Virtual Touch Quantification Research Articles

Preoperative discrimination of invasive and non-invasive breast cancer using machine learning based on automated breast volume scanning (ABVS) radiomics and virtual touch quantification (VTQ)

PurposeEvaluating the efficacy of machine learning for preoperative differentiation between invasive and non-invasive breast cancer through integrated automated breast volume scanning (ABVS) radiomics and virtual touch quantification (VTQ) techniques.MethodsWe conducted an extensive retrospective analysis on a cohort of 171 breast cancer patients, differentiating them into 124 invasive and 47 non-invasive cases. The data was meticulously divided into a training set (n = 119) and a validation set (n = 52), maintaining a 70:30 ratio. Several machine learning models were developed and tested, including Logistic Regression (LR), Random Forest (RF), Decision Tree (DT), and Support Vector Machine (SVM). Their performance was evaluated using the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC), and visualized the feature contributions of the optimal model using Shapley Additive Explanations (SHAP).ResultsThrough both univariate and multivariate logistic regression analyses, we identified key independent predictors in differentiating between invasive and non-invasive breast cancer types: coronal plane features, Shear Wave Velocity (SWV), and Radscore. The AUC scores for our machine learning models varied, ranging from 0.625 to 0.880, with the DT model demonstrating a notably high AUC of 0.874 in the validation set.ConclusionOur findings indicate that machine learning models, which integrate ABVS radiomics and VTQ, are significantly effective in preoperatively distinguishing between invasive and non-invasive breast cancer. Particularly, the DT model stood out in the validation set, establishing it as the primary model in our study. This highlights its potential utility in enhancing clinical decision-making processes.

The Value of Follow-Up Liver Stiffness Changes Measured by Virtual Touch Quantification Elastography for Predicting Recurrence of Gastroesophageal Varices after Endoscopic Injection Sclerotherapy on Cirrhotic Patients.

Recurrence of gastroesophageal varices (GEVs) after sclerotherapy is a public health problem. However, mass screening of recurrence of GEVs through gastroscopy is a high-cost procedure. We aim to evaluate the changes in liver stiffness (LS) over time after endoscopic injection sclerotherapy (EIS) and determine its value in predicting the recurrence of GEVs. One hundred and thirty-five patients with GEVs who underwent EIS treatment were included in this study. The patients were divided into two groups, namely, the nonrecurrence and recurrence groups, based on endoscopic findings at 6 months after discharge. LS measurements were obtained on five occasions. Repeated measure analysis of variance was employed to assess LS differences at different time points and compare them between the two groups. The LS values during the 6-month postdischarge period were consistently higher than the baseline value (measured on the day of hospitalization). The recurrence group demonstrated sustained elevated LS levels throughout the 6-month follow-up period, while the nonrecurrence group showed a gradual decline in LS. The difference in LS trend between the two groups was statistically significant (P = 0.04). The area under the curve (AUC) values for LS differences were 0.806, with a corresponding 95% confidence interval (CI) of 0.640-0.918 and a cut-off value of 0.556, indicating their potential utility in predicting GEV recurrence. Longitudinal assessment of LS values in post-EIS patients can provide valuable information for predicting the recurrence of GEVs.

Efficacy of Virtual Touch Quantification Technique for Differentiating Patients with Immunoglobulin A Nephropathy (IgAN) from Healthy Controls

Background: The virtual touch quantification (VTQ) using acoustic radiation force impulse (ARFI) is a type of ARFI technology, which has been widely used against many diseases. The sensitivity and specificity of VTQ in differentiating immunoglobulin A nephropathy (IgAN) patients from healthy controls remain unestablished. Objectives: The present study aimed to measure the VTQ values of renal parenchyma in patients with IgAN and to evaluate the efficacy of these values in distinguishing IgAN patients from healthy individuals. Patients and Methods: Ultrasound examinations were performed for the experimental and control groups. All routine ultrasound data, including the renal parenchymal thickness, renal volume, resistive index (RI) of interlobar renal arteries, and peak velocity of interlobar renal arteries, were collected. The VTQ values were measured in the middle and lower renal parenchyma using the VTQ technique. A receiver operating characteristic (ROC) curve was plotted to evaluate the efficacy of VTQ in differentiating IgAN patients from healthy individuals. Results: The VTQ values, RI values of interlobar arteries, and peak velocity of interlobar arteries were significantly different between patients with IgAN and the controls (2.14 ± 0.31 vs. 2.62 ± 0.24 m/s, 0.68 ± 0.05 vs. 0.63 ± 0.03 m/s, and 0.56 ± 0.59 vs. 0.60 ± 0.58 m/s; P < 0.05 for all). The VTQ values were associated with the renal parenchymal thickness, peak flow velocity of interlobular arteries, and Lee’s grade (P < 0.05 for all). The ROC curve analysis revealed that VTQ values might be used as a diagnostic method for differentiating IgAN patients (area under the curve [AUC] = 0.909) from healthy controls. Conclusion: The VTQ values significantly decreased in patients with IgAN and might play an important role in distinguishing IgAN patients from healthy individuals, with high sensitivity and specificity.

Sonoelastographic evaluation of salivary gland lesions with clinicopathological association

Sonoelastography is a comparatively new and developing technology in the field of salivary gland imaging. Nevertheless, it has the potential to distinguish between various types of lesions by calculating the degree of strain-related deformation under the externally applied force. With this background, the present study was undertaken to evaluate the role of sonoelastography in characterising salivary gland lesions as benign or malignant.
 The aim: To evaluate and characterize salivary Gland lesions on the Gray scale and Colour doppler ultrasonography and sonoelastography and to correlate these findings with the clinico-pathological diagnosis.
 Methodology: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre, Moradabad (U.P.), from Aug 2021 to Nov 2022. All patients referred to the radiology department for imaging with clinical suspicion of having salivary gland lesions were enrolled in the study and evaluated on the SIEMENS ACUSON S3000 machine. Gray scale USG was done first to assess various morphological features of lesions, and then a Doppler assessment was done to determine vascularity within the lesion. Subsequently, real-time strain elastography (eSie touch) was performed to assess the tissue stiffness. The elastogram image of the detected lesions was evaluated using colour coding ranging from blue (soft) through green (intermediate/average hardness) and red (hard). After strain elastography, shear wave elastography of the lesion was also performed using Virtual Touch Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) software. The sonographic findings were correlated with histopathological diagnosis. The acquired data were subjected to statistical analysis using the software SPSS version 20. Sensitivity, specificity, PPV and NPV were calculated for conventional ultrasound techniques alone & in combination with elastography.
 Results: Out of the 50 salivary gland lesions included in the study, 44 (88 %) were benign, whereas 6 (12 %) were malignant on cytology. The age of the study population ranged from 16 to 75 years, with a mean age of 38.82 years. Pleomorphic adenoma (60 %) was the most frequent lesion, followed by Warthin's tumour (28 %). The Conventional USG showed 66.67 %, sensitivity, 52.27 %, specificity, 16.00 %, PPV, 92.00 % NPV and 54.00 % accuracy in differentiating benign from malignant lesions while USG- Elastography combined showed higher diagnostic performance with 83.33 %, sensitivity, 79.55 %, specificity, 35.71 % PPV, 97.22 % NPV and 80.00 %, accuracy. The specific cut-off scores for the sonoelastography score, eSie touch, VTQ, and VTIQ were also determined to diagnose a lesion as malignant or benign, and the difference was found to be statistically significant.
 Conclusions: Sonoelastography alone cannot be solely relied upon to distinguish between malignant & benign salivary gland abnormalities. However, it can be combined with conventional USG for better differentiation and characterization of these lesions

Association between diagnostic efficacy of acoustic radiation force impulse for benign and malignant thyroid nodules and the presence or absence of non-papillary thyroid cancer: A meta-analysis.

The aim of this study was to investigate the diagnostic efficacy of Acoustic Radiation Force Impulse (ARFI) for benign and malignant thyroid nodules in the presence and absence of non-papillary thyroid cancer (NPTC) and to determine the cut-off values of Shear Wave Velocity (SWV) for the highest diagnostic efficacy of Virtual Touch Quantification (VTQ) and Virtual Touch Tissue Imaging and Quantification (VTIQ). The diagnostic accuracy of ARFI for benign and malignant thyroid nodules was assessed by pooling sensitivity, specificity and area under the curve (AUC) in each group in the presence and absence of both non-papillary thyroid glands, using histology and cytology as the gold standard. All included studies were divided into two groups according to VTQ and VTIQ, and each group was ranked according to the magnitude of the SWV cutoff value to determine the SWV cutoff interval with the highest diagnostic efficacy for VTQ and VTIQ. A total of 57 studies were collected on the evaluation of ARFI for the diagnosis of benign and malignant thyroid nodules. The results showed that the presence of non-papillary thyroid carcinoma led to differences in the specificity of VTIQ for the identification of benign and malignant thyroid nodules, and the differences were statistically significant. In addition, the diagnostic efficacy of VTQ was best when the cutoff value of SWV was in the interval of 2.48-2.55m/s, and the diagnostic efficacy of VTIQ was best when the cutoff value of SWV was in the interval of 3.01-3.15m/s. VTQ and VTIQ have a high diagnostic value for benign and malignant thyroid nodules; however, when the malignant nodules in the study contain non-papillary thyroid carcinoma occupying the thyroid gland, the findings should be viewed in a comprehensive manner.

Validation of a screening algorithm for hepatic fibrosis by Doppler ultrasound and elastography in a general population.

Early detection can prevent the initial stages of fibrosis from progressing to cirrhosis. To evaluate an algorithm combining three echographic indicators and elastographic measurements to screen for hepatic fibrosis in an unselected population. From May 2017 to June 2018, all patients with no history and no known chronic liver disease who were referred for an ultrasound (US) were prospectively included in eight hospitals. The indicators being sought were liver surface irregularity, demodulation of hepatic veins, and spleen length >110 mm. Patients presenting at least one of these underwent elastography measurements with virtual touch quantification (VTQ) or supersonic shear imaging (SSI). If elastography was positive, patients were referred to hepatologist for fibrosis evaluation. Reference standard was obtained by FibroMeterVCTE or biopsy. A FibroMeterVCTE result >0.384 indicated a "necessary referral" to a hepatologist. Of the 1501 patients included, 504 (33.6%) were positive for at least one US indicator. All of them underwent US elastography, with 85 being positive. Of the patients, 58 (3.6%) had a consultation with a liver specialist: 21 had positive FibroMeterVCTE and nine had an indication of biopsy for suspicion of fibrosis. This screening algorithm made it possible to diagnose 1.6% of patients in our population with unknown fibrosis. Of the patients, 50% referred to the liver specialist were "necessary referrals." Our study suggests that three simple US indicators with no systematic elastographic measurement could be applied in day-to-day practice to look for hepatic fibrosis in an unsuspected population allowing relevant referrals to a hepatologist.

Clinical Significance of Shear Wave Ultrasound Elastography in Patients With Idiopathic Adhesive Capsulitis: Can It Be Used Instead of Magnetic Resonance Imaging as an Early Indicator?

The aim of this study was to evaluate the elasticity of the supraspinatus (SSp) and infraspinatus (ISp) tendons and coracohumeral ligament (CHL), as well as the thickness of CHL in patients diagnosed with adhesive capsulitis (AC) using ultrasound (US) and 2D shear wave elastography (2D-SWE), determining their contributions to diagnosis and stage differentiation.This prospective case-control study was conducted between January 2020 and May 2021. In all cases, the ultrasound examinations were performed using the virtual touch quantification and expressed as shear wave velocity (SWV) in meters per second. After US examinations, magnetic resonance imaging (MRI) was planned for all cases.The measurements made in US and MRI revealed that CHL thicknesses and SWV values of CHL and SSp and ISp tendons were statistically substantially higher in the patient group. The diagnostic performance of 2D-SWE in predicting AC was evaluated using receiver operating characteristics curve analysis. When the cutoff value of the mean SWE for CHL was taken as 4.67 m/s, the sensitivity of SWE was found to be 90.2% and the specificity 85.7%.Our study results suggest that CHL thickness on B-mode US, as well as SWV values of CHL and SSp and ISp tendons in 2D-SWE examination, can be used as a useful tool for AC diagnosis without the need for MRI, a costly and time-consuming examination.

MO099: Elastography in the Assessment of Chronic Kidney Disease: A Meta-Analysis

Abstract BACKGROUND AND AIMS We require an imagistic quantitative technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in the last years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic. METHOD The databases of PubMed, Medscape and Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (KSWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results and outcome data were all collected from each study according to a set protocol. RESULTS We found 33 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of KSWS between studies, we found increased heterogeneity Q = 513.133; DF = 10; P < .001, I2 (inconsistency) = 98.12% (95% CI for I2 97.52–98.57%). With a standardized mean difference of –0.216, patients with CKD have a lower KSWS than healthy controls. A positive association between KSWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, P < .001), Q = 73.3, DF = 5, P < .001, I2 = 93.18% (95% CI for I2 87.86–96.18). The pooled area under the ROC curve for KSWS to predict mild renal disease was 0.831 (95% CI, P < .001), Q = 28.32, DF = 6, P = .0001, I2 = 78.8% (95% CI for I2 56.37–89.72). In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve values are used to compare distinct characteristics (differentiating KSWS between mildly and moderately impaired kidneys, between non-diabetic, prediabetic and diabetic patients, or KSWS between CKD and control group), therefore not being suitable for further evaluation. CONCLUSION The results show that patients with CKD have a lower KSWS than healthy controls. It remains a viable method for monitoring the progression of CKD but because the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity more research is needed to determine which factors actually influence KSWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice.

Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis

Background: We require an quantitative imaging technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in recent years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic. Methods: The databases of PubMed, Medscape, Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (SWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results, and outcome data were all collected from each study according to a set protocol. Results: We found 37 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of kidney SWS between studies we found increased heterogeneity Q = 513.133; DF = 10; p < 0001, I2 (inconsistency) = 98.12% (95% CI for I2 97.52–98.57%). With a standardized mean difference of −0.216, patients with CKD have a lower kidney SWS than healthy controls. A positive association between kidney SWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, p < 0.001), Q = 73.3, DF = 5, p < 000.1, I2 = 93.18% (95% CI for I2 87.86 to 96.18). The pooled area under the ROC curve for kidney SWS to predict chronic kidney disease was 0.831 (95% CI, p < 0.001), Q = 28.32, DF = 6, p = 0.0001, I2 = 78.8% (95% CI for I2 56.37 to 89.72). In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve (AUC) values are used to compare distinct characteristics (differentiating kidney SWS between mildly and moderately impaired kidneys, between non-diabetic/prediabetic/diabetic patients, or kidney SWS between the CKD and control group), therefore not being suitable for further evaluation. Conclusions: The results show that patients with CKD have a lower kidney SWS than healthy controls. However, the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity. Further research is needed to determine which factors actually influence kidney SWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice.

Liver stiffness measured by virtual touch quantification predicts the occurrence of posthepatectomy refractory ascites in patients with hepatocellular carcinoma.

This study assessed the significance of measuring liver stiffness using virtual touch quantification before hepatectomy to predict posthepatectomy refractory ascites. A total of 267 patients with hepatocellular carcinoma who underwent hepatectomy were prospectively analyzed. Liver stiffness was defined as the median value of the virtual touch quantification (Vs; m/s) by acoustic radio-force-impulse-based virtual touch. A multivariate analysis showed that Vs and the aspartate aminotransferase-to-platelet ratio index were independent risk factors for postoperative refractory ascites (odds ratio = 3.27 and 3.08, respectively). The cutoff value for Vs was 1.52m/s (sensitivity: 59.5%, specificity: 88.6%) as determined by the analysis of the receiver-operating characteristic curve, and the area under the receiver-operating characteristic curve was 0.79. The cutoff value for the aspartate aminotransferase-to-platelet ratio was 0.952 (sensitivity: 65.5%, specificity: 82.9%), and the area under the receiver-operating characteristic curve was 0.75. Vs is an independent risk factor for refractory ascites after hepatectomy. The measurement of liver stiffness by virtual touch quantification before hepatectomy can help estimate the risk of postoperative refractory ascites. Nonsurgical treatments should be considered for the management of patients who are at high risk for refractory ascites.

Application of virtual touch tissue imaging quantification in diagnosis of supraspinatus tendon injury.

To explore the value of virtual touch imaging and quantification (VTIQ) shear wave elastography (SWE) in diagnosis of supraspinatus tendon tear. Eighty patients with unilateral supraspinatus tendon tear underwent shoulder arthroscopy were prospective studied. Tendinopathy, partial-thickness tear or full-thickness tear of supraspinatus tendon were diagnosed according 2D ultrasound examination. Sensitivity, specificity and accuracy of ultrasonic diagnosis of supraspinatus tendon tear were calculated by arthroscopy as the gold standard. VTIQ was applied to measure the shear-wave velocity (SWV) of both normal and affected supraspinatus tendon. The differences of SWV in three types of supraspinatus tendon tear and receiver operating characteristic (ROC) curves were analyzed. Among 80 patients, there were 20 tendinopathy, 31 partial tears and 29 full-thickness tears diagnosed by shoulder arthroscopy. Sensitivity, specificity and accuracy of 2D ultrasound in diagnosis of tendinopathy, partial tear and full-thickness tear groups were 78%, 90%and 83%; 71%, 86%and 73%; 86%, 88%and 88%, respectively. SWV of 80 supraspinatus tendon tears was 4.59±1.00 m/s, which was lower than that of normal supraspinatus tendon (4.59±1.00 m/s vs. 6.68±1.05 m/s, P < 0.01). SWV of supraspinatus tendon in tendinopathy, partial tear and full-thickness tear groups respectively were 5.66±0.97, 4.66±1.00, and 3.78±0.55 m/s, all lower than that of the contralateral normal supraspinatus tendon (all P < 0.05). In addition, the analysis of variance and pairwise comparison showed that SWV of supraspinatus tendon among three different degree of injury was statistically significant (all P < 0.001). The cutoff thresholds of SWV was 4.83 m/s to identify tendinopathy tear from partial tear and was 4.08 m/s to identify full-thickness tear from partial-thickness tear. VTIQ SWE with SWV might identify degree of supraspinatus tendon tear and improve the value of ultrasonography, which should be further evaluated in large multicenter studies.

Automated breast volume scanning combined with shear wave elastography for diagnosis of triple-negative breast cancer and human epidermal growth factor receptor 2-positive breast cancer.

To explore the values of automated breast volume scanning (ABVS) combined with shear wave elastography (SWE) in the differential diagnosis of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2-positive breast cancers (HER2+BC). In this study, 28 patients with TNBC and 32 patients with HER2+BC were enrolled. The characteristics of ABVS and virtual touch quantification (VTQ) in SWE of all patients were reviewed. The multivariate logistic regression analysis was carried out and the receiver operating characteristic curves of ABVS and ABVS+VTQ were drawn. In ABVS imaging, the microcalcification, posterior echo, internal echo, shape, and edge had significant difference between TNBC and HER2+BC groups (p<0.05). The regular shape was the independent factor for TNBC (p=0.04, odds ratio [OR]=4.479), and the microcalcification in mass was the independent factor for HER2+BC (p=0.01, OR=2.997). In VTQ imaging, the shear wave velocity (SWV)max, SWVmin, and SWVmean in TNBC group were significantly lower than those in HER2+BC group (p<0.001). The sensitivity, specificity, and accuracy of ABVS+VTQ in diagnosing TNBC were higher than those of ABVS alone. ABVS combined with SWE has certain advantages in differentiating TNBC from HER2+BC, which is helpful for the treatment planning and prognosis judgment.

Acoustic radiation force impulse elastography findings of achilles tendon in patients with hypothyroidism

Introduction&#x0D; The aim of our study was to investigate the effect of thyroid dysfunction on tendons and the contribution of Acoustic Radiation Force Impulse (ARFI) elastography to the diagnosis of tendinopathy.&#x0D; Methods&#x0D; Eighty Achilles tendons of 40 patients under levothyroxine treatment, who had previously known hypothyroidism but high serum thyroid stimulating hormone levels, and 80 Achilles tendons of 40 healthy individuals were evaluated with ARFI (Virtual Touch Quantification®). 19 of 40 of the patients with hypotiroidism’ Achilles tendons were re-evaluated after thyroid stimulating hormone levels reached to normal limits following the adjustments in thyroid hormone replacement therapy. The middle portion of the each Achilles tendon was chosen for the examination. Every examination consisted of three to five independent measurements (shear wave velocity- meters per second). The mean shear wave velocity value was calculated for each tendon, and used for statistical analysis.&#x0D; Results&#x0D; The stiffness values of both left and right Achilles tendons, represented as shear wave velocity, were similar in patients with hypothyroidism and control group. There was no significant difference between the Achilles tendon shear wave velocity measurements of 19 of 40 hypothyroidism patients who were re-evaluated after the adjustments in thyroid hormone replacement therapy.&#x0D; Conclusions&#x0D; The lack of significant difference in Achilles tendon stiffness between non-naive hypothyroid patients and the control group may be explained as a positive clinical effect of thyroid hormone replacement therapy.

The impact of elastography with virtual touch quantification of future remnant liver before major hepatectomy.

Liver elastography with virtual touch quantification (VTQ) measures the velocity of the shear wave generated by a short-duration acoustic force impulse, with values expressed in units of velocity (m/s). VTQ can evaluate right or left hepatic lobes separately. VTQ might be appropriate for the evaluation of future remnant liver after hepatectomy. We analyzed 95 patients underwent liver elastography with VTQ and both future remnant liver and resected side before hepatectomy of more than two sections, except for central bisectionectomy. We divided the patients into a high VTQ group (≥1.52 m/s, n=37, 39%) and a low VTQ group (<1.52 m/s, n=58, 61%) according to the VTQ of future remnant liver. Transient elastography could not be performed in 22 cases due to tumor size. We defined the group with liver stiffness measurement (LSM) ≥7.9 kPa as the high LSM group (n=29, 40%) and those with LSM <7.9 kPa as the low LSM group (n=44, 60%). We investigated the outcome after hepatectomy and the correlations between the VTQ of future remnant liver and other indicators for hepatic fibrosis. The high VTQ group showed significantly higher postoperative ascites (19% vs. 3%; P=0.01), pathological fibrosis (19% vs. 5%; P=0.03), and rates of patients with postoperative T-bil ≥2.0 mg/dL (70% vs. 40%; P<0.01). The high LSM group showed no significant postoperative outcomes compared to the low LSM group. The high VTQ group showed a higher frequency of male gender (78% vs. 57%; P=0.03), higher indocyanine green retention rate at 15 min (ICGR15) (10.5% vs. 6.3%; P<0.01), hyaluronic acid (100 vs. 67 ng/mL; P=0.02), type IV collagen 7S (7.6 vs. 5.1 ng/mL; P<0.01), Mac-2 binding protein glycan isomer (M2BPGi) (1.19 vs. 1.00; P=0.01), Fibrosis-4 (FIB-4) index (2.25 vs. 1.76; P=0.01), and aspartate aminotransferase to platelet ratio index (APRI) score (0.64 vs. 0.41; P<0.01). We also observed an especially strong positive correlation between the high VTQ and hyaluronic acid or type IV collagen 7S. Elastography with VTQ for future remnant liver before major hepatectomy is an accurate and useful method as a preoperative evaluation.

Is There a Place for Elastography in the Diagnosis of Hepatocellular Carcinoma?

Background and Aims: Elastography can provide information regarding tissue stiffness (TS). This study aimed to analyze the elastographic features of hepatocellular carcinoma (HCC) and the factors that influence intratumoral elastographic variability in patients with liver cirrhosis. Methods: This prospective study included 115 patients with liver cirrhosis and hepatocellular carcinoma evaluated between June 2016–November 2019. A total of 88 HCC nodules visualized in conventional abdominal ultrasound (US) met the inclusion criteria and underwent elastographic evaluation. Elastographic measurements (EM) were performed in HCC and liver parenchyma using VTQ (Virtual Touch Quantification), a point shear wave elastography (pSWE) technique. In all patients, we performed contrast-enhanced ultrasound (CEUS), and the final diagnosis of HCC was established by contrast-enhanced-CT or contrast-enhanced-MRI. Results: The mean VTQ values in HCCs were 2.16 ± 0.75 m/s. TS was significantly lower in HCCs than in the surrounding liver parenchyma 2.16 ± 0.75 m/s vs. 2.78 ± 0.92 (p < 0.001). We did not find significant differences between the first five and the last five EM, and the intra-observer reproducibility was excellent ICC: 0.902 (95% CI: 0.87–0.950). However, the tumor size, heterogeneity, and depth correlated with higher intralesional stiffness variability (p < 0.001). Conclusions: VTQ brings additional information for HCC characterization. Intra-observer reproducibility for both HCC and liver parenchyma was excellent. Knowing the stiffness of HCC’s might endorse an algorithm-based approach towards focal liver lesions (FLLs) in liver cirrhosis.

Cystic fibrosis and noninvasive liver fibrosis assessment methods in children.

Noninvasive assessments of liver fibrosis are currently used to evaluate cystic fibrosis (CF)-related liver disease. However, there is scarce data regarding their repeatability and reproducibility, especially in children with CF. The present study aimed to evaluate the repeatability and reproducibility of transient elastography (TE) (FibroScan®) and point shear-wave elastography using virtual touch quantification (pSWE VTQ) in children with CF. TE and pSWE VTQ were performed in 56 children with CF by two different operators. Analysis of repeatability and reproducibility was available in 33 patients for TE and 46 patients for pSWE VTQ. Intra- and interobserver agreement were assessed using the intraclass correlation coefficient (ICC) and their 95% confidence interval (CI), and Bland and Altman graphs. For TE, ICC was 0.91 (0.83-0.95) for intraobserver agreement and 0.92 (95% CI: 0.86-0.96) for interobserver agreement. For pSWE VTQ, ICC was 0.83 (0.72-0.90) for intraobserver agreement and 0.67 (0.48-0.80) for interobserver agreement. Both technics can be proposed in the follow-up of patients, according to their availability in CF centers. This study shows that TE and pSWE VTQ are reliable methods to evaluate liver fibrosis in children with CF. This study shows for the first time that TE and pSWE VTQ are both repeatable and reproducible in children with CF. These data indicate that both TE and pSWE VTQ can be proposed for the follow-up of patients with CF, according to their availability in each CF center.

Severity of liver fibrosis using shear wave elastography is influenced by hepatic necroinflammation in chronic hepatitis patients, but not in cirrhotic patients.

Shear wave elastography (SWE) in patients with chronic liver diseases is a noninvasive useful method for the diagnosis of liver fibrosis severity, which can be an alternative to liver biopsy. However, the liver stiffness measurement using SWE can be affected by various factors including hepatic inflammation, extrahepatic cholestasis, heart failure, and underlying liver diseases. The aim of this study is to clarify the correlation between liver stiffness using SWE and hepatic necroinflammation serologically and pathologically. A total of 843 patients with chronic liver disease who received liver biopsy were analyzed. Liver stiffness measurement using transient elastography (TE) and virtual touch quantification (VTQ) were carried out on the same day as the liver biopsy. The correlation between SWE and hepatic inflammation was analyzed serologically and pathologically. The liver stiffness values increased significantly with the progression of liver fibrosis and inflammation (overall p<0.001). In patients with F0-1, F2, and F3, TE and VTQ values of A2 or A3 were significantly higher than those of A0 or A1 (p value, all <0.05), but not in patients with F4. The median alanine aminotransferase (ALT) values increased significantly with the progression of liver inflammation (p<0.001). Moreover, TE and VTQ in patients with ALT ≥70IU/L were significantly higher than those in patients with ALT <70 IU/L (p<0.01), but not in patients with F4. Shear wave elastography can be affected by hepatic necroinflammation in F0-F3 fibrosis, but not in F4.

Blood angiopoietin-2 predicts liver angiogenesis and fibrosis in hepatitis C patients

BackgroundPathological angiogenesis is involved in the development of hepatocellular carcinoma. In patients with chronic hepatitis C (CHC), the level of angiogenic factor angiopoietin (ANGP)-2 is reported to be increased in the blood, correlating with fibrosis. In this study, we aimed to clarify whether blood ANGP-2 is useful as a biomarker for liver angiogenesis and fibrosis in CHC patients and to further reveal the relationship between such pathology in a carbon tetrachloride (CCl4)-treated liver fibrosis mouse model.MethodsPlasma levels of ANGP-2, expression of a liver sinusoidal endothelial cell (LSEC) marker (CD31), collagen deposition (Sirius Red staining) in the liver, clinical fibrosis markers (Mac-2 binding protein glycosylation isomer, virtual touch quantification, and liver stiffness measurement), and liver function (albumin bilirubin score) were examined in CHC patients. To determine the effects of an anti-angiogenic agent on liver fibrosis in vivo, sorafenib was administered to the CCl4-treated mice (BALB/c male).ResultsThe plasma levels of ANGP-2 were increased in CHC patients compared to healthy volunteers and decreased by the eradication of hepatitis C with direct-acting antivirals. In addition, plasma ANGP-2 levels were correlated with CD31 expression, collagen deposition, clinical fibrosis markers, and liver function. Sorafenib inhibited liver angiogenesis and fibrosis in the CCl4-treated mice and was accompanied by decreased ANGP-2 expression in LSECs.ConclusionsANGP-2 may serve as a useful biomarker for liver angiogenesis and fibrosis in CHC patients. In addition, angiogenesis and fibrosis may be closely related.

The role of acoustic radiation force impulse imaging in the diagnosis of cervical carcinoma

Aim: To investigate the diagnostic value of acoustic radiation force impulse imaging in the detection of cervical cancer, and to assess the contribution of this imaging method in distinguishing histological subtypes of cervical carcinoma.Materials and Methods: Twenty four patients with malignant cervical mass and 25 healthy volunteers were included in this prospective study. Ultrasonographic evaluation were performed using a 3.5–6-MHz convex abdominal transducer and adequate software for performing elastographic examinations in quantitative acoustic radiation force impulse mode (Virtual Touch Quantification®). Every examination consisted of at least three independent shear wave velocity measurements. The mean shear wave velocity values were calculated, and used for statistical analysis. Postoperative pathology results of the lesions were used as the reference standard.Results: The mean shear wave velocity values were calculated as 2.79±1.03 m/s in cervical carcinomas, and as 1.86±0.62 m/s in control group. The mean shear wave velocity value of cervical carcinomas was significantly higher than the control group (p=0.003). The mean shear wave velocity values in squamous carcinoma, adenocarcinoma, and adenosquamous carcinoma subtypes were calculated as 2.78±0.93 m/s, 3.16±1.46 m/s, and 1.90±0.21 m/s, respectively. There were no significant differences between cervical carcinoma subtypes in terms of their shear wave velocity values (p=0.247).Conclusion: Acoustic radiation force impulse imaging is a non-invasive and cost-effective, promising adjunct modality that enables objective quantitative measurement, which may contribute to the diagnosis of malignant cervical masses.

SAT270 - Virtual touch quantification using acoustic radiation force impulse technology versus transient elastography for the non-invasive assessment of liver fibrosis in patients with chronic hepatitis B or C using liver biopsy as gold standard

SAT270 - Virtual touch quantification using acoustic radiation force impulse technology versus transient elastography for the non-invasive assessment of liver fibrosis in patients with chronic hepatitis B or C using liver biopsy as gold standard