Use Of Shear Wave Elastography Research Articles

Deltoid Muscle Tension Alterations Post Reverse Shoulder Arthroplasty: An Investigation Using Shear Wave Elastography.

This study aimed to evaluate the utility of shear wave elastography (SWE) in assessing changes in deltoid muscle properties following reverse shoulder arthroplasty (RSA). Our cohort consisted of 18 patients who underwent RSA due to various conditions, including osteoarthritis, cuff arthropathy, and irreducible proximal humeral fractures. Pre- and postoperative muscle elasticity and stiffness were measured using SWE and were compared with functional outcomes and radiological parameters. Our results showed significant changes in deltoid muscle elasticity after RSA, particularly in the anterior and middle portions. However, these alterations were not correlated with postoperative functional outcomes or specific radiological parameters. The study also underscored the potential of SWE for future applications, including the preoperative assessment of deltoid function, postoperative monitoring, and intraoperative use for optimal component positioning during RSA. Further research, involving larger, more homogeneous patient cohorts is needed to confirm these findings and to explore the potential influence of these changes on the biomechanical design of implants and prosthesis positioning in RSA.

High-resolution musculoskeletal ultrasonography and elastography for eosinophilic fasciitis diagnosis and follow-up: a case-based review.

Eosinophilic fasciitis (EF) remains a rare condition without precise diagnostic criteria due to common symptoms with other autoimmune diseases requiring broad differential diagnosis. This paper describes the use of high-resolution musculoskeletal ultrasonography and elastography in the diagnosis and follow-up of eosinophilic fasciitis through the case of a 56-year-old male patient. In addition to laboratory data, instrumental data, and biopsy, musculoskeletal ultrasonography (US) was used both in the diagnostic process and in the follow-up period for an objective assessment of the changes in the patient's condition and response to treatment. The US showed disorganization of the myofibrils adjacent to the superficial fascia, edema, and thickening of the fascia and subcutaneous edema. In addition, the use of shear-wave elastography (SWE) demonstrated significantly reduced skin elasticity. High-frequency musculoskeletal ultrasound in combination with SWE is an effective method both for the diagnosis of EF and for the follow-up of the changes occurring after therapy. Based on the fact that it can easily differentiate the substrate of involvement, such as skin, subcutaneous tissue, or muscle fascia, ultrasound can be used to distinguish EF from other skin and muscle diseases.

Effect of knee joint angle on vastus medialis and vastus lateralis rigidity during isometric submaximal voluntary knee extensions

The use of shear wave elastography during voluntary contraction has enabled the non-invasive assessment of load sharing strategies between agonist muscles. However, the change in joint angle and voluntary contraction intensity can modify contribution between muscles. The aim of this study was to investigate the effect of knee joint angle on the local mechanical properties of the vastus medialis (VM) and the vastus lateralis (VL) during isometric submaximal voluntary contractions from shear wave elastography mapping. The VM and VL Young’s modulus at rest and during constant isometric submaximal voluntary contractions (i.e., 25%, 50% and 75% of maximal voluntary contraction [MVC]) were assessed for two knee angles (50° and 100° | knee fully extended = 0°) in twelve participants. No significant difference was found in the VM Young’s modulus among all torque levels and knee angles (p > 0.05). VL Young’s modulus was significantly higher at 25% MVC for a knee angle of 100° than at 75% MVC for the same knee angle and was greater at 25% MVC for a knee angle of 100° than for 50° (p < 0.05). In contrast to the VM, the contribution of the VL to the knee joint torque production during isometric voluntary contraction appears to depend on the muscle length and the relative knee extension torque level.

Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis.

Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.

Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas.

Simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants. In total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher's exact test was used to compare independent groups, and Spearman's correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values. The B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas). As the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas.

A Comparative Analysis of Strain and 2D Shear Wave Elastography in the Diagnosis of Autoimmune Thyroiditis in Pediatric Patients.

This paper aims to assess the usefulness of shear-wave elastography (SWE) and strain elastography (SE) for identifying and monitoring thyroid gland changes in children diagnosed with chronic autoimmune thyroiditis (CAT). Our study included 77 children between the ages of six and eighteen. Of these, 45 were diagnosed with CAT, while 32 had no thyroid pathology. Following a clinical examination and laboratory tests, an ultrasound was carried out, and then a SE (using a Hitachi Preirus machine) and SWE (using an Aixplorer Mach 30, Supersonic imagine, France) were performed in the same session. The median thyroid elastic index (EI) in the CAT group was 13.8 (13.3-17) kPa compared to 10.1 (9.3-11.2) kPa in healthy children (p < 0.0001). We found a median strain ratio (SR) of 1.2 (1.2-1.3) for CAT compared to 0.7 (0.6-0.9) for healthy thyroid tissue (p < 0.0001). The optimal cut-off value for predicting the presence of CAT in children using SR was >1 (Se = 82.2%, Sp = 87.5%, PPV = 90.2%, and NPV = 77.8%, AUROC = 0.850), while using SWE, the optimal cut-off value for predicting the presence of CAT in children was >12 kPa (Se = 88.9%, Sp = 93.7%, PPV = 95.2%, and NPV = 85.5%, AUROC = 0.943). Both techniques are useful for measuring thyroid tissue elasticity, and their diagnostic accuracy and reliability are comparable.

Predicting the expansion of the lower pole of the breast following smooth breast implant augmentation: A novel shear wave elastography study

This study aimed to educate and demonstrate how the use of shear wave elastography (SWE) can be used to determine the elasticity of patient tissues preoperatively, which can then be used to predict the level of lower pole expansion postoperatively, following breast augmentation surgery. This study evaluated 60 breasts in 30 patients that were divided in 3 equal groups (n=20) according to their predefined elastography criteria measured via SWE (loose, moderate, and tight tissue elasticity). All measurements were taken under maximum stretch between the inferior border of the nipple alveolar complex (NAC) and inframammary fold (IMF) using a measuring tape in millimetres (mm). The follow-up appointments for routine assessments and measurements were done at 3, 6, 12, 18, and 24 months. The study engaged 38 patients over 4 years, but only 10 patients in each group attended all the appointments. Statistical analysis showed the elastic skin types (loose, moderate, and tight) had significantly different rates of lower pole expansion, and the rate of expansion increased significantly after 6 months postoperatively, whereas prior to 6 months, the rates were comparable (p<0.05). The results showed that increasingly elastic skin types have a greater rate of lower pole expansion. This is important for the operating surgeon to be aware of as looser skin types will be more prone to lower pole expansion, and thus, a higher surgical IMF suture may be advised to manage patient expectations. This study can be used as a guideline for surgeons, which will allow for a more predictable surgical planning system that will ultimately lead to fewer revisions and risks for patients worldwide.

Use of shear wave elastography to analyze the muscle structure in children with spastic cerebral palsy.

In children with cerebral palsy (CP), gastrocnemius muscle spasticity may lead to pes equinus posture which causes insufficient ankle joint dorsiflexion for normal gait. The aim of this study was to analyze the stiffness of gastrocnemius and tibialis anterior muscles by shear wave elastography (SWE) in children with pes equinus deformity due to spastic CP. 24 legs of 12 children (6 females and 6 males, mean age 45.8 months) with CP were prospectively included in the study. Tissue stiffness quantification with shear-wave velocity (SWV) was analyzed. The mean SWVs of the gastrocnemius and tibialis anterior muscles were 3.91±0.26 m/s and 2.67±0.18 m/s, respectively. The stiffness of the gastrocnemius muscle was significantly higher than the stiffness of the tibialis anterior muscle (p < 0.0001). There was no correlation between the stiffness of these muscles (r = 0.129, p > 0.05). Gastrocnemius muscles were stiffer than tibialis anterior muscles in patients with spastic CP. But stiffness between these muscles was not correlated with each other. Pes equinus may be related to stiff gastrocnemius in these patients. This study demonstrates the clinical potential for SWE as a non-invasive tool for analyzing calf muscle stiffness.

’Shear-wave elastografi bulgularının meme kanseri moleküler alt tipleri ile ilişkisi ve diğer radyolojik görüntüleme teknikleri ile karşılaştırılması

Purpose: We aimed to evaluate the shear-wave elastography (SWE) findings of breast cancer and to compare their differences with other imaging techniques and to determine the rela-tionship between molecular subtypes. &#x0D; Methods: Radiological findings and histopathology results of patients who underwent biopsy due to breast mass and diagnosed as malignant were evaluated retrospectively. SWE findings, ultrasonography (US), mammography and magnetic resonance imaging (MRI) findings were evaluated. The histo-pathology results of the tru-cut biopsy performed under the guidance of US-SWE were analyzed. The findings of SWE and other radiological techniques were compared statistically and relationship with molecular subtypes was evaluated. &#x0D; Results: We had 51 patients with a median age of 58 years. In SWE, the mean tumor size was 20 mm, and the tumor elasticity was 105 kPa. Statistically signi-ficant correlation was found between the tumor size differences measured by B mode US-SWE and the tumor elasticity value. No correlation was found between SWE findings and molecular subtypes. SWE had significantly high positive correlation with mamography and MRI in terms of lesion size, with US very high positive correlation and with ER positivity weak negative correlation. &#x0D; Conclusion: In addition to conventional radiological imaging techniques the use of SWE provides useful insight to evaluation of breast cancer.

Applicability of shear wave elastography for lacrimal gland evaluation in primary Sjögren syndrome.

Primary Sjögren syndrome (pSS) is a systemic autoimmune disease that mainly affects the salivary and lacrimal glands, leading to their progressive destruction. The primary aim of this study was to verify whether shear wave elastography (SWE) of the lacrimal glands can be used to differentiate patients with pSS from healthy controls. The secondary aim was to assess whether there are any associations between SWE values, results of other ocular tests included in pSS diagnosis (the Schirmer test, ocular staining score [OSS]), and subjective symptoms of eye dryness. The study included 45 patients with pSS (41 women, 4 men) and 108 healthy controls (104 women, 4 men). All pSS patients met the 2016 American College of Rheumatology / European League Against Rheumatism pSS classification criteria. The participants underwent bilateral SWE of the lacrimal glands with the results expressed in kilopascals (kPa). The Schirmer test was performed in all patients, and OSS was calculated only in the pSS group. The patients with pSS had significantly higher SWE values for the lacrimal glands than the controls. No significant differences in SWE results were observed between the groups of pSS patients with or without eye dryness confirmed by the Schirmer test and OSS, or the pSS patients with or without subjective symptoms of eye dryness. The optimal cutoff point for the diagnosis of pSS for the mean result of left and right lacrimal gland elastography was 7.2 kPa (sensitivity, 88.9%; specificity, 88%). Lacrimal gland SWE values may be a good classifier for the diagnosis of pSS, with an area under the receiver operating characteristic curve of 89.8 (95% CI, 81.5-98.1). SWE of the lacrimal glands is a noninvasive, quantitative method that seems to be a reliable additional examination tool to support the diagnosis of pSS. Its role among the functional tests has not yet been well defined. To confirm the usefulness of SWE for pSS diagnosis, a standardized and widely accepted study protocol should be defined first.

Study of Use of Shear Wave Elastography in Placental Dysfunction by Comparison of Elasticity Values in Normal and Pre-eclamptic Pregnancies

Study of Use of Shear Wave Elastography in Placental Dysfunction by Comparison of Elasticity Values in Normal and Pre-eclamptic Pregnancies

The use of shear wave elastography to monitor changes in gingival elasticity associated with initial periodontal therapy in patients with advanced periodontitis: A prospective pilot study

Background/purposeGingival tissue firmness cannot be objectively assessed or monitored in real-time in existing examinations. This study was designed to examine the potential utility of shear wave elastography (SWE) as a means of evaluating and monitoring gingival inflammation in an effort to assess the effects of initial periodontal therapy in patients with advanced periodontitis. Materials and methodsThis pilot study included analyses of 66 sites in 6 advanced periodontitis patients. Patients underwent the SWE examination of the gingiva at the mid-labial and interdental papillae at baseline and at 2, 4, and 6 weeks following initial periodontal therapy. Measured periodontal parameters in these patients include Plaque index (PI), Gingival bleeding index (GBI), Probing depth (PD), and Clinical attachment loss (CAL). ResultsRespective baseline SWE values at the mid-labial gingiva and interdental papilla 25.68 ± 6.82 kPa and 26.78 ± 6.20 kPa, with no significant differences between these two measures. A significant negative correlation between SWE and both PI (r = −0.350, P = 0.004) and GBI (r = −0.287, P = 0.020) was observed at baseline. Initial periodontal therapy contributed to significantly higher SWE values and tougher gingiva, particularly during the first two weeks. Postoperative changes in SWE were negatively correlated with SWE values at baseline (r = −0.710, P < 0.001). ConclusionThese results establish SWE as a sensitive noninvasive approach to quantitatively assessing changes in gingival elasticity in real-time.

Usefulness of Shear Wave Elastography in Determining the Tumor Extent of Basal Cell Carcinomas.

The purpose of this study was to investigate the value of shear wave elastography (SWE) in determining tumor extent of basal cell carcinomas (BCC), and thereby determine the optimal surgical margins (OSM). 10 patients (40 surgical margins) with BCC were collected, the visual observation boundaries (VOB) were marked, and the SWE parameters of soft tissues were measured 1 mm intervals in "3, 6, 9, 12" clock directions, starting from VOB. Then tumors were resected with a 5 mm surgical margin outward expansion of VOB. All specimens were examined pathologically 1 mm intervals from VOB in four clock directions. With the positive margins furthest from the tumor as the real tumor boundaries (RTB) and the negative margins closest to the tumor as the optimal surgical margins (OSM). The SWE parameters were compared between these two groups. The elasticity ratio (Eratio ) of average young's modulus between region of interest and adjacent normal soft tissue had statistically significant differences between groups (P= .000), while other parameters show no difference. The Eratio of RTB and OSM were 1.22 ± 0.14 and 0.99 ± 0.07. The area under the ROC curve was .947. Taking 1.075 as the threshold of Eratio for the diagnosis of tumor extent, the sensitivity, specificity and accuracy were 87.5%, 90.0% and 90.0%. The surgical margins designed according to OSM were better than those designed according to VOB +5 mm (P= .000). The Eratio of SWE is helpful in determining tumor extent of BCC. This is beneficial for surgical margin designing.

Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis.

BACKGROUNDTimely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness. The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies.AIMTo assess the utility of elastography in: (1) BA diagnosis, and (2) post-Kasai fibrosis surveillance.METHODSA literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up. Twenty studies met criteria for meta-analysis: Eleven for diagnosis and nine for follow-up post-Kasai. Estimated diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model using Meta-DiSc software.RESULTSMean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA, with overall DOR 24.61, sensitivity 83%, and specificity 79%. Post-Kasai, mean liver stiffness was significantly higher in BA patients with varices than in patients without, with DOR 16.36, sensitivity 85%, and specificity 76%. Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03, sensitivity 96%, and specificity 89%. Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68, sensitivity 85%, and specificity 81%.CONCLUSIONElastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai. This paper’s limitations include inter-study method heterogeneity and small sample sizes. Future, standardized, multi-center studies are recommended.

Shear wave elastography for the evaluation of testicular salvage after testicular torsion.

The aim of this study was to assess the utility of shear wave elastography in the follow-up of testicular detorsion, evaluate long-term outcomes, and explore its relationship with parameters such as tissue stiffness values, pain duration, and torsion type. Elastography examinations were independently performed by two radiologists to evaluate patients who presented to our hospital for follow-up after being diagnosed with testicular torsion and age-matched controls. Inter-observer variability of the mean testicular tissue elasticity was excellent (Intraclass correlation coefficient: 0.939, p < 0.001). Median time between testicular detorsion and follow-up ultrasound examination was 18 months (range, 11-36 months). Torsion side, torsion degree, and pain duration were recorded, and testicular volumes were calculated. The study population comprised 24 patients (48 testes) with a mean age of 21.1 ± 7.8 years. The mean testicular volume was measured as 12.3 ± 5.4ml for the testicular salvage group, 13.9 ± 3.8ml for the contralateral testes, and 13.7 ± 2.7ml for the control group (p=0.553). The mean testicular speed mode values were higher in the testicular salvage group (1.34 ± 1.21 m/s) compared with the contralateral testes group (1.00 ± 0.08 m/s), and the control group (1.01 ± 0.06 m/s), however there was no statistically significant difference between the three groups (p=0.861). While testicular atrophy was detected in three patients, an intraparenchymal wedge-shaped focal hypoechoic area developed after torsion in a further three patients. The elastography examination for focal hypoechoic areas revealed an increase or decrease in tissue stiffness compared to the normal parenchyma. The tissue stiffness values of the testicular salvage group were higher in complete torsion compared to incomplete torsion. The elastography method contributes to other imaging methods in distinguishing focal lesion areas that can be seen after testicular torsion from malignant conditions. Elastography presents as a feasible and practical complementary modality for the follow-up of testicular salvage after torsion.

Shear wave elastography options in the integrated assessment of liver parenchyma in children

Introduction. Chronic liver diseases in children are accompanied by fibrocirrhotic transformation of the organ. Modern ultrasound diagnostic procedures offer a method that can differentiate between the fibrous and unchanged tissues. The paper includes the results of a study of liver stiffness in healthy children using shear wave elastography. The method presented in the article can come to an active use in the non-invasive detection of fibrosis as part of the integrated assessment of liver in pediatric practice. Aim. To study the stiffness of unchanged liver in children of different gender and age groups.Materials and methods. Shear wave elastography was performed in 200 healthy children aged 3 to 18 years (103 girls and 97 boys) using Aixplorer apparatus (Supersonic Imagine, France), in three age subgroups: a 3- to 6-year-old group (n = 103), a 7- to 11-year-old group (n = 52), and a 12- to 18-year-old group (n = 45). The measurements were taken in different segments of the right lobe of the liver, in the area free from the vascular structures, fixing the zone of scanning at the depth of 3-5 cm from the capsule. Not less than 10 measurements were made, which enabled to calculate the mean value of liver elasticity.Results. The study identified the liver stiffness measurement normal range in a group of healthy children. Significant differences in liver stiffness were obtained by comparing the values of 3- to 6- year-old and 7- to 11-year-old groups (P = 0.001); 3- to 6-year-old and 12- to 18-year-old groups (P = 0.001); there were no statistically significant differences in the stiffness values depending on gender (P = 0.345).Conclusions. Young modulus values obtained may be used as normative. The use of shear wave elastography enhances the accuracy of the conventional ultrasound examination in identifying patients with liver disease.

Effectiveness of Quantitative Shear Wave Elastography for the Prediction of Axillary Lymph Node Metastasis

Objective Invasive breast cancer can be metastasized through axillary lymph nodes (LNs). This study was to evaluate the effectiveness of quantitative shear wave elastography (SWE) to predict axillary LN metastasis, which also provides prognostic implication of SWE as a histopathologic element of invasive breast cancer. Methods 72 prospectively enrolled patients received B-mode ultrasound (BUS) and SWE, and the elasticity index (EI) of SWE at the stiffest part of lymph nodes (LNs) was measured. EI of SWE was closely associated with pathologic results and the histopathologic elements. The receiver operating characteristics (ROC) curve was drawn to evaluate the optimal cut-off value for the assessment of disease severity. Results A significantly longer short-axis diameter and a larger maximal cortex were observed in malignant LNs than that in healthy LNs. The absence of the hilum was associated with metastatic LNs. The EI of SWE varied markedly between the benign and malignant LNs. The combination of Emax and BUS showed higher area under the curve (AUC) than BUS alone to predict metastatic LNs (0.7762 vs. 0.7230). EI of SWE in malignant lymph nodes those with extranodal extension are higher than those without extranodal extension. Conclusions Quantitative SWE provides a viable alternative for the assessment of axillary LN and shows great potential to predict pathological prognostic elements of metastatic axillary LNs in invasive breast cancer. Joint use of SWE and BUS allows examination of the predictive outcome of BUS for axillary lymph node metastasis in invasive breast cancer.

Shear wave elastography in the diagnosis of rhabdomyolysis

Rhabdomyolysis is a life-threatening skeletal muscle disease, the time of diagnosis and initiation of treatment which directly affects the likelihood of developing acute kidney injury and the quality of recovery of muscle function. The ultrasound method of diagnostics is accessible and can be used at the stage of primary diagnosis, but it has low a sensitivity of 68% and specificity of 57% when using such ultrasound symptoms as a diffuse expressed increase of echogenicity (homogeneous or heterogeneous), a disorder of transverse striation of the muscle structure and high volume of the muscular tissue damage (over 30%).&#x0D; The possibility of ultrasonic elastography in the diagnosis of rhabdomyolysis in 95 patients admitted with suspected damage to muscle tissue is discussed. Comparison of the parameters of shear wave elastography in patients with rhabdomyolysis and patients with other diseases manifested by muscle edema (muscle contusion, inflammatory myopathies, post-exercise muscle edema), as well as with the control group, significant differences were noted (p 0.01) allows to determine the quantitative ultrasound characteristics of muscle tissue, pathognomonic for rhabdomyolysis. The use of shear wave elastography with obtaining lateral wave velocity of less than 1.64 m/s increased the sensitivity and specificity of the method in the diagnosis of rhabdomyolysis to 75 and 62%, respectively.&#x0D; A logit model with integrated use of elastography indices was developed, with a diagnostic accuracy of 77%. During muscle recovery, there was an increase in lateral wave velocity to the level of control group values, which can be used as one of the markers of patient recovery.

How to perform shear wave elastography. Part II.

Recently a series of papers was introduced describing on "how to do" certain techniques. More specifically we published on how to perform strain imaging using the transcutaneous and endoscopic ultrasound approach and shear wave elastography (SWE). In the first part we describe how to optimize the examination technique, discussing normal values, pitfalls, artefacts and specific tips for applying SWE to specific organs (liver, breast, thyroid, salivary glands) as part of a diagnostic US examination. In part II, the use of SWE in the pancreas, spleen, kidney, prostate, scrotum, musculoskeletal system, lymph nodes and future developments are discussed.

Combined Use of Shear Wave Elastography, Microvascular Doppler Ultrasound Technique, and BI-RADS for the Differentiation of Benign and Malignant Breast Masses.

ObjectiveTo evaluate the value of the combined use of Breast Imaging Reporting and Data System (BI-RADS), qualitative shear wave elastography (SWE), and AngioPLUS microvascular Doppler ultrasound technique (AP) for distinguishing benign and malignant breast masses.Materials and MethodsA total of 210 pathologically confirmed breast lesions in 210 patients were reviewed using BI-RADS, qualitative SWE, and AP. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and area under the receiver operating characteristic curve (AUC) of BI-RADS and the combination of qualitative SWE and/or AP with BI-RADS were compared, respectively.ResultsCompared with using BI-RADS alone, the use of combined qualitative SWE and/or AP with BI-RADS had higher AUC values (P < 0.001). Besides this, the combination of qualitative SWE and AP with BI-RADS had the best diagnostic performance for differentiating between benign and malignant masses. When AP and SWE were combined with BI-RADS, 49/76 benign masses were downgraded from BI-RADS category 4a into BI-RADS category 3, while no benign masses were upgraded from BI-RADS category 3 into BI-RADS category 4a. Three sub-centimeter malignant masses were downgraded from BI-RADS category 4a into BI-RADS category 3, while three malignant masses remain in BI-RADS category 3 due to a benign manifestation in both AP and qualitative SWE. Moreover, 5/6 of them were sub-centimeter masses, and 4/6 of them were intraductal carcinoma. The sensitivity, specificity, PPV, NPV, accuracy, and AUC were 91.0%, 81.1%, 69.3%, 95.1%, 84.3%, and 0.861 (95% confidence interval, 0.806–0.916; P < 0.001), respectively. Compared with BI-RADS alone, the sensitivity slightly decreased, while the specificity, PPV, NPV, and accuracy were significantly improved.ConclusionCombination of qualitative SWE and AP with BI-RADS improved the diagnostic performance in differentiating benign from malignant breast lesions, which is helpful for avoiding unnecessary biopsies. However, we should be careful about the downgrading of sub-centimeter BI-RADS 4a category lesions.