Elastography is a non-invasive medical imaging technique to map the spatial variation of elastic properties of soft tissues.The quality of reconstruction results in elastography is highly sensitive to the noise induce...Elastography is a non-invasive medical imaging technique to map the spatial variation of elastic properties of soft tissues.The quality of reconstruction results in elastography is highly sensitive to the noise induced by imaging measurements and processing.To address this issue,we propose a deep learning(DL)model based on conditional Generative Adversarial Networks(cGANs)to improve the quality of nonhomogeneous shear modulus reconstruction.To train this model,we generated a synthetic displacement field with finite element simulation under known nonhomogeneous shear modulus distribution.Both the simulated and experimental displacement fields are used to validate the proposed method.The reconstructed results demonstrate that the DL model with synthetic training data is able to improve the quality of the reconstruction compared with the well-established optimization method.Moreover,we emphasize that our DL model is only trained on synthetic data.This might provide a way to alleviate the challenge of obtaining clinical or experimental data in elastography.Overall,this work addresses several fatal issues in applying the DL technique into elastography,and the proposed method has shown great potential in improving the accuracy of the disease diagnosis in clinical medicine.展开更多
BACKGROUND Integrating conventional ultrasound features with 2D shear wave elastography(2D-SWE)can potentially enhance preoperative hepatocellular carcinoma(HCC)predictions.AIM To develop a 2D-SWE-based predictive mod...BACKGROUND Integrating conventional ultrasound features with 2D shear wave elastography(2D-SWE)can potentially enhance preoperative hepatocellular carcinoma(HCC)predictions.AIM To develop a 2D-SWE-based predictive model for preoperative identification of HCC.METHODS A retrospective analysis of 884 patients who underwent liver resection and pathology evaluation from February 2021 to August 2023 was conducted at the Oriental Hepatobiliary Surgery Hospital.The patients were divided into the modeling group(n=720)and the control group(n=164).The study included conventional ultrasound,2D-SWE,and preoperative laboratory tests.Multiple logistic regression was used to identify independent predictive factors for RESULTS In the modeling group analysis,maximal elasticity(Emax)of tumors and their peripheries,platelet count,cirrhosis,and blood flow were independent risk indicators for malignancies.These factors yielded an area under the curve of 0.77(95%confidence interval:0.73-0.81)with 84%sensitivity and 61%specificity.The model demonstrated good calibration in both the construction and validation cohorts,as shown by the calibration graph and Hosmer-Lemeshow test(P=0.683 and P=0.658,respectively).Additionally,the mean elasticity(Emean)of the tumor periphery was identified as a risk factor for microvascular invasion(MVI)in malignant liver tumors(P=0.003).Patients receiving antiviral treatment differed significantly in platelet count(P=0.002),Emax of tumors(P=0.033),Emean of tumors(P=0.042),Emax at tumor periphery(P<0.001),and Emean at tumor periphery(P=0.003).CONCLUSION 2D-SWE’s hardness value serves as a valuable marker for enhancing the preoperative diagnosis of malignant liver lesions,correlating significantly with MVI and antiviral treatment efficacy.展开更多
BACKGROUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent addit...BACKGROUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis progression.The assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWE).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with DAAs.AIM To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus(HCV).METHODS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV clearance.In accordance with the study protocol,a qualitative and quantitative analysis of the evidence was planned.RESULTS At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source data.There was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CONCLUSION SWE could be a promising tool for prediction of HCC occurrence in patients treated with DAAs.Further studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.展开更多
BACKGROUND Real-time shear wave elastography(SWE)is a non-invasive imaging technique used to measure tissue stiffness by generating and tracking shear waves in real time.This advanced ultrasound-based method provides ...BACKGROUND Real-time shear wave elastography(SWE)is a non-invasive imaging technique used to measure tissue stiffness by generating and tracking shear waves in real time.This advanced ultrasound-based method provides quantitative information regarding tissue elasticity,offering valuable insights into the mechanical properties of biological tissues.However,the application of real-time SWE in the musculoskeletal system and sports medicine has not been extensively studied.AIM To explore the practical value of real-time SWE for assessing Achilles tendon hardness in older adults.METHODS A total of 60 participants were enrolled in the present study,and differences in the elastic moduli of the bilateral Achilles tendons were compared among the following categories:(1)Age:55-60,60-65,and 65-70-years-old;(2)Sex:Male and female;(3)Laterality:Left and right sides;(4)Tendon state:Relaxed and tense state;and(5)Tendon segment:Proximal,middle,and distal.RESULTS There were no significant differences in the elastic moduli of the bilateral Achilles tendons when comparing by age or sex(P>0.05).There were,however,significant differences when comparing by tendon side,state,or segment(P<0.05).CONCLUSION Real-time SWE plays a significant role compared to other examination methods in the evaluation of Achilles tendon hardness in older adults.展开更多
Magnetic resonance imaging is the gold standard compared other clinical fin-dings.But shear wave elastography technique combined with endoscopic ultra-sound can evaluate the degree of fibrosis of fistula tissue in Cr...Magnetic resonance imaging is the gold standard compared other clinical fin-dings.But shear wave elastography technique combined with endoscopic ultra-sound can evaluate the degree of fibrosis of fistula tissue in Crohn’s disease patients.This topic is highly relevant to the current discourse,especially for It shows a certain degree of innovation and practicality and is worthy of study and popularization.展开更多
BACKGROUND Breast cancer morbidity has been increasing worldwide,but treatments are improving.The therapeutic response depends on the stage at which the disease is diagnosed.Therefore,early diagnosis has never been mo...BACKGROUND Breast cancer morbidity has been increasing worldwide,but treatments are improving.The therapeutic response depends on the stage at which the disease is diagnosed.Therefore,early diagnosis has never been more essential for successful treatment and a reduction in mortality rates.Radiology plays a pivotal role in cancer detection,and advances in ultrasound(US)palpation have shown promising results for breast cancer imaging.The addition of two-dimensional-shear wave elastography(2D-SWE)US in the routine breast imaging exam can increase early cancer detection and promote better surveillance.AIM To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities.METHODS The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions.All patients underwent mammography,bright mode(B-mode)US,and 2D-SWE followed by US-guided biopsy in two consecutive sessions.RESULTS Combining B-mode and shear wave US imaging with X-ray mammography revealed 100%of the suspicious lesions,resulting in greater sensitivity,specificity,and negative predictive value.The result improves compared to either B-mode or 2D-SWE alone(P=0.02).CONCLUSION Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection.Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.展开更多
BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treat...BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.展开更多
Aim: To describe the two-dimensional elastographic profile according to the Shearwave (2D-SWE) technique in patients with chronic liver disease in Lom. Materials and method: Cross-sectional, descriptive study conducte...Aim: To describe the two-dimensional elastographic profile according to the Shearwave (2D-SWE) technique in patients with chronic liver disease in Lom. Materials and method: Cross-sectional, descriptive study conducted over seven month at the Autel dElie Clinic in Lom, from January to August 2022, on adult patients with chronic liver disease who underwent abdominal ultrasound coupled with two-dimensional elastography. Results: The sample size was 54 patients. The mean age of the patients was 33 12 years, with extremes of 18 and 66 years. Patients aged 30 years or less accounted for 48.1% (n = 26). All patients (n = 54) had at least one transaminase assay with a mean of 69.3 78.3 IU/l (AST) and 59.3 82.8 IU/l (ALT). There was no statistically significant association between the biological parameters and the presence of fibrosis. Viral liver disease was the main cause, accounting for 81.5% (n = 44) of cases, with no significant association with the degree of fibrosis. Ultrasound revealed a dysmorphic liver (57.4%;n = 31) and portal hypertension (18.5%, n = 10). Fibrosis stages F1, F2 and F4 accounted for (48.1%, n = 26), (24.1%, n = 13) and (13%, n = 7) of cases respectively. Liver dysmorphia was significantly associated with the presence of fibrosis (p = 0.012) and portal hypertension was significantly associated with the degree of fibrosis (p = 0.0063). Conclusion: Assessment of liver fibrosis in patients with chronic liver disease using 2D-SWE elastography is essential for patient follow-up.展开更多
BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect i...BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect in inhibiting carcinogenesis as IFN therapy.The age-male-albumin-bilirubin-platelets(aMAP)score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients,and the velocity of shear waves(Vs)measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk.Combining these two may improve the prediction of carcinogenic risk.AIM To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.METHODS This retrospective,observational study involved hepatitis C patients treated with DAAs who achieved SVR.Vs was measured before treatment(baseline),at the end of treatment(EOT),and 12 wk(follow-up 12)and 24 wk(follow-up 24)after treatment.The patients were followed for at least six months after EOT to determine whether cancer developed.Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis.The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic(ROC)curve analyses.RESULTS A total of 279 patients(mean age 65.9 years,118 males,161 females)were included in the analysis.Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase,platelets,α-fetoprotein,Vs,and the Fib-4 index as explanatory variables;only Vs was found to be significant(P=0.0296).The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s.Carcinoma developed in 2.0%(3/151)of those with Vs<1.53 m/s and in 10.5%(9/86)of those with Vs≥1.53 m/s.CONCLUSION In hepatitis C patients after SVR,combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.展开更多
BACKGROUND Artifacts are common when using two-dimensional shear wave elastography(2-D SWE)to measure liver stiffness(LS),but they are poorly recognized.AIM To investigate the presence and influence of artifacts in 2-...BACKGROUND Artifacts are common when using two-dimensional shear wave elastography(2-D SWE)to measure liver stiffness(LS),but they are poorly recognized.AIM To investigate the presence and influence of artifacts in 2-D SWE of liver.METHODS We included 158 patients with chronic liver disease,who underwent 2-D SWE examination by a novice and an expert.A cross line at the center of the elastogram was drawn and was divided it into four locations:top-left,top-right,bottom-left,and bottom-right.The occurrence frequency of artifacts in different locations was compared.The influence of artifacts on the LS measurements was evaluated by comparing the elastogram with the most artifacts(EMA)and the elastogram with the least artifacts(ELA).RESULTS The percentage of elastograms with artifacts in the novice(51.7%)was significantly higher than that of the expert(19.6%)(P<0.001).It was found that both operators had the highest frequency of artifacts at bottom-left,followed by top-left and bottom-right,and top-right had the lowest frequency.The LS values(LSVs)and standard deviation values of EMAs were significantly higher than those of ELAs for both operators.An intraclass correlation coefficient value of 0.96 was found in the LSVs of EMAs of the two operators,and it increased to 0.98 when the LSVs of the ELAs were used.Both operators had lower stability index values for EMAs than ELAs,but the difference was only statistically significant for the novice.CONCLUSION Artifacts are common when using 2-D SWE to measure LS,especially for the novice.Artifacts may lead to the overestimation of LS and reduce the repeatability and reliability of LS measurements.展开更多
BACKGROUND Noninvasive methods have been developed to detect fibrosis in many liver diseases due to the limits of liver biopsy.However,previous studies have focused primarily on chronic viral hepatitis and nonalcoholi...BACKGROUND Noninvasive methods have been developed to detect fibrosis in many liver diseases due to the limits of liver biopsy.However,previous studies have focused primarily on chronic viral hepatitis and nonalcoholic fatty liver disease.The diagnostic value of transient elastography for autoimmune liver diseases(AILDs)is worth studying.AIM To compare the diagnostic accuracy of imaging techniques with serum biomarkers of fibrosis in AILD.METHODS The PubMed,Cochrane Library and EMBASE databases were searched.Studies evaluating the efficacy of noninvasive methods in the diagnosis of AILDs[autoimmune hepatitis(AIH),primary biliary cholangitis(PBC)and primary sclerosing cholangitis(PSC)]were included.The summary area under the receiver operating characteristic curve(AUROC),diagnostic odds ratio,sensitivity and specificity were used to assess the accuracy of these noninvasive methods for staging fibrosis.RESULTS A total of 60 articles were included in this study,and the number of patients with AIH,PBC and PSC was 1594,3126 and 501,respectively.The summary AUROC of transient elastography in the diagnosis of significant fibrosis,advanced fibrosis and cirrhosis in patients with AIH were 0.84,0.88 and 0.90,respectively,while those in patients with PBC were 0.93,0.93 and 0.91,respectively.The AUROC of cirrhosis for patients with PSC was 0.95.However,other noninvasive indices(aspartate aminotransferase to platelet ratio index,aspartate aminotransferase/alanine aminotransferase ratio,fibrosis-4 index)had corresponding AUROCs less than 0.80.CONCLUSION Transient elastography exerts better diagnostic accuracy in AILD patients,especially in PBC patients.The appropriate cutoff values for staging advanced fibrosis and cirrhosis ranged from 9.6 to 10.7 and 14.4 to 16.9 KPa for PBC patients.展开更多
BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a...BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for NAFLD.AIM To analyze how this CDST impacted health care utilization and patient outcomes.METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and mortality.RESULTS We identified 958 patients who had FibroScan,115 before and 843 after the CDST was implemented.The percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was implemented.Though there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more referrals.Very few patients were hospitalized or died.CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.展开更多
Objective:To investigat the diagnostic value of transient elastography combined with serum amyloid A and interleukin-6 in the degree of hepatitis B liver fibrosis.Methods:A total of 334 patients with chronic HBV infec...Objective:To investigat the diagnostic value of transient elastography combined with serum amyloid A and interleukin-6 in the degree of hepatitis B liver fibrosis.Methods:A total of 334 patients with chronic HBV infection that were admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Hainan Medical College from January 2020 to May 2022 with informed consent and underwent liver biopsy puncture were selected.According to the pathological results,they were divided into no obvious fibrosis group,obvious fibrosis group and liver cirrhosis group.Comparison of liver stiffness measurement(LSM),serum amyloid A(SAA0,IL-6 levels between different groups.This study drawed was conducted draw the receiver operating characteristic(ROC)curve of each index to diagnose significant liver fibrosis and liver cirrhosis,and compared the area under the ROC curve(AUC)and diagnostic efficacy of each non-invasive fibrosis diagnostic model.The diagnostic performance of the combined assay was superior to that of APRI and FIB-4 In different degrees of liver fibrosis.Results:According to the degree of liver fibrosis,the levels of SAA,IL-6,and LSM in the no significant fibrosis group(n=140),the significant fibrosis group(n=134),and the cirrhosis group(n=60)were statistically significant difference(All P<0.001).SAA,IL-6 and LSM were significantly correlated with the degree of liver fibrosis(rs=0.456,rs=0.482,rs=0.602,All P<0.001).The AUC of SAA and IL-6 for the diagnosis of significant fibrosis in hepatitis B were 0.738 and 0.809,respectively.And the AUC for the diagnosis of liver cirrhosis were 0.813 and 0.823,respectively.The AUC for the combined diagnosis of significant fibrosis and cirrhosis were 0.930 and 0.964,respectively.The diagnostic performance of the combined assay was superior to that of APRI and FIB-4 in different degrees of liver fibrosis(All P<0.001).Conclusion:LSM combined with serum SAA and IL-6 has great diagnostic value for different degrees of hepatitis B liver fibrosis.展开更多
BACKGROUND Primary breast diffuse large B-cell lymphoma(PB-DLBCL)is a rare subtype of non-Hodgkin lymphoma that accounts for<3%of extranodal lymphomas and 1%of breast tumors.Its diagnosis and management are challen...BACKGROUND Primary breast diffuse large B-cell lymphoma(PB-DLBCL)is a rare subtype of non-Hodgkin lymphoma that accounts for<3%of extranodal lymphomas and 1%of breast tumors.Its diagnosis and management are challenging because of its rarity,heterogeneity,and aggressive behavior.Conventional ultrasound(US)is the first-line imaging modality for breast lesions;however,it has limited specificity and accuracy for PB-DLBCL.Shear wave elastography(SWE)is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.AIM To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.METHODS We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment.We analyzed conventional US features(shape,margin,orientation,echo,posterior acoustic features,calcification,and vascularity)and SWE features(mean elasticity value,standard deviation,minimum elasticity value,maximum elasticity value,and lesion-to-fat ratio)of the PB-DLBCL lesions.Using receiver operating characteristic curve analysis,we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features.We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.RESULTS The results showed that the PB-DLBCL lesions were mostly irregular in shape(84.4%),microlobulated or spiculated in margins(75%),parallel in orientation(65.6%),hypoechoic in echo(87.5%),and had posterior acoustic enhancement(65.6%).Calcification was rare(6.3%)and vascularity was variable(31.3%avascular,37.5%hypovascular,and 31.3%hypervascular).The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions(113.4±46.9 kPa vs 27.8±16.4 kPa,P<0.001).The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa,with a sensitivity of 93.8%,specificity of 92.9%,positive predictive value of 93.8%,negative predictive value of 92.9%,and accuracy of 93.3%.The mean elasticity value was also significantly correlated with Ki-67 expression level(r=0.612,P<0.001),which is a marker of tumor proliferation and aggressiveness.Survival analysis showed that patients with higher mean elasticity values(>54.5 kPa)had worse overall survival(OS)and progression-free survival(PFS)than those with lower mean elasticity values(<54.5 kPa)(P=0.038 for OS and P=0.027 for PFS).CONCLUSION Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL.SWE excels in distinguishing PB-DLBCL from benign breast lesions,reflects tumor proliferation and aggressiveness,and improves disease management.展开更多
FibroScan®is a non-invasive device that assesses the‘hardness’(or stiffness)of the liver via the technique of transient elastography.Because fibrous tissue is harder than normal liver,the degree of hepatic fibr...FibroScan®is a non-invasive device that assesses the‘hardness’(or stiffness)of the liver via the technique of transient elastography.Because fibrous tissue is harder than normal liver,the degree of hepatic fibrosis can be inferred from the liver hardness.This technique is increasingly being employed to diagnose liver fibrosis,even in critically ill patients.It is now being used not only for diagnosis and staging of liver cirrhosis,but also for outcome prognostication.However,the presence of several confounding factors,especially in critically ill patients,may make interpretation of these results unreliable.Through this review we aim to describe the indications and pitfalls of employing FibroScan in patients admitted to intensive care units.展开更多
Objective:To explore the value of real-time elastic shear wave in evaluating muscle elasticity in patients with renal failure.Methods:50 patients with chronic renal failure from January 2019 to December 2022 were rand...Objective:To explore the value of real-time elastic shear wave in evaluating muscle elasticity in patients with renal failure.Methods:50 patients with chronic renal failure from January 2019 to December 2022 were randomly selected as the experimental group,and 50 healthy patients aged 21-61 during the same period were selected as the control group,and the basic information of the patients,including age,gender,body mass index,etc.,were collected.Besides,the Young's modulus of the two groups of patients were observed and analyzed.Results:The Young's modulus values of left and right gastrocnemius muscles in the experimental group were significantly lower than those in the control group(P<0.05),and there was no statistical difference between the left and right sides of the experimental group and the control group(P>0.05).Conclusion:Real-time shear wave elastography provides a non-invasive,real-time and effective tool for the assessment of muscle elasticity in patients with renal failure.Through further research and optimization,real-time shear wave elastography will play a greater role in the prevention and treatment of patients with renal failure,improving the quality of life and prognosis of patients.展开更多
Objective:To explore the feasibility of two-dimensional shear wave elastography in evaluating calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome.Methods:A total of 48 di...Objective:To explore the feasibility of two-dimensional shear wave elastography in evaluating calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome.Methods:A total of 48 diabetic nephropathy patients with medial tibial stress syndrome from January 2020 to December 2022 were included as the study group,and 48 patients with diabetic nephropathy during the same period were included as the control group.Both groups were detected by two-dimensional shear wave elastography with ultrasonic equipment,and Young‘s modulus of the tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle were observed and analyzed in the two groups.Results:The Young‘s modulus values of tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle in the study group were significantly lower than those in the control group(P<0.05).Conclusion:Two-dimensional shear wave elastography is feasible for the evaluation of calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome,and has high accuracy and repeatability.This technique can be used to diagnose,treat and monitor muscle lesions in patients with diabetic nephropathy,and can also be used to assess muscle fatigue and exercise capacity,which has broad application prospects.展开更多
Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered...Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks(inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis(serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasoundbased elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography(TE) and acoustic radiation force impulse(ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shearwave elastography, the Elast PQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.展开更多
Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultra...Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.展开更多
基金National Natural Science Foundation of China (12002075)National Key Research and Development Project (2021YFB3300601)Natural Science Foundation of Liaoning Province in China (2021-MS-128).
文摘Elastography is a non-invasive medical imaging technique to map the spatial variation of elastic properties of soft tissues.The quality of reconstruction results in elastography is highly sensitive to the noise induced by imaging measurements and processing.To address this issue,we propose a deep learning(DL)model based on conditional Generative Adversarial Networks(cGANs)to improve the quality of nonhomogeneous shear modulus reconstruction.To train this model,we generated a synthetic displacement field with finite element simulation under known nonhomogeneous shear modulus distribution.Both the simulated and experimental displacement fields are used to validate the proposed method.The reconstructed results demonstrate that the DL model with synthetic training data is able to improve the quality of the reconstruction compared with the well-established optimization method.Moreover,we emphasize that our DL model is only trained on synthetic data.This might provide a way to alleviate the challenge of obtaining clinical or experimental data in elastography.Overall,this work addresses several fatal issues in applying the DL technique into elastography,and the proposed method has shown great potential in improving the accuracy of the disease diagnosis in clinical medicine.
基金Supported by the National Natural Science Foundation of China Youth Training Project,No.2021GZR003and Medical-engineering Interdisciplinary Research Youth Training Project,No.2022YGJC001.
文摘BACKGROUND Integrating conventional ultrasound features with 2D shear wave elastography(2D-SWE)can potentially enhance preoperative hepatocellular carcinoma(HCC)predictions.AIM To develop a 2D-SWE-based predictive model for preoperative identification of HCC.METHODS A retrospective analysis of 884 patients who underwent liver resection and pathology evaluation from February 2021 to August 2023 was conducted at the Oriental Hepatobiliary Surgery Hospital.The patients were divided into the modeling group(n=720)and the control group(n=164).The study included conventional ultrasound,2D-SWE,and preoperative laboratory tests.Multiple logistic regression was used to identify independent predictive factors for RESULTS In the modeling group analysis,maximal elasticity(Emax)of tumors and their peripheries,platelet count,cirrhosis,and blood flow were independent risk indicators for malignancies.These factors yielded an area under the curve of 0.77(95%confidence interval:0.73-0.81)with 84%sensitivity and 61%specificity.The model demonstrated good calibration in both the construction and validation cohorts,as shown by the calibration graph and Hosmer-Lemeshow test(P=0.683 and P=0.658,respectively).Additionally,the mean elasticity(Emean)of the tumor periphery was identified as a risk factor for microvascular invasion(MVI)in malignant liver tumors(P=0.003).Patients receiving antiviral treatment differed significantly in platelet count(P=0.002),Emax of tumors(P=0.033),Emean of tumors(P=0.042),Emax at tumor periphery(P<0.001),and Emean at tumor periphery(P=0.003).CONCLUSION 2D-SWE’s hardness value serves as a valuable marker for enhancing the preoperative diagnosis of malignant liver lesions,correlating significantly with MVI and antiviral treatment efficacy.
文摘BACKGROUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis progression.The assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWE).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with DAAs.AIM To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus(HCV).METHODS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV clearance.In accordance with the study protocol,a qualitative and quantitative analysis of the evidence was planned.RESULTS At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source data.There was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CONCLUSION SWE could be a promising tool for prediction of HCC occurrence in patients treated with DAAs.Further studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.
基金Supported by Sichuan Orthopaedic Hospital Research Project,No.2019MS02.
文摘BACKGROUND Real-time shear wave elastography(SWE)is a non-invasive imaging technique used to measure tissue stiffness by generating and tracking shear waves in real time.This advanced ultrasound-based method provides quantitative information regarding tissue elasticity,offering valuable insights into the mechanical properties of biological tissues.However,the application of real-time SWE in the musculoskeletal system and sports medicine has not been extensively studied.AIM To explore the practical value of real-time SWE for assessing Achilles tendon hardness in older adults.METHODS A total of 60 participants were enrolled in the present study,and differences in the elastic moduli of the bilateral Achilles tendons were compared among the following categories:(1)Age:55-60,60-65,and 65-70-years-old;(2)Sex:Male and female;(3)Laterality:Left and right sides;(4)Tendon state:Relaxed and tense state;and(5)Tendon segment:Proximal,middle,and distal.RESULTS There were no significant differences in the elastic moduli of the bilateral Achilles tendons when comparing by age or sex(P>0.05).There were,however,significant differences when comparing by tendon side,state,or segment(P<0.05).CONCLUSION Real-time SWE plays a significant role compared to other examination methods in the evaluation of Achilles tendon hardness in older adults.
文摘Magnetic resonance imaging is the gold standard compared other clinical fin-dings.But shear wave elastography technique combined with endoscopic ultra-sound can evaluate the degree of fibrosis of fistula tissue in Crohn’s disease patients.This topic is highly relevant to the current discourse,especially for It shows a certain degree of innovation and practicality and is worthy of study and popularization.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008.
文摘BACKGROUND Breast cancer morbidity has been increasing worldwide,but treatments are improving.The therapeutic response depends on the stage at which the disease is diagnosed.Therefore,early diagnosis has never been more essential for successful treatment and a reduction in mortality rates.Radiology plays a pivotal role in cancer detection,and advances in ultrasound(US)palpation have shown promising results for breast cancer imaging.The addition of two-dimensional-shear wave elastography(2D-SWE)US in the routine breast imaging exam can increase early cancer detection and promote better surveillance.AIM To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities.METHODS The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions.All patients underwent mammography,bright mode(B-mode)US,and 2D-SWE followed by US-guided biopsy in two consecutive sessions.RESULTS Combining B-mode and shear wave US imaging with X-ray mammography revealed 100%of the suspicious lesions,resulting in greater sensitivity,specificity,and negative predictive value.The result improves compared to either B-mode or 2D-SWE alone(P=0.02).CONCLUSION Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection.Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.
基金Egyptian Ministry for Scientific Research,Science,Technology&Innovation Funding Authority(STDF),No.HCV-3506.
文摘BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.
文摘Aim: To describe the two-dimensional elastographic profile according to the Shearwave (2D-SWE) technique in patients with chronic liver disease in Lom. Materials and method: Cross-sectional, descriptive study conducted over seven month at the Autel dElie Clinic in Lom, from January to August 2022, on adult patients with chronic liver disease who underwent abdominal ultrasound coupled with two-dimensional elastography. Results: The sample size was 54 patients. The mean age of the patients was 33 12 years, with extremes of 18 and 66 years. Patients aged 30 years or less accounted for 48.1% (n = 26). All patients (n = 54) had at least one transaminase assay with a mean of 69.3 78.3 IU/l (AST) and 59.3 82.8 IU/l (ALT). There was no statistically significant association between the biological parameters and the presence of fibrosis. Viral liver disease was the main cause, accounting for 81.5% (n = 44) of cases, with no significant association with the degree of fibrosis. Ultrasound revealed a dysmorphic liver (57.4%;n = 31) and portal hypertension (18.5%, n = 10). Fibrosis stages F1, F2 and F4 accounted for (48.1%, n = 26), (24.1%, n = 13) and (13%, n = 7) of cases respectively. Liver dysmorphia was significantly associated with the presence of fibrosis (p = 0.012) and portal hypertension was significantly associated with the degree of fibrosis (p = 0.0063). Conclusion: Assessment of liver fibrosis in patients with chronic liver disease using 2D-SWE elastography is essential for patient follow-up.
文摘BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect in inhibiting carcinogenesis as IFN therapy.The age-male-albumin-bilirubin-platelets(aMAP)score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients,and the velocity of shear waves(Vs)measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk.Combining these two may improve the prediction of carcinogenic risk.AIM To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.METHODS This retrospective,observational study involved hepatitis C patients treated with DAAs who achieved SVR.Vs was measured before treatment(baseline),at the end of treatment(EOT),and 12 wk(follow-up 12)and 24 wk(follow-up 24)after treatment.The patients were followed for at least six months after EOT to determine whether cancer developed.Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis.The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic(ROC)curve analyses.RESULTS A total of 279 patients(mean age 65.9 years,118 males,161 females)were included in the analysis.Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase,platelets,α-fetoprotein,Vs,and the Fib-4 index as explanatory variables;only Vs was found to be significant(P=0.0296).The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s.Carcinoma developed in 2.0%(3/151)of those with Vs<1.53 m/s and in 10.5%(9/86)of those with Vs≥1.53 m/s.CONCLUSION In hepatitis C patients after SVR,combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.
文摘BACKGROUND Artifacts are common when using two-dimensional shear wave elastography(2-D SWE)to measure liver stiffness(LS),but they are poorly recognized.AIM To investigate the presence and influence of artifacts in 2-D SWE of liver.METHODS We included 158 patients with chronic liver disease,who underwent 2-D SWE examination by a novice and an expert.A cross line at the center of the elastogram was drawn and was divided it into four locations:top-left,top-right,bottom-left,and bottom-right.The occurrence frequency of artifacts in different locations was compared.The influence of artifacts on the LS measurements was evaluated by comparing the elastogram with the most artifacts(EMA)and the elastogram with the least artifacts(ELA).RESULTS The percentage of elastograms with artifacts in the novice(51.7%)was significantly higher than that of the expert(19.6%)(P<0.001).It was found that both operators had the highest frequency of artifacts at bottom-left,followed by top-left and bottom-right,and top-right had the lowest frequency.The LS values(LSVs)and standard deviation values of EMAs were significantly higher than those of ELAs for both operators.An intraclass correlation coefficient value of 0.96 was found in the LSVs of EMAs of the two operators,and it increased to 0.98 when the LSVs of the ELAs were used.Both operators had lower stability index values for EMAs than ELAs,but the difference was only statistically significant for the novice.CONCLUSION Artifacts are common when using 2-D SWE to measure LS,especially for the novice.Artifacts may lead to the overestimation of LS and reduce the repeatability and reliability of LS measurements.
基金Natural Science and Technology Major Project of Fujian Province,No.2021D033Natural Science Foundation of Shanghai,No.20ZR1410900+1 种基金Medical Innovation Project of Fujian Province,No.2022CXB020National Science and Technology Major Project,No.2017ZX 10203202-003-002.
文摘BACKGROUND Noninvasive methods have been developed to detect fibrosis in many liver diseases due to the limits of liver biopsy.However,previous studies have focused primarily on chronic viral hepatitis and nonalcoholic fatty liver disease.The diagnostic value of transient elastography for autoimmune liver diseases(AILDs)is worth studying.AIM To compare the diagnostic accuracy of imaging techniques with serum biomarkers of fibrosis in AILD.METHODS The PubMed,Cochrane Library and EMBASE databases were searched.Studies evaluating the efficacy of noninvasive methods in the diagnosis of AILDs[autoimmune hepatitis(AIH),primary biliary cholangitis(PBC)and primary sclerosing cholangitis(PSC)]were included.The summary area under the receiver operating characteristic curve(AUROC),diagnostic odds ratio,sensitivity and specificity were used to assess the accuracy of these noninvasive methods for staging fibrosis.RESULTS A total of 60 articles were included in this study,and the number of patients with AIH,PBC and PSC was 1594,3126 and 501,respectively.The summary AUROC of transient elastography in the diagnosis of significant fibrosis,advanced fibrosis and cirrhosis in patients with AIH were 0.84,0.88 and 0.90,respectively,while those in patients with PBC were 0.93,0.93 and 0.91,respectively.The AUROC of cirrhosis for patients with PSC was 0.95.However,other noninvasive indices(aspartate aminotransferase to platelet ratio index,aspartate aminotransferase/alanine aminotransferase ratio,fibrosis-4 index)had corresponding AUROCs less than 0.80.CONCLUSION Transient elastography exerts better diagnostic accuracy in AILD patients,especially in PBC patients.The appropriate cutoff values for staging advanced fibrosis and cirrhosis ranged from 9.6 to 10.7 and 14.4 to 16.9 KPa for PBC patients.
文摘BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for NAFLD.AIM To analyze how this CDST impacted health care utilization and patient outcomes.METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and mortality.RESULTS We identified 958 patients who had FibroScan,115 before and 843 after the CDST was implemented.The percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was implemented.Though there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more referrals.Very few patients were hospitalized or died.CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.
基金Natural Science Foundation of Hainan Province(No.819MS122)。
文摘Objective:To investigat the diagnostic value of transient elastography combined with serum amyloid A and interleukin-6 in the degree of hepatitis B liver fibrosis.Methods:A total of 334 patients with chronic HBV infection that were admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Hainan Medical College from January 2020 to May 2022 with informed consent and underwent liver biopsy puncture were selected.According to the pathological results,they were divided into no obvious fibrosis group,obvious fibrosis group and liver cirrhosis group.Comparison of liver stiffness measurement(LSM),serum amyloid A(SAA0,IL-6 levels between different groups.This study drawed was conducted draw the receiver operating characteristic(ROC)curve of each index to diagnose significant liver fibrosis and liver cirrhosis,and compared the area under the ROC curve(AUC)and diagnostic efficacy of each non-invasive fibrosis diagnostic model.The diagnostic performance of the combined assay was superior to that of APRI and FIB-4 In different degrees of liver fibrosis.Results:According to the degree of liver fibrosis,the levels of SAA,IL-6,and LSM in the no significant fibrosis group(n=140),the significant fibrosis group(n=134),and the cirrhosis group(n=60)were statistically significant difference(All P<0.001).SAA,IL-6 and LSM were significantly correlated with the degree of liver fibrosis(rs=0.456,rs=0.482,rs=0.602,All P<0.001).The AUC of SAA and IL-6 for the diagnosis of significant fibrosis in hepatitis B were 0.738 and 0.809,respectively.And the AUC for the diagnosis of liver cirrhosis were 0.813 and 0.823,respectively.The AUC for the combined diagnosis of significant fibrosis and cirrhosis were 0.930 and 0.964,respectively.The diagnostic performance of the combined assay was superior to that of APRI and FIB-4 in different degrees of liver fibrosis(All P<0.001).Conclusion:LSM combined with serum SAA and IL-6 has great diagnostic value for different degrees of hepatitis B liver fibrosis.
基金This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Guizhou Medical University.
文摘BACKGROUND Primary breast diffuse large B-cell lymphoma(PB-DLBCL)is a rare subtype of non-Hodgkin lymphoma that accounts for<3%of extranodal lymphomas and 1%of breast tumors.Its diagnosis and management are challenging because of its rarity,heterogeneity,and aggressive behavior.Conventional ultrasound(US)is the first-line imaging modality for breast lesions;however,it has limited specificity and accuracy for PB-DLBCL.Shear wave elastography(SWE)is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.AIM To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.METHODS We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment.We analyzed conventional US features(shape,margin,orientation,echo,posterior acoustic features,calcification,and vascularity)and SWE features(mean elasticity value,standard deviation,minimum elasticity value,maximum elasticity value,and lesion-to-fat ratio)of the PB-DLBCL lesions.Using receiver operating characteristic curve analysis,we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features.We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.RESULTS The results showed that the PB-DLBCL lesions were mostly irregular in shape(84.4%),microlobulated or spiculated in margins(75%),parallel in orientation(65.6%),hypoechoic in echo(87.5%),and had posterior acoustic enhancement(65.6%).Calcification was rare(6.3%)and vascularity was variable(31.3%avascular,37.5%hypovascular,and 31.3%hypervascular).The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions(113.4±46.9 kPa vs 27.8±16.4 kPa,P<0.001).The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa,with a sensitivity of 93.8%,specificity of 92.9%,positive predictive value of 93.8%,negative predictive value of 92.9%,and accuracy of 93.3%.The mean elasticity value was also significantly correlated with Ki-67 expression level(r=0.612,P<0.001),which is a marker of tumor proliferation and aggressiveness.Survival analysis showed that patients with higher mean elasticity values(>54.5 kPa)had worse overall survival(OS)and progression-free survival(PFS)than those with lower mean elasticity values(<54.5 kPa)(P=0.038 for OS and P=0.027 for PFS).CONCLUSION Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL.SWE excels in distinguishing PB-DLBCL from benign breast lesions,reflects tumor proliferation and aggressiveness,and improves disease management.
文摘FibroScan®is a non-invasive device that assesses the‘hardness’(or stiffness)of the liver via the technique of transient elastography.Because fibrous tissue is harder than normal liver,the degree of hepatic fibrosis can be inferred from the liver hardness.This technique is increasingly being employed to diagnose liver fibrosis,even in critically ill patients.It is now being used not only for diagnosis and staging of liver cirrhosis,but also for outcome prognostication.However,the presence of several confounding factors,especially in critically ill patients,may make interpretation of these results unreliable.Through this review we aim to describe the indications and pitfalls of employing FibroScan in patients admitted to intensive care units.
文摘Objective:To explore the value of real-time elastic shear wave in evaluating muscle elasticity in patients with renal failure.Methods:50 patients with chronic renal failure from January 2019 to December 2022 were randomly selected as the experimental group,and 50 healthy patients aged 21-61 during the same period were selected as the control group,and the basic information of the patients,including age,gender,body mass index,etc.,were collected.Besides,the Young's modulus of the two groups of patients were observed and analyzed.Results:The Young's modulus values of left and right gastrocnemius muscles in the experimental group were significantly lower than those in the control group(P<0.05),and there was no statistical difference between the left and right sides of the experimental group and the control group(P>0.05).Conclusion:Real-time shear wave elastography provides a non-invasive,real-time and effective tool for the assessment of muscle elasticity in patients with renal failure.Through further research and optimization,real-time shear wave elastography will play a greater role in the prevention and treatment of patients with renal failure,improving the quality of life and prognosis of patients.
文摘Objective:To explore the feasibility of two-dimensional shear wave elastography in evaluating calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome.Methods:A total of 48 diabetic nephropathy patients with medial tibial stress syndrome from January 2020 to December 2022 were included as the study group,and 48 patients with diabetic nephropathy during the same period were included as the control group.Both groups were detected by two-dimensional shear wave elastography with ultrasonic equipment,and Young‘s modulus of the tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle were observed and analyzed in the two groups.Results:The Young‘s modulus values of tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle in the study group were significantly lower than those in the control group(P<0.05).Conclusion:Two-dimensional shear wave elastography is feasible for the evaluation of calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome,and has high accuracy and repeatability.This technique can be used to diagnose,treat and monitor muscle lesions in patients with diabetic nephropathy,and can also be used to assess muscle fatigue and exercise capacity,which has broad application prospects.
文摘Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks(inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis(serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasoundbased elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography(TE) and acoustic radiation force impulse(ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shearwave elastography, the Elast PQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.
文摘Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.
