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Ohno E, Kuzuya T, Kawabe N, Nakaoka K, Tanaka H, Nakano T, Funasaka K, Miyahara R, Hashimoto S, Hirooka Y. Current status of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms. DEN OPEN 2025; 5:e413. [PMID: 39040523 PMCID: PMC11260769 DOI: 10.1002/deo2.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/02/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
The new Kyoto guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) provide evidence-based recommendations for the diagnosis and treatment of IPMN. Endoscopic ultrasonography (EUS) is a diagnostic modality with a high spatial resolution that allows detailed observation and obtaining cyst fluid or tissue samples via EUS-guided fine needle aspiration (EUS-FNA). Currently, EUS is an indispensable examination method for the diagnosis of pancreatic diseases. On the other hand, there have been concerns that EUS imaging tends to be highly operator-dependent, and may lack objectivity. Previous guidelines have assigned EUS as an option for patients with worrisome features. However, recent reports indicate that the sensitivity of EUS for the diagnosis of mural nodules (MNs) is more than 90%, comparable or superior to that of contrast-enhanced computed tomography or magnetic resonance cholangiopancreatography. The specific advantages of EUS in the diagnosis of IPMN are: (1) high spatial resolution imaging for the diagnosis of MNs, (2) contrast-enhanced EUS for differentiation of intra-cystic MNs from mucous clots, and (3) pathological diagnosis using EUS-FNA and differential diagnosis of a pancreatic cystic tumor by cystic fluid analysis. In order to utilize EUS in the diagnosis of IPMN, endoscopists are required to have the skills to provide sufficiently objective imaging findings.
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Affiliation(s)
- Eizaburo Ohno
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Teiji Kuzuya
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Naoto Kawabe
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Kazunori Nakaoka
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Hiroyuki Tanaka
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Takuji Nakano
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Kohei Funasaka
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Ryoji Miyahara
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
| | - Senju Hashimoto
- Department of Gastroenterology and HepatologyFujita Health University Bantane HospitalAichiJapan
| | - Yoshiki Hirooka
- Department of Gastroenterology and HepatologyFujita Health University School of MedicineAichiJapan
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Itonaga M, Ashida R, Kitano M. Updated techniques and evidence for endoscopic ultrasound-guided tissue acquisition from solid pancreatic lesions. DEN OPEN 2025; 5:e399. [PMID: 38911353 PMCID: PMC11190023 DOI: 10.1002/deo2.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
Endoscopic ultrasound-guided tissue acquisition (EUS-TA), including fine-needle aspiration (EUS-FNA) and fine-needle biopsy (EUS-FNB), has revolutionized specimen collection from intra-abdominal organs, especially the pancreas. Advances in personalized medicine and more precise treatment have increased demands to collect specimens with higher cell counts, while preserving tissue structure, leading to the development of EUS-FNB needles. EUS-FNB has generally replaced EUS-FNA as the procedure of choice for EUS-TA of pancreatic cancer. Various techniques have been tested for their ability to enhance the diagnostic performance of EUS-TA, including multiple methods of sampling at the time of puncture, on-site specimen evaluation, and specimen processing. In addition, advances in next-generation sequencing have made comprehensive genomic profiling of EUS-TA samples feasible in routine clinical practice. The present review describes updates in EUS-TA sampling techniques of pancreatic lesions, as well as methods for their evaluation.
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Affiliation(s)
- Masahiro Itonaga
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Reiko Ashida
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Masayuki Kitano
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
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3
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Shintani S, Inatomi O, Okamoto T, Hiroe K, Eguchi T, Tomozawa Y, Inoue A, Kimura H, Nishida A, Tsuji Y, Watanabe Y, Andoh A. Diagnostic accuracy of endoscopic ultrasonographic shear wave elastography for assessing early chronic pancreatitis using the Japanese diagnostic criteria 2019. DEN OPEN 2025; 5:e387. [PMID: 38868706 PMCID: PMC11167156 DOI: 10.1002/deo2.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/13/2024] [Accepted: 05/05/2024] [Indexed: 06/14/2024]
Abstract
Background and Aim Endoscopic ultrasound shear wave elastography (EUS-SWE) can facilitate an objective evaluation of pancreatic fibrosis. Although it is primarily applied in evaluating chronic pancreatitis, its efficacy in assessing early chronic pancreatitis (ECP) remains underinvestigated. This study evaluated the diagnostic accuracy of EUS-SWE for assessing ECP diagnosed using the Japanese diagnostic criteria 2019. Methods In total, 657 patients underwent EUS-SWE. Propensity score matching was used, and the participants were classified into the ECP and normal groups. ECP was diagnosed using the Japanese diagnostic criteria 2019. Pancreatic stiffness was assessed based on velocity (Vs) on EUS-SWE, and the optimal Vs cutoff value for ECP diagnosis was determined. A practical shear wave Vs value of ≥50% was considered significant. Results Each group included 22 patients. The ECP group had higher pancreatic stiffness than the normal group (2.31 ± 0.67 m/s vs. 1.59 ± 0.40 m/s, p < 0.001). The Vs cutoff value for the diagnostic accuracy of ECP, as determined using the receiver operating characteristic curve, was 2.24m/s, with an area under the curve of 0.82 (95% confidence interval: 0.69-0.94). A high Vs was strongly correlated with the number of EUS findings (rs = 0.626, p < 0.001). Multiple regression analysis revealed that a history of acute pancreatitis and ≥2 EUS findings were independent predictors of a high Vs. Conclusions There is a strong correlation between EUS-SWE findings and the Japanese diagnostic criteria 2019 for ECP. Hence, EUS-SWE can be an objective and invaluable diagnostic tool for ECP diagnosis.
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Affiliation(s)
- Shuhei Shintani
- Department of MedicineDivision of GastroenterologyShiga University of Medical ScienceShigaJapan
| | - Osamu Inatomi
- Department of MedicineDivision of GastroenterologyShiga University of Medical ScienceShigaJapan
| | - Takuya Okamoto
- Department of MedicineDivision of GastroenterologyShiga University of Medical ScienceShigaJapan
| | - Kosuke Hiroe
- Department of MedicineDivision of GastroenterologyShiga University of Medical ScienceShigaJapan
| | - Takaaki Eguchi
- Department of General MedicineShiga University of Medical ScienceShigaJapan
| | - Yuki Tomozawa
- Department of RadiologyShiga University of Medical ScienceShigaJapan
| | - Akitoshi Inoue
- Department of RadiologyShiga University of Medical ScienceShigaJapan
| | - Hidenori Kimura
- Department of EndoscopyShiga University of Medical ScienceShigaJapan
| | - Atsushi Nishida
- Department of MedicineDivision of GastroenterologyShiga University of Medical ScienceShigaJapan
| | - Yoshihisa Tsuji
- Department of General MedicineShiga University of Medical ScienceShigaJapan
| | | | - Akira Andoh
- Department of MedicineDivision of GastroenterologyShiga University of Medical ScienceShigaJapan
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4
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Wan S, Wang S, He X, Song C, Wang J. Noninvasive diagnosis of interstitial fibrosis in chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2024; 46:2367021. [PMID: 38938187 PMCID: PMC11216256 DOI: 10.1080/0886022x.2024.2367021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024] Open
Abstract
RATIONALE AND OBJECTIVES Researchers have delved into noninvasive diagnostic methods of renal fibrosis (RF) in chronic kidney disease, including ultrasound (US), magnetic resonance imaging (MRI), and radiomics. However, the value of these diagnostic methods in the noninvasive diagnosis of RF remains contentious. Consequently, the present study aimed to systematically delineate the accuracy of the noninvasive diagnosis of RF. MATERIALS AND METHODS A systematic search covering PubMed, Embase, Cochrane Library, and Web of Science databases for all data available up to 28 July 2023 was conducted for eligible studies. RESULTS We included 21 studies covering 4885 participants. Among them, nine studies utilized US as a noninvasive diagnostic method, eight studies used MRI, and four articles employed radiomics. The sensitivity and specificity of US for detecting RF were 0.81 (95% CI: 0.76-0.86) and 0.79 (95% CI: 0.72-0.84). The sensitivity and specificity of MRI were 0.77 (95% CI: 0.70-0.83) and 0.92 (95% CI: 0.85-0.96). The sensitivity and specificity of radiomics were 0.69 (95% CI: 0.59-0.77) and 0.78 (95% CI: 0.68-0.85). CONCLUSIONS The current early noninvasive diagnostic methods for RF include US, MRI, and radiomics. However, this study demonstrates that US has a higher sensitivity for the detection of RF compared to MRI. Compared to US, radiomics studies based on US did not show superior advantages. Therefore, challenges still exist in the current radiomics approaches for diagnosing RF, and further exploration of optimized artificial intelligence (AI) algorithms and technologies is needed.
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Affiliation(s)
- Shanshan Wan
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shiping Wang
- Department of Radiology, The Affiliated Anning First People’s Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xinyu He
- Department of Radiology, The Affiliated Anning First People’s Hospital of Kunming University of Science and Technology, Kunming, China
| | - Chao Song
- Department of Radiology, The Affiliated Anning First People’s Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jiaping Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Zhang X, He N, Zhang L, Dai T, Sun Z, Shi Y, Li S, Yu N. Application of high intensity focused ultrasound combined with nanomaterials in anti-tumor therapy. Drug Deliv 2024; 31:2342844. [PMID: 38659328 PMCID: PMC11047217 DOI: 10.1080/10717544.2024.2342844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
High intensity focused ultrasound (HIFU) has demonstrated its safety, efficacy and noninvasiveness in the ablation of solid tumor. However, its further application is limited by its inherent deficiencies, such as postoperative recurrence caused by incomplete ablation and excessive intensity affecting surrounding healthy tissues. Recent research has indicated that the integration of nanomaterials with HIFU exhibits a promising synergistic effect in tumor ablation. The concurrent utilization of nanomaterials with HIFU can help overcome the limitations of HIFU by improving targeting and ablation efficiency, expanding operation area, increasing operation accuracy, enhancing stability and bio-safety during the process. It also provides a platform for multi-therapy and multi-mode imaging guidance. The present review comprehensively expounds upon the synergistic mechanism between nanomaterials and HIFU, summarizes the research progress of nanomaterials as cavitation nuclei and drug carriers in combination with HIFU for tumor ablation. Furthermore, this review highlights the potential for further exploration in the development of novel nanomaterials that enhance the synergistic effect with HIFU on tumor ablation.
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Affiliation(s)
- Xuehui Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ningning He
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Liang Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tong Dai
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Zihan Sun
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Yuqing Shi
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Shangyong Li
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Ning Yu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
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6
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Gu W, Tan JRL, Jin HB, Lou Q, Cheung KS, Yang J, Zhang X. The characteristic "alveolus nest sign" in solid pseudopapillary neoplasm of the pancreas. Endoscopy 2024; 56:E662-E664. [PMID: 39074827 PMCID: PMC11286345 DOI: 10.1055/a-2353-6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Affiliation(s)
- Weigang Gu
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
| | - Justin Ryan L. Tan
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
- Section of Gastroenterology, Chinese General Hospital and Medical Center, Manila, Philippines
| | - Hang Bin Jin
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
| | - Quifeng Lou
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
| | - Ka Shing Cheung
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Queen Mary Hospital, Hong Kong, Hong Kong
| | - Jianfeng Yang
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
| | - Xiaofeng Zhang
- Department of Gastroenterology, Hangzhou First Peopleʼs Hospital, Hangzhou, China
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7
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Wang F, Numata K, Funaoka A, Kumamoto T, Takeda K, Chuma M, Nozaki A, Ruan L, Maeda S. Construction of a nomogram combining CEUS and MRI imaging for preoperative diagnosis of microvascular invasion in hepatocellular carcinoma. Eur J Radiol Open 2024; 13:100587. [PMID: 39070064 PMCID: PMC11279689 DOI: 10.1016/j.ejro.2024.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/22/2024] [Accepted: 06/30/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose To use Sonazoid contrast-enhanced ultrasound (S-CEUS) and Gadolinium-Ethoxybenzyl-Diethylenetriamine Penta-Acetic Acid magnetic-resonance imaging (EOB-MRI), exploring a non-invasive preoperative diagnostic strategy for microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods 111 newly developed HCC cases were retrospectively collected. Both S-CEUS and EOB-MRI examinations were performed within one month of hepatectomy. The following indicators were investigated: size; vascularity in three phases of S-CEUS; margin, signal intensity, and peritumoral wedge shape in EOB-MRI; tumoral homogeneity, presence and integrity of the tumoral capsule in S-CEUS or EOB-MRI; presence of branching enhancement in S-CEUS; baseline clinical and serological data. The least absolute shrinkage and selection operator regression and multivariate logistic regression analysis were applied to optimize feature selection for the model. A nomogram for MVI was developed and verified by bootstrap resampling. Results Of the 16 variables we included, wedge and margin in HBP of EOB-MRI, capsule integrity in AP or HBP/PVP images of EOB-MRI/S-CEUS, and branching enhancement in AP of S-CEUS were identified as independent risk factors for MVI and incorporated into construction of the nomogram. The nomogram achieved an excellent diagnostic efficiency with an area under the curve of 0.8434 for full data training set and 0.7925 for bootstrapping validation set for 500 repetitions. In evaluating the nomogram, Hosmer-Lemeshow test for training set exhibited a good model fit with P > 0.05. Decision curve analysis of nomogram model yielded excellent clinical net benefit with a wide range (5-80 % and 85-94 %) of risk threshold. Conclusions The MVI Nomogram established in this study may provide a strategy for optimizing the preoperative diagnosis of MVI, which in turn may improve the treatment and prognosis of MVI-related HCC.
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Affiliation(s)
- Feiqian Wang
- Ultrasound Department, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, Shaanxi 710061, PR China
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Akihiro Funaoka
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Takafumi Kumamoto
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Kazuhisa Takeda
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Litao Ruan
- Ultrasound Department, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, Shaanxi 710061, PR China
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
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Zhang S, Ma M, Zhao C, Li J, Xu L, Zhang Z, Diao Q, Ma P, Song D. A novel low-background nitroreductase fluorescent probe for real-time fluorescence imaging and surgical guidance of thyroid cancer resection. Biosens Bioelectron 2024; 261:116514. [PMID: 38908291 DOI: 10.1016/j.bios.2024.116514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Thyroid cancer always appears insidiously with few noticeable clinical symptoms. Due to its limitations, conventional ultrasound imaging can lead to missed or misdiagnosed cases. Surgery is still the primary treatment method of thyroid cancer, but removal of surrounding healthy tissues to minimize recurrence leads to overtreatment and added patient suffering. To address this challenge, herein, a nitroreductase (NTR) fluorescent probe, Ox-NTR, has been developed for detecting thyroid cancer and tracking the surgical removal of thyroid tumors by fluorescence imaging. The conjugated structure of oxazine 1 was disrupted, significantly reducing the issue of high background signals, thus effectively achieving low background fluorescence. Under hypoxic conditions, the nitro group of Ox-NTR can be reduced to an amine and subsequently decomposed into oxazine 1, emitting intense red fluorescence. Ox-NTR has a low detection limit of 0.09 μg/mL for NTR with excellent photostability and selectivity. Cellular studies show that Ox-NTR can effectively detect NTR levels in hypoxic thyroid cancer cells. Moreover, the ability of Ox-NTR of rapid response to thyroid cancer in vivo is confirmed by fluorescence imaging in mice, distinguishing tumors from normal tissues due to its superior low background fluorescence. Utilizing this fluorescence imaging method during surgical resection can guide the removal of tumors, preventing both missed tumor tissues and accidental removal of healthy tissue. In summary, the novel Ox-NTR offers precise detection capabilities that provide significant advantages over traditional imaging methods for thyroid cancer diagnosis and treatment, making it a valuable tool to guide tumor removal in surgical procedures.
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Affiliation(s)
- Siqi Zhang
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China
| | - Mo Ma
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China; School of Pharmacy, Jilin University, Qianjin Street 2699, Changchun, 130012, China
| | - Chen Zhao
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China
| | - Jingkang Li
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China
| | - Lanlan Xu
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China
| | - Zihe Zhang
- The First Hospital of China Medical University, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China
| | - Quanping Diao
- Liaoning Key Laboratory of Development and Utilization for Natural Products Active Molecules, School of Chemistry and Life Science, Anshan Normal University, Anshan, China
| | - Pinyi Ma
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China.
| | - Daqian Song
- College of Chemistry, Jilin Province Research Center for Engineering and Technology of Spectral Analytical Instruments, Jilin University, Qianjin Street 2699, Changchun, 130012, China; Liaoning Key Laboratory of Development and Utilization for Natural Products Active Molecules, School of Chemistry and Life Science, Anshan Normal University, Anshan, China.
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Grossi AP, Astori AF, Nakatani ET, Jure R, Salazar D, Tonni G, Sepulveda W. Prenatal Diagnosis of Umbilical Cord Angiomyxoma: Case Studies and Literature Review of 45 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1769-1784. [PMID: 38884130 DOI: 10.1002/jum.16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024]
Abstract
We describe two cases of umbilical cord (UC) angiomyxoma diagnosed prenatally by sonography in the second trimester of pregnancy. In both cases, a complex mass was detected at the placental insertion site, characterized by an echoic nodule surrounding the umbilical vessels and distal edematous Wharton's jelly. Follow-up scans showed that the mass grew mainly at the expense of its edematous component, with normal uteroplacental Dopplers throughout the remaining of the pregnancy. However, late-onset fetal growth restriction complicated the progress of pregnancy, requiring delivery by Cesarean section at 37 weeks' gestation in both cases. Neonatal courses were unremarkable. An extensive review of the English literature was also performed, collecting 45 similar cases including ours. Our experience as well as the review of the literature confirms that UC angiomyxoma is an uncommon, sporadic condition that is usually detected incidentally during prenatal sonography and presents as an isolated finding. Nevertheless, it represents a high-risk condition for pregnancy complications including prematurity, fetal growth restriction, and fetal demise.
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Affiliation(s)
- Alexandra Pires Grossi
- Department of Obstetrics and Gynecology, Nossa Senhora do Rocio Hospital, Campo Largo, Brazil
| | | | | | | | - Deyana Salazar
- Department of Pathology, Hospital Dr. Franco Ravera Zunino, Rancagua, Chile
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Azienda USL - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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10
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Attachaipanich T, Chattipakorn SC, Chattipakorn N. Cardiovascular toxicities by calcineurin inhibitors: Cellular mechanisms behind clinical manifestations. Acta Physiol (Oxf) 2024; 240:e14199. [PMID: 38984711 DOI: 10.1111/apha.14199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
Calcineurin inhibitors (CNI), including cyclosporine A (CsA) and tacrolimus (TAC), are cornerstones of immunosuppressive therapy in solid organ transplant recipients. While extensively recognized for their capacity to induce nephrotoxicity, hypertension, and dyslipidemia, emerging reports suggest potential direct cardiovascular toxicities associated with CNI. Evidence from both in vitro and in vivo studies has demonstrated direct cardiotoxic impact of CNI, manifesting itself as induction of cardiomyocyte apoptosis, enhanced oxidative stress, inflammatory cell infiltration, and cardiac fibrosis. CNI enhances cellular apoptosis through CaSR via activation of the p38 MAPK pathway and deactivation of the ERK pathway, and enhancement of miR-377 axis. Although CNI could attenuate cardiac hypertrophy in certain animal models, CNI concurrently impaired systolic function, enhanced cardiac fibrosis, and increased the risk of heart failure. Evidence from in vivo studies demonstrated that CNI prolong the duration of action potentials through a decrease in potassium current. CNI also exerted direct effects on endothelial cell injury, inducing apoptosis and enhancing oxidative stress. CNI may induce vascular inflammation through TLR4 via MyD88 and TRIF pathways. In addition, CNI affects vascular function by impairing endothelial-dependent vasodilation and promoting vasoconstriction. Clinical studies in transplant patients also revealed an increased incidence of cardiac remodeling. However, the evidence is constrained by the limited number of participants and potential confounding factors. Several studies indicate differing cardiovascular toxicity profiles between CsA and TAC, and these could be potentially due to their different interactions with calcineurin subunits and calcineurin-independent effects. Further studies are needed to clarify these mechanisms to improve cardiovascular outcomes for transplant patients with CNI.
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Affiliation(s)
- Tanawat Attachaipanich
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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11
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Mao Y, Xia T, Wang H, Wei X, Mu J. Evaluation of image-pro plus assisted superb microvascular imaging for differential diagnosis of renal masses. Urol Oncol 2024; 42:292.e9-292.e16. [PMID: 38760275 DOI: 10.1016/j.urolonc.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE Previous research on diagnostic assessment by superb microvascular imaging (SMI) were based on qualitative or semi-quantitative assessments of vascularity, which may be subjective and unrepeatable by different sonographers. This study aimed to evaluate diagnostic performance of SMI Image-pro Plus (IPP) based vascular index (VI) for malignant renal masses. METHOD We retrospectively reviewed 222 masses in 214 patients who underwent SMI between August 2019 and August 2022 in our study. We evaluated the diagnostic performance of blood flow via Alder grade, VI based on both IPP and SMI. RESULTS The kappa consistency of the Adler grade and VI for renal masses was classified among different observers were 0.765 and 0.824. The intra-observers correlation ecoefficiency (ICC) were 0.727 and 0.874. Benign renal masses were mainly Adler grade 0, grade I, and grade II, VI was 4.30 ± 4.27 (Range 0.98-16.42); while malignant masses were mainly Adler grade III, VI was 14.95 ± 10.94 (Range 0.79-56.89). VI was higher in malignant than benign masses (t = 15.638, P < 0.01). Among the malignant masses, the mean VI in clear cell renal cell carcinoma was higher than that in papillary renal cell carcinoma and chromophobe renal cell carcinoma (F = 30.659, P < 0.01). The sensitivity, specificity and accuracy of SMI were 80.00%, 71.15%, and 78.64%, respectively. The sensitivity, specificity, and accuracy were 60.59%, 88.46%, and 80.18% by using a VI of 7.95 as the cutoff value to identify malignant lesions from benign masses yielded. VI had better diagnostic efficiency than ultrasonic characteristics and Adler grade in benign and malignant differential diagnosis (Z = 4.851, P < 0.01; Z = 2.732, P < 0.01). CONCLUSION VI was higher in malignant than benign in renal masses. In malignant masses, VI in CCRCC was higher than that in papillary renal cell carcinoma and ChRCC. As a noninvasive examination, it had important clinical significance in the differential diagnosis of renal masses. VI from IPP may assist sonographer in distinguish renal malignances as a quantitative tool for vascularity.
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Affiliation(s)
- Yiran Mao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, China
| | - Tingting Xia
- Oncology Department, Zibo First Hospital, Zibo, Shandong province, China
| | - Hailing Wang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, China
| | - Xi Wei
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, China
| | - Jie Mu
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, China.
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12
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Cameselle-García S, Abdulkader-Nallib I, Sánchez-Ares M, Cameselle-Teijeiro JM. Cribriform morular thyroid carcinoma: Clinicopathological and molecular basis for both a preventive and therapeutic approach for a rare tumor (Review). Oncol Rep 2024; 52:119. [PMID: 39027989 PMCID: PMC11292300 DOI: 10.3892/or.2024.8778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
Cribriform morular thyroid carcinoma (CMTC) has been included within the group of thyroid tumors of uncertain histogenesis in the recent World Health Organization classification of endocrine tumors. Most CMTCs occur in young euthyroid women with multiple (and bilateral) thyroid nodules in cases associated with familial adenomatous polyposis (FAP) or as single nodules in sporadic cases. CMTC generally behaves indolently, while aggressiveness and mortality are associated with high‑grade CMTC. This tumor histologically displays a distinctive combination of growth patterns with morular structures. Strong diffuse nuclear and cytoplasmic immunostaining for β‑catenin is the hallmark of CMTC. Tumor cells are also positive for thyroid transcription factor‑1 and for estrogen and progesterone receptors, but negative for thyroglobulin and calcitonin. It is possible that the CMTC phenotype could result from blockage in the terminal/follicular differentiation of follicular cells (or their precursor cells) secondary to the permanent activation of the Wnt/β‑catenin pathway. In CMTC, the activation of the Wnt/β‑catenin pathway is the central pathogenetic event, which in FAP‑associated cases results from germline mutations of the APC regulator of WNT signaling pathway (APC) gene, and in sporadic cases from somatic inactivating mutations in the APC, AXIN1 and CTNNB1 genes. Estrogens appear to play a tumor‑promoting role by stimulating both the PI3K/AKT/mTOR and the RAS/RAF/MAPK signaling pathways. Additional somatic mutations (i.e. RET rearrangements, or KRAS, phosphatidylinositol‑4,5‑bisphosphate 3‑kinase catalytic subunit α, telomerase reverse transcriptase or tumor protein 53 mutations) may further potentiate the development and progression of CMTC. While hemithyroidectomy would be the treatment of choice for sporadic cases without high‑risk data, total thyroidectomy would be indicated in FAP‑associated cases. There is insufficient clinical data to propose therapies targeting the Wnt/β‑catenin pathway, but multikinase or selective inhibitors could be used in a manner analogous to that of conventional thyroid tumors. It is also unknown whether adjuvant antiestrogenic therapy could be useful in the subgroup of women undergoing surgery with high‑risk CMTC, as well as when there is tumor recurrence and/or metastasis.
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Affiliation(s)
- Soledad Cameselle-García
- Department of Medical Oncology, University Hospital Complex of Ourense, Galician Healthcare Service (SERGAS), 32005 Ourense, Spain
| | - Ihab Abdulkader-Nallib
- Department of Pathology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), 15706 Santiago de Compostela, Spain
- School of Medicine, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - María Sánchez-Ares
- Department of Pathology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), 15706 Santiago de Compostela, Spain
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), 15706 Santiago de Compostela, Spain
- School of Medicine, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
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Machado P, Tahmasebi A, Fallon S, Liu JB, Dogan BE, Needleman L, Lazar M, Willis AI, Brill K, Nazarian S, Berger A, Forsberg F. Characterizing Sentinel Lymph Node Status in Breast Cancer Patients Using a Deep-Learning Model Compared With Radiologists' Analysis of Grayscale Ultrasound and Lymphosonography. Ultrasound Q 2024; 40:e00683. [PMID: 38958999 DOI: 10.1097/ruq.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
ABSTRACT The objective of the study was to use a deep learning model to differentiate between benign and malignant sentinel lymph nodes (SLNs) in patients with breast cancer compared to radiologists' assessments.Seventy-nine women with breast cancer were enrolled and underwent lymphosonography and contrast-enhanced ultrasound (CEUS) examination after subcutaneous injection of ultrasound contrast agent around their tumor to identify SLNs. Google AutoML was used to develop image classification model. Grayscale and CEUS images acquired during the ultrasound examination were uploaded with a data distribution of 80% for training/20% for testing. The performance metric used was area under precision/recall curve (AuPRC). In addition, 3 radiologists assessed SLNs as normal or abnormal based on a clinical established classification. Two-hundred seventeen SLNs were divided in 2 for model development; model 1 included all SLNs and model 2 had an equal number of benign and malignant SLNs. Validation results model 1 AuPRC 0.84 (grayscale)/0.91 (CEUS) and model 2 AuPRC 0.91 (grayscale)/0.87 (CEUS). The comparison between artificial intelligence (AI) and readers' showed statistical significant differences between all models and ultrasound modes; model 1 grayscale AI versus readers, P = 0.047, and model 1 CEUS AI versus readers, P < 0.001. Model 2 r grayscale AI versus readers, P = 0.032, and model 2 CEUS AI versus readers, P = 0.041.The interreader agreement overall result showed κ values of 0.20 for grayscale and 0.17 for CEUS.In conclusion, AutoML showed improved diagnostic performance in balance volume datasets. Radiologist performance was not influenced by the dataset's distribution.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Aylin Tahmasebi
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Samuel Fallon
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Basak E Dogan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | | | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Alliric I Willis
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Kristin Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Susanna Nazarian
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Adam Berger
- Chief, Department of Melanoma and Soft Tissue Surgical Oncology, Rutgers University, New Brunswick, NJ
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
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Kurt SA, Taskin F, Kayadibi Y, Ozturk T, Adaletli İ, Icten GE. Role of Combining Grayscale Findings With Superb Microvascular Imaging and Shear Wave Elastography in Standardization and Management of NON-MASS Breast Lesions. Ultrasound Q 2024; 40:e00689. [PMID: 39172910 DOI: 10.1097/ruq.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
ABSTRACT The non-mass breast lesions on ultrasound (US) are a group of challenging pathology. We aimed to standardize these grayscale findings and investigate the effectiveness of superb microvascular imaging (SMI) and shear wave elastography (SWE). A total of 195 lesions were evaluated by B-mode US, SWE, and SMI in the same session. A "NON-MASS model" was built on grayscale US to group the lesions only as areas and those with associated features: microcalcifications, architectural distortion, ductal changes, and microcysts. The mean stiffness parameters Emean, Eratio, and mean vascular index (VI) were recorded following consecutive measurements. Besides, the microvascularity was graded based on Adler's classification (grades 0 to 3). Lesions were divided into 3 groups: benign, category B3, and malignant. One hundred twelve (57.4%) lesions were benign, 23 (11.8%) were B3, and 60 were (30.8%) in the malignant category. Thirty-eight (19.5%) lesions were observed only as an area, whereas associated features were present in 157 lesions (80.5%). Distortion was the only associated feature predicting malignancy among the grayscale findings (P < 0.001). There was a significant difference between malignant and nonmalignant (benign and B3) groups in terms of Adler's grade, Emean, Eratio, and VI values (P < 0.001). Sensitivity, specificity, and accuracy increased when advanced imaging parameters were added to grayscale findings (P < 0.001). In the presence of microcalcifications, architectural distortion, high elasticity, and hypervascularity in the "NON-MASS" imaging model, the suspicion of malignancy increases. The non-mass findings and advanced imaging techniques have the potential to find greater coverage in the following versions of BI-RADS atlas.
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Affiliation(s)
| | - Fusun Taskin
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University
| | | | - Tulin Ozturk
- Department of Pathology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Gul Esen Icten
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University
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Kodesho T, Kato T, Nakao G, Yokoyama Y, Saito Y, Watanabe K, Ohsaki Y, Katayose M, Taniguchi K. Effects of superficial tissue and intermuscular connections on rectus femoris muscle shear modulus heterogeneity. J Ultrasound 2024; 27:449-455. [PMID: 36749499 PMCID: PMC11333411 DOI: 10.1007/s40477-022-00769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Intramuscular heterogeneity exists in the shear modulus of the rectus femoris (RF) muscle. However, the underlying heterogeneity mechanisms are not entirely understood. Previous research has reported that detachment of superficial tissues reduces the shear modulus by 50%. The aim of this study was to examine the effects of the skin, deep fascia, and intermuscular connections on the shear modulus of the RF at multiple sites. MATERIALS AND METHODS Eleven donors were fixed using the Thiel method. Measurements were performed at 0°, 60°, and 120° knee flexion in a neutral hip position. Tissue processing was performed under four conditions: superficial tissue (CONT), skin off (SKIN), deep fascia detachment (FASC), and intermuscular connections detachment (ALL). The shear modulus at the proximal, central, and distal regions were measured using ultrasound shear wave elastography. The study was approved by the Sapporo Medical University Ethical Committee. RESULTS Three-way ANOVA revealed no significant interaction between treatment, site, and angle (P = 0.156), treatment and angle (P = 0.067), or site and angle (P = 0.441). There was a significant effect of treatment (P < 0.001), site (P = 0.010), and angle (P < 0.001) and interaction between treatment and site (P < 0.001). The proximal shear modulus was greater than the central for CONT. There were no significant differences between the measurement sites for SKIN. The distal shear modulus was greater than the proximal for FASC. The distal shear modulus was also greater than the proximal and central for ALL. CONCLUSIONS Intramuscular regional differences that influence superficial tissue and intermuscular connections of RF elasticity heterogeneity were observed.
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Affiliation(s)
- Taiki Kodesho
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Takuya Kato
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Gakuto Nakao
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
- Professional Post-Secondary Course (Physical Therapist), Sapporo Medical Technology, Welfare, and Dentistry Professional Training College of Nishino Gakuen School Foundation, Sapporo, Japan
| | - Yu Yokoyama
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Yuhei Saito
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, West 17, South 1, Chuo-ku, Sapporo, Japan
| | - Yuki Ohsaki
- First Division of Anatomy, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, West 17, South 1, Chuo-ku, Sapporo, Japan
| | - Keigo Taniguchi
- First Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan.
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16
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Zhou Y, Nie M, Mao F, Zhou H, Zhao L, Ding J, Kan Y, Jing X. Associations Between Multiparametric US-Based Indicators and Pathological Status in Patients with Metabolic Associated Fatty Liver Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1395-1402. [PMID: 38871490 DOI: 10.1016/j.ultrasmedbio.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/05/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Noninvasive evaluation of metabolic dysfunction-associated fatty liver disease (MAFLD) using ultrasonography holds significant clinical value. The associations between ultrasound (US)-based parameters and the pathological spectra remain unclear and controversial. This study aims to investigate the associations thoroughly. METHODS The participants with MAFLD undergoing liver biopsy and multiparametric ultrasonography were prospectively recruited from December 2020 to September 2022. Three US-based parameters, namely attenuation coefficient (AC), liver stiffness (LS) and dispersion slope (DS) were obtained. The relationship between these parameters and steatosis grades, inflammation grades and fibrosis stages was examined. RESULTS In this study with 116 participants, AC values significantly differed across distinct steatosis grades (p < 0.001), while DS and LS values varied among inflammation grades (p < 0.001) and fibrosis stages (p < 0.001). The area under the receiver operating characteristic curves (AUCs) of AC ranged from 0.82 to 0.84 for differentiating steatosis grades, while AUCs of LS ranged from 0.62 to 0.76 for distinguishing inflammation grades and 0.83-0.95 for discerning fibrosis stages. AUCs for DS ranged from 0.79 to 0.81 in discriminating inflammation grades and 0.80-0.88 for differentiating fibrosis stages. Subgroup analysis revealed that LS demonstrated different trends in inflammation grade but consistent trends in fibrosis stage across subgroups, whereas DS showed consistent trends for both inflammation grade and fibrosis stage across all subgroups. CONCLUSION AC values indicate the degree of hepatic steatosis but not inflammation or fibrosis. LS values are determined only by fibrosis stage and are not associated with inflammation grades. DS values are associated with both fibrosis and inflammation grades.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Mengjin Nie
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yanmin Kan
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China.
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Özdemir M, Koç U, Gökhan MB, Beşler MS. Unveiling the potential of strain elastography in perihilar cholangiocarcinoma biopsies. Abdom Radiol (NY) 2024; 49:3143-3148. [PMID: 38557769 DOI: 10.1007/s00261-024-04255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This study was conducted to investigate the effectiveness of strain elastography in guiding precise and sufficient tissue sampling for perihilar cholangiocarcinoma (CCA) biopsies. METHODS Our retrospective analysis included 23 liver biopsies conducted between March 2019 and July 2022 for suspected perihilar CCA. An experienced radiologist performed the biopsies via an ultrasound machine with elastography configuration. Tissue stiffness color maps were used for guiding when the biopsies were performed. Strain index value calculations were made by radiologists on recorded images. RESULTS Patient demographics revealed a mean age of 65.17 ± 9.25 years, with a gender distribution of six females and 17 males. Gray-scale examinations unveiled diverse echogenic characteristics in liver lesions. Elastography-guided biopsies demonstrated no need for repeats, while gray-scale biopsies necessitated re-biopsy in four patients, resulting in cholangiocarcinoma diagnosis (P = 0.037). Strain index values showcased strong inter- and intra-observer agreements (P < 0.001). Notably, no post-biopsy complications emerged in either study group. CONCLUSION The diagnostic advantage of elastography, particularly in enhancing accuracy in challenging isoechoic lesions, was demonstrated, although the substantial overlap between strain index values of benign and malignant liver masses limits clinical usefulness of this technique.
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Affiliation(s)
- Mustafa Özdemir
- Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Ural Koç
- Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Muhammed Said Beşler
- Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Radiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
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18
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Smith E, O'Brien O, Woo M, Pretorius V, Cronin B. Rosai-Dorfman-Destombes Disease: A Rare Cardiac Presentation. J Cardiothorac Vasc Anesth 2024; 38:2017-2023. [PMID: 38926004 DOI: 10.1053/j.jvca.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Emma Smith
- Department of Anesthesiology, University of California, San Diego
| | - Orestes O'Brien
- Department of Anesthesiology, University of California, San Diego
| | - Matt Woo
- Department of Anesthesiology, University of California, San Diego
| | - Victor Pretorius
- Department of Cardiothoracic Surgery, University of California, San Diego
| | - Brett Cronin
- Department of Anesthesiology, University of California, San Diego.
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Goo M, Johnston LM, Tucker K. Shear modulus of lower limb muscles in school-aged children with mild hypotonia. J Biomech 2024; 174:112267. [PMID: 39141960 DOI: 10.1016/j.jbiomech.2024.112267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
The objective of this study is to compare shear modulus of lower limb muscles between children with hypotonia versus typical development (TD) or developmental disorders associated with altered tone. Nineteen children with mild hypotonia (mean age 9.4 ± 2.3y, 13 male) completed assessment of resting shear modulus of rectus femoris, biceps femoris (BF), tibialis anterior (TA) and gastrocnemius lateralis (GL) at short and long lengths using shear wave elastography. Data was compared with previous data from TD children and a scoping review for children with developmental disorders. Data were collated according to Net-Longitudinal Tension Angle (Net-LTA), which is the muscle length expressed as the net proximal and distal joint angles. Effects of Net-LTA (e.g., short, neutral, long) were examined according to sex, age and body mass index (BMI). In children with hypotonia, shear modulus was: higher at longer versus shorter lengths for four muscles (p < 0.01); correlated with age for BF-short (r = 0.60, p < 0.03) and GL-short (r = -0.54, p < 0.03), with BMI for BF-short (r = 0.71, p < 0.05); and not different between sexes (p > 0.05). The shear modulus values for lower limb muscles for children with mild hypotonia were lower than those for children with Duchenne Muscular Dystrophy (TA-neutral), or Cerebral Palsy (GL-neutral), but not TD children (all four muscles). In conclusion, shear modulus increases with longer muscle length (i.e. higher Net-LTA) in mildly hypotonic children. Children with mild hypotonia have lower shear modulus than children with cerebral palsy and Duchenne muscular dystrophy.
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Affiliation(s)
- Miran Goo
- The University of Queensland, School of Biomedical Sciences, Brisbane, Australia
| | - Leanne M Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Kylie Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, Australia.
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20
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Selcuk OT, Ozturk Yılmaz G, Ellidag HY, Ilden O, Turkoglu Selcuk N, Yilmaz G, Ensari N, Konsuk Unlu H, Eyigor H. Can we use serum SCUBE 1 levels as a biomarker in obstructive sleep apnea hypopnea syndrome? Cranio 2024; 42:490-498. [PMID: 34842057 DOI: 10.1080/08869634.2021.2005917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the SCUBE1 level, a biomarker in vascular biology that could determine the prognosis of cardiovascular events during OSA treatment. METHODS In total, 129 patients were included in the study. Thirty were diagnosed with simple snoring and 99 with OSA. RESULTS In males, significant correlation was determined between SCUBE1 non-REM AHI, hypopnea index, total apnea index, mean SO2, minimum SO2, and < 90% saturation duration. CONCLUSION Serum SCUBE1 levels increased more in male patients with severe OSA compared to other OSA levels, and high serum SCUBE1 levels were found to be associated with lower oxygen levels in OSA patients. The SCUBE1 biomarker can correlate with severe OSA in males. There was a statistically significant difference between OSA groups in terms of SCUBE1 score for male patients (p = 0.002) but not for females (p = 0.498). It is important that future SCUBE1 studies evaluate males vs. females.
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Affiliation(s)
- Omer Tarik Selcuk
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gamze Ozturk Yılmaz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hamit Yasar Ellidag
- Department of Biochemistry, Antalya Training and Research Hospital, Antalya, Turkey
| | - Oğuzhan Ilden
- Department of Otorhinolaryngology, Kumluca Public Hospital, Antalya, Turkey
| | | | - Gokhan Yilmaz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nuray Ensari
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Hülya Eyigor
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
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Komi K, Fujita M, Manabe N, Takaoka M, Kato K, Fujiwara H, Konishi T, Bukeo E, Misawa H, Nakamura J, Ayaki M, Murao T, Suehiro M, Akiyama T, Kawamoto H, Kamada T, Urakami A, Naomoto Y, Yamatsuji T, Moriya T, Haruma K, Hata J. Contrast-enhanced ultrasonography combined with superb microvascular imaging for preoperative diagnosis of sporadic intra-abdominal desmoid-type fibromatosis: A case report. Radiol Case Rep 2024; 19:3988-3993. [PMID: 39055107 PMCID: PMC11269867 DOI: 10.1016/j.radcr.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 07/27/2024] Open
Abstract
We herein report a case of sporadic intra-abdominal desmoid-type fibromatosis in which contrast-enhanced ultrasonography (US) combined with superb microvascular imaging (SMI) was useful for preoperative diagnosis. 18-Fluorodeoxyglucose positron emission tomography performed for systematic screening for lung cancer revealed an abnormal accumulation in the abdominal cavity. Transabdominal US showed a tumor with a mixture of hypoechoic and hyperechoic areas. Contrast-enhanced US combined with SMI revealed dendritic blood flow signals and no abnormal vascular network within the tumor. Macroscopic examination of the resected specimen revealed a white tumor with relatively clear boundaries. Microscopic examination revealed spindle cells with poor atypia proliferating in bundles with collagenous stromal cells. Immunohistochemistry showed nuclear localization of beta-catenin within the tumor cells. From these findings, we finally diagnosed intra-abdominal desmoid-type fibromatosis. Contrast-enhanced US combined with SMI is useful for diagnosing intra-abdominal desmoid-type fibromatosis.
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Affiliation(s)
- Kazuhiro Komi
- Center for Doctors’ Career Development, Kawasaki Medical School Hospital, Kurashiki, Japan
- Department of Pathology, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Munenori Takaoka
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Katsuya Kato
- Department of Diagnostic and Therapeutic Radiology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hideyo Fujiwara
- Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takako Konishi
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Emiko Bukeo
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hiraku Misawa
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Jun Nakamura
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Maki Ayaki
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Gastroenterology and Hepatology, HITO Medical Center, Shikokuchuou, Japan
| | - Takahisa Murao
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takashi Akiyama
- Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Atsushi Urakami
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yoshio Naomoto
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoki Yamatsuji
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, Kurashiki, Japan
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Brown DC, Nguyen K, Miller SR, Moore JZ. Identifying diversity of patient anatomy through automated image analysis of clinical ultrasounds. J Ultrasound 2024; 27:635-643. [PMID: 38910220 PMCID: PMC11333779 DOI: 10.1007/s40477-024-00908-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/06/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Central venous catheterization (CVC) carries inherent risks which can be mitigated through the use of appropriate ultrasound-guidance during needle insertion. This study aims to comprehensively understand patient anatomy as it is visualized during CVC by employing a semi-automated image analysis method to track the internal jugular vein and carotid artery throughout recorded ultrasound videos. METHODS The ultrasound visualization of 50 CVC procedures were recorded at Penn State Health Milton S. Hershey Medical Center. The developed algorithm was used to detect the vessel edges, calculating metrics such as area, position, and eccentricity. RESULTS Results show typical anatomical variations of the vein and artery, with the artery being more circular and posterior to the vein in most cases. Notably, two cases revealed atypical artery positions, emphasizing the algorithm's precision in detecting anomalies. Additionally, dynamic vessel properties were analyzed, with the vein compressing on average to 13.4% of its original size and the artery expanding by 13.2%. CONCLUSION This study provides valuable insights which can be used to increase the accuracy of training simulations, thus enhancing medical education and procedural expertise. Furthermore, the novel approach of employing automated data analysis techniques to clinical recordings showcases the potential for continual assessment of patient anatomy, which could be useful in future advancements.
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Affiliation(s)
- Dailen C Brown
- Department of Mechanical Engineering, The Pennsylvania State University, State College, USA
| | | | - Scarlett R Miller
- Department of Engineering Design and Industrial Engineering, The Pennsylvania State University, State College, USA
| | - Jason Z Moore
- Department of Mechanical Engineering, The Pennsylvania State University, State College, USA.
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23
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Zhang J, Wu D, Wang S, Bai L, Meng Y, Wang L. Color Duplex Ultrasonography for the Evaluation of Innominate, Subclavian, and Common Carotid Artery Stenosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1695-1709. [PMID: 38837497 DOI: 10.1002/jum.16492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE This study aimed to validate the efficiency of Doppler ultrasonography for predicting the innominate, subclavian, and common carotid artery stenosis. METHODS This retrospective multicenter study between 2013 and 2022 enrolled 636 patients who underwent carotid Doppler ultrasonography and subsequent digital subtraction angiography. And 58 innominate artery stenosis, 147 common carotid artery stenosis, and 154 subclavian artery stenosis were included. The peak systolic velocity at innominate, subclavian, and common carotid artery, and velocity ratios of innominate artery to common carotid artery, innominate artery to subclavian artery, and common carotid artery to internal carotid artery were measured or calculated. The threshold values were determined using receiver operating characteristic analysis. RESULTS The threshold values of innominate artery stenosis were peak systolic velocity >206 cm/s (sensitivity: 82.8%; specificity: 91.4%) to predict ≥50% stenosis and >285 cm/s (sensitivity: 89.2%; specificity: 94.9%) to predict ≥70% stenosis. The threshold values of common carotid artery stenosis were peak systolic velocity >175 cm/s (sensitivity: 78.2%; specificity: 91.9%) to predict ≥50% stenosis and >255 cm/s (sensitivity: 87.1%; specificity: 87.2%) to predict ≥70% stenosis. The threshold values of subclavian artery stenosis were peak systolic velocity >200 cm/s (sensitivity: 68.2%; specificity: 84.4%) to predict ≥50% stenosis and >305 cm/s (sensitivity: 57.9%; specificity: 91.4%) to predict ≥70% stenosis. CONCLUSIONS Symptomatic patients with ultrasonic parameters of velocity at innominate artery ≥206 cm/s, velocity at common carotid artery ≥175 cm/s, or velocity at subclavian artery ≥200 cm/s need to be considered for further verification and whether revascularization is necessary.
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Affiliation(s)
- Jie Zhang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Dianze Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Shaopeng Wang
- Department of Ultrasonography, Meihekou Central Hospital, Meihekou, China
| | - Liyang Bai
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yan Meng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lijuan Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
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24
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West G, Haslinger S, Bamber J, Lowe M, Huthwaite P, Harris E. Simulation of ultrasound backscatter coefficient measurement using the finite element method. ULTRASONICS 2024; 143:107394. [PMID: 39053241 DOI: 10.1016/j.ultras.2024.107394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
Ultrasound backscatter coefficient (BSC) measurement is a method for assessing tissue morphology that can inform on pathologies such as cancer. The BSC measurement is, however, limited by the accuracy with which the investigator can normalise their results to account for frequency dependent effects of diffraction and attenuation whilst performing such measurements. We propose a simulation-based approach to investigate the potential sources of error in assessing the BSC. Presented is a tool for the 2D Finite Element (FE) simulation mimicking a BSC measurement using the planar reflector substitution method in reduced dimensionality. The results of this are verified against new derivations of BSC equations also in reduced dimensionality. These new derivations allow computation of BSC estimates based on the scattering from a 2D scattering area, a line reference reflector and a theoretical value for the BSC of a 2D distribution of scatterers. This 2D model was designed to generate lightweight simulations that allow rapid investigation of the factors associated with BSC measurement, allowing the investigator to generate large data sets in relatively short time scales. Under the conditions for an incoherent scattering medium, the simulations produced BSC estimates within 6% of the theoretical value calculated from the simulation domain, a result reproduced across a range of source f-numbers. This value of error compares well to both estimated errors from other simulation based approaches and to physical experiments. The mathematical and simulation models described here provide a theoretical and experimental framework for continued investigation into factors affecting the accuracy of BSC measurements.
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Affiliation(s)
- George West
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, SM2 5NG, United Kingdom; Department of Mechanical Engineering, Imperial College London, London, SW7 2BX, United Kingdom
| | - Stewart Haslinger
- Department of Mathematics, The University of Liverpool, Liverpool, L69 3BX, United Kingdom
| | - Jeffrey Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, SM2 5NG, United Kingdom
| | - Michael Lowe
- Department of Mechanical Engineering, Imperial College London, London, SW7 2BX, United Kingdom
| | - Peter Huthwaite
- Department of Mechanical Engineering, Imperial College London, London, SW7 2BX, United Kingdom
| | - Emma Harris
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, SM2 5NG, United Kingdom.
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Mekonen NM, Abicho TB, Asfaw KG, Leulseged TW, Mera NA, Habte YW, Moges FH, Birhan YA, Tesfaye M, Tesfaye B. Accuracy of focused cardiac ultrasound interpretation among emergency and critical care medicine residents in Ethiopia: A multi-center cross-sectional study. Afr J Emerg Med 2024; 14:150-155. [PMID: 39005756 PMCID: PMC11245902 DOI: 10.1016/j.afjem.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia. Methods A cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI). Result The overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8-60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32-13.04, p = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06-21.82, p = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01-9.82, p = 0.047) demonstrated significantly higher accuracy. Conclusion The study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills.
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Affiliation(s)
- Nahom Mesfin Mekonen
- Department of Emergency and Critical Care Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Temesgen Beyene Abicho
- Department of Emergency and Critical Care Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Kalsidagn Girma Asfaw
- Department of Emergency and Critical Care Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Tigist Workneh Leulseged
- Medical Research Lounge (MRL), Addis Ababa, Ethiopia
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nebiat Adane Mera
- Department of Internal medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | | | - Yidnekachew Asrat Birhan
- Department of Internal Medicine, Cardiology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Meron Tesfaye
- Department of Emergency and Critical Care Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Birhanu Tesfaye
- Department of Emergency and Critical Care Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
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26
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Adler RS. What is the place of ultrasound in MSK imaging? Skeletal Radiol 2024; 53:1699-1709. [PMID: 38492028 DOI: 10.1007/s00256-024-04642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
During the past four decades, ultrasound has become popular as an imaging modality applied to the musculoskeletal (MSK) system, particularly outside the USA, due to its low cost, accessibility, and lack of ionizing radiation. A basic requirement in performing these examinations is to have a core group of radiologists and ultrasound technologists with expertise in MSK ultrasound. The extent to which ultrasound will be part of the imaging offered by a particular radiology practice or in an academic institution will vary according to expertise, availability, and reimbursements. A brief discussion of the technical capabilities of the current generation of ultrasound scanners will be followed by a description of some of the more prevalent MSK ultrasound imaging applications. The extent to which training to perform these exams within and outside of Radiology plays a role is discussed. Applications that are unique to ultrasound, such as dynamic evaluation of musculoskeletal anatomy and some, US-guided interventions are an important part of MSK imaging. Ultrasound is increasingly important in the assessment of superficial structures, such as tendons, small joints, and peripheral nerves. These applications help to establish the place of ultrasound as an important part of the Radiologists approach to MSK imaging. Outside of radiology, for a variety of clinical subspecialties, ultrasound already plays an integral role in MSK imaging.
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Affiliation(s)
- Ronald S Adler
- Department of Radiology NYU Grossman School of Medicine, 333 East 38Th Street, 6-209, New York, NY, USA.
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27
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Rosen R, Bodnar M, Randolph J, Bailey CJ, Nickel C, Katsoulakis E, Mifsud M. Risk, prevention, screening and management of carotid artery stenosis in head & neck cancer patients-An evidence based review. Oral Oncol 2024; 156:106876. [PMID: 38908097 DOI: 10.1016/j.oraloncology.2024.106876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/24/2024]
Abstract
Our review aims to clarify the incidence of carotid artery stenosis, risks of development, screening, management, and primary prevention strategies documented in the literature after radiation therapy for head and neck cancers. The high prevalence of carotid stenosis after radiation therapy for head and neck cancers has made surveillance and risk stratification critical. In addition to general cardiovascular risk factors such as smoking, diabetes, and dyslipidemia, risk factors for carotid artery stenosis after head and neck radiation included total plaque score, radiotherapy use and dosage, length of time after radiotherapy, and age greater than 50. Cancer subtype, namely nasopharyngeal cancer, may be correlated with increased risk as well, though contrasting results have been found. Interestingly, however, no significant relationship has been found between radiotherapy dose and stroke risk. Surgical management of post-radiation carotid stenosis is similar to that of stenosis unrelated to radiation, with carotid endarterectomy considered to be the gold standard treatment and carotid artery stenting being an acceptable, less-invasive alternative. Medical management of these patients has not been well-studied, but antiplatelet therapy, statins, and blood pressure control may be beneficial. The mainstay of screening for radiation-induced stenosis has been Doppler ultrasound, with measurement of changes in the intima-media thickness being a primary marker of disease development. A literature review was carried out using the MeSH terms "Carotid Artery Stenosis," "Head and Neck Neoplasms," and "Radiotherapy."
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Affiliation(s)
| | | | - Jackson Randolph
- Georgetown University Medical Center, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Charles J Bailey
- University of South Florida Morsani College of Medicine, Division of Vascular & Endovascular Surgery, USA
| | - Christopher Nickel
- University of South Florida Morsani College of Medicine, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Evangelia Katsoulakis
- University of South Florida Morsani College of Medicine, Department of Radiation Oncology, USA
| | - Matthew Mifsud
- University of South Florida Morsani College of Medicine, Department of Otolaryngology-Head and Neck Surgery, USA.
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28
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Klich S, Kristiansen M, Wang HK, Kawczyński A, Larsen RG, Madeleine P. Dependence of Rotator Cuff Muscle Thickness and Stiffness on Low-Level Contractions: Metrology of the Contraction Level Using Shear-Wave Imaging. J Sport Rehabil 2024; 33:542-548. [PMID: 39089674 DOI: 10.1123/jsr.2023-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/22/2024] [Accepted: 05/28/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The study aimed to investigate the effects of the level of contraction during isometric shoulder abduction at different abduction angles on muscle thickness and stiffness of the shoulder girdle in asymptomatic individuals. DESIGN Measurement properties study. SETTING Biomechanics and motion analysis lab. PARTICIPANTS Twenty individuals volunteered to participate in this study. MAIN OUTCOME MEASURE The subjects were tested for morphological and mechanical properties, expressed by thickness and stiffness of the supraspinatus tendon and muscle, and upper trapezius muscle. Moreover, acromiohumeral distance was also evaluated using B-mode ultrasound and shear-wave elastography. INTERVENTION The thickness and stiffness of the supraspinatus and upper trapezius muscle were assessed at 3 angles of abduction (0°, 60°, and 90°) and 3 levels of contraction (0%, 10%, and 20% of the maximal voluntary isometric contraction) using ultrasonography with shear-wave imaging. Moreover, the acromiohumeral distance was measured to establish the occupation ratio during passive movement. RESULTS The supraspinatus and upper trapezius muscle thickness and stiffness were significantly greater at 60° shoulder abduction compared with 0°, and 90° compared with 60°, as well as significantly greater at 20% maximal voluntary isometric contraction compared with 0% and 10% maximal voluntary isometric contraction. Thickness and stiffness were significantly greater in the supraspinatus compared with the upper trapezius muscle at all 3 angles of shoulder abduction for all 3 level of contractions. The acromiohumeral distance decreased significantly from 0° to 60° and from 60° to 90°. CONCLUSION Morphological and mechanical properties of the supraspinatus and upper trapezius muscles depended on the relative level of muscle contraction and the angle of shoulder abduction.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wrocław University of Health and Sport Science, Wrocław, Poland
| | - Mathias Kristiansen
- Department of Health Science and Technology, ExerciseTech, Aalborg University, Aalborg, Denmark
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Adam Kawczyński
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Ryan Godsk Larsen
- Department of Health Science and Technology, ExerciseTech, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Department of Health Science and Technology, ExerciseTech, Aalborg University, Aalborg, Denmark
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Zhang Y, Mao S, Zhang F. Evaluating the role and diagnostic performance of ultrasound in diagnosing soft tissue tumors and pseudotumors in adults: a systematic review and meta-analysis. Expert Rev Med Devices 2024:1-10. [PMID: 39161112 DOI: 10.1080/17434440.2024.2393349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis evaluates the combined accuracy of ultrasonic imaging in diagnosing soft tissue tumors and pseudotumors and identifies factors contributing to variability in its diagnostic accuracy. METHODS A literature search in significant databases used specific keywords and inclusion/exclusion criteria. Two authors independently performed cohort characterization and data analysis, with a third author resolving disagreements. A multivariate random effects model estimated pooled sensitivity, specificity, predictive values, and overall accuracy. RESULTS Ultrasound imaging demonstrated high pooled sensitivity and specificity, indicating effectiveness in identifying lesions. Variability in accuracy was attributed to factors such as tumor type and location, operator experience, and clinic location. CONCLUSIONS Ultrasonic imaging is a reliable diagnostic tool for soft tissue tumors and pseudotumors, providing high sensitivity and specificity. However, variability in accuracy underscores the need to consider operator experience and tumor characteristics. Further research should explore the impact of technological advancements and include non-English studies to enhance understanding of ultrasound imaging's diagnostic validity.
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Affiliation(s)
- Yufei Zhang
- Department Ultrasound, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Shijie Mao
- Department Ultrasound, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fangfang Zhang
- Department Ultrasound, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
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30
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Ito T, Manabe H, Kubota M, Komoike Y. Current status and future perspectives of contrast-enhanced ultrasound diagnosis of breast lesions. J Med Ultrason (2001) 2024:10.1007/s10396-024-01486-0. [PMID: 39174799 DOI: 10.1007/s10396-024-01486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/28/2024] [Indexed: 08/24/2024]
Abstract
Advances in various imaging modalities for breast lesions have improved diagnostic capabilities not only for tumors but also for non-tumorous lesions. Contrast-enhanced ultrasound (CEUS) plays a crucial role not only in the differential diagnosis of breast lesions, identification of sentinel lymph nodes, and diagnosis of lymph node metastasis but also in assessing the therapeutic effects of neoadjuvant chemotherapy (NAC). In CEUS, two image interpretation approaches, i.e., qualitative analysis and quantitative analysis, are employed and applied in various clinical settings. In this paper, we review CEUS for breast lesions, including its various applications.
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Affiliation(s)
- Toshikazu Ito
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Hironobu Manabe
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Michiyo Kubota
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshifumi Komoike
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
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Ozturk HA, Arici FN. Achilles tendon thickness and serum asprosin level significantly increases in patients with polycystic ovary syndrome. PeerJ 2024; 12:e17905. [PMID: 39184386 PMCID: PMC11345002 DOI: 10.7717/peerj.17905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
Aim In our study, we aimed to investigate the Achilles tendon thickness (ATT) and asprosin levels in patients with polycystic ovary syndrome (PCOS) and to evaluate the relationship of these parameters, which may be related to cardio-metabolic diseases. Methods In our prospective cross-sectional study, 45 female patients with PCOS and 30 female healthy individuals similar in age were included. Serum dehydroepiandrosterone sulfate (DHEAS), total testosterone, anti-Müllerian hormone (AMH) and asprosin levels were measured using appropriate kits and homeostatic model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio was calculated. ATT measurements were performed by two radiologists using a high-resolution ultrasound doppler system. Results Serum DHEAS, total testosterone, AMH and asprosin levels, HOMA-IR value, LF/FSH ratio, and ATT values were higher in patients with PCOS compared to healthy controls. Correlation analysis was performed between ATT and other parameters in patients with PCOS. In univariate analysis, parameters associated with ATT were detected as asprosin, DHEAS and AMH. In the linear regression analysis performed with significant parameters, asprosin and DHEAS levels were found to be associated with ATT. Conclusion ATT values and serum asprosin levels were found to be significantly increased in patients with PCOS, and there is a very close positive relationship between ATT and serum asprosin levels. For this reason, it was thought that ATT measurement could be a cheap, simple and non-invasive monitoring parameter that can be used in the routine cardiometabolic follow-up of patients with PCOS.
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Affiliation(s)
- Huseyin Ali Ozturk
- Department of Internal Medicine, University of Health Sciences–Adana Health Practice and Research Center, Adana, Turkey
| | - Fatih Necip Arici
- Department of Internal Medicine, University of Health Sciences–Adana Health Practice and Research Center, Adana, Turkey
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Guan H, Wu Y, Wang X, Liu B, Yan T, Abedi-Firouzjah R. Ultrasound therapy for pain reduction in musculoskeletal disorders: a systematic review and meta-analysis. Ther Adv Chronic Dis 2024; 15:20406223241267217. [PMID: 39170758 PMCID: PMC11337181 DOI: 10.1177/20406223241267217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/20/2024] [Indexed: 08/23/2024] Open
Abstract
Background Ultrasound therapy is a non-invasive technique used to address a variety of health issues. Objectives This systematic review and meta-analysis aim to assess the effectiveness of ultrasound therapy in alleviating pain associated with musculoskeletal diseases. Design This study was conducted following PRISMA guidelines, with relevant articles identified through comprehensive searches in electronic databases. Data sources and methods We conducted searches across multiple databases, including Scopus, PubMed, MEDLINE, ProQuest, Science Direct, CINAHL, AIM, and ELDIS. Two independent reviewers screened the titles and abstracts of the retrieved articles. We included randomized controlled trials (RCTs) and observational cohort studies published between 2010 and 2023 that evaluated ultrasound therapy for knee and shoulder skeletal disorders. The selected data were analyzed qualitatively and synthesized, with the risk of bias assessed using the RoB2 tool. Results Initially, 117 articles were reviewed using the search strategy, and 10 trials that met the inclusion criteria were identified. In seven of these studies, the primary musculoskeletal disorder was osteoarthritis, while three studies focused on shoulder pain and impingement. Most studies indicated that ultrasound therapy significantly reduced pain. The meta-analysis showed that ultrasound therapy was significantly more effective than other interventions for knee disorders (I 2 = 51%, Z = 2.65, p = 0.008). However, for shoulder disorders, both ultrasound and other intervention methods were found to be ineffective (I 2 = 93%, Z = 0.73, p = 0.46). Conclusion The current evidence supports the effectiveness of ultrasound therapy in reducing pain and aiding rehabilitation for knee conditions. However, there are mixed results regarding its efficacy for shoulder conditions, highlighting the need for further research in this area.
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Affiliation(s)
- Haiying Guan
- Department of Spine Surgery, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Yilun Wu
- Department of Ultrasound, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xiangyang Wang
- Department of Spine Surgery, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Bo Liu
- Department of Spine Surgery, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Ting Yan
- Department of Ultrasound, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710000, China
| | - Razzagh Abedi-Firouzjah
- Department of Medical Physics, Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Tonni G, Lituania M, Cecchi A, Carboni E, Grisolia G, Bonasoni MP, Rizzo G, Ruano R, Júnior EA, Werner H, Sepulveda W. Placental and umbilical cord anomalies detected by ultrasound as clinical risk factors of adverse perinatal outcome: Case series review of selected conditions. Part 1: Placental abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39165051 DOI: 10.1002/jcu.23773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND The aim of this extended review of multicenter case series is to describe the prenatal ultrasound features and pathogenetic mechanisms underlying placental and umbilical cord anomalies and their relationship with adverse perinatal outcome. From an educational point of view, the case series has been divided in three parts; Part 1 is dedicated to placental abnormalities. METHODS Multicenter case series of women undergoing routine and extended prenatal ultrasound and perinatal obstetric care. RESULTS Prenatal ultrasound findings, perinatal care, and pathology documentation in cases of placental pathology are presented. CONCLUSIONS Our case series review and that of the medical literature confirms the ethiopathogenetic role and involvement of placenta abnormalities in a wide variety of obstetrics diseases that may jeopardize the fetal well-being. Some of these specific pathologies are strongly associated with a high risk of poor perinatal outcome.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynecology, E.O. Ospedali Galliera, Genoa, Italy
| | - Alessandro Cecchi
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR, Loreto Hospital, Loreto, Italy
| | - Elisa Carboni
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR, Loreto Hospital, Loreto, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, AST, Mantova, Mantua, Italy
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Maternal and Child Health, Urological Sciences, Policlinc Hospital Umberto I, University "La Sapienza", Rome, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Chen Z, Wang H, Jiang T. Value of Two-Dimensional Shear-Wave Elastography in Differentiating Pancreatic Steatosis From Pancreatic Fibrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39152758 DOI: 10.1002/jum.16541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES Pancreatic steatosis (PS) and pancreatic fibrosis (PF) both show increased pancreatic echogenicity on conventional B-mode ultrasound. In this study, we assessed the applicability of two-dimensional shear-wave elastography (2D-SWE) for their discrimination. METHODS We gathered data from 120 adults with valid 2D-SWE measurements, comprising 40 healthy individuals, 55 individuals diagnosed with PS via non-enhanced computed tomography (CT), and 25 patients clinically diagnosed with non-calcific chronic pancreatitis. The participants were divided into three groups: normal pancreas (NP), PS, and PF. pancreatic echogenicity, pancreatic stiffness, and CT values between groups were analyzed. RESULTS The 2D-SWE and CT values among the NP, PS, and PF groups all showed significant differences (P < .001). For the diagnosis of PS and PF using 2D-SWE, the area under the curve (AUC) values were 0.9100 and 0.9940, respectively, with optimal cut-off values of 5.7 kPa for predicting PS and 8.2 kPa for predicting PF. CONCLUSIONS The 2D-SWE technique enabled rapid and quantitative assessment of the hardness of hyperechoic pancreas visualized on conventional B-mode ultrasound, which holds certain value in distinguishing PS from PF.
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Affiliation(s)
- Zhenzhen Chen
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huiyang Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Pulsed Electric Field Technology for Medical Transformation of Zhejiang Province, Hangzhou, China
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Lu H, Liu Y, Yang F, Wu D, Qi J, Ji Y, Hu M. The value of real-time shear wave elastography in spontaneous preterm birth. Medicine (Baltimore) 2024; 103:e39288. [PMID: 39151541 PMCID: PMC11332725 DOI: 10.1097/md.0000000000039288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/10/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024] Open
Abstract
This study aimed to investigate the predictive value of real-time shear wave elastography (SWE) for spontaneous preterm birth (SPB). This study prospectively selected 175 women with singleton pregnancies at 16 to 36 weeks of gestation. Cervical length (CL) and uterocervical angle (UCA) were measured using transvaginal ultrasonography. Real-time shear wave elastography was used to measure Young's modulus values, including the average Young's modulus (Emean) and the maximum Young's modulus (Emax) at 4 points: point A on the inner lip of the cervical os, point B on the outer lip of the cervical os, point C on the inner lip of the external os, and point D on the outer lip of the external os. Receiver operating characteristic (ROC) curve analysis was performed to compare the accuracy of Young's modulus values at the 4 points, CL, and UCA in predicting SPB. Significant variables were used to construct a binary logistic regression model to predict the multifactorial predictive value of SPB, which was evaluated using an ROC curve. A total 176 valid cases, including 160 full-term pregnancies and 16 SPB, were included in this study. Receiver operating characteristic curve analysis revealed that Emean at point A, as well as Emean and Emax at point D, had a relatively high accuracy in diagnosing SPB, with area under the curve values of 0.704, 0.708, and 0.706, respectively followed by CL (0.670), SWE at point C (Emean 0.615, Emax 0.565), SWE at point B (Emean 0.577, Emax 0.584), and UCA (0.476). Binary logistic regression analysis showed that comorbidities during pregnancy (including diabetes mellitus, hypertension, cholestasis and thyroid dysfunction), CL, and Emean at point A were independent predictors of preterm birth. In addition, the AUC value of the logistic regression model's ROC curve was 0.892 (95% CI: 0.804-0.981), with a sensitivity of 0.867, specificity of 0.792, and Youden's index of 0.659, indicating that the regression model has good predictive ability for SPB. Real-time shear wave elastography showed a higher predictive value for SPB than CL and UCA. The SWE combined with CL and comorbidities during pregnancy model has a good predictive ability for SPB.
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Affiliation(s)
- Huiling Lu
- Department of Ultrasonography, Baoji Central Hospital, Shaanxi, China
| | - Yang Liu
- Department of Gynecology, Baoji Central Hospital, Shaanxi, China
| | - Fangrui Yang
- Department of Ultrasonography, Baoji Central Hospital, Shaanxi, China
| | - Dan Wu
- Department of Ultrasonography, Baoji Central Hospital, Shaanxi, China
| | - Jiarui Qi
- Department of Ultrasonography, Baoji Central Hospital, Shaanxi, China
| | - Yonghao Ji
- Department of Ultrasonography, Baoji Central Hospital, Shaanxi, China
| | - Mengli Hu
- Department of Ultrasonography, Baoji Central Hospital, Shaanxi, China
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Gurun E, Ozturk M, Bozduman O. How should meniscus tissue stiffness be measured, what are the correct parameters? Acad Radiol 2024:S1076-6332(24)00564-6. [PMID: 39153962 DOI: 10.1016/j.acra.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Enes Gurun
- Department of Radiology, Samsun University Faculty of Medicine, SAMSUN.
| | - Mesut Ozturk
- Department of Radiology, Samsun University Faculty of Medicine, SAMSUN.
| | - Omer Bozduman
- Department of Orthopedics and Traumatology, Memorial Antalya Hospital, ANTALYA.
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David M, Devantéry K, Nauche B, Chagnon M, Keezer M, Gaudreault N, Bureau NJ, Cloutier G. Ultrasound elastography of back muscle biomechanical properties: a systematic review and meta-analysis of current methods. Insights Imaging 2024; 15:206. [PMID: 39143409 PMCID: PMC11324641 DOI: 10.1186/s13244-024-01785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES To report the current elastography methods used to quantify back muscles' biomechanical characteristics in patients with musculoskeletal disorders (MSKd) and inform on their reliability, validity, and responsiveness. METHODS MEDLINE, Embase, CINAHL, Cochrane library and grey literature were consulted. Predefined criteria allowed for study selection and data extraction. The quality of evidence was rated using the COSMIN tool. Data were meta-analyzed in terms of pooled intraclass correlation coefficient (pICC) for reliability and pooled standardized mean difference (pSMD) for validity and responsiveness. Heterogeneity was assessed. RESULTS Seventy-nine studies were included in the meta-analysis (total number of participants N = 3178). Three elastography methods were identified: strain imaging (SI; number of cohorts M = 26), shear wave imaging (SWI; M = 50), and vibration sonoelastography (VSE; M = 3). Strain imaging and SWI studies reported good reliability measurement properties (pICC > 0.70) and a medium pSMD (0.58 for SI and 0.60 for SWI; p ≤ 0.020) in discriminating MSKd from controls' condition (validity). Strain imaging studies reported a medium pSMD (0.64; p = 0.005) in detecting within-group changes over time, whereas SWI pSMD was very high (1.24; p = 0.005). Only SWI reported significant but small pSMD (0.30; p = 0.003) in detecting between-group changes over time. The small number of VSE studies could not be meta-analyzed. Heterogeneity was high (I-squared > 90%; p < 0.001). CONCLUSIONS Elastography presents good reliability results and a medium pSMD in discriminating MSKd from control conditions. Responsiveness data suggest detectable changes within groups over time using SI and SWI, calling for long-term longitudinal studies. Assessing changes between groups over time using elastography still needs to be proven. Highly significant heterogeneity limits meta-analytic results. CRITICAL RELEVANCE STATEMENT While still in its early-stage exploration phase, musculoskeletal ultrasound elastography may reliably quantify back muscles' biomechanics in asymptomatic individuals, moderately discriminate back musculoskeletal disorders and detect biomechanical changes over time in these conditions, calling for long-term longitudinal studies. KEY POINTS Ultrasound elastography is reviewed for back pain and related musculoskeletal disorder assessments. Growing literature supports good reproducibility, some validity and responsiveness. Back muscle elastography considers assumptions calling for standardized protocols.
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Affiliation(s)
- Mercedes David
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, QC, H2L 2W5, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | | | | | - Miguel Chagnon
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, H2C 3J7, Canada
| | - Mark Keezer
- University of Montreal Hospital, Montreal, QC, H3X 0C1, Canada
- Department of Neurology, University of Montreal, Montreal, QC, H2C 3J7, Canada
| | | | - Nathalie J Bureau
- University of Montreal Hospital, Montreal, QC, H3X 0C1, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, QC, H2L 2W5, Canada.
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, H3C 3J7, Canada.
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada.
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Gao R, Tsui PH, Li S, Bin G, Tai DI, Wu S, Zhou Z. Ultrasound normalized cumulative residual entropy imaging: Theory, methodology, and application. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 256:108374. [PMID: 39153229 DOI: 10.1016/j.cmpb.2024.108374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound information entropy imaging is an emerging quantitative ultrasound technique for characterizing local tissue scatterer concentrations and arrangements. However, the commonly used ultrasound Shannon entropy imaging based on histogram-derived discrete probability estimation suffers from the drawbacks of histogram settings dependence and unknown estimator performance. In this paper, we introduced the information-theoretic cumulative residual entropy (CRE) defined in a continuous distribution of cumulative distribution functions as a new entropy measure of ultrasound backscatter envelope uncertainty or complexity, and proposed ultrasound CRE imaging for tissue characterization. METHODS We theoretically analyzed the CRE for Rayleigh and Nakagami distributions and proposed a normalized CRE for characterizing scatterer distribution patterns. We proposed a method based on an empirical cumulative distribution function estimator and a trapezoidal numerical integration for estimating the normalized CRE from ultrasound backscatter envelope signals. We presented an ultrasound normalized CRE imaging scheme based on the normalized CRE estimator and the parallel computation technique. We also conducted theoretical analysis of the differential entropy which is an extension of the Shannon entropy to a continuous distribution, and introduced a method for ultrasound differential entropy estimation and imaging. Monte-Carlo simulation experiments were performed to evaluate the estimation accuracy of the normalized CRE and differential entropy estimators. Phantom simulation and clinical experiments were conducted to evaluate the performance of the proposed normalized CRE imaging in characterizing scatterer concentrations and hepatic steatosis (n = 204), respectively. RESULTS The theoretical normalized CRE for the Rayleigh distribution was π/4, corresponding to the case where there were ≥10 randomly distributed scatterers within the resolution cell of an ultrasound transducer. The theoretical normalized CRE for the Nakagami distribution decreased as the Nakagami parameter m increased, corresponding to that the ultrasound backscattered statistics varied from pre-Rayleigh to Rayleigh and to post-Rayleigh distributions. Monte-Carlo simulation experiments showed that the proposed normalized CRE and differential entropy estimators can produce a satisfying estimation accuracy even when the size of the test samples is small. Phantom simulation experiments showed that the proposed normalized CRE and differential entropy imaging can characterize scatterer concentrations. Clinical experiments showed that the proposed ultrasound normalized CRE imaging is capable to quantitatively characterize hepatic steatosis, outperforming ultrasound differential entropy imaging and being comparable to ultrasound Shannon entropy and Nakagami imaging. CONCLUSION This study sheds light on the theory and methodology of ultrasound normalized CRE. The proposed ultrasound normalized CRE can serve as a new, flexible quantitative ultrasound envelope statistics parameter. The proposed ultrasound normalized CRE imaging may find applications in quantified characterization of biological tissues. Our code will be made available publicly at https://github.com/zhouzhuhuang.
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Affiliation(s)
- Ruiyang Gao
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sinan Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Guangyu Bin
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shuicai Wu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Zhuhuang Zhou
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China.
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Okuno T, Watanabe T, Yamaguchi T, Konno S, Takaki R, Watanabe R, Ban K, Hirokaga K, Tsuruoka M, Morita T. Usefulness of color Doppler and strain elastography adjunctive to B-mode ultrasonography in the diagnosis of non-mass abnormalities of the breast: results of the BC-07 multicenter study of 385 cases. J Med Ultrason (2001) 2024:10.1007/s10396-024-01485-1. [PMID: 39138813 DOI: 10.1007/s10396-024-01485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/20/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE The concept of non-mass abnormalities of the breast has been employed in Japan for approximately 20 years. Although B-mode findings are classified as non-mass abnormalities, the usefulness of adding color Doppler ultrasonography (US) and strain elastography to B-mode US is unclear. Therefore, we conducted a multicenter study (JABTS BC-07) to establish the diagnostic criteria for breast US, including color Doppler and elastography, for non-mass abnormalities of the breast and verify their diagnostic usefulness. METHODS We registered US images of non-mass abnormalities of the breast and their clinical and histopathological data from 13 institutions (202 malignant and 183 benign non-mass lesions). Furthermore, we evaluated the centralized image interpretation usefulness of the diagnostic criteria for B-mode and color Doppler US, as well as the sensitivity and specificity when color Doppler US and elastography were added to B-mode US. RESULTS Echogenic foci in the mammary gland (odds ratio 3.45, 95% confidence interval [CI] 1.92-6.19, p < 0.0001) and the configuration of internal solid components of the ducts (odds ratio 0.056, 95% CI 0.005-0.591, p < 0.0165) significantly differentiated benign and malignant non-mass abnormalities. The sensitivity of B-mode alone (83.7%) was significantly improved by adding color Doppler US (93.1%) (p = 0.0004); however, adding color Doppler US and elastography to B-mode US made no significant difference in either sensitivity or specificity. CONCLUSION Although adding color Doppler US and elastography to B-mode US improved sensitivity, the diagnostic significance was limited. Therefore, a comprehensive diagnostic method comprising mammography and magnetic resonance imaging is warranted.
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Affiliation(s)
- Toshitaka Okuno
- Department of Breast Surgery, Nishi-Kobe Medical Center, 7-5-1 Koji-dai, Nishi-ku, Kobe City, Kobe, 651-2273, Japan.
| | | | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sachiyo Konno
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, Shimotsuga-gun, Mibu, Japan
| | - Rie Takaki
- Department of Clinical Laboratory, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Ryoji Watanabe
- Department of Breast Surgery, Itoshima Medical Association Hospital, Itoshima, Japan
| | - Kanako Ban
- Department of Breast Surgery, Yotsuya Medical Cube, Tokyo, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Takako Morita
- Department of Breast Surgery, Nagoya Medical Center, Nagoya, Japan
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Tan R, Liu J, Tang Q, Chen H, Zhang Z. Clinical Diagnostic Value of Shear-Wave Elastography in Detecting Malignant Nipple Retraction. J Comput Assist Tomogr 2024:00004728-990000000-00345. [PMID: 39143669 DOI: 10.1097/rct.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVES In recent years, the use of shear-wave elastography (SWE) as a diagnostic tool for detecting malignant breast lesions has shown promising results. This study aims to determine the clinical diagnostic value of SWE in detecting malignant nipple retraction. METHODS Both US and SWE (Philips EPIQ7 system) were performed for 41 consecutive patients with nipple retraction (56 nipples). The mean, median, and maximum tissue elasticity values (in kilopascals) were determined for each nipple by using SWE. The sensitivity, specificity, and overall accuracy of each measurement was determined by using the surgical pathology results or clinical diagnosis as the gold standard. RESULTS Of the 56 retracted nipples, 32 were due to benign lesions, and 24 were due to malignant lesions. No significant differences in dimensions or echo features were found between the benign and malignant groups. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the color Doppler flow imaging (CDFI) pattern were 63.89% (23/36), 95% (19/20), 95.83 (23/24), 59.38 (19/32), and 75% (42/56), respectively; the corresponding values for median elasticity on SWE were 88.46% (23/26), 96.67% (29/30), 95.83 (23/24), 90.63 (29/32), and 92.85 (52/56), respectively. CONCLUSIONS The addition of SWE to conventional US could help differentiate benign from malignant lesions associated with nipple retraction.
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Affiliation(s)
- Rong Tan
- From the Department of Ultrasonography, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha)
| | - Jie Liu
- Department of Medical Record and Statistical Analysis, Hunan Provincial Maternal and Child Health Care Hospital
| | - Qi Tang
- From the Department of Ultrasonography, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha)
| | | | - Zhenhui Zhang
- Department of Obstetrics, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha), Changsha, Hunan, PR China
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Yamashita Y, Yamazaki H, Nakahata A, Shimokawa T, Tamura T, Kawaji Y, Tamura T, Hatamaru K, Itonaga M, Ashida R, Kitano M. Endoscopic ultrasonography for microvascular imaging without contrast enhancement in the differential diagnosis of pancreatic lesions. Dig Endosc 2024. [PMID: 39129171 DOI: 10.1111/den.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/30/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Detective flow imaging endoscopic ultrasonography (DFI-EUS) is a recent imaging modality developed for detecting fine vessels without the need for ultrasound contrast agents. The aim of the present study was to evaluate the utility of DFI-EUS for solid pancreatic lesions and to compare the diagnostic ability for pancreatic cancer (PC) between DFI-EUS, directional power Doppler (eFLOW) EUS, and contrast-enhanced harmonic (CH)-EUS. METHODS Patients with a pancreatic lesion who underwent DFI-EUS, eFLOW-EUS, and CH-EUS between March 2019 and November 2023 were retrospectively enrolled. Final diagnoses were confirmed by pathologic examination of EUS-guided tissue acquisition and/or resected specimens. Lesions were categorized into the three patterns of poor, mild, and rich vascularity on DFI-EUS and eFLOW-EUS, and hypo-, iso-, and hypervascular on CH-EUS. PC was defined as a poor pattern on DFI-EUS and eFLOW-EUS, and a hypovascular pattern on CH-EUS. RESULTS The final diagnoses of 90 examined tumors were PC (n = 57), inflammatory mass (n = 6), autoimmune pancreatitis (n = 13), neuroendocrine tumor (n = 9), and others (n = 5). The sensitivity, specificity, and accuracy for diagnosis of PC were 93%, 82%, and 88%, respectively, on DFI-EUS, 97%, 42%, and 77% on eFLOW-EUS, and 95%, 89%, and 92% on CH-EUS. The accuracy of DFI-EUS was significantly superior to eFLOW-EUS (P = 0.005), but no significant difference was found between DFI-EUS and CH-EUS. CONCLUSION DFI-EUS is more sensitive for depicting vasculature than eFLOW-EUS, and has higher diagnostic sensitivity for PC. Evaluation of vascularity on DFI-EUS is useful for the differential diagnosis of pancreatic lesions without the need for intravenous contrast agent.
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Affiliation(s)
- Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hirofumi Yamazaki
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akiya Nakahata
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan
| | - Takaaki Tamura
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Yuki Kawaji
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tamura
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Reiko Ashida
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Kubota K, Iwasaki E, Ishikawa T, Kuwatani M, Takenaka M, Iwashita T, Masuda A, Ikeura T, Nakamura A, Tanaka A, Isayama H, Hirooka Y, Hirano K, Ryozawa S, Ogura T, Fujisawa T, Kurita Y, Kikuta K, Hayashi N, Masamune A, Yasuda I. Diagnosis of isolated hilar-/extrahepatic-type IgG-4-related sclerosing cholangitis can be increased by improved recognition of this condition-A Japanese multicenter analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024. [PMID: 39123289 DOI: 10.1002/jhbp.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
BACKGROUND Patients with isolated IgG4-related sclerosing cholangitis (IgG4-SC) often undergo unnecessary resection. The aim of this study was to validate the revised Japanese diagnostic criteria for isolated IgG-4-SC and to improve awareness about this condition in the population. METHODS This was a Japanese retrospective multicenter study. We focused on the data and diagnostic yield obtained using the Japanese diagnostic criteria published initially in 2012 and revised later in 2020 for the diagnosis of isolated IgG4-SC. RESULTS Patients with isolated IgG4-SC could be classified into two groups based on the primary location of the lesion: the hilar type (n = 40) and the extrahepatic type (n = 13). In total, 10 patients with the hilar type had undergone unnecessary resection. The revised 2020 criteria are useful for the diagnosis of extrahepatic lesions, which are not included in the 2012 criteria. The need for a steroid trial was reduced from 37.7% when the diagnosis was based on the 2012 criteria to 7.6% when the diagnosis was based on the revised 2020 criteria. The diagnostic specificity also improved from 58.5% for the 2012 criteria to 88.7% for the revised 2020 criteria. CONCLUSION Our validation of the 2020 criteria for the diagnosis of IgG4-SC could contribute to avoiding unnecessary resection in patients with isolated IgG4-SC, which can be classified into the hilar and extrahepatic types. The 2020 criteria can enhance the diagnosis rate of isolated IgG4-SC and uncover this tough-to-diagnose entity based on inclusion of the imaging findings and decrease the dependence on a steroid trial.
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Affiliation(s)
| | - Eisuke Iwasaki
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, Keio University, Minato, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kindai University Faculty of Medicine, Higashiosaka, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Akira Nakamura
- Department of Gastroenterology, Shinshu University, Matsumoto, Japan
| | | | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Bunkyo, Japan
| | - Yoshiki Hirooka
- Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Kenji Hirano
- Department of Gastroenterology, Tokyo Takanawa Hospital, Minato, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Bunkyo, Japan
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuhiro Kikuta
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhiko Hayashi
- Third Department of Internal Medicine, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Atsushi Masamune
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Graduate School of Medicine, University of Toyama, Toyama, Japan
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Bauer DJ, De Silvestri A, Maiocchi L, Raimondi A, Mare R, Mandorfer M, Sporea I, Müllner-Bucsics T, Ferraioli G, Reiberger T. Understanding confounding factors allows for accurate interpretation of liver stiffness measurements by ElastQ, a novel 2D shear wave elastography technique. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 39117313 DOI: 10.1055/a-2329-2801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) or two-dimensional shear wave elastography (2D-SWE) is recommended to assess the risk of liver fibrosis and advanced chronic liver disease. Even though both techniques measure liver stiffness, their numerical results often diverge. Confounders and reliability criteria for 2D-SWE have not been systematically investigated. MATERIALS AND METHODS We prospectively recruited participants with paired LSM by VCTE and the novel 2D-SWE technique ElastQ (Philips) in three European tertiary centers. The following parameters were recorded: sex, age, body mass index (BMI), etiology, laboratory markers of liver damage and function, as well as cholestasis, LSM by VCTE and controlled attenuation parameter (CAP), interquartile range (IQR)/median for VCTE-LSM and ElastQ-LSM, and the skin-to-liver capsule distance. RESULTS We included 840 participants: 447 (53.2%) males; median age 57.0 [IQR:19.0] years; median BMI 25.4 [6.0] kg/m2; median VCTE-LSM 7.25 [9.2] kPa; median ElastQ-LSM 6.7 [5.4] kPa. On uni- and multivariable modeling (adjusted for LSM), we found that the discrepancy increased with liver stiffness and markers of disease severity. Skin-to-liver capsule distance and BMI affected VCTE-LSM more compared to ElastQ-LSM and significantly increased the discordance between the two measurements. CONCLUSION The discrepancy of ElastQ-LSM to VCTE-LSM increases with liver stiffness and disease severity. BMI and skin-to-liver capsule distance increase the discrepancy between VCTE- and ElastQ-LSM but affect ElastQ-LSM less. The quality criterion IQR/median ≤ 30% indicates reliable ElastQ-LSM.
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Affiliation(s)
- David Jm Bauer
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Maiocchi
- Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy
| | - Ambra Raimondi
- Clinical Sciences and Infectious Diseases Department, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy, Pavia, Italy
| | - Ruxandra Mare
- Department of Internal Medicine II, Division of Gastroenterology & Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Ioan Sporea
- Department of Internal Medicine II, Division of Gastroenterology & Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | | | - Giovanna Ferraioli
- Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, Medical School, University of Pavia, Pavia, Italy
| | - Thomas Reiberger
- Internal Medicine III, Div. of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria
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Ohta T, Sasai H, Kikuchi N, Nakazato K, Okamoto T. Muscle Performance as a Predictor of Bone Health: Among Community-Dwelling Postmenopausal Japanese Women from Setagaya-Aoba Study. Calcif Tissue Int 2024:10.1007/s00223-024-01269-2. [PMID: 39105770 DOI: 10.1007/s00223-024-01269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
Osteoporosis is a significant health concern for postmenopausal women, necessitating efficient screening methods for bone health. This study explores the potential of muscle function, assessed through the 30-s chair stand test (CS-30), as an indicator for low bone stiffness in this demographic, aiming to establish a practical threshold for large-scale fitness surveillance without the need for specialized tools. We analyzed data from 1055 community-dwelling postmenopausal Japanese women, aged 41-89 years, collected between 2016 and 2019. Participants underwent CS-30 to evaluate muscle function alongside quantitative ultrasound (QUS) measurements to assess bone stiffness. The cohort was divided into two groups for the development and validation of a cutoff point for low bone stiffness, defined as a QUS speed of sound less than 1487.3 m/s. The CS-30 cutoff was determined using receiver operating characteristic (ROC) curve analysis and validated through logistic regression, accounting for age, body mass index, and smoking status. Among 577 postmenopausal women, 16.0% exhibited low bone stiffness. In the development group (n = 382), ROC analysis identified a CS-30 cutoff of 25 repetitions for detecting low bone stiffness, with an area under the curve of 0.744 (P < 0.001). In the validation group (n = 195), participants performing ≥ 25 repetitions had a higher risk of low bone stiffness compared to those performing ≤ 24 repetitions. The CS-30 test is an effective preliminary screening tool for identifying postmenopausal women at risk of low bone stiffness, with a threshold of 25 repetitions. This method could facilitate early detection of individuals at higher osteoporosis risk, promoting timely intervention.
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Affiliation(s)
- Takahisa Ohta
- Research Institute for Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508, Japan.
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Naoki Kikuchi
- Research Institute for Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508, Japan
| | - Koichi Nakazato
- Research Institute for Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508, Japan
| | - Takanobu Okamoto
- Research Institute for Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508, Japan
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Afyouni S, Zandieh G, Nia IY, Pawlik TM, Kamel IR. State-of-the-art imaging of hepatocellular carcinoma. J Gastrointest Surg 2024:S1091-255X(24)00570-5. [PMID: 39117267 DOI: 10.1016/j.gassur.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/20/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
Hepatocellular carcinoma (HCC) is the third most fatal and fifth most common cancer worldwide, with rising incidence due to obesity and nonalcoholic fatty liver disease. Imaging modalities, including ultrasound (US), multidetector computed tomography (MDCT), and magnetic resonance imaging (MRI) play a vital role in detecting HCC characteristics, aiding in early detection, detailed visualization, and accurate differentiation of liver lesions. Liver-specific contrast agents, the Liver Imaging Reporting and Data System, and advanced techniques, including diffusion-weighted imaging and artificial intelligence, further enhance diagnostic accuracy. This review emphasizes the significant role of imaging in managing HCC, from diagnosis to treatment assessment, without the need for invasive biopsies.
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Affiliation(s)
- Shadi Afyouni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Ghazal Zandieh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Iman Yazdani Nia
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH, United States
| | - Ihab R Kamel
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States.
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Sato M, Tamura Y, Murao Y, Yorikawa F, Katsumata Y, Watanabe S, Zen S, Kodera R, Oba K, Toyoshima K, Chiba Y, Araki A. Coexistence of high visceral fat area and sarcopenia is associated with atherosclerotic markers in old-old patients with diabetes: A cross-sectional study. J Diabetes Investig 2024. [PMID: 39105252 DOI: 10.1111/jdi.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024] Open
Abstract
AIMS/INTRODUCTION To investigate whether sarcopenic obesity is associated with the progression of atherosclerotic lesions in older patients with diabetes and to identify the obesity components of sarcopenic obesity that best reflect atherosclerosis. MATERIALS AND METHODS In 118 inpatients aged ≥75 years with diabetes mellitus, sarcopenia defined as a low skeletal muscle mass and low grip strength was assessed, and sarcopenia coexisting with a high body-fat percentage or visceral fat area was defined as sarcopenic obesity. Correlations between the obesity components and atherosclerotic markers, including the carotid intima-media thickness, were analyzed; the intima-media thickness was analyzed in four groups with and without obesity and sarcopenia, and a multiple linear regression analysis adjusted for covariates was conducted to investigate whether sarcopenic obesity was independently associated with the intima-media thickness. RESULTS The visceral fat area and intima-media thickness showed positive correlations in the overall patients (P = 0.032) and the sarcopenia (P = 0.016) group but showed no associations in participants without sarcopenia. The intima-media thickness in the group showing sarcopenia with a high visceral fat area was significantly higher than that in the control group (P = 0.012). Sarcopenic obesity defined by a high body-fat percentage and high visceral fat area was independently associated with the intima-media thickness even after adjusting for age, sex, and atherogenic risk factors. However, sarcopenic obesity defined by a high visceral fat area was more strongly associated with the intima-media thickness (β = 0.384, P = 0.002) than that defined by the high body-fat percentage (β = 0.237, P = 0.068). CONCLUSIONS Sarcopenic obesity, especially that defined by visceral fat accumulation, reflected the risk of atherosclerotic lesion progression in older patients with diabetes.
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Affiliation(s)
- Motoya Sato
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
- The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Yuji Murao
- The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Fumino Yorikawa
- The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Yuu Katsumata
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - So Watanabe
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Shugo Zen
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
- The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
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Shima H, Doi T, Yoshikawa Y, Okamoto T, Tashiro M, Inoue T, Okada K, Minakuchi J. The association between renal medullary and cortical fibrosis, stiffness, and concentrating capacity: an observational, single-center cross-sectional study. Clin Exp Nephrol 2024:10.1007/s10157-024-02538-y. [PMID: 39098924 DOI: 10.1007/s10157-024-02538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/05/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Fibrosis is a common final pathway leading to end-stage renal failure. As the renal medulla and cortex contain different nephron segments, we analyzed the factors associated with the progression of renal medullary and cortical fibrosis. METHODS A total of 120 patients who underwent renal biopsy at Kawashima Hospital between May 2019 and October 2022 were enrolled in this retrospective study. Renal medullary and cortical fibrosis and stiffness were evaluated using Masson's trichrome staining and shear wave elastography, respectively. Maximum urine osmolality in the Fishberg concentration test was also examined. RESULTS Medullary fibrosis was positively correlated with cortical fibrosis (p < 0.0001) and log-converted urinary β2-microglobulin (MG) (log urinary β2-MG) (p = 0.022) and negatively correlated with estimated glomerular filtration rate (eGFR) (p = 0.0002). Cortical fibrosis also correlated with log urinary β2-MG, eGFR, and maximum urine osmolality. Multivariate analysis revealed that cortical fibrosis levels (odds ratio [OR]: 1.063) and medullary stiffness (OR: 1.089) were significantly associated with medullar fibrosis (≧45%). The severe fibrosis group with both medullary fibrosis (≧45%) and cortical fibrosis (≧25%) had lower eGFR and maximum urine osmolality values and higher urinary β2-MG levels than the other groups. CONCLUSIONS Patients with disorders involving both renal medullary and cortical fibrosis had decreased maximum urine osmolality but had no abnormalities in the urinary concentrating capacities with either condition. Renal medullary and cortical fibrosis were positively correlated with urinary β2-MG, but not with urinary N-acetyl-beta-D-glucosaminidase.
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Affiliation(s)
- Hisato Shima
- Department of Kidney Disease, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan.
- Department of Nephrology and Hypertension, Kamei Hospital, 231 Terayama, Hachiman-Cho, Tokushima, 770-8070, Japan.
| | - Toshio Doi
- Department of Kidney Disease, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
| | - Yukari Yoshikawa
- Department of Laboratory, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
| | - Takuya Okamoto
- Department of Laboratory, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
| | - Manabu Tashiro
- Department of Kidney Disease, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
| | - Tomoko Inoue
- Department of Kidney Disease, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
| | - Kazuyoshi Okada
- Department of Kidney Disease, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
| | - Jun Minakuchi
- Department of Kidney Disease, Kawashima Hospital, 6-1 Kitasakoichiban-Cho, Tokushima, Tokushima, 770-0011, Japan
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King EL, Patwardhan S, Bashatah A, Magee M, Jones MT, Wei Q, Sikdar S, Chitnis PV. Distributed Wearable Ultrasound Sensors Predict Isometric Ground Reaction Force. SENSORS (BASEL, SWITZERLAND) 2024; 24:5023. [PMID: 39124070 PMCID: PMC11314925 DOI: 10.3390/s24155023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
Rehabilitation from musculoskeletal injuries focuses on reestablishing and monitoring muscle activation patterns to accurately produce force. The aim of this study is to explore the use of a novel low-powered wearable distributed Simultaneous Musculoskeletal Assessment with Real-Time Ultrasound (SMART-US) device to predict force during an isometric squat task. Participants (N = 5) performed maximum isometric squats under two medical imaging techniques; clinical musculoskeletal motion mode (m-mode) ultrasound on the dominant vastus lateralis and SMART-US sensors placed on the rectus femoris, vastus lateralis, medial hamstring, and vastus medialis. Ultrasound features were extracted, and a linear ridge regression model was used to predict ground reaction force. The performance of ultrasound features to predict measured force was tested using either the Clinical M-mode, SMART-US sensors on the vastus lateralis (SMART-US: VL), rectus femoris (SMART-US: RF), medial hamstring (SMART-US: MH), and vastus medialis (SMART-US: VMO) or utilized all four SMART-US sensors (Distributed SMART-US). Model training showed that the Clinical M-mode and the Distributed SMART-US model were both significantly different from the SMART-US: VL, SMART-US: MH, SMART-US: RF, and SMART-US: VMO models (p < 0.05). Model validation showed that the Distributed SMART-US model had an R2 of 0.80 ± 0.04 and was significantly different from SMART-US: VL but not from the Clinical M-mode model. In conclusion, a novel wearable distributed SMART-US system can predict ground reaction force using machine learning, demonstrating the feasibility of wearable ultrasound imaging for ground reaction force estimation.
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Affiliation(s)
- Erica L. King
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA; (S.P.); (A.B.); (Q.W.); (S.S.)
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA 22030, USA
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA;
| | - Shriniwas Patwardhan
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA; (S.P.); (A.B.); (Q.W.); (S.S.)
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA 22030, USA
- National Institute of Health, Bethesda, MD 20892, USA
| | - Ahmed Bashatah
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA; (S.P.); (A.B.); (Q.W.); (S.S.)
| | - Meghan Magee
- School of Kinesiology, George Mason University, Fairfax, VA 22030, USA;
- School of Sports, Recreation and Tourism Management, George Mason University, Fairfax, VA 22030, USA
- School of Health Sciences, Kent State University, Kent, OH 44240, USA
| | - Margaret T. Jones
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA;
- School of Kinesiology, George Mason University, Fairfax, VA 22030, USA;
- School of Sports, Recreation and Tourism Management, George Mason University, Fairfax, VA 22030, USA
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA; (S.P.); (A.B.); (Q.W.); (S.S.)
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA; (S.P.); (A.B.); (Q.W.); (S.S.)
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA 22030, USA
| | - Parag V. Chitnis
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA; (S.P.); (A.B.); (Q.W.); (S.S.)
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA 22030, USA
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Skuk E, Cvjetićanin B, Pirš B, Belcijan NL, Jakimovska M. Ovarian sclerosing stromal tumor mimicking malignancy: case series and literature review. Arch Gynecol Obstet 2024; 310:1171-1177. [PMID: 38910143 DOI: 10.1007/s00404-024-07520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/15/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Sclerosing stromal tumors (SST) are rare ovarian neoplasms that often appear as solid unilateral tumors of the ovary with no specific clinical or radiological presentation. The definitive treatment is surgical removal. CASE PRESENTATION Our article presents four cases of female patients with sclerosing stromal ovarian tumor with clinical characteristics mimicking malignant ovarian lesions. Interestingly, two of our cases had elevated levels of inhibin B. All patients were treated with surgery (oophorectomy) and had no disease recurrence. CONCLUSION Tumors' macroscopic features are usually non-specific and often suggestive of possible malignancy, therefore diagnosis is always based on histopathological report.
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Affiliation(s)
- Eva Skuk
- Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Branko Cvjetićanin
- Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Boštjan Pirš
- Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Neža Lebič Belcijan
- Division of Gynaecology and Obstetrics, Department of Pathology, University Medical Centre Ljubljana, Šlajmerjeva 2, 1000, Ljubljana, Slovenia
| | - Marina Jakimovska
- Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Ferraioli G, Barr RG, Berzigotti A, Sporea I, Wong VWS, Reiberger T, Karlas T, Thiele M, Cardoso AC, Ayonrinde OT, Castera L, Dietrich CF, Iijima H, Lee DH, Kemp W, Oliveira CP, Sarin SK. WFUMB Guidelines/Guidance on Liver Multiparametric Ultrasound. Part 2: Guidance on Liver Fat Quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1088-1098. [PMID: 38658207 DOI: 10.1016/j.ultrasmedbio.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has promoted the development of this document on multiparametric ultrasound. Part 2 is a guidance on the use of the available tools for the quantification of liver fat content with ultrasound. These are attenuation coefficient, backscatter coefficient, and speed of sound. All of them use the raw data of the ultrasound beam to estimate liver fat content. This guidance has the aim of helping the reader in understanding how they work and interpret the results. Confounding factors are discussed and a standardized protocol for measurement acquisition is suggested to mitigate them. The recommendations were based on published studies and experts' opinion but were not formally graded because the body of evidence remained low at the time of drafting this document.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Richard Gary Barr
- Department of Radiology, Northeastern Ohio Medical University, Youngstown, OH, USA
| | - Annalisa Berzigotti
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ioan Sporea
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ana Carolina Cardoso
- Hepatology Division, School of Medicine, Federal University of Rio de Janeiro, Clementino, Fraga Filho Hospital, Rio de Janeiro, RJ, Brazil
| | - Oyekoya Taiwo Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia; Medical School, The University of Western Australia, Crawley, WA, Australia; Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Laurent Castera
- Université Paris-Cité, Inserm UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem and Permancence, Bern, Switzerland
| | - Hiroko Iijima
- Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Disease, Hyogo Medical University, Nishinomiya, Hyogo, Japan; Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Dong Ho Lee
- Department of Radiology, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Claudia P Oliveira
- Gastroenterology Department, Laboratório de Investigação (LIM07), Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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