagnostic and therapeutic approaches. Chronic liver diseases (CLD) vary in origin, with MASLD affecting approximately 20-25% of the general population. The insidious progression of CLD from inflammation to fibrosis and cirrhosis underscores the need for effective early detection methods. This review aims to highlight the evolving role of non-invasive ultrasound-based diagnostic tests in the early detection and staging of liver diseases. By synthesizing current evidence, we aim to provide an updated perspective on the utility of advanced ultrasound techniques in redefining the diagnostic landscape for metabolic liver diseases.

The Role of Shear Wave Elastography in Differentiation Between Tumoral and Bland Portal Vein Thrombosis

The Role of Shear Wave Elastography in Differentiation Between Tumoral and Bland Portal Vein Thrombosis

Comparison of Shear-Wave Elastography USG and CT: Composition Analysis of Rectus Femoris Muscle in Healthy Adults and Chronic Kidney Disease Patients.

This study aimed to compare shear-wave elastography (SWE) USG and composition analysis of CT on the right mid-rectus femoris muscle (RF) in both healthy adults and chronic kidney disease (CKD) patients. Sixty-three healthy adults and 22 CKD patients were included. One musculoskeletal radiologist performed right RF SWE USG, while two radiologists measured shear-wave velocity (SWV) from the same SWE images. CT scan was performed, and muscle composition was measured using imageJ, categorized into four HU-based compositions. Interobserver agreement for SWV between two readers was evaluated. Correlations between SWV and CT compositions were analyzed using Pearson's or Spearman's correlation. SWV of healthy group was significantly higher than CKD group by each reader (p = 0.030 and 0.038). The percentage of low-density muscle was higher in CKD group than healthy group (p < 0.001), and the percentage of normal density muscle was higher in healthy group than CKD (p < 0.001) by each reader. Interobserver agreement of SWV by the two readers was almost perfect in both groups (k = 0.957-0.984, 0.959-0.993). There was a statistically significant correlation between SWV and the percentage of normal density muscle on CT in both healthy adults and CKD patient groups (Reader 1, r = 0.318-0.480, p = 0.001 and 0.024; Reader 2, r = 0.511-0.518, p < 0.001 and p = 0.013). SWV demonstrated a significant correlation with the percentage of normal density muscle on CT in both healthy adults and CKD patients by each reader. SWE provides a radiation-free approach that may offer an objective method for evaluating muscle quality, potentially making it an option for muscle monitoring.

COMPARISON DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY ELASTOGRAPHY FOR DETECTING LIVER FIBROSIS COMPARED TO LIVER BIOPSY: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS STUDIES

Background: Liver fibrosis significantly impacts disease outcomes in chronic liver disease. While liver biopsy has long been the gold standard for assessing and staging fibrosis, non-invasive ultrasound-based methods are emerging as valuable alternatives. The aim of this study is to systematically review and conduct a meta-analysis to compare the diagnostic accuracy of ultrasound elastography with liver biopsy for detecting liver fibrosis based on literatures in the last 10 years. Method: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines using the PICO framework. Rigorous screening, data extraction, risk of bias assessment, and statistical analysis were performed to investigate diagnostic accuracy of ultrasonography elastography for detecting liver fibrosis compared to liver biopsy. Results: A total of 32 articles were retrieved from online databases (PubMed, SagePub, Nature and Cochrane). After three rounds of screening, seven articles directly relevant to the meta-analysis were selected for full-text reading and analysis. Conclusion: Liver fibrosis significantly impacts disease outcomes in chronic liver disease. While liver biopsy has long been the gold standard for assessing and staging fibrosis, non-invasive ultrasound-based methods like shear wave elastography are emerging as valuable alternatives.

The Role of Endoscopic Ultrasound-Guided Shear Wave Elastography in Pancreatic Diseases.

Elastography is a non-invasive imaging modality that has been developed for the evaluation of the stiffness of various organs. It is categorized into two main types: strain elastography and shear wave elastography. While strain elastography offers valuable information on the mechanical properties of the organ being studied, it is limited by the qualitative nature of its measurements and its reliance on operator skills. On the other hand, shear wave elastography overcomes these limitations as it provides a quantitative assessment of tissue stiffness, offers more reproducibility, and is less operator-dependent. Endoscopic ultrasound-guided shear wave elastography (EUS-SWE) is an emerging technique that overcomes the limitations of transabdominal ultrasound in the evaluation of the pancreas. A growing body of literature has demonstrated its safety and feasibility in the evaluation of pancreatic parenchyma. This article provides a comprehensive review of the current state of the literature on EUS-SWE, including its technical aspects, clinical applications in the evaluation of various pancreatic conditions, technological limitations, and future directions.

Advancements and challenges in Shear-Wave Elastography of tendons: a comprehensive review.

Shear-Wave Elastography (SWE) has emerged as a promising non-invasive imaging technique for assessing the mechanical properties of tendons, particularly larger and more superficially located tendons of the body. Despite its potential, significant variability in SWE measurements exists due to differences in protocols, positioning, and equipment. Standardizing these factors, enhancing operator training, and reporting reliability metrics are crucial to improve the consistency and comparability of SWE data. This review aims to synthesize current knowledge and report on the existing practices in tendon SWE. By addressing the current challenges and variability, SWE has the potential to become a reliable tool for diagnosing and monitoring tendon pathologies, ultimately enhancing patient care and outcomes.

A convolutional attention model for predicting response to chemo-immunotherapy from ultrasound elastography in mouse tumor models

BackgroundIn the era of personalized cancer treatment, understanding the intrinsic heterogeneity of tumors is crucial. Despite some patients responding favorably to a particular treatment, others may not benefit, leading to the varied efficacy observed in standard therapies. This study focuses on the prediction of tumor response to chemo-immunotherapy, exploring the potential of tumor mechanics and medical imaging as predictive biomarkers. We have extensively studied “desmoplastic” tumors, characterized by a dense and very stiff stroma, which presents a substantial challenge for treatment. The increased stiffness of such tumors can be restored through pharmacological intervention with mechanotherapeutics.MethodsWe developed a deep learning methodology based on shear wave elastography (SWE) images, which involved a convolutional neural network (CNN) model enhanced with attention modules. The model was developed and evaluated as a predictive biomarker in the setting of detecting responsive, stable, and non-responsive tumors to chemotherapy, immunotherapy, or the combination, following mechanotherapeutics administration. A dataset of 1365 SWE images was obtained from 630 tumors from our previous experiments and used to train and successfully evaluate our methodology. SWE in combination with deep learning models, has demonstrated promising results in disease diagnosis and tumor classification but their potential for predicting tumor response prior to therapy is not yet fully realized.ResultsWe present strong evidence that integrating SWE-derived biomarkers with automatic tumor segmentation algorithms enables accurate tumor detection and prediction of therapeutic outcomes.ConclusionsThis approach can enhance personalized cancer treatment by providing non-invasive, reliable predictions of therapeutic outcomes.

Editorial: Pushing the physical limits of wave propagation in soft tissues: an add-on to shear wave elastography

Editorial: Pushing the physical limits of wave propagation in soft tissues: an add-on to shear wave elastography

An Assessment of the Impact of Smoking and Vaping During Pregnancy on Placental Dysfunction Using Shear-Wave Elastography

An Assessment of the Impact of Smoking and Vaping During Pregnancy on Placental Dysfunction Using Shear-Wave Elastography

Comparison of Two-Dimensional Shear Wave Elastography Between Two Different Instruments for Hepatocellular Carcinoma Patients.

This study aimed to investigate and compare 2-dimensional shear wave elastography (2D-SWE) measurements and influencing factors among 2 different devices and to evaluate the ability and influencing factors of these measurements to assess liver fibrosis. From October 2022 to September 2023, 290 hepatocellular carcinoma (HCC) patients and 30 healthy volunteers were prospectively included. The 2D-SWE measurements were performed using AixPlorer V (SEmean) and APLIO i900 (CEmean). This study compared 2D-SWE measurements between instruments for evaluating the liver fibrosis stage and analyzed the potential influencing factors. The 2D-SWE measurements obtained by the 2 instruments were significantly different (P < .001), but the differences were significant only for patients with stage F4 liver fibrosis (P < .001) and not for volunteers or patients with stage F0-F3 liver fibrosis (all P > .050). Multivariate linear regression analysis revealed that the factors independently influencing the SEmean were alanine aminotransferase (ALT) (P = .034) and liver fibrosis stage (P < .001), while fibrosis stage (P = .028) was the only factor influencing the CEmean. Although 2D-SWE from the 2 different instruments was capable of detecting liver fibrosis, it yielded varying results in HCC patients. These discrepancies were predominantly observed in patients with F4 liver fibrosis but not in healthy adults or patients with F0-F3 liver fibrosis. One potential contributing factor to the differences between instruments could be ALT levels.

Shear wave elastography to evaluate the effect of serum uric acid levels on carotid artery elasticity in patients with high-normal blood pressure

Background: Populations with normal high blood pressure often already have elevated blood uric acid levels and a higher chance of developing atherosclerosis, which accelerates the process of cardiovascular disease. The risk of atherosclerosis increases with thickening of the carotid artery intima-media, and changes in carotid artery elasticity precede intima-media changes, so early monitoring of carotid artery elasticity is of great significance in the prevention of cardiovascular disease. Using shear wave elastography (SWE) to evaluate the effect of serum uric acid (SUA) levels on carotid artery elasticity in patients with high-normal blood pressure (BP). Methods: One hundred and fifteen patients with high-normal BP were selected, and then divided into tertiles according to the SUA levels. The left carotid intima-media thickness (IMT), peak systolic velocity (PSV) and diameter of common carotid artery were measured by two-dimensional ultrasound and Doppler flow imaging. Longitudinal elasticity of the left anterior carotid wall was measured by SWE, including the mean values of the minimum elastic modulus (MEmin), maximum elastic modulus (MEmax) and mean elastic modulus (MEmean). Results: IMT, MEmean, MEmin and MEmax were obviously higher in the 3rd tertile (all P &lt; 0.05), while there were no obviously different between the 1st tertile and 2nd tertile. Pearson correlation analysis showed positive correlations between SUA and SWE-related parameters, while there was no correlation with IMT. Multiple linear regression analysis found that age, systolic BP, and SUA levels were independently associated with SWE-related parameters. Conclusion: SWE will be more helpful than IMT in monitoring the effect of blood uric acid levels on carotid artery elasticity in patients with high-normal BP.

Value of image enhancement of endoscopic ultrasound for diagnosis of gastrointestinal subepithelial lesions.

Among subepithelial lesions (SELs), gastrointestinal stromal tumors (GISTs) should be identified and surgically treated at an early stage. However, it is difficult to diagnose SELs smaller than 20 mm. In recent years, endoscopic ultrasound (EUS) elastography (EUS-EG) and contrast-enhanced harmonic EUS (CH-EUS) have been reported to be useful for the diagnosis of SELs, although the diagnostic accuracy of a combination of EUS techniques with image enhancement is unknown. Patients with SELs who underwent EUS-guided tissue acquisition, EUS shear-wave elastography (EUS-SWE), EUS strain elastography (EUS-SE), and CH-EUS from January 2019 to June 2023 were enrolled. To assess the diagnostic accuracy for differentiating GISTs from other SELs, shear-wave velocity on EUS-SWE, the strain ratio on EUS-SE, and vascularity on CH-EUS were determined and their diagnostic accuracies were compared. Forty-three patients were enrolled. When the cut-off value was set at 3.27 m/s, the sensitivity, specificity, and diagnostic accuracy of shear-wave velocity were 28.6%, 86.2%, and 34.9%, respectively. When the cut-off value was set at 3.79, the sensitivity, specificity, and diagnostic accuracy of the strain ratio were 93.1%, 64.3%, and 83.7%, respectively. The sensitivity, specificity, and diagnostic accuracy of CH-EUS were 79.3%, 92.3%, and 83.7%, respectively. When EUS-SE was combined with CH-EUS, the sensitivity and diagnostic accuracy were the highest among binary combinations of image enhancement modalities. EUS-SE and CH-EUS are useful for differentiating GISTs from other SELs. Furthermore, the use of both modalities may further improve the identification of GISTs.

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.

The effect of tongue-to-palate on deep neck flexor activity

Deep neck flexor (DNF) muscles contribute to cervical stability and proprioception. Reduced muscle strength and endurance lead to faulty movement patterns, muscle imbalances, and dysfunction. Potentially, the orofacial muscles contribute to cervical strength by providing stability through muscular connections. This study examined effects of tongue muscle activity on cervical spine muscular stiffness. Twenty-three healthy subjects assumed three supine positions [at rest (AR), chin tuck (CT), and head lift (HL)] with and without tongue-to-palate pressure. The DNF stiffness was measured using shear wave elastography. Without tongue-to-palate, stiffness increased with CT and HL compared to AR (p <0.001) but not between CT and HL (p = 0.22). Tongue-to-palate increased stiffness AR (p <0.001) but not during CT (p = 0.95) or HL (p = 0.67). Stiffness levels between the AR and HL conditions during tongue-to-palate performance did not differ (p = 0.734), but CT stiffness was significantly greater than AR (p = 0.029) with tongue-to-palate. Tongue-to-palate AR increases DNF stiffness to a similar level as HL with or without tongue-to-palate, while CT with or without tongue-to-palate resulted in the highest stiffness levels. Tongue-to-palate pressure AR or with CT performance may be alternatives to HL strengthening in healthy necks. This may be a useful strategy to increase cervical stability during loads on the cervical spine.

Quantification of Radiation-Induced Fibrosis in Head and Neck Cancer Patients Using Shear Wave Elastography

Quantification of Radiation-Induced Fibrosis in Head and Neck Cancer Patients Using Shear Wave Elastography

Neck muscle stiffness during craniocervical flexion under functional upper extremity conditions in patients with chronic non-specific neck pain: A shear-wave elastography study

ObjectiveThe primary objective of the present study was to examine the differences and patterns of change in the neck extensor (NE) muscle stiffness during the Cranio-cervical flexion (CCF) task under different functional conditions of the upper extremity between CNSNP participants and asymptomatic controls. MethodsIn the current case-control study, 25 participants with CNSNP and 25 asymptomatic controls were recruited. The stiffness of the superficial (i.e., upper trapezius, splenius capitis, and semispinalis capitis) and deep (i.e., semispinalis cervicis and multifidus) NE muscles was measured at prone resting, sitting resting, and during the CCF task in different functional conditions of upper extremity using shear wave elastography. ResultsThe findings showed that there was a significant main effect of condition in all NE muscles (P < 0.05), as well as a significant main effect of the group on the stiffness of superficial neck muscles (P < 0.05), indicating higher muscle stiffness in participants with CNSNP compared to the control group. There was no significant group-by-condition interaction effect on the stiffness of NE muscles (P > 0.05), except for the upper trapezius muscle (P = 0.00), indicating a different pattern of stiffness changes compared to the other muscles. ConclusionsIndividuals with CNSNP exhibited significantly greater stiffness in the superficial neck extensor muscles compared to healthy controls. Furthermore, the CCF task performed under functional upper extremity conditions, which includes bilateral shoulder scaption and shoulder abduction-external rotation while seated, resulted in increased stiffness of the NE muscles. Additionally, participants with CNSNP exhibited a higher magnitude of stiffness changes in the upper trapezius muscle across different conditions.