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Wang Z, Ma Y, Zhou J, Jiang F, Chen JY, Chen WZ. Comparing the effect of FUAS and myomectomy on the elasticity of myometrium around targeted uterine fibroid. Int J Hyperthermia 2024; 41:2362998. [PMID: 39128847 DOI: 10.1080/02656736.2024.2362998] [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: 12/15/2023] [Revised: 05/09/2024] [Accepted: 05/28/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Focused ultrasound ablation surgery (FUAS) has been widely employed to treat patients with uterine fibroid (UF). This study aimed to estimate myometrial stiffness changes in patients who received FUAS for UFs or myomectomy (ME) and compare the recovery of surrounding myometrium between FUAS and ME groups. Our results may provide more evidence for guiding the proper conception timing in patients with UF. METHODS This study enrolled 173 patients from May 2022 to August 2023. Shear wave elastography (SWE) was used to dynamically monitor myometrial elasticity changes in patients before and after surgery. Moreover, our study monitored and analyzed the stiffness changes in the targeted fibroid after FUAS, as well as in the myometrium around after FUAS or ME. RESULTS The stiffness of the myometrium around the resected fibroid was significantly higher than at the preoperative level until 6 months. Conversely, the stiffness of the surrounding myometrium was only temporarily increased 1 day after FUAS. The comparison between FUAS and ME groups regarding the stiffness of the surrounding myometrium showed that nonsignificant differences were detected between the two groups before the treatment. The stiffness of the surrounding myometrium in the ME group was statistically significantly higher than that of the FUAS group 1 day as well as 1, 3, and 6 months after the treatment, respectively. CONCLUSION The FUAS had less impact on the surrounding myometrium than the ME, which may be more conducive to the recovery of myometrial elasticity in patients with UF.
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Affiliation(s)
- Ziyao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Department of Ultrasound Medicine, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Yan Ma
- Department of Gynecology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Jia Zhou
- Department of Ultrasound Medicine, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Feng Jiang
- Department of Gynecology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wen-Zhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Bayraktar E, Erel CT, Akturk H, Erkan IBO, Hamid R, Alper E, Adaletli I, Urfalioglu M. A novel objective evaluation method, shear wave elastography, in the treatment of atrophic vaginitis by nonablative intravaginal Er:YAG laser, a randomized-sham controlled pilot study. Menopause 2024; 31:716-723. [PMID: 38860935 DOI: 10.1097/gme.0000000000002380] [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: 06/12/2024]
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography. METHODS In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (E mean ) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia. RESULTS Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and E mean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final E mean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline E mean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment. CONCLUSIONS Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
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Affiliation(s)
- Elif Bayraktar
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - C Tamer Erel
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Hayedeh Akturk
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ipek Betul Ozcivit Erkan
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Rauf Hamid
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ebru Alper
- Department of Obstetrics and Gynecology, American Hospital, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mert Urfalioglu
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Barrett F, Willson S, Werner M. Advancements in the application of uterine ultrasound elastography. Curr Opin Obstet Gynecol 2024; 36:181-185. [PMID: 38656810 DOI: 10.1097/gco.0000000000000949] [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: 04/26/2024]
Abstract
PURPOSE OF REVIEW This article reviews recent advances in ultrasound elastography in diagnosing and evaluating the normal nongravid uterus and the infertile uterus in the gynecologic patient. RECENT FINDINGS Focusing on the most recent primary literature, studies have demonstrated new findings among a breadth of gynecologic clinical settings. Studies in the nongravid uterus have found that menopausal status, age, and menstrual phase have not been associated with changes in uterine tissue stiffness. Focusing on myometrial disease, there have been conflicting data regarding the ability to distinguish uterine fibroids from adenomyosis. One area of expanding research surrounding uterine elastography includes the infertile population, where ongoing studies attempt to provide a predictive model using shear wave elastography (SWE) in patients undergoing in-vitro fertilization. SUMMARY Ultrasound elastography has become an increasingly studied and utilized tool in assessing physiologic and pathologic processes in the field of gynecology. Evaluating tissue stiffness through strain and SWE can serve to improve diagnosis of various uterine and cervical lesions, as well as prognosticate outcomes after fertility treatments. This growing area of research will continue to establish the role and application of ultrasound elastography into clinical practice.
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Affiliation(s)
- Francesca Barrett
- IVI RMA New Jersey, Basking Ridge, New Jersey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephanie Willson
- IVI RMA New Jersey, Basking Ridge, New Jersey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Ma Y, Zhao X, Chen X. Contrast-enhanced ultrasound combined with elastic imaging for predicting the efficacy of concurrent chemoradiotherapy in cervical cancer: a feasibility study. Front Oncol 2024; 14:1301900. [PMID: 38634056 PMCID: PMC11021703 DOI: 10.3389/fonc.2024.1301900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Contrast-enhanced ultrasound (CEUS) and elastography are of great value in the diagnosis of cervical cancer (CC). However, there is limited research on the role of contrast-enhanced ultrasound combined with elastography in predicting concurrent chemoradiotherapy and disease progression for cervical cancer. The purpose of this study was to evaluate the feasibility of contrast-enhanced ultrasound combined with elastography and tumor prognosis. Methods MRI was performed on 98 patients with cervical cancer before and after treatment. Before, during, and 1 week after the treatment, contrast-enhanced ultrasound and elastography were conducted, and the alterations of ultrasound-related parameters at each time point of the treatment were compared. The correlation between contrast-enhanced ultrasound combined with elastic imaging and oncological outcome was assessed. Results There was no notable difference in overall clinical data between the complete remission (CR) group and the partial remission (PR) group (P>0.05). Before treatment, there were no statistically significant differences in elasticity score, time to peak (TTP), and peak intensity (PI) between the CR group and the PR group. However, there were no statistical differences in elastic strain ratio (SR) and area under the curve (AUC) before and after treatment between the CR group and the PR group, and there were also no statistical differences in the elastic strain ratio (SR) and area under the curve (AUC) of contrast-enhanced ultrasound parameters between the CR group and the PR group before and during treatment. There was a statistically significant difference after treatment (P<0.05).At present, the follow-up of patients is about 1 year, 7 patients were excluded due to loss to follow-up, and 91 patients were included in the follow-up study. Through the review of the cases and combined with MRI (version RECIST1.1) and serology and other related examinations, if the patient has a new lesion or the lesion is larger than before, the tumor marker Squamous cell carcinoma antigen (SCC-Ag) is significantly increased twice in a row, and the patient is divided into progressive disease (PD). Those who did not see significant changes were divided into stable disease (SD) group. The relationship between clinical characteristics, ultrasound parameters and disease progression in 91 patients was compared. There was no significant difference in age and clinical stage between the two groups (P>0.05), but there was a significant difference in the elevation of tumor marker squamous cell carcinoma antigen (SCC-Ag) between the two groups (P<0.05).With the growth of tumors, TTP decreased, elasticity score and PI increased, and the difference was statistically significant (P<0.05). The AUC of SCC-Ag was 0.655, the sensitivity was 85.3%, and the specificity was 45.6%.The AUC, sensitivity and specificity of ultrasound parameters combined with SCC-Ag predicted disease progression was 0.959, 91.2% and 94.8%. Conclusions Using contrast-enhanced ultrasound and elastography to predict the efficacy and disease progression of concurrent chemoradiotherapy is feasible. In addition, the combination of SCC-Ag with contrast-enhanced ultrasound and elastography can further enhance the efficiency of predicting disease progression.
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Affiliation(s)
- Yujuan Ma
- Tianshui Maternity and Child Healthcare Hospital, Tianshui, China
| | - Xuebo Zhao
- Graduate School of Qinghai University, Xining, China
- Department of Ultrasound Medicine, Qinghai Provincial People’s Hospital, Xining, China
| | - Xianxia Chen
- Department of Ultrasound Medicine, Qinghai Provincial People’s Hospital, Xining, China
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Yücel E, Koca Yıldırım HE, Şahin Duran F, Çakır C, Korkmaz V. The role of cervical elastography in the differential diagnosis of preinvasive and invasive lesions of the cervix. Arch Gynecol Obstet 2024; 309:1585-1595. [PMID: 38282023 DOI: 10.1007/s00404-023-07345-6] [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: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/30/2024]
Abstract
STUDY OBJECTIVE This study aims to evaluate the role of cervical elastography in the differential diagnosis of preinvasive and invasive lesions of the cervix. MATERIALS AND METHODS A total of 95 women participated in this prospective study and were divided into the following groups: 19 healthy subjects (group 1) with normal cervicovaginal smear (CVS) and negative human papillomavirus test (HPV DNA), 19 women with normal cervical biopsy and normal final pathological result of cervical biopsy (group 2), 19 women with low-grade squamous intraepithelial lesion (LSIL) (group 3), 19 women with high-grade squamous intraepithelial lesion (HSIL) (group 4), and 19 women with cervical cancer (group 5). Clinical, demographic, histopathological, and elastographic results were compared between these groups. RESULTS Comparing groups, age (40.42 ± 8.31 vs. 39.53 ± 8.96 vs. 38.79 ± 9.53 vs. 40.74 ± 7.42 vs. 54.63 ± 12.93, p < 0.001 respectively), gravida (1.74 ± 1.33 vs. 2.16 ± 1.68 vs. 2.21 ± 1.96 vs. 2.53 ± 1.93 vs. 4.63 ± 2.17 p < 0.001 respectively), parity (1.37 ± 0.68 vs. 1.68 ± 1.20 vs. 1.58 ± 1.30 vs. 2.00 ± 1.67 vs. 3.37 ± 1.61, p < 0.001 respectively), and the proportion of patients at menopause (10.5% vs., 15.8% vs. 10.5% vs. 5.3% vs. 57.9%, p < 0.01 respectively), a statistically significant difference was found (Table 1). However, no statistically significant difference was found in the number of abortions, BMI, mode of delivery, smoking, additional disease status, history of surgery, and family history (p > 0.05) (Table 2. As a result of the applied roc analysis, mean cervical elastographic stiffness degree (ESD) was found to be an influential factor in predicting cervical cancer (p < 0.05). The mean cut-off value was 44.65%, with a sensitivity of 94.7% and a specificity of 96.1% (Table 7). CONCLUSION Measurement of ESD by elastography is a low-cost, easily applicable, and non-invasive indicator that can distinguish cervical cancer from normal cervical and preinvasive lesions. However, it is unsuitable for determining preinvasive cervical lesions from normal cervix.
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Affiliation(s)
- Ecem Yücel
- Niğde Ömer Halis Demir Training and Research Hospital, Niğde, Turkey
| | - Hande Esra Koca Yıldırım
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Firdevs Şahin Duran
- Department of Pathology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Caner Çakır
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey
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Jo HB, Lee HJ, Kim SC, Joo JK, Suh DS, Kim KH. Evaluation of endometrial thickness in breast cancer patients with tamoxifen treatment - Difference between 2-dimensional ultrasonography and elastosonography. Taiwan J Obstet Gynecol 2023; 62:547-552. [PMID: 37407192 DOI: 10.1016/j.tjog.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE This study aimed to confirm the clinical significance of elastographic endometrium measurement in comparison with conventional ultrasonography for tamoxifen users with breast cancer. MATERIALS AND METHODS In this retrospective analysis, 98 women receiving tamoxifen as postoperative breast cancer treatment were included. Patient medical charts were reviewed, and related medical, obstetric, and gynecological information and histories relevant to breast cancer were evaluated. Patient clinical imaging data included endometrial thickness measurements using both conventional ultrasonography and elastography, and the differences between these two modalities in delta values were statistically analyzed along with possible influencing factors. RESULTS Endometrial thickness measured using 2-dimensional ultrasonography had a mean value of 5.81 mm (standard deviation [SD] = 3.09), and elastosonography showed a mean value of 3.07 mm (SD = 1.62). A paired t-test was conducted and a significant difference between them was confirmed (P-value <0.001). Logistic regression analysis revealed that age and duration of tamoxifen treatment significantly influenced the degree of difference between endometrial thickness measurements. CONCLUSIONS Elastosonography may be a more successful and useful tool for measuring actual endometrial thickness than generalized 2-dimensional ultrasonography. In clinical cases with limited use of elastosonography and consequent inability for thorough evaluation of endometrial thickness, practitioners should exercise caution in deciding whether or not to adopt invasive diagnostic procedures, such as endometrial curettage, especially for young patients of reproductive age or those with prolonged treatment of breast cancer with tamoxifen.
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Affiliation(s)
- Hyun Been Jo
- Pusan National University Graduate School, Busan, South Korea
| | - Hyun Joo Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
| | - Seung Chul Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea.
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
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Zhang HP, Wu JJ, Zhang WY, Tao JZ, Ma CB, Zhou YQ. Evaluation of the stiffness of normal cervix and its change with different factors using transvaginal two-dimensional shear wave elastography under strict quality control. BMC Med Imaging 2023; 23:65. [PMID: 37217872 DOI: 10.1186/s12880-023-01020-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The usefulness of transvaginal two-dimensional shear wave elastography (2D SWE) for cervical lesions is still uncertain. This study was to explore the value of transvaginal 2D SWE in the evaluation of the stiffness of normal cervix and its change with different factors under strict quality control (QC). METHODS Two hundred patients with normal cervix were included in this study and were examined using quantitative 2D SWE to evaluate cervical stiffness and its change with different factors under strict QC. RESULTS Intra-observer concordance of transvaginal 2D SWE parameters in midsagittal planes were acceptable with intraclass correlation coefficients higher than 0.5. Transvaginal 2D SWE parameters were significantly higher than the corresponding transabdominal parameters. 2D SWE parameters of internal cervical os were significantly higher than the corresponding parameters of external cervical os in a transvaginal midsagittal plane. 2D SWE parameters of external cervical os increased significantly over 50 years old, while these parameters of internal cervical os didn't change significantly with increasing age. 2D SWE parameters of internal cervical os of horizontal position cervix were significantly higher than those of vertical position cervix. SWE parameters of normal cervix did not change according to different menstrual cycles, parities and human papilloma virus test results. CONCLUSIONS Transvaginal 2D SWE under strict QC could provide quantitative, repeatable and reliable cervical stiffness information. Internal cervical os was stiffer than external cervical os. Menstrual cycles, parities and human papilloma virus test results wouldn't affect cervical stiffness. However, age and cervical positions should be taken into condition while interpreting 2D SWE results of cervical stiffness.
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Grants
- 19ZR1441500 natural science foundation of Shanghai, China
- 22ZR1458200 natural science foundation of Shanghai, China
- CNKW2020Z04 key program of science and technology commission foundation of Changning district, Shanghai, China
- CNKW2020Z04 key program of science and technology commission foundation of Changning district, Shanghai, China
- CNKW2020Z04 key program of science and technology commission foundation of Changning district, Shanghai, China
- CNKW2020Z04 key program of science and technology commission foundation of Changning district, Shanghai, China
- RCJD2021B09 medical PhD innovative talent base project of Changning district, Shanghai, China
- RCJD2021B09 medical PhD innovative talent base project of Changning district, Shanghai, China
- RCJD2021B09 medical PhD innovative talent base project of Changning district, Shanghai, China
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Affiliation(s)
- Hui-Ping Zhang
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, China
| | - Jing-Jing Wu
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, China
| | - Wen-Ying Zhang
- Department of Gynecology, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, China
| | - Jiu-Zhi Tao
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, China
| | - Cheng-Bin Ma
- Department of Gynecology, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, China
| | - Yu-Qing Zhou
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, China.
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Guo YJ, Yan XJ, Zhao HX, Wen XD, Wang J, Du YY, Wang N, Yang Y. Quantitative Evaluation of the Normal Cervix, Cervical Cancer, and Cervical Precancerous Changes Via Real-Time Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:345-354. [PMID: 35338721 DOI: 10.1002/jum.15981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The present study aims to evaluate the clinical application values of ultrasound real-time shear wave elastography (SWE) in the diagnosis and differential diagnosis of cervical cancer (CC). METHODS A total of 285 married female patients were screened and divided into three groups according to the results of the pathological examination and the cervical ThinPrep cytologic test: 1) the CC group (n = 94); 2) the cervical intraepithelial neoplasia (CIN) group (n = 91); and 3) the normal control group (n = 100). The maximum Young's modulus (Emax), mean Young's modulus (Emean), minimum Young's modulus (Emin), and Young's modulus stability (Esd) in each group were measured and statistically analyzed. RESULTS There were no statistically significant differences in Emax, Emean, Emin, and Esd values between the anterior and posterior cervical walls, premenopausal and postmenopausal women, and nonparturient and parturient women in the normal control group. The Emax, Emean, Emin, and Esd values in the CIN group showed no statistically significant differences in different periods when compared with the control group. The differences between the normal control group and the CC group were statistically significant; the CC group showed no statistically significant differences in Emax, Emean, Emin, and Esd values at different clinical stages and in different pathological types. The cutoff value of Emax for CC diagnosis, which was of the highest accuracy (89.7%), was 43.48 kpa. CONCLUSION Ultrasound real-time SWE can be applied to CC diagnosis.
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Affiliation(s)
- Yan-Jing Guo
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Jing Yan
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hai-Xia Zhao
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Duo Wen
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Wang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan-Yuan Du
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nan Wang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Yang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Shear-Wave-Elastography in Neurofibromatosis Type I. Diagnostics (Basel) 2022; 12:diagnostics12020360. [PMID: 35204451 PMCID: PMC8871512 DOI: 10.3390/diagnostics12020360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023] Open
Abstract
Ultrasound shear wave elastography (SWE) is an increasingly used imaging modality that expands clinical ultrasound by measuring the elasticity of various tissues, such as the altered elasticity of tumors. Peripheral nerve tumors are rare, have been well-characterized by B-mode-ultrasound, but have not yet been investigated with SWE. Given the lack of studies, a first step would be to investigate homogeneous peripheral nerve tumors (PNTs), histologically neurofibromas or schwannomas, which can occur in multiple in neurofibromatosis type 1 and 2 (NF1 and 2), respectively. Hence, we measured shear wave velocity (SWV) in 30 PNTs of 11 patients with NF1 within the median nerve. The SWV in PNTs ranged between 2.8 ± 0.8 m/s and correlated with their width and approximate volume but not with their length or height. Furthermore, we determined the extent to which PNTs alter the SWV of the median nerve for three positions of the wrist joint: neutral (zero-degree), individual maximal flexion and maximal extension. Here, SWV was decreased in NF1 patients compared to age- and sex-matched controls (p = 0.029) during maximal wrist extension. We speculate that the presence of PNTs may have a biomechanical impact on peripheral nerves which has not been demonstrated yet.
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Săsăran V, Turdean S, Gliga M, Ilyes L, Grama O, Muntean M, Pușcașiu L. Value of Strain-Ratio Elastography in the Diagnosis and Differentiation of Uterine Fibroids and Adenomyosis. J Pers Med 2021; 11:jpm11080824. [PMID: 34442468 PMCID: PMC8399978 DOI: 10.3390/jpm11080824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 12/26/2022] Open
Abstract
Benign uterine disorders, including uterine fibroids (UF) and adenomyosis (AM), can impact the life quality and fertility of women of reproductive age. Transvaginal ultrasound (TVUS) has long been used for their early identification, but its combined use with elastography seems to improve diagnostic accuracy of UF and AM. Thus, a prospective pilot study was conducted on 79 patients who underwent hysterectomy (25 microscopically diagnosed with AM and 53 with UF), with the aim of assessing the ability of TVUS combined with strain ratio elastography (SE) to accurately diagnose and distinguish UF and AM. Significantly higher mean and maximal strain ratio (SR) values were identified for patients with histologically confirmed AM as opposed to those with UF (p < 0.001). Diagnostic sensitivity and specificity, calculated in comparison with histology results, were higher for UF than AM. Receiver operating characteristic (ROC) analysis was applied between the two study groups, revealing cutoff values of 7.71 for mean SR and 8.91 for maximal SR, respectively, with good sensitivity and specificity parameters (100% and 96.23%; 96% and 96.23%). Our results support the use of TVUS in combination with SE for the positive and differential diagnosis of UF and AM, through identification of their particular tissue stiffness features.
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Affiliation(s)
- Vladut Săsăran
- Department of Obstetrics and Gynecology 2, Faculty of Medicine in English, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania;
| | - Sabin Turdean
- Department of Morphopathology, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania
- Correspondence:
| | - Marius Gliga
- Department of Obstetrics and Gynecology 2, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania; (M.G.); (L.I.); (O.G.)
| | - Levente Ilyes
- Department of Obstetrics and Gynecology 2, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania; (M.G.); (L.I.); (O.G.)
| | - Ovidiu Grama
- Department of Obstetrics and Gynecology 2, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania; (M.G.); (L.I.); (O.G.)
| | - Mihai Muntean
- Department of Obstetrics and Gynecology, Clinical County Hospital Mures, Samuel Koteles Street No. 29, 540057 Târgu Mureș, Romania;
| | - Lucian Pușcașiu
- Department of Obstetrics and Gynecology 1, Faculty of Medicine in English, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania;
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Shao J, Shi G, Qi Z, Zheng J, Chen S. Advancements in the Application of Ultrasound Elastography in the Cervix. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2048-2063. [PMID: 34049726 DOI: 10.1016/j.ultrasmedbio.2021.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
Ultrasound elastography is a modern imaging technique that has developed rapidly in recent years. It enables objective measurement of tissue stiffness, a physical property intuitive to the human sense of touch. This novel technology has become a hotspot and plays a major role in scientific research and academic practice. Presently, ultrasound elastography has been used in the identification of benign and malignant tumors in superficial organs, such as breast and thyroid, providing clinically accurate diagnosis and treatment. The method has also been widely used for the liver, kidney, prostate, lymph nodes, blood vessels, skin and muscle system. In the application of cervical lesions, ultrasound elastography can distinguish normal cervix from abnormal cervix and differentiate benign from malignant lesions. It can significantly improve the diagnostic specificity for cervical cancer and is also useful for assessing infiltration depth and stage of cervical cancer, as well as predicting chemoradiotherapy treatment response. For cervical evaluation during pregnancy, ultrasound elastography is useful for assessing cervical softening and predicting premature delivery and outcome of induced labor. This article reviews the principles of ultrasound elastography as well as the current status and limitations in its application for cervical lesions and the cervix during pregnancy.
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Affiliation(s)
- Juntao Shao
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China.
| | - Guilian Shi
- School of Biomedical Engineering, Hubei University of Science and Technology, Xianning, Hubei Province, China
| | - Zhengqin Qi
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Jingjing Zheng
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Du YY, Yan XJ, Guo YJ, Wang J, Wen XD, Wang N, Yang Y. Transvaginal Real-Time Shear Wave Elastography in the Diagnosis of Endometrial Lesions. Int J Gen Med 2021; 14:2849-2856. [PMID: 34211293 PMCID: PMC8242144 DOI: 10.2147/ijgm.s312292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/15/2023] Open
Abstract
Background To explore the value of transvaginal real-time shear wave elastography (SWE) in the diagnosis of endometrial lesions. Methods A total of 140 female patients with endometrial lesions, confirmed by pathological results, were divided into three groups: 45 cases of endometrial polyps, 29 cases of endometrial hyperplasia and 66 cases of endometrial cancer. A total of 100 cases of normal endometrium were used as the control group, including 52 cases in the proliferative stage and 48 cases in the secretory stage. Transvaginal real-time shear wave elastography was performed in all four groups. Results Emean, Emax and Esd were expressed as the average standard deviation. Among the control group, the results were 26.24±9.74, 38.09±9.18, and 4.25±2.73 kPa, respectively, in the proliferative endometrium cases and 12.51±7.46, 27.22±11.32, 4.40±2.52 kPa, respectively, in the secretory endometrium cases. Among the experimental group, the result was 15.68±8.18, 27.28±10.28 and 3.62±1.81 kPa respectively in the endometrial polyps cases; 21.20 ± 12.57, 36.32 ± 15.04, and 5.09 ±3.93 kPa in the endometrial hyperplasia cases; 49.36±25.51, 86.66±42.27 and 14.86±10.63 kPa in the endometrial cancer cases. The difference was statistically significant (P <0.05). When the truncation values of Emean, Emax and Esd were 28.50, 52.45 and 9.05 kPa, respectively, to distinguish between normal endometrium and endometrial cancer, Emax has the highest diagnostic value. Conclusion Real-time SWE technology might be used as an auxiliary method in the diagnosis and differential diagnosis of endometrial cancer. More quantitative indicators are conducive to diagnosis.
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Affiliation(s)
- Yuan-Yuan Du
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xiao-Jing Yan
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yan-Jing Guo
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jing Wang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xiao-Duo Wen
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Nan Wang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yi Yang
- Department of Gynecology and Obstetrics Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
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Zhu Y, Leng XF, Zhang GN, Huang ZY, Qiu L, Huang W. Accuracy of transvaginal sonoelastography for differential diagnosis between malignant and benign cervical lesions: A systematic review and meta-analysis. Cancer Med 2020; 9:7943-7953. [PMID: 32869506 PMCID: PMC7643678 DOI: 10.1002/cam4.3424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/13/2020] [Accepted: 08/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To evaluate the performance of transvaginal sonoelastography (TVSE) for differential diagnosis between malignant and benign cervical lesions using a meta-analysis. METHODS An independent literature search was conducted on the English medical database, including PubMed, Embase and Medline, Cochrane Library, Web of Science, and OVID. The diagnostic accuracy of TVSE was compared with that of histopathology, which is the gold reference standard for diagnosis. The accuracy of TVSE was assessed by calculating the pooled sensitivity, specificity, diagnostic odds ratio, and area under the curve (AUC). The imaging mechanisms, assessment methods, and QUADAS scores were assessed with a meta-regression analysis. A Deeks funnel plot was performed for evaluating publication bias. RESULTS Six eligible studies reported a total sample of 615 cervical lesions (415 cancers, 200 benign lesions). TVSE showed a pooled diagnostic odds ratio of 21.42 (95% CI 13.65-33.61), sensitivity of 0.87 (95% CI 0.84-0.90), specificity of 0.79 (95% CI 0.72-0.84), and an AUC of 0.892 (Q* = 0.822). The results of the meta-regression analysis showed that the imaging mechanism (P = .253), the assessment method (P = .279), or QUADAS score (P = .205) did not affect the study heterogeneity. CONCLUSION TVSE has a relatively high and satisfactory value for differential diagnosis between malignant and benign cervical lesions. The diagnostic performance of strain elastography and shear wave elastography were similar and good. However, to accommodate heterogeneity and publication bias, high-quality studies are required to further comparative effectiveness analyses to verify the efficacy of ultrasound detection.
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Affiliation(s)
- Yi Zhu
- Department of Ultrasound, the Affiliated Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Xue-Feng Leng
- Department of Thoracic Surgery, the Affiliated Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Guo-Nan Zhang
- Department of Gynecological Oncology, the Affiliated Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Zi-Yi Huang
- Department of Bioinformatics, Basic Medical College of Chongqing Medical University, Chongqing, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
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Shear wave elastography of the uterine cervix under different conditions with inter-operator agreement analysis. Pol J Radiol 2020; 85:e245-e249. [PMID: 32612722 PMCID: PMC7315054 DOI: 10.5114/pjr.2020.95527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/19/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Shear wave elastography (SWE) is a relatively new technique for measuring tissue elasticity. Its implementation for assessing the tissue of the cervix is evolving, and SWE analyses of healthy, nonpregnant cervixes is the first step in understanding other SWE changes related to cervical pathologies; nevertheless, some challenges in the use of the technique still require investigation. We aimed to target the consistency of healthy cervix shear wave elastography measurements and examine the changes induced by patient-related factors. Material and methods Elastograms were obtained at the internal and external os in the anterior (IA, EA) and posterior (IP, EP) portions of the cervix using a transvaginal approach in eight postmenopausal and 25 premenopausal women. Measurements with a standard deviation of over 20% and patients who presented with colour loss or heterogeneity were excluded from the study. Shear wave elastography assessments were performed using a Toshiba Aplio 500 version 6. Statistical significance was defined as a p value less than 0.10, due to the small number of patients. Results The mean speeds obtained at the external os on the anterior and posterior aspects was 3.17 ± 0.85 m/s and 3.18 ± 0.84 m/s, respectively, and at the internal os, the results on the anterior and posterior aspects were 3.38 ± 0.73 m/s and 3.53 ± 0.81 m/s, respectively. The difference in speed among all regions was statistically significant (p < 0.05). Fifteen patients were also analysed by a second radiologist with a similar experience level as that of the first. Nine measurements for IP, 13 measurements for IA, 11 measurements for EP, and 15 measurements for EA were performed. The correlation coefficients between the two sets of measurements were 0.46, 0.30, 0.67, and 0.51, respectively. There was no difference in the SWE values with respect to age, parity, and gravidity for any of the regions. The SWE values at the IA, IP, and EA regions between the postmenopausal and premenopausal women were significantly different (p = 0.038, p = 0.059, p = 0.065). Conclusions The posterior portion of the internal os is most likely to undergo inaccurate SWE measurement among the different anatomical positions. The correlation between radiologists was found to be different for different locations in the cervix. More studies are needed to determine the SWE values of the healthy cervix and the agreement levels between radiologists.
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