Use Of Ultrasound Elastography Research Articles

Ultrasound Elastography in Benign Gynecology: A Scoping Review.

To perform a scoping review of the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for its use in future research and clinical implementations. A structured search of EMBASE, Medline and Cochrane databases was conducted (last search date April 15th, 2022). Eligible studies included adult participants with female pelvic anatomy. English language papers focusing on the utility of ultrasound elastography applied to benign gynecology were included. Narrative reviews, conference abstracts, and letters to the editor were excluded. Two independent reviewers screened titles and abstracts for inclusion, a third reviewer was consulted in cases of disagreement. Study quality was assessed by a checklist for study implementation and elastography technique. Extracted data included elastography technology, gynecologic application, opportunities for clinical implementation, and strengths and limitations. The search returned 2026 studies. A total of 40 studies, published between 2013 and 2022, were retained for data extraction. Studies most frequently used shear wave elastography as the method of UE (n = 23), followed by strain elastography (n = 13) and acoustic radiation force impulse (n = 4). Most common clinical applications for UE were the diagnosis of adenomyosis and uterine fibroids (27.5%), assessment of pelvic floor muscle function (22.5%), and describing the elastic properties of polycystic ovaries (17.5%) and the uterine cervix (15.0%). Limitations of the technology were identified as the lack of published reference values for gynecologic organs and difficulties in assessing tissues deep to the transducer. Future research is needed to validate the use of ultrasound elastography in gynecology under both normal and pathologic conditions.

Можливості еластографії зсувної хвилі в діагностиці фіброзу печінки та моніторингу автоімунних захворювань печінки в дітей

Autoimmune liver disease (ALD) in children, when not diagnosed and treated timely, are characterised by a progressive course leading to liver cirrhosis. Monitoring the progression of the disease is crucial for evaluating the effectiveness of treatment in ALD patients. We believe that the use of ultrasound elastography is not only valuable for diagnosing liver fibrosis but also for monitoring the course of ALD in children, representing a promising research method. Purpose - to assess the feasibility of using shear wave elastography for diagnosing liver fibrosis and monitoring the course of ALD in children. Materials and methods. In 108 children with ALD aged 3-18 years, examined at the Department of Pediatric Hepatology of the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine», from 2019 to 2023, ultrasound shear wave elastography (2D-SWE) parameters were evaluated before treatment (baseline) and at 6, 12, 24, and 36 months of therapy, depending on the stage of liver fibrosis determined by histological method using the Metavir scoring system (F0-F4) in all children. Statistical analysis was performed using GraphPad Prism 9 version 10.0.0. Results. The mean age of the children was 11 years (range 8-13.8 years), with 91% (n=98) having liver fibrosis stage ≥F2 according to Metavir. There was a significant correlation between complete biochemical remission and median 2D-SWE at 12, 24, and 36 months of treatment (p=0.0002; p=0.002; p=0.0004, respectively). The area under the ROC curve (AUC) for diagnosing liver fibrosis stage ≥F3 and F4 at 0, 6, 12, 24 and 36 months of treatment was 0.81; 0.78; 0.67; 0.81; 0.75 and 0.80; 0.91; 0.84; 0.89; 0.92, respectively. The optimal cutoff value for median 2D-SWE was 10.1 kPa; 8.9 kPa; 9.1 kPa; 8.9 kPa; 7.0 kPa and 14.0 kPa; 10.5 kPa; 10.2 kPa; 9.7 kPa; 8.1 kPa, respectively. Conclusions. Shear wave elastography is an effective method for diagnosing fibrosis ≥F3 and cirrhosis in children with ALD. Reduction in 2D-SWE values in children with ALD during treatment is a predictor of its effectiveness. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Effects of acetylsalicylic acid and ultrasound elastography on testicular torsion in rats.

To investigate the effects of acetylsalicylic acid (ASA) and the use of ultrasound elastography on testicular torsion. Herein, 6 equal groups of rats were formed (n: 48): control group, sham group, torsion/detorsion (T/D)-1 h group, T/D-1 h + ASA group, T/D-8 h group, and T/D-8 h + ASA group. Testicular torsion was created by rotating the left testis 720° clockwise. At 30 min before torsion, 100 mg/kg of ASA was injected intraperitoneally. Elastography was performed at 8 and 24 h. After orchiectomy, specimens were collected for histopathological evaluation. When comparing the left testicular volume (LV) parameters obtained from the elastography applied at 8 h, significant differences were observed between the following group pairs: the sham and T/D-8 h groups, T/D-1 h and T/D-8 h groups, and T/D-1 h + ASA and T/D-8 h groups (p = 0.004, p = 0.023, and p = 0.026, respectively). The mean LVS (velocity) (stiffness assessment) of the groups was similar at 8 h. When comparing the LV parameters at 24 h, significant differences were found between the T/D-1 h and T/D-8 h groups and between the T/D-8 h and T/D-8 h + ASA groups (p = 0.008 and p = 0.004, respectively). For the LVS mean values at 24 h, significant differences were found between the control and sham groups, sham and T/D-1 h groups, sham and T/D-8 h groups, and sham and T/D-8 h + ASA groups (p = 0.009, p = 0.021, p = 0.027, and p = 0.009, respectively).Histopathological evaluation showed a decrease in the morphological grades and an increase in the mean testicular injury scores in the T/D-1 h + ASA group compared to the T/D-1 h group. The T/D-8 h + ASA group had a higher morphological grade than the T/D-8 h group, whereas their mean testicular injury scores were similar. ASA treatment for testicular torsion was shown to be ineffective. Elastography can be a complementary method to Doppler ultrasonography in the diagnosis of testicular torsion and can guide surgeons in their approach to surgery.

Diagnostic potential of ultrasound elastography in patients with surgical diseases and injuries: Systematic review

In recent years, ultrasound elastography has been introduced into clinical practice. Because of the low availability of this equipment and the short period of operation, professionals are unaware of the technologys potential. Based on the findings of a systematic review of published scientific studies, this study aims to determine the diagnostic use of ultrasound elastography in patients with surgical diseases and injuries. PubMed, Google Scholar, eLibrary, and other information databases were searched for publications in Pediatric Surgery, Russian Bulletin of Pediatric Surgery, Anesthesiology and Intensive Care, Pediatric Surgery, and SonoAce Ultrasound from 2016 to 2022. The total number of sources in the sample is 7,040. The analysis comprised 32 papers that met the PRISMA criteria. The findings are divided into surgical diseases and injuries. The works on space-occupying formations predominated among the surgical diseases (27 publications). A single study was related to vascular problems and ectopic pregnancy, and three articles corresponded to the criteria of injury. The methods specificity was confirmed in the interquartile interval [Q1 77 Q3 95], Me 88.1, with sensitivity in the interval [Q1 81 Q3 94], Me 85.5. The advantages of elastography have been established in terms of the specificity of the method in identifying predictors of rotator cuff rupture, amounting to 96.7% and 61.2%62.5%, respectively, when compared with the B-mode. In pancreatic cysts, elastography had a specificity of 75.0% but only 40.0% in B-mode. The advantage of elastography (84.0%) over grayscale studies (69.0%) in metastatic lymph node lesions was established. Elastography is 15% more effective than standard ultrasonography in treating supraspinatus tendon injury. Elastography raised the specificity of prostate cancer diagnosis from 45.0% to 89.0%.

Clinical Usefulness of Ultrasound Elastography in Colonic Diseases: A Narrative Review.

Ultrasound elastography is an innovation of ultrasound technology that has developed since the 1990s. It has been successfully applied for many organs, such as the thyroid, breast, liver, prostate, and muscle systems, providing qualitative and quantitative information about tissue stiffness for clinical diagnoses. For colorectal tumors, ultrasound elastography can distinguish colon adenoma from colon adenocarcinoma and predict the chemotherapeutic effects of colon cancer by monitoring the stiffness changes of cancer tissue. In Crohn's disease, ultrasound elastography helps assess the stages of the course and guides further treatment strategies. Compared with colonoscopy, ultrasound elastography frees patients from the fears of uncomfortable procedures and enables operators to comprehensively observe the bowel wall and the surrounding structures. In this review, we introduced the principles and the pathological basis of ultrasound elastography and compared the diagnostic efficacies of colonoscopy with colonic ultrasound elastography. Meanwhile, we summarized the ultrasonography of colonic diseases and reviewed the clinical usefulness of ultrasound elastography in colonic diseases.

Use of ultrasound elastography in differentiating benign from malignant thyroid nodules: a prospective study.

Elastography is a real-time non-invasive ultrasonography modality wherein the tissue stiffness is evaluated by calculating the degree of tissue distortion in response to an external force. This study was undertaken to assess the diagnostic value of elastography in differentiating benign from malignant thyroid nodules. In this prospective comparative study, a total of 52 thyroid nodules from 44 euthyroid patients undergoing fine needle aspiration cytology were assessed. Elastography was performed by a single experienced sonologist, wherein the nodules were graded as per elastography scoring (ES), and the strain ratio (SR) for each nodule was computed. Final histopathology findings of the patients undergoing surgery were compared to elastography findings, and measures of diagnostic accuracy to differentiate between benign and malignant nodules were determined for ES and SR. Thirty (68.2%) females and 14 (31.8%) males, with a mean age of 45.18 ± 11.23years, were assessed. Fourteen (31.8%) patients underwent thyroidectomy, and histopathology was reported for 18 (34.6%) nodules. In all, nine (17.3%) nodules were malignant, and 43 (82.7%) nodules were considered benign. ES demonstrated a sensitivity of 88.9%, specificity of 88.3%, PPV of 61.5%, NPV of 97.4%, and accuracy of 88.5% to identify benign thyroid nodules. The mean SR for benign nodules was significantly lower as compared to malignant nodules (2.72 ± 0.62 vs. 4.52 ± 0.75, P < 0.0001). The optimal cut-point value for SR to differentiate benign and malignant thyroid nodules was determined to be 3.8, with the sensitivity, specificity, PPV, NPV, and accuracy being 88.9%, 95.4%, 80%, 94.6%, and 94.2%, respectively. Ultrasound elastography (ES and SR) demonstrated good diagnostic efficacy to differentiate benign thyroid nodules from the malignant ones, and can be a good supplementary tool to gray-scale ultrasonography. It can also help in reducing the rates of unnecessary fine needle-aspiration biopsy.

Role of perfusion computed tomography for diagnostic intermediate stages of fibrosis in diffuse liver diseases: prospective study

INTRODUCTION: Despite the wide availability of the use of ultrasonic elastography to assess fibrosis in patients with diffuse liver diseases, this method didn’t have a high specificity for diagnosing intermediate stages of fibrosis.OBJECTIVE: To evaluate the diagnostic effectiveness of perfusion computed tomography (PCT) for detecting intermediate stages of fibrosis in patients with diffuse liver diseases.MATERIALS AND METHODS: PCT of the liver was performed in 73 patients (37 men, 36 women, mean age 47.2±4.4 years). All patients underwent a biochemical blood test, ultrasound elastography, PCT, based on the obtained biochemical blood test and instrumental data, the examined patients were divided into three groups depending on diffuse liver disease: hepatitis (n=25), cirrhosis (n=26), non-alcoholic inflammatory liver disease (n=22). Statistics: The results were processed using the Statistica 10.0 for Windows software package. Identification of the relationship between two quantitative variables that do not obey the normal distribution law was carried out using the Spearman rank correlation coefficient. To assess the diagnostic efficiency of perfusion parameters in patients with DLD, an ROC-analysis (Receiver Operating Characteristic Analysis) was performed. In all statistical analysis procedures, changes were considered statistically significant at a significance level of p&lt;0.05. RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p&gt;&lt;0.04), in patients with alcoholic cirrhosis (r=0.66; p&gt;&lt;0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p&gt;&lt;0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p&gt;&lt;0.001), with viral hepatitis — HAF and elastography index (r=0.66; p&gt;&lt;0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p&gt;&lt;0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p&gt;&lt;0.0001). DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited. CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.&gt; p&lt;0.05.RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p&lt;0.04), in patients with alcoholic cirrhosis (r=0.66; p&gt;&lt;0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p&lt;0.02). &gt;&lt;0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p&lt;0.001), with viral hepatitis — HAF and elastography index (r=0.66; p&gt;&lt;0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p&lt;0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p&gt;&lt;0.0001). &gt;p&lt;0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p&lt;0.0001). &gt;&lt;0.0001).DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited.CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.

Ultrasound Elastography in the Evaluations of Tendon-Related Disorders—A Systematic Review

Tendon-related disorders are a common condition in both sports medicine and orthopedic clinical practice. Ultrasonography, power doppler, and magnetic resonance imaging (MRI) are the most widespread technologies, but the use of ultrasound elastography—including strain elastography and shear wave elastography—has been increasing in the last years. The aim of this paper is to evaluate the use of ultrasound elastography in tendon-related disorders. Research in PubMed, Scopus, and Web of Science databases is performed, and 364 papers are exported. After the study selection process, 38 papers are included in this systematic review. The risk of bias of each paper is evaluated using the RoBANS tool. Blinding, confounding variables, and measurement of exposure are the most affected items. From the included papers, tendinopathy is the most analyzed pathology, followed by tenosynovitis and rotator cuff disease. The Achilles tendon, patellar tendon, and common extensor tendon of the hand are the most analyzed tendons. Ultrasound elastography results in being the method providing good sensitivity and specificity (up to 100% and 100%, respectively, in tendinosis of the long head of the biceps tendon, in transverse plan examination) and accuracy (up to 97.8% in Achilles tendinopathy); furthermore, this technique is able to ensure real-time feedback on tissue elasticity and appears more sensitive than B-mode alone.

668 Intraoperative Ultrasound Elastography is a Promising Technology to Quantify Reduced Spinal Cord Tension During Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome

INTRODUCTION: Tethered cord syndrome (TCS) has been traditionally treated with detethering surgery.1,2 Posterior vertebral column subtraction osteotomy (PVCSO) is a novel surgery that can treat TCS while avoiding complications of detethering surgery, such as retethering or cerebrospinal fluid leaks.2-6 The pathophysiology of PVCSO is not completely understood. However, the hypothesis is that shortening the vertebral column decreases the spinal cord (SC) tension thereby improving neurological function. Intraoperative ultrasound elastography (USE) is well suited to elucidate the changes that can occur in SC parenchyma secondary to PVCSO.7,8 Through different modalities, such as superb microvascular imaging (SMI) and elastography (USE), US can analyze changes in blood flow and tissue tension.9 METHODS: Three patients with recurrent TCS underwent PVCSO and intraoperative USE to analyze the tension of the SC at 3 timepoints: pre-, mid- and post-shortening. RESULTS: All three patients (two female, one male) had undergone multiple detethering surgeries. Prior to shortening, the median SC elasticity of all patients was 9.8 kPa (IQR 9.7-12.4 kPa). After complete compression of the rods, the SC elasticity decreased by 17.4% to 7.7 kPa (6.5-9.7 kPa). All patients had significant improvement in sensation and reduction in pain at their 2 month follow up appointment. CONCLUSIONS: Here we report the first use of USE to demonstrate decreased SC tension after PVCSO for TCS. All patients reported improved symptoms and USE demonstrated decreased SC tension after shortening. USE is a promising tool for evaluating tissue elasticity and blood flow in spinal pathologies, including TCS. This technology serves as an intraoperative confirmation that SC tension decreases after PVCSO. Patients and neurosurgeons both benefit from an intraoperative objective tool to demonstrate reduced SC tension.

Correlation of Mammography, Ultrasound and Sonoelastographic Findings With Histopathological Diagnosis in Breast Lesions.

Introduction Breast masses range from inflammatory and benign to malignant lesions, varying in different age groups and clinical presentations. Breast imaging techniques leading to prompt and specific diagnosis have been a lifesaver for millions around the globe saving them undue mental stress in inflammatory lesions and preventing early death in case of neoplasms. Here, we compare mammography, ultrasonography (US) and ultrasound elastography in the screening and diagnosis of breast lesions and the usefulness of strain ratio as a non-invasive tool in diagnosing breast malignancies. Aims and objectives Determining the characteristics ofbreast lesions on imaging by mammogram, ultrasonography, elastography, calculating strain ratio andcorrelating them with histopathology. To further estimate the advantages and limitations of one modality over the other in the evaluation of breast lesions. Methods The study was done over a duration of 18 months from November 2019 to June 2021 at JSS Medical College and Hospital, Mysuru. In this prospective study, 73 female patients with palpable breast lesions were evaluated using mammography, US and sonoelastography and were co-related with histopathological findings. Results This study has proved that the use of ultrasound elastography has higher sensitivity (91.67% with strain ratio kept at 3) in detecting malignant lesions when compared with x-ray mammography and ultrasonography having a sensitivity of 87.88% and 90.91%, respectively. Our study confirmed that there is a correlation between strain ratio and histopathological findings and that the strain ratio has high sensitivity in diagnosing and differentiating malignant breast lesions. Conclusions Mammography, US and sonoelastography when combined together are helpful in characterization and management of breast lesions. This helps to avoid unnecessary invasive interventions. The specificity of the study in detecting malignant lesions was comparable with that of histopathological analysis.

THE EFFECTIVENESS OF SHEAR WAVE ELASTOGRAPHY IN THE ASSESSMENT OF LIVER DAMAGE IN PATIENTS WITH POST-COVID SYNDROME

The article presents a review of literature data on the aspects of post-covid liver damage, as well as on the diagnostic capabilities of shear wave ultrasound elastography in its assessment. Development of consequences to the new coronavirus infection COVID-19 resulted in an increased interest in their study. In May 2020, the set of symptoms after COVID-19 was combined by the term "post-covid syndrome" and was introduced into the ICD-10 system – (U09.9). The post-covid syndrome is a set of multisystem manifestations of COVID-19, lasting more than 12 weeks, on a permanent basis or with a wave-like course. According to the literature, 35% of patients have liver damage. As part of the study of pathogenetic mechanisms, several theories have now been proposed: direct damaging effect of the virus, immune-mediated inflammation, hypoxia, drug hepatotoxicity and hepatic comorbidity. Laboratorially liver dysfunction in COVID-19 is characterized by an increase in the level of transaminases, intrahepatic cholestasis, signs of hepatic cell insufficiency. Increased ALAT, thrombocytopenia and hypoalbuminemia are proved to be factors of severe course and increased mortality in patients with COVID-19. Therefore, the issues of early instrumental diagnosis of hepatopathies are actualized in this issue. The "gold standard" for instrumental assessment of liver structure is biopsy, but it is limited in use due to the invasiveness of the procedure. According to the WHO experts, priority in the study of post-covid syndrome should be given to the development of new non-invasive and accessible diagnostic methods. Taking into account the success in the use of ultrasound elastography in the diagnosis of diffuse liver diseases in recent years, it seems that the most informative method in the diagnosis of post-covid liver damage is shear wave ultrasound elastography. The advantages of the method are established to be absence of radiation load on the patient and the doctor, the possibility of conducting the study under optimal visual navigation, non-invasiveness, the choice of any zone of interest, assessment of the structure and functional state of the liver. Shear wave ultrasound elastography is a promising innovative way to assess the structure of the liver in patients with post-COVID syndrome and requires further study.

Intestinal Elastography in the Diagnostics of Ulcerative Colitis: A Narrative Review.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that mainly affects developed countries, but the number of cases in developing countries is increasing. We conducted a narrative review on the potential application of ultrasound elastography in the diagnosis and monitoring of UC, as this newly emerging method has promising results in other gut diseases. This review fulfilled the PRISMA Statement criteria with a time cut-off of June 2022. At the end of the review, of the 1334 identified studies, only five fulfilled all the inclusion criteria. Due to the small number of studies in this field, a reliable assessment of the usefulness of ultrasound elastography is difficult. We can only conclude that the transabdominal elastography examination did not significantly differ from the standard gastrointestinal ultrasonography examination and that measurements of the frontal intestinal wall should be made in the longitudinal section. The reports suggest that it is impossible to estimate the clinical scales used in disease assessment solely on the basis of elastographic measurements. Due to the different inclusion criteria, measurement methodologies, and elastographic techniques used in the analysed studies, a reliable comparative evaluation was impossible. Further work is required to assess the validity of expanding gastrointestinal ultrasonography with elastography in the diagnosis and monitoring of UC.

Measurement of aspiration pressure in cannula brain tumour biopsy and its correlation with ultrasonographic elastography

BackgroundStereotactic brain biopsy is to perform the manual aspiration tissue biopsy using a cannula on a syringe under stereotactic guidance to provide histological confirmation. Excessive vacuum aspiration increases the risk of haemorrhage. Manual aspiration relies on the surgeon’s experience while the minimum vacuum pressure is unknown. Objectives1. To assess the aspiration vacuum pressure range in cannula brain tumour biopsy;2. To understand the correlation of ultrasound elastography data with the aspiration pressure. MethodsThis prospective study has recruited 10 patients for stereotactic brain tumour biopsy. With the use of ultrasound elastography, strain ratio of the lesion was assessed in real time before biopsy. Vacuum aspiration pressures were recorded using a T-connector pressure sensor during the stereotactic biopsy. ResultsA total of 11 biopsies were taken from 10 patients, including a bilateral biopsy for a patient with bifrontal lesions. The diagnostic yield was 100% in all the 10 patients with no symptomatic haemorrhage (but 2 subclinical haemorrhages in CT scan) nor infection. The vacuum pressures ranged from 40.34 to 65.61 kPa and the strain-ratio ranged from 0.405 to 2.74. Strain ratio of the lesion at the lower range required a lower range of aspiration pressure, whereas lesions of Strain ratio over 0.45 required a higher range of aspiration pressure. ConclusionA vacuum pressure of 40 to 66 kPas is safe and adequate for biopsy of various types of tumours with heterogenous elastographic characters. Ultrasonographic elastography may be a real-time guide for the minimum vacuum pressure required for biopsy.

A COMPARATIVE STUDY BETWEEN B-MODE WITH COLOR DOPPLER SONOGRAPHY AND ELASTOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT CERVICAL LYMPHADENOPATHY

Objectives- The purpose of this study was to determine the usefulness of ultrasound elastography in the evaluation of enlarged cervical lymph nodes in comparison with B-mode and color Doppler sonography. Methods-A total of 230 lymph nodes in 164 consecutive patients referred for sonography of the neck were included. B-mode sonograms were evaluated according to short-axis diameter, long-to-short-axis ratio, hilum, echogenicity, and microcalcication. Five different patterns were dened according to vascularity for color doppler sonography. Elastography patterns of the lymph nodes were categorized to 5 main types. The strain index values were calculated for all lymph nodes. Histopathologic ndings were used as reference standards for the diagnosis of benign and malignant lymph nodes. Results-Of the 230 lymph nodes, 62.6% were diagnosed as benign, and 37.4% were diagnosed as malignant. The sensitivity, specicity, and accuracy of B-mode sonography with color Doppler were 76.7%, 81.9%, and 80.0%, respectively; the values were 82.6%, 56.6%, and 66.9% for strain elastography sonography. The strain index cutoff value for the differentiation of benign and malignant lymph nodes was accepted as 1.7. Conclusions-Combination of B-mode sonographic features and vascular pattern of the lymph nodes is best imaging modality in differentiating between malignant and benign cervical lymphadenopathy. Ultrasound elastography adds no additional value to combined B- mode and color Doppler sonography for differentiation of benign and malignant cervical lymph nodes.

Modern approach to the use of ultrasound elastography in secondary female infertility

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Обосновать применение ультразвуковой эластографии сдвиговой волной в оценке состояния структур матки у женщин репродуктивного возраста при вторичном бесплодии. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Основная группа (<i>n</i>=169) состояла из пациенток репродуктивного возраста с вторичным бесплодием, которых разделили на две подгруппы: 68 женщин с генитальным туберкулезом с поражением эндометрия и 101 женщина с хроническим эндометритом без сопутствующего туберкулеза. В группу сравнения (<i>n</i>=45) вошли здоровые женщины. Средний возраст женщин основной группы составил 34,4±2,6 года, группы сравнения — 32,9±3,1 года. Продолжительность вторичного бесплодия у женщин основной группы составляла 5,7±1,7 года.<b></b> Всем женщинам проведено ультразвуковое исследование с протоколом Shear Wave Elastography (2DSWE) — двумерной эластографии сдвиговой волной с эластометрией (сканер Aixplorer, SuperSonic Imagine, Франция) через вагинальный доступ. <h3>РЕЗУЛЬТАТЫ</h3> По данным 2DSWE установлено, что у здоровых женщин репродуктивного возраста жесткость эндометрия (<i>Emean</i>=16,5 кПа; SD=1,0) имеет меньшие значения, чем жесткость эндоцервикса (<i>Emean</i>=23,2 кПа; <i>SD</i>=1,9) (<i>p</i>&lt;0,05), а жесткость миометрия в области шейки матки выше, чем в теле матки (<i>Emean</i>=28,3 кПа; <i>SD</i>=3,0 и <i>Emean</i>=22,3 кПа; <i>SD</i>=1,7 соответственно; <i>p</i>&lt;0,05), при этом не выявлена потенциальная зависимость от различных фаз менструального цикла. У больных с вторичным бесплодием при хроническом эндометрите наибольшее диагностическое значение и статистическую значимость представляют показатели жесткости эндометрия. При более высоких значениях модуля упругости Юнга жесткости эндометрия, которые превышают нормальные значения и длительно сохраняются без значимых изменений, отмечен больший риск ненаступления беременности. <h3>ЗАКЛЮЧЕНИЕ</h3> Технология двумерной эластографии сдвиговой волной с эластометрией может стать дополнением к неинвазивным методам оценки состояния эндометрия у пациенток репродуктивного возраста с вторичным бесплодием.

Successful experience in the use of ultrasound elastography in the differentiating of lymphomatous and metastatic superficial lymphadenopathy

The objective: to evaluate the possibilities of ARFI technology (Acoustic Radiation Force Impulse), including Virtual Touch™ Tissue Imaging (VTI) and Virtual Touch™ Tissue Quantification (VTQ) for differentiation of lymphomatous and metastatic superficial lymphadenopathy.Materials and methods. The prospective study included 138 patients with enlarged superficial lymph nodes (LN). Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd group (n = 30) – patients with metastasis of solid tumors in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology. In VTI study the Area Ratio parameter was evaluated, and the minimum and average values of the shear wave velocity were estimated in VTQ study.Results. According to the results of VTI study the Area Ratio parameter for enlarged LN in lymphoma (1st group) and for metastatic lymphadenopathy (2 nd group) were 1.031 ± 0.197 and 0.851 ± 0.15, respectively (p = 0.000009). The cut off value of the Area Ratio parameter was 0.901 with sensitivity, specificity and accuracy 80.6, 70.0 and 78.8 %, respectively. Minimum values of shear wave velocities for 1st and 2 nd groups were 1.980 ± 0.557 and 2.214 ± 0.367 m/s, respectively (p = 0.032). The cut off values of the average shear wave velocity in the differentiating of lymphomatous and metastatic lymphadenopathy are determined at the level of 2.00 m/s, with sensitivity of 70.0 %, specificity of 59.3 %, and accuracy of 61.6 %.Conclusion. Ultrasound elastography with ARFI technology demonstrated statistically significant differences in the Area Ratio parameter and in the minimum shear wave velocity in the enlarged superficial LN in lymphoma and with metastasis that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions. Moreover, the Area Ratio parameter has a statistically more significant effect on differentiating of lymphomatous and metastatic lymphadenopathy.

Shearwave Elastography in the Differentiation of Carpal Tunnel Syndrome Severity.

There is emerging evidence that ultrasound elastography may provide additional diagnostic information in peripheral neuropathies. To investigate the use of ultrasound elastography to evaluate median nerve stiffness in patients with carpal tunnel syndrome (CTS), as well as the relationship between the elastographic stiffness and electrophysiological severity. Case control study. Tertiary hospital outpatient neurophysiology clinic. Twenty eight patients (47 wrists) with CTS and 25 control patients (25 wrists). None. Ultrasound parameters (median nerve cross-sectional area [CSA] at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm), shearwave elastography parameter (median nerve stiffness), and electrophysiological severity of carpal tunnel syndrome. In patients with CTS, median nerve stiffness by ultrasound elastography was increased between the different severity groups (control 83.5 ± 24.8, EDx negative CTS 84.2 ± 46.4, mild 117.7 ± 79.3, moderate 144.0 ± 71.1, severe 196.6 ± 48.4). The control versus moderate and severe subgroup was statistically significant. In total, this study has demonstrated that ultrasound elastography was able to discriminate the severity of CTS whereas conventional ultrasound parameters did not.

Successful use of ultrasound elastography in the preliminary intermediate evaluation of therapeutic response in patients with Hodgkin’s lymphoma

Objective. The possibilities of ultrasound elastography of the lymph nodes as an additional technique for the intermediate control of treatment of patients with Hodgkin’s lymphoma are determined. Materials and methods. A prospective study included patients with a diagnosis of classical Hodgkin’s lymphoma with affected superficial lymph nodes. Patients underwent ultrasound elastography (compression elastography and shear wave elastography) of the enlarged lymph nodes before treatment and after two cycles of chemotherapy. The reasons for the ultrasound examination of superficial lymph nodes after the second chemotherapy cycle were: an earlier ultrasound examination with revealed changes in the superficial lymph nodes (in 100% of cases), preservation of the palpable formation in the projection of the superficial lymph nodes (in 56.9% of cases). Before ultrasound elastography of the studied group of patients, the positive dynamics after two cycles of chemotherapy was confirmed by PET/CT (Deauville scale 2—3). Results and conclusion. According to strain elastography, stiff heterogeneous (third type of elastogram) and stiff structure (fourth type of elastogram) of affected lymph nodes were noted in 53.5 and 42.3% of cases, respectively, before treatment. After two cycles of chemotherapy, these types of elastogram were 52.1 and 43.7% of cases, respectively. According to the results of shear wave elastography before and after treatment, a decrease in the average shear wave velocity in the affected lymph nodes from 2.67 + 0.69 to 2.21 + 0.40m/s (p = 0.000003) was revealed.

Is ultrasound elastography adding value in diagnosis of focal hepatic lesions? Our experience in a single-center study

BackgroundThe aim of this study was to assess the use of ultrasound elastography in differentiating hepatic lesions in order to increase the sensitivity and specificity of grey-scale ultrasound.MethodsThis study included 104 patients who were referred to the radiology department at Alexandria Main University Hospital for focal hepatic lesions detected by grey-scale ultrasound and were recommended to undergo further evaluation by ultrasound elastography. All studied patients were subjected to the following: (1) grey-scale ultrasound and ultrasound elastography using semiquantitative technique and (2) triphasic MDCT of the liver. MRI was done in 11 patients with malignant lesions; further confirmation with histopathological assessment was conducted.ResultsBenign lesions showed a low strain ratio, while malignant lesions showed a high strain ratio. The mean ratio in the benign lesions was 1.08 ± 0.40, while the mean ratio in the malignant lesions was 4.14 ± 1.25. The cut-off value used to diagnose the malignant lesions and differentiate these lesions from the benign lesions was 1.7, which had a sensitivity of 100%, specificity of 93.10%, PPV of 97.40% and NPV of 100%.ConclusionUltrasound elastography is a promising non-invasive, non-contrast technique that can be added to routine grey-scale sonographic examinations of the liver to characterize hepatic lesions.

Ultrasound elastography for the evaluation of peripheral nerves: A systematic review.

Peripheral nerve disorders are commonly encountered in clinical practice. Electrodiagnostic studies remain the cornerstone of the evaluation of nerve disorders. More recently, ultrasound has played an increasing complementary role in the neuromuscular clinic. Ultrasound elastography is a technique that measures the elastic properties of tissues. Given the histological changes that occur in diseased peripheral nerves, nerve ultrasound elastography has been explored as a noninvasive way to evaluate changes in nerve tissue composition. Studies to date suggest that nerve stiffness tends to increase in the setting of peripheral neuropathy, regardless of etiology, consistent with loss of more compliant myelin, and replacement with connective tissue. The aim of this systematic review is to summarize the current literature on the use of ultrasound elastography in the evaluation of peripheral neuropathy. Limitations of ultrasound elastography and gaps in current literature are discussed, and prospects for future clinical and research applications are raised.