Specificity Of Shear Wave Elastography Research Articles

Diagnostic Performance of Shear-Wave Elastography in Autoimmune Hepatitis: Evaluating Baseline Characteristics and Accuracy Across Fibrosis Stages.

Background Autoimmune hepatitis (AIH) is a chronic inflammatory condition affecting the liver, ultimately leading to fibrosis, followed by cirrhosis and liver failure. Although liver biopsy is necessary to confirm the disease and outline different stages of liver fibrosis, it is associated with several risks due to its invasiveness. Shear-wave elastography (SWE) has recently emerged as a non-invasive imaging modality, representing liver stiffness and providing additional fibrosis assessment. This study aims to validate SWE for diagnosing and discriminating liver fibrosis stage in AIH patients. Methodology This retrospective cohort study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, with the enrollment of 162 patients diagnosed with AIH between March 2022 and December 2023. All participants underwent SWE and liver biopsy. The stages of fibrosis were assessed using the Metavir scoring system. Demographic, biochemical, and serological data were analyzed, including autoantibody and serum IgG levels. Diagnostic accuracy, sensitivity, and specificity of SWE were compared with histopathological findings. Results Of the 162 patients, 71 (43.8%) were males, and 91 (56.2%) were females, with a mean age of 35.8 ± 16.6 years. SWE had an overall diagnostic accuracy of 92.11%, sensitivity of 82.86%, and specificity of 98.7% in predicting fibrosis stages. SWE was effective in differentiating early fibrosis (F1-F2), while it showed reduced sensitivity for advanced fibrosis (F3-F4). Female gender (p = 0.009), elevated bilirubin (p = 0.009), autoantibody titers, and serum IgG levels (p = 0.043) were significant factors related to advanced fibrosis. Conclusions SWE has shown high diagnostic accuracy and specificity for the estimation of liver fibrosis in AIH, especially in the early stages. Sensitivity is lowered in advanced fibrosis. SWE is a very valuable non-invasive alternative to liver biopsy. Its use may decrease procedural risks, accelerate diagnosis, and improve outcomes in AIH. Further multicenter studies are recommended for confirmation and to explore the comparative performance of SWE against other non-invasive approaches.

The Value of Elastography in the Detection of Prostate Cancer – Clinical Experience

The aim of this study was to evaluate the efficacy of real-time shear wave elastography (SWE) in prostate cancer diagnosis in patients with elevated prostate-specific antigen values and abnormal results on digital rectal examination. This study included 74 patients (mean age 68.3 years) with suspected prostate cancer – prostate-specific antigen>4 ng/mL and abnormal digital rectal examination. All patients scheduled for transrectal ultrasound biopsy of the prostate underwent standard transrectal ultrasonography and SWE. The reported sensitivity and specificity of SWE in the various studies varied widely, from 43–96% and 33–96%, respectively. This study showed that patients with elevated levels of prostate-specific antigen, abnormal digital rectal examination, and negative SWE may not require a biopsy which could significantly reduce the number of biopsies performed.

Differentiating benign and malignant thyroid nodules: A cross-sectional study on the comparison of diagnostic value of ultrasound elastography and fine needle aspiration biopsy.

This study examines the comparison of ultrasound elastography and fine needle aspiration (FNA) in diagnosing thyroid cancers and investigates the use of elastography as the initial diagnostic test of thyroid cancers to avoid the need for invasive diagnostic tests. In this study, 28 patients with 48 thyroid nodules (TNs) who were candidates for FNA or surgery were examined within a period of 18 months. Cut-off and subsequently sensitivity and specificity for elastography results, compared to pathology results as the gold standard, were calculated using the receiver operating characteristic curve (ROC). Based on ROC, the cut-off point differentiating the tissue stiffness between benign and malignant TNs was 25.400 kilopascal (kPa) (sensitivity of 90.9% and specificity of 78.4%). It was observed that age affects the tissue stiffness; therefore, the cut-off was defined as 65.625 kpa for age groups under 50 years old (sensitivity of 100% and specificity of 100%) and 25.400 kpa for the age group above 50 years old (sensitivity of 88.9% and specificity of 70.4%). Based on the high sensitivity and specificity of shear wave elastography in the differentiation of benign and malignant TNs, it can be employed as a stand-alone or in combination with other diagnostic techniques to reduce the need for inessential surgical operations. However, future studies or developments are needed on this promising diagnostic technique.

Diagnostic accuracy of cervical elastography for predicting preterm delivery: Systematic review and meta-analysis.

Cervical elastography has been used in pregnant women to diagnose preterm births. However, there is a variability in the measured elasticity parameters and imaging mode used. We evaluated the precision of cervical elastography in identifying preterm births. Extensive and methodical searches were made in the databases such as Scopus, Embase, Cochrane Library, PubMed Central, Medline, ScienceDirect, and Google Scholar from the inception until November 2022, for studies that report diagnostic accuracy of cervical elastography for preterm deliveries in antenatal women. The pooled sensitivity and specificity value of cervical elastography for preterm deliveries were 82% (95%CI: 73%-89%) and 77% (95%CI: 64%-86%), respectively with area under curve (AUC) of 0.87 (95%CI: 0.72-0.95). The diagnostic odds ratio (DOR) was 15 (95%CI: 8-28), positive likelihood ratio (LRP) was 3.5 (95%CI: 2.3-5.5) and negative likelihood ratio LRN was 0.23 (0.16-0.34). Pooled sensitivity and specificity of shear wave elastography was 88% and 71%, respectively. Pooled sensitivity and specificity of strain elastography was 80% and 79%, respectively. Heterogeneity was significant, as indicated by chi-square test and an I2 statistic of over 75. Cervical elastography can be used for predicting preterm deliveries with moderate to high level of accuracy.

Evaluation of the Clinical Effectiveness of Shear Wave Elastography in Pediatric Cases With Acute Appendicitis.

To determine sensitivity and specificity of shear wave elastography in pediatric patients diagnosed with acute inflammation of the appendix. Forty-eight patients who were referred for abdominal pain, with 18 volunteers recruited for the evaluation. Alvarado scores were calculated on the patients. The elasticity and stiffness of the inflamed appendix tissues of patients and controls were measured using shear wave elastography. The anterior, posterior, and medial parts of the appendix tissue were measured, calculating the highest elasticity values in kPa. In the end, 32 patients with Alvarado scores between 7 and 9 (group 1) underwent surgery, whereas 3 of them had pathological specimens reporting as normal. Eight of the patients whose Alvarado scores were between 4 and 6 and had inflammatory conditions of the appendix (group 2), plus the control group totaled 16 patients (group 3). The median shear wave value was found to be significantly higher in group 1 (14.7 kPa) than in either group 2 (12.7 kPa) or group 3 (9.3 kPa) (P < 0.01). In the evaluation of the receiver operating characteristic curve, the cutoff value was discovered to be 14.3 kPA (95% CI: 0.753-0.995) in the acute appendicitis group, with a 100% sensitivity and 79.17% specificity. Shear wave elastography examination is not considered an invasive method and is an easily accessible diagnostic tool that can be used to differentiate between inflamed and noninflamed tissue in children. The quantitative measurement for flexibility of the appendix contributes to the diagnosis.

Application of ultrasonic shear wave elastography and contrast-enhanced ultrasound in the differential diagnosis of patients with benign and malignant thyroid lesions.

Thyroid nodules are a common thyroid disorder. The aim of the present study was to observe the application value of ultrasonic shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of patients with benign and malignant thyroid lesions. Eighty-two patients with thyroid nodules (96 thyroid nodules) at our hospital were enrolled. All patients underwent ultrasonic SWE and CEUS examination. With surgical pathology as the gold standard, the Young's modulus, CEUS imaging features, and quantitative parameters were compared between the benign and malignant groups. The diagnostic efficiency of SWE, CEUS, and their combination was analyzed by receiver-operating characteristic curve (ROC). The average of the Young's modulus in the malignant group was significantly higher than that of the benign group (P<0.05). There were significant differences in the CEUS images of nodules between the benign and malignant groups in terms of boundary conditions, morphology, perfusion intensity, homogeneous enhancement, and perfusion defects (P<0.05), while there were no significant difference in initial increase time, peak intensity, time to peak, and area under the curve (P>0.05). The curve sharpness in the benign group was significantly lower than that of the malignant group (P<0.05). ROC analysis found that the diagnostic sensitivity and specificity of SWE, CEUS, and their combination were 90.1% and 81.6%, 67.8% and 75.4%, and 97.3% and 71.5%, respectively. Compared with CEUS, the sensitivity and specificity of SWE were relatively higher in the differential diagnosis of benign and malignant thyroid lesions, and a combination of both can improve the diagnostic sensitivity of SWE alone to a certain extent.

Shear wave elastography findings in Immunoglobulin A Nephropathy patients: is it more specific and sensitive for interstitial fibrosis or interstitial fibrosis/tubular atrophy?

Background Prediction of prognosis in Immunoglobulin A Nephropathy (IgAN) and taking appropriate precautions may reduce annual incidence of chronic kidney disease. This may be possible by close follow-up for the development and progression of interstitial fibrosis (IF) or interstitial fibrosis/tubular atrophy (IFTA) in IgAN patients. Aim To investigate whether Young’s elastic modulus (YM) which measured shear wave elastography (SWE) might be used for follow-up of IF or IFTA in IgAN patients. Methods Prospective study was approved by Human Research Ethics Committee. Group 1 consisted of patients with IgAN. Group 2 consisted of healthy control participants. Young’s elastic modulus which is a value of stiffness along with longitudinal stiffness was used to evaluate tissue elasticity. Specificity, sensitivity, positive predictive value (PPV) of YM for the presence of IF and IFTA were evaluated. Results Group 1 consisted of 30 participants, and group 2 consisted of 32 participants. Sensitivity and specificity of SWE to diagnose presence of IF for YM > 15 kPa were 89% and 90%, respectively. PPV among the ones whom IF was diagnosed by YM >15 kPa was 91%. Sensitivity and specificity of SWE to diagnose presence of IFTA for YM > 15 were 65% and 51%, respectively. PPV among the ones whom IFTA was diagnosed by YM >15 kPa was 78.1%. Conclusions YM which measured SWE is highly specific and sensitive in the diagnosis of IF, but not for IFTA in IgAN patients. Therefore, progression for IF in IgAN may be followed by SWE.

Performance Characteristics of Transrectal Shear Wave Elastography Imaging in the Evaluation of Clinically Localized Prostate Cancer: A Prospective Study

We tested the diagnostic accuracy of shear wave elastography to detect and phenotypically characterize prostate cancer compared with whole mount radical prostatectomy histopathology. In this prospective, protocol driven, diagnostic accuracy study 212 consecutive men undergoing laparoscopic radical prostatectomy for clinically localized prostate cancer were recruited. Quantitative stiffness data on the prostate gland were obtained in each patient using an endocavitary transrectal transducer before laparoscopic radical prostatectomy. Those data were compared with a detailed histopathological examination of the radical prostatectomy specimen using 3-dimensional printing mold based technology to ensure an improved image histology orientation. ROC curves were assessed between the groups. Quantitative stiffness data estimated in kPa were significantly higher in malignant compared with benign areas. At a cutoff of 82.6 kPa the sensitivity and specificity of shear wave elastography were 96.8% and 67.8%, respectively (p<0.01). Significant differences were observed for different cancer grades with the Young moduli, including 91.6, 102.3 and 131.8 kPa for low grade (Gleason score 6), intermediate grade (Gleason score 7) and high grade (Gleason score 8 or greater) prostate cancer, respectively (p <0.05). Shear wave elastography also detected capsular breaches with significant prediction of prostate cancer pathological staging. Potential limitations include selection bias and study being single center site. Quantitative shear wave elastography via the transrectal approach accurately detected cancer foci and revealed significant differences between cancerous and benign tissue. Moreover, this technique can be used to reliably phenotype prostate cancer aggressiveness.

Value of shear wave elastography in discriminating malignant and benign breast lesions: A meta-analysis.

The analysis was aimed to evaluate the diagnostic accuracy of shear wave elastography (SWE) for malignant breast lesions through a meta-analysis.Related articles were searched from Pubmed, Embase, and Cochrane library. Overall sensitivity and specificity were analyzed with DerSimonian and Laird random effects model. Area under curve with corresponding 95% confidence interval (were calculated to evaluate the diagnostic accuracy of SWE. Sensitivity and publication bias were assessed as well.A total of 25 articles including 4128 patients and 4546 breast lesions were included in the pooled analysis. In the subgroup analysis, diagnostic sensitivity and specificity of SWE in Asian population were 0.84 (0.79–0.88) and 0.87 (0.84–0.90), respectively, whereas they were 0.92 (0.86–0.96) and 0.89 (0.84–0.92) in Caucasian population. The diagnostic accuracy of SWE was a little higher for Caucasians than for Asians (0.95 vs. 0.92). The diagnostic sensitivity and specificity of virtual touch tissue quantification were 0.85 (0.77–0.91) and 0.93 (0.88–0.96), respectively. It showed a little higher value in specificity and summary ROC curve than SWE (0.93 vs. 0.87; 0.95 vs. 0.93). In addition, maximum stiffness exhibited higher detection sensitivity than that of mean stiffness (0.91 vs. 0.85).SWE serves as an accurate diagnostic technology for discriminating between malignant and benign breast lesions.

Benign and malignant breast lesions identification through the values derived from shear wave elastography: evidence for the meta-analysis.

ObjectiveThe analysis was aimed to evaluate the diagnostic accuracy of shear wave elastography (SWE) for malignant breast lesions through a meta-analysis.Materials and MethodsRelated articles were searched in databases of Pubmed, Embase and Cochrane library. Overall sensitivity and specificity were analyzed with DerSimonian and Laird random effects model. Area under curve (AUC) with corresponding 95% confidence interval were also analyzed to evaluate the diagnostic accuracy of SWE. P value < 0.05 predicted the significant heterogeneity between study. Sensitivity and publication bias were assessed as well.ResultsAccording to the inclusion criteria, 25 articles were selected. In the subgroup analysis, diagnostic sensitivity and specificity of SWE in Asian population were 0.84 (0.79–0.88) and 0.87 (0.84–0.90), respectively, while they were 0.92 (0.86–0.96) and 0.89 (0.84–0.92) in Caucasian population. The diagnostic accuracy of SWE was a little higher for Caucasians than for Asians (0.95 vs. 0.92). The diagnostic sensitivity and specificity of virtual touch tissue quantification (VTTQ) were 0.85 (0.77–0.91) and 0.93 (0.88–0.96), respectively. It showed a little higher value in specificity and summary receiver operating curve (sROC) than that of SWE (0.93 vs. 0.87; 0.95 vs. 0.93). In addition, maximum stiffness exhibited higher detection sensitivity than that of mean stiffness (0.91 vs. 0.85).ConclusionsSWE serves as an accurate diagnostic technology for discriminating malignant and benign breast lesions.

Quantitative comparison of transient elastography (TE), shear wave elastography (SWE) and liver biopsy results of patients with chronic liver disease.

[Purpose] The purpose of this study was to carry out a comparitive analysis of hepatic fibrosis results of the liver hardness of patients with chronic liver disease as measured by elastography (TE), shear wave elastography (SWE), and liver biopsy. [Subjects and Methods] This study was a retrospective analysis of 304 patients who underwent SWE and TE before and after liver biopsy, taken from among patients who had been checked for liver fibrosis by liver biopsy between August 2013 and August 2014. We used receiver operating characteristic (ROC) curve to prove the diagnostic significance of liver stiffness, and then analyzed the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and TE, as well as the kappa index through cross-analysis of SWE, TE, and liver biopsy. [Results] For liver hardness, the sensitivity of SWE was 84.39%, the specificity of SWE was 97.92%, the accuracy of SWE was 87.33%, the positive predictive value of SWE was 99.32%, and the negative predictive value of SWE was 63.51%. The sensitivity of TE was 94.80%, the specificity of TE was 77.08%, the accuracy of TE was 90.95%, the positive predictive value of TE was 93.97%, and the negative predictive value of TE was 80.43%. [Conclusion] It is our opinion that SWE and TE are non-invasive methods that are more effective than the invasive methods used for diagnosing liver hardness. Invasive methods cover only a section of liver tissue, and are more likely to cause side effects during biopsy.

Shear-wave elastography in detection of residual breast cancer after neoadjuvant chemotherapy.

102 Background: To evaluate the accuracy of shear-wave elastography (SWE) in detecting residual cancer after neoadjuvant chemotherapy. Methods: This retrospective study was approved by our institutional review board and the requirement for written informed consent was waived. From January 2012 to February 2013, 71 women with stage II-III invasive breast cancers who received neoadjuvant chemotherapy and were imaged with B-mode ultrasonography (US), SWE, and magnetic resonance (MR) imaging before surgery were included. Presence of residual cancer was evaluated and categorized according to the morphology on preoperative B-mode US and MR imaging. Quantitative elasticity values (maximum kPa) were acquired for primary lesions depicted on US. Pathological complete response (pCR) was defined as no residual invasive cancer cells. The quantitative SWE values were compared between the pCR and non-pCR group using independent samples t-test. The areas under the receiver operating characteristics curve (AUC), sensitivities, and specificities of B-mode US, MR, and SWE for detecting residual cancer were compared, with histopathologic examination as the reference standard. Results: Of the 71 women, 15 (21%) achieved pCR. The mean size of residual invasive cancers was 2.2 cm (range 0.1-6.4 cm).The maximum SWE value was significantly higher in the non-pCR group (mean, 122.9 kPa) than in the pCR group (30.6 kPa) (P &lt; 0.001). The AUC of SWE for detecting residual cancer (0.893) was higher than that of B-mode US (0.684) (P = 0.001) and comparable to that of MR (0.884) (P = 0.825). The optimal cut-off value, yielding the maximal sum of sensitivity and specificity, was 98.1 kPa, and the sensitivity and specificity of SWE at that cut-off value were 66% (37 of 56) and 100% (15 of 15). When SWE was added to B-mode US, the AUC value was significantly increased to 0.830 (P = 0.039). Conclusions: SWE was accurate in the detection of residual cancer after neoadjuvant chemotherapy. When SWE was combined with B-mode US, the accuracy was significantly improved.

Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis.

To examine the performance of shear-wave elastography (SWE) for the differentiation of benign and malignant breast lesions using a meta-analysis. PubMed, Embase and the Cochrane library were searched for studies published up to January 2014. The references of retrieved relevant articles were reviewed to identify potential publications. Random-effect meta-analysis was conducted to assess the overall sensitivity and specificity of SWE in the differentiation of breast lesions. A total of 11 articles, including 2424 patients, were included in the present meta-analysis. The summarized sensitivity and specificity of the shear wave elastography performance based on maximum elasticity were 0.93 (95% CI 0.91-0.95) and 0.81 (95% CI 0.78-0.83), respectively. For the mean elasticity, the summarized sensitivity and specificity were 0.94 (95% CI 0.92-0.96) and 0.71 (95% CI 0.69-0.74), respectively. The summarized sensitivity and specificity were 0.77 (95% CI 0.70-0.83) and 0.88 (95% CI 0.84-0.91) for the SD of elasticity. SWE has a high sensitivity and specificity in the differentiation of benign and malignant breast lesions. More large and prospective studies are warranted to further examine the performance of SWE.

Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases

Shear wave elastography (SWE) is an emerging technique which can obtain quantitative elasticity values in breast disease. We therefore evaluated the diagnostic performance of SWE for the differentiation of breast masses compared with conventional ultrasound (US). Conventional US and SWE were performed by three experienced radiologists for 158 consecutive women who had been scheduled for US-guided core biopsy or surgical excision in 182 breast masses (89 malignancies and 93 benign; mean size, 1.76cm). For each lesion, quantitative elasticity was measured in terms of the Young's modulus (in kilopascals, kPa) with SWE, and BI-RADS final categories were assessed with conventional US. The mean elasticity values were significantly higher in malignant masses (153.3kPa±58.1) than in benign masses (46.1kPa±42.9), (P<0.0001). The average mean elasticity values of invasive ductal (157.5±57.07) or invasive lobular (169.5±61.06) carcinomas were higher than those of ductal carcinoma in situ (117.8kPa±54.72). The average mean value was 49.58±43.51 for fibroadenoma, 35.3±31.2 for fibrocystic changes, 69.5±63.2 for intraductal papilloma, and 149.5±132.4 for adenosis or stromal fibrosis. The optimal cut-off value, yielding the maximal sum of sensitivity and specificity, was 80.17kPa, and the sensitivity and specificity of SWE were 88.8% (79 of 89) and 84.9% (79 of 93). The area under the ROC curve (Az value) was 0.898 for conventional US, 0.932 for SWE, and 0.982 for combined data. In conclusion, there were significant differences in the elasticity values of benign and malignant masses as well as invasive and intraductal cancers with SWE. Our results suggest that SWE has the potential to aid in the differentiation of benign and malignant breast lesions.