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Sandomenico F, De Rosa G, Catalano O, Iovino M, Sandomenico G, Corvino A, Petrillo A. Free-hand ultrasound strain elastography in evaluation of soft tissue tumors. J Ultrasound 2024; 27:589-598. [PMID: 39052198 PMCID: PMC11333419 DOI: 10.1007/s40477-024-00893-w] [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: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE The purpose of this study is to evaluate elastography in a wide spectrum of soft tissue superficial lesions by correlating the elastographic characteristics of these lesions with the elastographic score (ES) system established by Asteria. METHODS Forty patients with different superficial lesions of the soft tissues were studied, including lipomas, schwannomas, neuromas, epidermal inclusion cysts, "in transit" melanoma metastasis, arterio-venous malformation, and giant-cell tumor. An ultrasound examination was performed combined with color-Doppler and elastographic module. The B-mode criteria were echogenicity, margins, and structural homogeneity of the lesion. The color-Doppler criterion was irregular and mainly intra-nodular vascularization. ES 1-4 was attributed, in relation with the increasing tissue stiffness, according to the classification of Asteria adapted for soft tissues. Subsequently, we added to each single B-mode and color-Doppler criterion the ES 3 and 4, thus crossing two parameters of malignancy. All the presumptive diagnoses formulated were confirmed with the clinical data or with the histopathological result. RESULTS The hypoechoic appearance had the best diagnostic performance. Sensitivity was 87%, specificity 71%, positive predictive value (PPV) 80%, negative predictive value (NPV) 80%, and diagnostic accuracy 80%. There was a good correlation with the clinical and biopsy data, the irregularity of margins the worst performance, the inhomogeneity an intermediate. Color-Doppler had sensitivity 74%, specificity 82%, PPV 85%, NPV 70% and diagnostic accuracy 77.5%. Elastography had sensitivity 87%, specificity 94%, PPV 95%, NPV 84%, and diagnostic accuracy 90%. The combination hypoechoic appearance + ES3/ES4 showed sensitivity 83%, specificity 100%, PPV 100%, NPV 81%,and diagnostic accuracy of 90%. The combination of irregularity of margins + ES3/ES4 showed sensitivity 43%, specificity 100%, PPV 100%, NPV 59%, and diagnostic accuracy of 67.5%. The combination of inhomogeneity of the lesion + ES3/ES4 showed sensitivity 65%, specificity 94%, PPV 94%, NPV 68%, and diagnostic accuracy of 78%. The combination of the color-Doppler with the ES3/ES4 showed sensitivity 69.5%, specificity 100%, PPV 100%, NPV 71%, and diagnostic accuracy of 82.5%.In the combined evaluation, there was a significant increase in specificity, allowing healthy subjects to be categorized as correctly negative, with a reduction in false positives which also translates into an increase in PPV. CONCLUSIONS Elastography alone is not sufficient for a correct diagnostic classification and must be considered as an additional parameter in the study of soft-tissue lesions. Although there was a good agreement between B-mode malignancy criteria and ES3/ES4, there is no significant improvement in sensitivity. Ultrasound assessment, especially of superficial lesions, cannot be separated from an integrated approach that foresees the additional and routine use of the elastographic examination.
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Affiliation(s)
- Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123, Naples, Italy.
| | | | | | - Maria Iovino
- Radiology Unit, San Giuliano Hospital, Giugliano in Campania, NA, Italy
| | - Gabriella Sandomenico
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Naples, Italy
| | | | - Antonella Petrillo
- Radiology Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
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Tang S, Weiner B, Taraballi F, Haase C, Stetco E, Mehta SM, Shajudeen P, Hogan M, De Rosa E, Horner PJ, Grande-Allen KJ, Shi Z, Karmonik C, Tasciotti E, Righetti R. Assessment of spinal cord injury using ultrasound elastography in a rabbit model in vivo. Sci Rep 2023; 13:15323. [PMID: 37714920 PMCID: PMC10504274 DOI: 10.1038/s41598-023-41172-8] [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: 02/19/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
The effect of the mechanical micro-environment on spinal cord injury (SCI) and treatment effectiveness remains unclear. Currently, there are limited imaging methods that can directly assess the localized mechanical behavior of spinal cords in vivo. In this study, we apply new ultrasound elastography (USE) techniques to assess SCI in vivo at the site of the injury and at the time of one week post injury, in a rabbit animal model. Eleven rabbits underwent laminectomy procedures. Among them, spinal cords of five rabbits were injured during the procedure. The other six rabbits were used as control. Two neurological statuses were achieved: non-paralysis and paralysis. Ultrasound data were collected one week post-surgery and processed to compute strain ratios. Histologic analysis, mechanical testing, magnetic resonance imaging (MRI), computerized tomography and MRI diffusion tensor imaging (DTI) were performed to validate USE results. Strain ratios computed via USE were found to be significantly different in paralyzed versus non-paralyzed rabbits. The myelomalacia histologic score and spinal cord Young's modulus evaluated in selected animals were in good qualitative agreement with USE assessment. It is feasible to use USE to assess changes in the spinal cord of the presented animal model. In the future, with more experimental data available, USE may provide new quantitative tools for improving SCI diagnosis and prognosis.
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Affiliation(s)
- Songyuan Tang
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Bradley Weiner
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Francesca Taraballi
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | - Candice Haase
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | - Eliana Stetco
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | | | - Peer Shajudeen
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Matthew Hogan
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Enrica De Rosa
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | - Philip J Horner
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Zhaoyue Shi
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Ennio Tasciotti
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele Roma Open University and IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Raffaella Righetti
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
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Kim KD, Kim H, Cho S, Lee SH, Joh JH. Ultrasound Elastography to Differentiate the Thrombus and Plaque in Peripheral Arterial Diseases. Vasc Specialist Int 2022; 38:34. [PMID: 36575112 PMCID: PMC9794493 DOI: 10.5758/vsi.220046] [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: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose Arterial stiffness and steno-occlusion of the lower-extremity can result from many vascular lesions, including acute thromboembolisms, soft plaques, calcified plaques, or inflammatory disease. Ultrasound (US) elastography measures the tissue deformation response to compression and displays tissue stiffness. This study aimed to evaluate the characteristics of arterial lesions in the lower extremities using US elastography. Materials and Methods We retrospectively analyzed the data of 20 patients who visited our institute for arterial disease treatment between May 2016 and November 2017. An US examination with B-mode and strain elastography (SE) was performed of four different lesion types at 45 sites: acute and subacute thromboembolisms, soft plaques, calcified plaques, and thromboangiitis obliterans lesions (TAOs). During SE, stress was externally applied by the operator using the transducer. Strain ratio (SR) was calculated as the fraction of the average strain in the reference area divided by the average strain in the lesion. The SR was compared among different lesion types, with the accompanying vein as the reference region of interest. Results The strain was highest in the soft plaques (0.63%±0.23%), followed by the TAOs (0.45%±0.11%), calcified plaques (0.44%±0.13%), and acute thromboembolisms (0.34%±0.23%), which were statistically significant (P=0.026). However, the mean SR was highest for the calcified plaques (2.33%±0.80%), followed by the TAOs (1.63%±0.40%), acute thromboembolisms (1.60%±0.48%), and soft plaques (1.51±0.39), and which were statistically significant (P=0.013). Conclusion Despite several limitations, vascular elastography may be useful for differentiating between lesion types in peripheral arterial disease.
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Affiliation(s)
- Ki Duk Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyangkyoung Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sungsin Cho
- Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea,Corresponding author: Jin Hyun Joh, Department of Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea, Tel: 82-2-440-6261, Fax: 82-2-440-6296, E-mail: , https://orcid.org/0000-0002-8533-6755
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Sainz JA, Castro L, Romo JM, Holgado A, Fernández-Palacín A, García-Mejido JA. Evaluation of Pre-malignant Lesions of the Uterine Cervix by Shear Wave Elastography: A New Diagnostic Tool. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3275-3282. [PMID: 34376298 DOI: 10.1016/j.ultrasmedbio.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
The objective of the study was to evaluate the difference in the stiffness between a healthy cervix (no pre-invasive lesions [NPILs]) and a cervix with a pre-invasive lesion (PIL). In the PIL group, we determined whether there was a difference in stiffness between the cervix with persistent low-grade lesions (>2 y, LSIL-persistent) and that with high-grade lesions (HSILs). Evaluation was performed using 2-D shear-wave elastography (SWE) in the midsagittal-plane of the uterine cervix (UC) at 0.5 cm (cervical canal, anterior and posterior cervical lips). In this prospective observational study (consecutive series), we evaluated 96 non-pregnant women: a group with PIL (LSIL-persistent, 22 cases; HSIL, 26 cases) with indications for cervical conization (48 cases) and a group without UC pathology (NPIL, 48 cases). Although we did not observe statistically significant differences (SSDs) in epidemiological characteristics, we did find an SSD in the speed and stiffness between the PIL versus NPIL groups at all evaluated depths (speed: 4.1 m/s vs 3.0 m/s, stiffness: 58.6 and 34.5kPa in the PIL and NPIL groups, respectively, p < 0.001). An SSD in speed and stiffness (speed: 4.9 m/s vs. 3.2 m/s, and stiffness: 76.1 and 38.0 kPa) between the HSIL (26 cases) and LSIL-persistent (22 cases) groups, respectively, was also detected (p < 0.001). The area under the curve of speed differentiation between a cervix with HSILs and without lesions was 73.4% (95% confidence interval [CI]: 63.1-83.7), and the best cutoff of speed was 3.25 m/s (sensitivity = 62.5%, 95% CI: 47.3-76.0), with a specificity of 75.5% (95% CI: 60.4-87.1).
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Affiliation(s)
- José Antonio Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain; Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
| | - Laura Castro
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - José María Romo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Ainhoa Holgado
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain; Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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Seyedpour SM, Nabati M, Lambers L, Nafisi S, Tautenhahn HM, Sack I, Reichenbach JR, Ricken T. Application of Magnetic Resonance Imaging in Liver Biomechanics: A Systematic Review. Front Physiol 2021; 12:733393. [PMID: 34630152 PMCID: PMC8493836 DOI: 10.3389/fphys.2021.733393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022] Open
Abstract
MRI-based biomechanical studies can provide a deep understanding of the mechanisms governing liver function, its mechanical performance but also liver diseases. In addition, comprehensive modeling of the liver can help improve liver disease treatment. Furthermore, such studies demonstrate the beginning of an engineering-level approach to how the liver disease affects material properties and liver function. Aimed at researchers in the field of MRI-based liver simulation, research articles pertinent to MRI-based liver modeling were identified, reviewed, and summarized systematically. Various MRI applications for liver biomechanics are highlighted, and the limitations of different viscoelastic models used in magnetic resonance elastography are addressed. The clinical application of the simulations and the diseases studied are also discussed. Based on the developed questionnaire, the papers' quality was assessed, and of the 46 reviewed papers, 32 papers were determined to be of high-quality. Due to the lack of the suitable material models for different liver diseases studied by magnetic resonance elastography, researchers may consider the effect of liver diseases on constitutive models. In the future, research groups may incorporate various aspects of machine learning (ML) into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification.
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Affiliation(s)
- Seyed M. Seyedpour
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Mehdi Nabati
- Department of Mechanical Engineering, Faculty of Engineering, Boğaziçi University, Istanbul, Turkey
| | - Lena Lambers
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Sara Nafisi
- Faculty of Pharmacy, Istinye University, Istanbul, Turkey
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
- Center of Medical Optics and Photonics, Friedrich Schiller University, Jena, Germany
- Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University, Jena, Germany
| | - Tim Ricken
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
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Turnaoğlu H, Haberal KM, Arslan S, Yavuz Çolak M, Ulu Öztürk F, Uslu N. Interobserver and intermethod variability in data interpretation of breast strain elastography in suspicious breast lesions. Turk J Med Sci 2021; 51:547-554. [PMID: 32950046 PMCID: PMC8203122 DOI: 10.3906/sag-2006-257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background/aim Strain elastography has the disadvantage of being operator-dependent. Interobserver variability is observed during image acquisition and interpretation. This study aimed to analyze the interobserver and intermethod variability of strain elastography in image interpretation and evaluate the diagnostic performance combining elasticity score and strain ratio with ultrasonography. Materials and methods A retrospective study was conducted on 70 breast lesions evaluated with B-mode ultrasonography and strain elastography. B-mode ultrasonography findings, elasticity scores, and strain ratio values were evaluated using static images by two radiologists. BI-RADS assessment of the lesions and the decision of both observers as to whether the biopsy was required using B-mode ultrasonography, and the combined ultrasonography+elasticity score, and the combined ultrasonography+elasticity score+strain ratio were compared with the histopathological results. Also, the interobserver agreement was analyzed for all the combinations. Results There was very good agreement (weighted κ = 0.865) between the observers for the elasticity scores. Very good agreement was observed between the observers for BI-RADS assessments using the combined ultrasonography+elasticity score and the combined ultrasonography+elasticity score+strain ratio (weighted κ = 0.848, and 0.902, respectively). Area under the curve of B-mode ultrasonography, the combined B-mode ultrasonography+elasticity score, and the combined B-mode ultrasonography+elasticity score+strain ratio, were calculated as 0.859, 0.866, and 0.916 for observer 1, and 0.851, 0.829, and 0.916 for observer 2, respectively. There were no statistically significant differences between the observers’ diagnostic performances in any of the combinations (P = 0.703, 0.067, and 0.972, respectively). Conclusion In the evaluation and further assessment of breast lesions, semiquantitative strain ratio calculation may help improve diagnostic accuracy by reducing interpretational variety, when used together with B-mode ultrasonography and elasticity scoring, especially for inexperienced individuals.
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Affiliation(s)
- Hale Turnaoğlu
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Kemal Murat Haberal
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Serdar Arslan
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Meriç Yavuz Çolak
- Department of Biostatistics, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Funda Ulu Öztürk
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Nihal Uslu
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
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Zhu L, Chen Y, Ai H, Gong W, Zhou B, Xu Y, Chen S, Cheng F. Combining real-time elastography with fine-needle aspiration biopsy to identify malignant thyroid nodules. J Int Med Res 2021; 48:300060520976027. [PMID: 33327813 PMCID: PMC7747118 DOI: 10.1177/0300060520976027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the diagnostic performance of real-time elastography (RTE) combined with fine-needle aspiration (FNA) biopsy in identifying malignant thyroid nodules. Methods This was a single-centre, retrospective study and involved patients who had underogone partial or total thyroidectomy from 01 January 2014 to 31 December 2018 at our centre. Eligible patients were at least18 years of age, had reliable grayscale ultrasound imaging results, a RTE evaluation and had undergone a FNA biopsy. Results Data were available from 437 patients. A high RTE score was a significant independent risk factors for malignancy. RTE plus FNA biopsy increased diagnostic accuracy compared with either method alone and the sensitivity and specificity of the combined model were 86% and 78%, respectively. Conclusions The combination of RTE imaging with FNA biopsy improves the diagnostic performance in differentiating benign and malignant thyroid nodules.
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Affiliation(s)
- Lei Zhu
- Department of Thyroid and Breast Surgery, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Yanyan Chen
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou China
| | - Huijun Ai
- Department of Ultrasound, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui China
| | - Wei Gong
- Department of Pathology, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Bin Zhou
- Department of Thyroid and Breast Surgery, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Yonghong Xu
- Department of Thyroid and Breast Surgery, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Shuzheng Chen
- Department of Thyroid and Breast Surgery, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Feng Cheng
- Department of Thyroid and Breast Surgery, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
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Hu L, He NA, Xie L, Ye X, Liu X, Pei C, Zhou HC, Zhong W. Evaluation of the Perinodular Stiffness Potentially Predicts the Malignancy of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2183-2193. [PMID: 32412124 DOI: 10.1002/jum.15329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the surrounding tissue stiffness measured by sound touch elastography for differential diagnosis of thyroid nodules (TNs). METHODS Thirty-nine benign and 90 malignant TNs were included in this study. The conventional ultrasound features, the maximum Young modulus value of the stiffness of the TNs (recorded as E), and the stiffness of the 0.5-, 1.0-, 1.5-, and 2.0-mm perinodular regions of the TNs (recorded as Eshell0.5 , Eshell1.0 , Eshell1.5 , and Eshell2.0 , respectively) were prospectively analyzed and compared to histopathologic results. The abundance of collagen fibers at various widths in the perinodular regions of the TNs was evaluated by Masson staining and ImageJ software (National Institutes of Health, Bethesda, MD). The fibrous structures in the perinodular regions of the TNs were classified. RESULTS The various Eshell values of malignant TNs were significantly higher than those of benign TNs (P < .001 for all). Eshell0.5 correlated highly with E in the malignant TNs and in all samples (r = 0.722 and 0.772; P < .001 for both). Eshell2 yielded the highest area under the receiving operating characteristic curve value (0.96) for the differential diagnosis of TNs. The abundance of collagen fibers in the 2-mm perinodular region of the TNs was closely correlated with Eshell2 in the malignant TNs and in all samples (r =0.729 and 0.867; P < .001). The Eshell2 values for different levels of disorder of the tissue surrounding TNs were significantly different (P < .01 for all). CONCLUSIONS Perinodular stiffness measured by sound touch elastography improved the diagnostic accuracy in TNs.
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Affiliation(s)
- Lei Hu
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Nian An He
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li Xie
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianjun Ye
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiao Liu
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chong Pei
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Hefei City, Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hang Cheng Zhou
- Department of Pathology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wen Zhong
- Department of Pathology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Unal O, Caglayan M, Kosekahya P, Yulek F, Taslipinar G. Evaluation of Optic Nerve Head Biomechanical Properties in Pseudoexfoliation Glaucoma with Real-time Elastography. Curr Med Imaging 2020; 15:637-644. [PMID: 32008511 DOI: 10.2174/1573405614666180621093908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the biomechanical properties of the optic nerve head in patients with Pseudoexfoliation (PEX) glaucoma using Real-time Elastography (RTE) and to compare these results with those of Primary Open Angle Glaucoma (POAG) patients and healthy subjects. METHODS Twenty eyes of 20 PEX glaucoma patients (PEX group), 20 eyes of 20 POAG patients (POAG group), and 20 eyes of 20 healthy subjects (control group) were enrolled in this prospective study. The strain Ratios of Orbital Fat to Optic Nerve head (ROFON) and lateral rectus muscle to optic nerve head (RLRON) were determined. Comparisons were performed using Chi-square, Kruskal Wallis, Mann-Whitney U, and One-way ANOVA tests. RESULTS The strain ratios of orbital fat to optic nerve head were 2.34, 6.85 and 1.76 in PEX glaucoma, POAG, and control groups, respectively (p<0.001). The strain ratios of the lateral rectus muscle to the optic nerve head were 0.51, 0.82, and 0.55 in PEX glaucoma, POAG, and control groups, respectively (p=0.256). CONCLUSION The strain ratios of orbital fat to optic nerve head were different in PEX glaucoma patients than in POAG and control groups. RTE can provide biomechanical assessment of the optic nerve head in a non-invasive, quick, easily accessible, and user-friendly manner.
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Affiliation(s)
- Ozlem Unal
- Department of Radiology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Department of Ophthalmology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Pinar Kosekahya
- Ulucanlar Eye Research and Training Hospital, Ankara, Turkey
| | - Fatma Yulek
- Department of Ophthalmology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Guzin Taslipinar
- Department of Ophthalmology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
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10
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Park HJ, Kim SM, Yun BL, Jang M, Kim B, Lee SH, Ahn HS. Comparison of One- and Two-Region of Interest Strain Elastography Measurements in the Differential Diagnosis of Breast Masses. Korean J Radiol 2020; 21:431-441. [PMID: 32193891 PMCID: PMC7082658 DOI: 10.3348/kjr.2019.0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/09/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Hee Jeong Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Soo Hyun Lee
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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11
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Kanagaraju V, Dhivya B, Devanand B, Maheswaran V. Utility of Ultrasound Strain Elastography to Differentiate Benign from Malignant Lesions of the Breast. J Med Ultrasound 2020; 29:89-93. [PMID: 34377638 PMCID: PMC8330691 DOI: 10.4103/jmu.jmu_32_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to determine the utility and diagnostic performance of strain elastography (SE) in differentiating benign from malignant lesions of the breast. Methods In this prospective study, 50 palpable breast masses in 50 patients were examined by mammography, B-mode ultrasound (US) and SE. Lesions were categorized using Breast Imaging Reporting and Data System (BIRADS) scoring based on mammographic and sonographic features. Elasticity scores were assessed on a five-point scale based on the distribution of strain, and the lesion size on SE imaging and B-mode (elasticity imaging/B mode [EI/B] ratio) was compared. Findings were correlated with the BIRADS assessment and diagnostic performance of sonoelastography was evaluated taking histopathology as reference standard. Results Histopathology revealed 29 (58%) malignant and 21 (42%) benign lesions. Infiltrative ductal carcinoma and fibroadenoma were the most common malignant and benign lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE was 100%, 76.1%, 85.2%, 100%, and 90%, respectively. Higher elasticity score was significantly associated with malignant histopathology (P < 0.00001). The mean EI/B ratio for malignant lesions was 1.36 ± 0.24 while that of benign lesions was 1.03 ± 0.30 (P = 0.000). Conclusion Real-time SE of the breast, with its superior sensitivity and specificity, could provide improved characterization of benign and malignant breast masses compared with mammography and conventional US. Due to greater diagnostic accuracy, SE can be an effective adjunctive tool to B-mode US in predicting malignancy of breast, as well as in reducing the need for biopsies in benign breast lesions.
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Affiliation(s)
- Vikrant Kanagaraju
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Dhivya
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Devanand
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - V Maheswaran
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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12
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Kanagaraju V, Rakshith AVB, Devanand B, Rajakumar R. Utility of Ultrasound Elastography to Differentiate Benign from Malignant Cervical Lymph Nodes. J Med Ultrasound 2020; 28:92-98. [PMID: 32874867 PMCID: PMC7446693 DOI: 10.4103/jmu.jmu_72_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 07/26/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background: The purpose of this study was to evaluate the usefulness of strain elastography and acoustic radiation force impulse (ARFI) imaging in the differentiation of benign and malignant cervical lymph nodes (LNs). Materials and Methods: In this prospective study, 50 enlarged cervical LNs (33 benign and 17 malignant) were examined by B-mode ultrasound (US), color Doppler, and strain elastography. Elastographic patterns (1–5) were categorized based on distribution of hard area within LN. The shear wave velocity (SWV) of LNs was evaluated by ARFI imaging. Diagnostic performance of sonoelastographic parameters was compared taking histopathology of LN as a reference standard. Optimal cutoff value of the mean SWV values for predicting malignancy was determined using receiver operating characteristic curve analysis. Results: Among US parameters, borders of LN had the highest diagnostic accuracy (80%), while echogenicity had the least (48%). Majority of benign LNs (n = 31) had elastography patterns 1 and 2, while majority of malignant LNs (n = 16) had patterns 3–5 (P = 0.000). The sensitivity, specificity, and accuracy of elastography were 94.1%, 93.9%, and 94%, respectively. The mean SWV of benign LNs (1.670 ± 0.367 m/s) differed significantly from malignant LNs (2.965 ± 0.826 m/s; P = 0.000). A cutoff value of 2.05 m/s predicted malignancy with 88.2% sensitivity and 84.8% specificity and gave an area under the curve of 0.949 (95% confidence interval: 0.70–1.20). Conclusion: Elastography has high diagnostic accuracy in differentiating benign and malignant cervical LNs and can be potentially useful in selecting the LN with high probability of malignancy, on which fine-needle aspiration cytology/biopsy can be performed.
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Affiliation(s)
- Vikrant Kanagaraju
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - A V B Rakshith
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Devanand
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - R Rajakumar
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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13
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Determination of the Relationships Between intra- and Extraoral Tongue Hardness, Thickness, and Pressure Using Ultrasonic Elastography. Dysphagia 2020; 36:623-634. [PMID: 32875351 DOI: 10.1007/s00455-020-10176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 08/24/2020] [Indexed: 12/17/2022]
Abstract
Involved with various bodily functions, including ingestion and swallowing, the tongue is an important organ. We measured resting tongue hardness using real-time tissue elastography (RTE) to establish a simple tongue evaluation for patients who may have limited capacities to follow commands. Relationships between tongue hardness, thickness, and pressure were investigated, using both intra- and extraoral probes. Assessments were performed for a total of 27 healthy adults (11 male, 16 female, average age 26.4 ± 1.8 years). Measurements of tongue hardness and thickness were made using strain ratios (SR), and averaged across nine images. Maximum tongue pressure was determined using a tongue pressure device. A negative correlation was observed between intraorally measured tongue hardness and maximum tongue pressure (r = -0.76, p < 0.01). A positive correlation between extraorally measured tongue thickness and maximum tongue pressure was observed (r = 0.59, p < 0.01). Additionally, significant differences were observed between males and females with regards to intraorally measured tongue hardness (p = 0.02), maximum tongue pressure (p = 0.02), and extraorally measured tongue thickness (p < 0.01). The results of this study demonstrated the clinical applicability of RTE-based tongue hardness measurements, and suggest the feasibility of predicting tongue strength based on extraoral tongue thickness measurements.
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14
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Liang M, Ou B, Wu J, Xiao X, Ruan J, Tian J, Xu X, Wang B, Yang H, Luo B. Combined use of strain elastography and superb microvascular imaging with grayscale ultrasound according to the BI-RADS classification for differentiating benign from malignant solid breast masses. Clin Hemorheol Microcirc 2020; 74:391-403. [PMID: 31683470 DOI: 10.3233/ch-190693] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Ming Liang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Xiao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Tian
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Wang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyun Yang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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15
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Mirzaei M, Asif A, Rivaz H. Combining Total Variation Regularization with Window-Based Time Delay Estimation in Ultrasound Elastography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2744-2754. [PMID: 31021794 DOI: 10.1109/tmi.2019.2913194] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A major challenge of free-hand palpation ultrasound elastography (USE) is estimating the displacement of RF samples between pre- and post-compressed RF data. The problem of displacement estimation is ill-posed since the displacement of one sample by itself cannot be uniquely calculated. To resolve this problem, two categories of methods have emerged. The first category assumes that the displacement of samples within a small window surrounding the reference sample is constant. The second class imposes smoothness regularization and optimizes an energy function. Herein, we propose a novel method that combines both approaches, and as such, is more robust to noise. The second contribution of this work is the introduction of the L1 norm as the regularization term in our cost function, which is often referred to as the total variation (TV) regularization. Compared to previous work that used the L2 norm regularization, optimization of the new cost function is more challenging. However, the advantages of using the L1 norm are twofold. First, it leads to substantial improvement in the sharpness of displacement estimates. Second, to optimize the cost function with the L1 norm regularization, we use an iterative method that further increases the robustness. We name our proposed method tOtal Variation Regularization and WINDow-based time delay estimation (OVERWIND) and show that it is robust to signal decorrelation and generates sharp displacement and strain maps for simulated, experimental phantom and in-vivo data. In particular, OVERWIND improves strain contrast-to-noise ratio (CNR) by 27.26%, 144.05%, and 49.90% on average in simulation, phantom, and in-vivo data, respectively, compared to our recent Global Ultrasound Elastography (GLUE) method.
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Forte AJ, Huayllani MT, Boczar D, Cinotto G, McLaughlin SA. Ultrasound Elastography Use in Lower Extremity Lymphedema: A Systematic Review of the Literature. Cureus 2019; 11:e5578. [PMID: 31695997 PMCID: PMC6820675 DOI: 10.7759/cureus.5578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lower extremity lymphedema (LEL) is mainly assessed clinically. Ultrasound elastography (UE) is a promising imaging tool to assess this disorder. We conducted a systematic literature review to describe the studies evaluating the use of UE in LEL. The PubMed database was queried for studies that evaluated the use of UE in LEL. The keywords "elastography" AND "lymphedema" were used for the search. Original articles in English were included in our study, whereas reviews were excluded. Our search resulted in 12 articles, 4 of which met the inclusion criteria. UE methods included free-hand real-time tissue elastography and UE with transducer in B mode. The imaging parameters applied were the tissue strains and the area of red region, respectively. All studies tested UE use in the assessment of LEL, and only one considered its use for staging. All studies but one found a difference in strain parameters for assessment of patients with LEL. Our systematic review has shown that UE appears to be a great tool in the assessment of LEL in moderate-to-advanced stages of disease. However, further studies using new effective methods are needed to evaluate patients with early lymphedema.
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Affiliation(s)
- Antonio J Forte
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Maria T Huayllani
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Daniel Boczar
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Gabriela Cinotto
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Sarah A McLaughlin
- Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
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Comparison of Diagnostic Performance of B-Mode Ultrasonography and Shear Wave Elastography in Cervical Lymph Nodes. Ultrasound Q 2019; 35:290-296. [PMID: 31283566 DOI: 10.1097/ruq.0000000000000464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to compare the diagnostic performance of B-mode ultrasonography (US) and shear wave elastography (SWE) for differentiating benign from malignant cervical lymph nodes (LNs). This study evaluated 130 cervical LNs in 127 patients. On conventional B-mode US, short-axis and long-axis diameters, long-to-short-axis ratio, cortical morphology, border, and presence of necrosis or calcification were evaluated. Maximum elasticity value (Emax) was collected for SWE. The area under the receiver operator characteristic curve (AUC), sensitivity, and specificity of B-mode US features and SWE were compared. Final histopathologic results showed 89 benign and 41 metastatic LNs. Among the B-mode US features, cortical morphology had the highest AUC (0.884). When 54 kPa of Emax was applied as a cutoff value, the SWE showed significantly lower AUC than cortical morphology (0.734, P = 0.02). Both sensitivity and specificity for cortical morphology on B-mode US were higher than for Emax (80.5% vs 65.9%, P = 0.212 and 89.9% vs 76.4%, P = 0.026, respectively). Conventional B-mode US resulted in higher diagnostic yield than SWE in evaluating cervical LNs in our study. However, further studies on potential factors that may affect the SWE velocity are needed to validate the diagnostic value of SWE.
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18
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Leong LCH, Moey THL, Tan PH, Fook-Chong S, Sim LSJ. Comparative Study of Pattern-Based Versus Size Ratio Ultrasound Strain Elastographic Techniques on Breast Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1779-1790. [PMID: 30484886 DOI: 10.1002/jum.14867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/13/2018] [Accepted: 07/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to compare the diagnostic performance of strain elastographic techniques involving pattern-based elastography versus size ratio elastography on breast masses. METHODS Female patients presenting to the radiology department for ultrasound (US)-guided biopsies, fine-needle aspirations, or localizations of breast masses were invited to undergo US elastographic assessments of the lesions before the breast procedures. The masses were evaluated for color score and color map size ratio elastographic assessments with one US machine and size ratio and grayscale strain pattern elastographic assessments with another machine. With the histopathologic diagnosis as the reference standard, the sensitivity, specificity, and area under the receiver operating characteristic curve were compared among the 4 groups. RESULTS A total of 154 breast masses from 139 women were assessed. The sensitivity and specificity were 0.615 (95% confidence interval, 0.470-0.747) and 0.824 (0.736-0.892), respectively for the color score, 0.962 (0.868-0.995) and 0.765 (0.670-0.843) for the size ratio, 0.904 (0.790-0.968) and 0.745 (0.649-0.826) for the color map size ratio, and 0.635 (0.490-0.764) and 0.422 (0.324-0.523) for the grayscale strain pattern. The areas under the receiver operating characteristic curve were 0.729 for the color score, 0.874 for the size ratio (P = .001 with the color score as a reference), 0.836 for the color map size ratio (P = .002), and 0.556 for the grayscale strain pattern (P < .001). CONCLUSIONS Size ratio elastography had higher sensitivity and better diagnostic accuracy compared to color score elastography. This superiority was demonstrated on two different US systems, and size ratio elastography should thus be considered over color score elastography in the adjunctive US assessment of breast lesions.
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Affiliation(s)
- Lester Chee Hao Leong
- Department of Diagnostic Radiology, (L.C.H.L., T.H.L., L.S.-J.S.) and Division of Pathology (P.H.T.), Singapore
| | - Tammy Hui Lin Moey
- Department of Diagnostic Radiology, (L.C.H.L., T.H.L., L.S.-J.S.) and Division of Pathology (P.H.T.), Singapore
| | - Puay Hoon Tan
- General Hospital, Duke-NUS Medical School, Singapore
| | | | - Llewellyn Shao-Jen Sim
- Department of Diagnostic Radiology, (L.C.H.L., T.H.L., L.S.-J.S.) and Division of Pathology (P.H.T.), Singapore
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Singla V, Prakash A, Prabhakar N, Singh T, Bal A, Singh G, Khandelwal N. Does Shear Wave Elastography Score Over Strain Elastography in Breast Masses or Vice Versa? Curr Probl Diagn Radiol 2019; 49:96-101. [PMID: 30981528 DOI: 10.1067/j.cpradiol.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study was done to compare parameters of strain elastography (SE) and shear-wave elastography (SWE) for differentiation of benign and malignant breast masses and determine their best cut-offs. MATERIAL AND METHODS B mode ultrasound (USG), SE, and SWE were performed in 199 breast masses. During SE, 5-point visual elastography score (SEvisual score) and strain ratio (SEstrain ratio) were obtained. During SWE, mean and maximum elasticity values in kilopascals, and shear wave ratio were obtained in two orthogonal planes. The shear wave mean average (SWEmean avg), shear wave maximum average (SWEmax avg) and shear wave ratio average (SWEratio avg) were calculated by averaging the respective values in the two planes. The SE and SWE parameters of every mass were correlated with its histopathology. RESULTS The areas under the receiver operating characteristic curve of SEvisual score, SEstrain ratio, SWEmean avg, SWEmax avg, and SWEratio avg were 0.815, 0.814, 0.846, 0.846, and 0.799, respectively. CONCLUSIONS The best cut-off values that achieved the highest sensitivity and specificity for SEstrain ratio, SWEmean avg, SWEmax avg, and SWEratio avg were 3.91, 113 kPa, 123.5 kPa, and 7.32, respectively. Quantitative parameter of SE showed comparable diagnostic performance with quantitative parameters of SWE.
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Affiliation(s)
- Veenu Singla
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Aparna Prakash
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gurpreet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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20
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Tang S, Sabonghy EP, Chaudhry A, Shajudeen PS, Islam MT, Kim N, Cabrera FJ, Reddy JN, Tasciotti E, Righetti R. A Model-Based Approach to Investigate the Effect of a Long Bone Fracture on Ultrasound Strain Elastography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:2704-2717. [PMID: 29994472 DOI: 10.1109/tmi.2018.2849996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The mechanical behavior of long bones and fractures has been under investigation for many decades due to its complexity and clinical relevance. In this paper, we report a new subject-specific methodology to predict and analyze the mechanical behavior of the soft tissue at a bone interface with the intent of identifying the presence and location of bone abnormalities with high accuracy, spatial resolution, and contrast. The proposed methodology was tested on both intact and fractured rabbit femur samples with finite element-based 3-D simulations, created from actual femur computed tomography data, and ultrasound elastography experiments. The results included in this study demonstrate that elastographic strains at the bone/soft tissue interface can be used to differentiate fractured femurs from the intact ones on a distribution level. These results also demonstrate that coronal plane axial shear strain creates a unique contrast mechanism that can be used to reliably detect fractures (both complete and incomplete) in long bones. Kruskal-Wallis test further demonstrates that the contrast measure for the fracture group (simulation: 2.1286±0.2206; experiment: 2.7034 ± 1.0672) is significantly different from that for the intact group (simulation: 0 ± 0; experiment: 1.1540±0.6909) when using coronal plane axial shear strain elastography ( < 0.01). We conclude that: 1) elastography techniques can be used to accurately identify the presence and location of fractures in a long bone and 2) the proposed model-based approach can be used to predict and analyze strains at a bone fracture site and to better interpret experimental elastographic data.
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21
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Xiang L, Ma F, Yao M, Xu G, Pu H, Liu H, Fang Y, Wu R. Benign lesion evaluation: Factors causing the "stiff rim" sign in breast tissues using shear-wave elastography. Br J Radiol 2018; 92:20180602. [PMID: 30303694 DOI: 10.1259/bjr.20180602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE: To investigate the factors causing the "stiff rim" sign in breast lesions using shear-wave elastography. METHODS: A total of 907 patients with 907 lesions were included retrospectively in this study. Traditional ultrasound and shear-wave elastography imaging were both performed. Patients age, maximum diameter, depth, distance, echogenicity, shape, boundary, margin, internal components, CDFI, calcification, echogenicity attenuation and longitudinal growth of lesions were observed and calculated by both univariate and multivariate analyses. RESULTS: Univariate analyses indicated that the age, depth, shape, margin, internal components, CDFI, calcification and pathology showed significant difference between the benign lesions with and without a "stiff rim", whereas there was no correlation of "stiff rim" with maximum diameter, distance, boundary, echogenicity, echo attenuation and longitudinal growth of the lesions. Multivariate analysis expressed that CDFI, margin, internal components, depth and age were significantly associated with the "stiff rim" sign in breast benign lesions, whereas there was no correlation with the pathology, shape or calcification of the lesions. CONCLUSIONS: The "stiff rim" sign can be helpful for differentiation between benign and malignant lesions. Older patients with a "stiff rim" sign whose benign masses are deep, poorly defined, heterogeneous and have a positive CDFI should be examined more closely to avoid unnecessary false-positives. ADVANCES IN KNOWLEDGE: The "stiff rim" sign can be helpful for differentiation between benign and malignant lesions. Positive CDFI, poorly defined margin, heterogeneous internal components, deep depth and older age were significantly associated with the "stiff rim" sign in benign breast lesions.
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Affiliation(s)
- Lihua Xiang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Fang Ma
- 3 Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People'sHospital , Shanghai , China
| | - Minghua Yao
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Guang Xu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Huan Pu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Hui Liu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Yan Fang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Rong Wu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,4 Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong UniversitySchool of Medicine , Shanghai , China
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Hu L, He N, Ye L, Zhou H, Zhong W, Zhang X. Evaluation of the Stiffness of Tissues Surrounding Thyroid Nodules with Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2251-2261. [PMID: 29480517 DOI: 10.1002/jum.14578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/14/2017] [Accepted: 12/10/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study evaluated the stiffness of tissue surrounding thyroid nodules using shear wave elastography (SWE). METHODS A total of 128 thyroid nodules in 108 patients were examined with conventional ultrasound imaging and SWE. The maximum Young modulus value was measured to evaluate the stiffness of the thyroid nodules (E) and the 2-mm perinodular region (Eshell ). The number of thyroid fibrocytes was evaluated by Masson trichrome staining and image-processing software. The arrangement of the fibrous structure was also classified. RESULTS The mean age ± SD of the 108 patients was 33.12 ± 13.34 years (range, 18-80 years). Thirty-nine thyroid nodules were classified as benign and 89 as malignant. Eshell was significantly higher for malignant nodules (95.0 ± 21.9 kPa) compared with benign nodules (48.1 ± 17.0 kPa; P < .001). Eshell yielded an area under the receiver operator characteristic curve value of 0.951, which was used for the diagnosis of nodules. There was a high positive correlation between E and Eshell in the malignant group (R = 0.722; P < .001) and a moderate positive correlation in the benign group (R = 0.601; P < .001). Percentages of fibrocytes correlated highly with Eshell in all samples as well as in malignant samples (R = 0.867 and R = 0.729, respectively; P < .001). The degree of disorder of the tissue surrounding thyroid nodules was positively correlated with Eshell (R = 0.833). CONCLUSIONS Perinodular stiffness has potential to improve diagnosis of thyroid nodules.
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Affiliation(s)
- Lei Hu
- Department of Ultrasound, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Nianan He
- Department of Ultrasound, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Lei Ye
- Department of Ultrasound, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Hangcheng Zhou
- Department of Pathology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Wen Zhong
- Department of Pathology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Xinshu Zhang
- Department of Ultrasound, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Zou H, Xue Y, Ou Y, Li S, Zhao Y, Shao L, Li Y. Factors Affecting the Quality of Breast Quasistatic Ultrasound Elastograms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1701-1712. [PMID: 29288591 DOI: 10.1002/jum.14518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/01/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore factors affecting the quality of quasistatic ultrasound elastograms of the breast and to evaluate their accuracy in distinguishing benign and malignant breast lesions. METHODS A total of 663 patients with 702 breast lesions were recruited. All patients received both conventional ultrasonography and quasistatic elastography. Patients' breast lesions were divided into A and B groups according to satisfactory and unsatisfactory elastographic examinations. Group A included 590 satisfactory elastograms, whereas Group B included 112 unsatisfactory elastograms. Various factors-maximum depth of the lesion, maximum transverse diameter of the lesion, thickness of the adipose layer, thickness of the glandular layer, thickness of the breast, distance between the nipple and lesion, age, body mass index, and menopausal status-were analyzed and compared between the groups to gauge their effects on the quality of the elastograms. RESULTS Significantly deeper lesions, higher maximum transverse lesion diameters, thicker adipose layers, thicker glandular layers, and thicker breasts were identified in group B patients compared to group A patients (P < .05). Multivariate logistic regression analyses showed that the maximum depth of the lesion, thickness of the adipose layer, and thickness of the breast were independent factors in the quality of elastograms. The area under the curve for the maximum depth of the lesion was 0.986 with the optimal cutoff threshold of 2.5 cm. CONCLUSIONS Quasistatic elastography can be a supplementary approach to conventional ultrasonography in helping improve the diagnostic accuracy of breast lesions. The depth and size of breast lesions are correlated with the quality of elastograms.
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Affiliation(s)
- Hongsheng Zou
- Department of Surgical Intensive Care Unit, People's Hospital of Rongcheng, Rongcheng, China
| | - Yan Xue
- Department of Statistics, Jinan Child Hospital, Jinan, China
| | - Yang Ou
- Department of Graduate School, School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Zhangqiu, China
- Departments of Hepatobiliary Surgery, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Sheng Li
- Departments of Hepatobiliary Surgery, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yuehuan Zhao
- Department of Special Diagnosis, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Limei Shao
- Department of Special Diagnosis, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yunling Li
- Department of Special Diagnosis, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
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Uff C, Garcia L, Fromageau J, Chakraborty A, Dorward N, Bamber J. Further characterization of changes in axial strain elastograms due to the presence of slippery tumor boundaries. J Med Imaging (Bellingham) 2018; 5:021211. [PMID: 29430480 PMCID: PMC5798943 DOI: 10.1117/1.jmi.5.2.021211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/04/2018] [Indexed: 01/05/2023] Open
Abstract
Elastography measures tissue strain, which can be interpreted under certain simplifying assumptions to be representative of the underlying stiffness distribution. This is useful in cancer diagnosis where tumors tend to have a different stiffness to healthy tissue and has also shown potential to provide indication of the degree of bonding at tumor-tissue boundaries, which is clinically useful because of its dependence on tumor pathology. We consider the changes in axial strain for the case of a symmetrical model undergoing uniaxial compression, studied by characterizing changes in tumor contrast transfer efficiency (CTE), inclusion to background strain contrast and strain contrast generated by slip motion, as a function of Young's modulus contrast and applied strain. We present results from a finite element simulation and an evaluation of these results using tissue-mimicking phantoms. The simulation results show that a discontinuity in displacement data at the tumor boundary, caused by the surrounding tissue slipping past the tumor, creates a halo of "pseudostrain" across the tumor boundary. Mobile tumors also appear stiffer on elastograms than adhered tumors, to the extent that tumors that have the same Young's modulus as the background may in fact be visible as low-strain regions, or those that are softer than the background may appear to be stiffer than the background. Tumor mobility also causes characteristic strain heterogeneity within the tumor, which exhibits low strain close to the slippery boundary and increasing strain toward the center of the tumor. These results were reproduced in phantom experiments. In addition, phantom experiments demonstrated that when fluid lubrication is present at the boundary, these effects become applied strain-dependent as well as modulus-dependent, in a systematic and characteristic manner. The knowledge generated by this study is expected to aid interpretation of clinical strain elastograms by helping to avoid misinterpretation as well as provide additional diagnostic criteria stated in the paper and stimulate further research into the application of elastography to tumor mobility assessment.
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Affiliation(s)
- Christopher Uff
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, Surrey, United Kingdom
| | - Leo Garcia
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, Surrey, United Kingdom
| | - Jeremie Fromageau
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, Surrey, United Kingdom
| | - Aabir Chakraborty
- Southampton General Hospital, Department of Neurosurgery, Southampton, United Kingdom
| | - Neil Dorward
- National Hospital for Neurology and Neurosurgery, Victor Horsley Department of Neurosurgery, Queen Square, London, United Kingdom
| | - Jeffrey Bamber
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, Surrey, United Kingdom
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Dong Y, Zhou C, Zhou J, Yang Z, Zhang J, Zhan W. Breast strain elastography: Observer variability in data acquisition and interpretation. Eur J Radiol 2018; 101:157-161. [DOI: 10.1016/j.ejrad.2018.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 12/21/2022]
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Nagolu H, Kattoju S, Natesan C, Krishnakumar M, Kumar S. Role of Acoustic Radiation Force Impulse Elastography in the Characterization of Focal Solid Hepatic Lesions. J Clin Imaging Sci 2018. [PMID: 29541491 PMCID: PMC5843967 DOI: 10.4103/jcis.jcis_64_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: The purpose of the study is to investigate the usefulness of acoustic radiation force impulse (ARFI) elastography in the characterization of focal solid liver lesions as benign, malignant, or metastatic using ARFI two-dimensional (2D) imaging and ARFI quantification (shear wave velocities [SWVs]). Materials and Methods: Sixty lesions were included in this study. The lesions were classified into three groups: Group I included benign lesions (n = 25), Group II included malignant lesions (n = 27), and Group III included metastatic lesions (n = 8). ARFI elastography was performed in all these patients using a Siemens ACUSON S 2000™ ultrasound machine. Stiffness and size of the lesions were assessed on ARFI 2D images in correlation with B-mode ultrasound images. SWVs were obtained in these lesions for the quantification of stiffness. Results: In ARFI 2D images, malignant lesions were predominantly stiffer and larger, while benign lesions were softer and similar in size (P < 0.05). The mean SWVs in benign, malignant, and metastatic lesions were 1.30 ± 0.35 m/s, 2.93 ± 0.75 m/s, and 2.77 ± 0.90 m/s, respectively. The area under receiver operating characteristic curve of SWV for differentiating benign from malignant lesions was 0.877, suggesting fair accuracy (95% confidence interval: 0.777–0.976); with a cutoff value of 2 m/s, showing sensitivity: 92%; specificity: 96%; positive predictive value: 96%; negative predictive value: 93% (P < 0.05). Statistically significant difference exists in SWV of benign and malignant or metastatic lesions. Conclusion: ARFI elastography with 2D imaging and quantification might be useful in the characterization of benign and malignant liver lesions.
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Affiliation(s)
- Harshavardhan Nagolu
- Department of Radiology and Imaging Sciences, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sudhakar Kattoju
- Department of Radiology and Imaging Sciences, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Meera Krishnakumar
- Department of Radiology and Imaging Sciences, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sunil Kumar
- Department of Pathology, Apollo Hospitals, Chennai, Tamil Nadu, India
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The value of shear wave elastography in predicting for undiagnosed small cervical lymph node metastasis in nasopharyngeal carcinoma: A preliminary study. Eur J Radiol 2018; 103:19-24. [PMID: 29803380 DOI: 10.1016/j.ejrad.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND To investigate the diagnostic value of shear wave elastography (SWE) in identifying cervical small lymph node metastases in nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS This prospective study was approved by the local institutional review board. From July 2014 to March 2016, 114 sLNs from 62 newly diagnosed NPC patients (47 men, 15 women) were assessed. Target small lymph nodes (sLNs), which were undiagnosed by magnetic resonance imaging (MRI), were defined as scattered cervical lymph nodes that had no evidence of central necrosis or extracapsular spread and exhibited a maximum transverse diameter ≥5 mm and <10 mm in MRI. The mean (Emean), minimum (Emin) and maximum (Emax) of the elasticity indices (EIs) were measured by SWE at the stiffest part of the sLN (kPa). Biopsy pathology was served as the reference standard. Diagnostic performances were assessed using receiver operating curve (ROC) analysis on a node-by-node basis. RESULTS Of the 114 small cervical lymph nodes, 88 (77.2%) were benign, and 26 (22.8%) were malignant. All SWE EIs were significantly higher in malignant sLNs than in benign sLNs (p < 0.001). Emean exhibited the highest diagnostic value (area under the curve = 0.879 ± 0.036) (p < 0.001) and the corresponding sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 84.6%, 83.0%, 59.5%, 94.8% and 83.3%, respectively. The intra-observer reproducibility of all SWE EIs were significant, with intra-class correlation coefficient (ICC) of 0.745 in Emean, 0.716 in Emax and 0.702 in Emin. CONCLUSION Shear wave elastography is an optional supplementary imaging modality to routine MRI examination to diagnose cervical lymph nodes in NPC patients.
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Ultrasound elastography: How can it help in differentiating breast lesions? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Liu H, Xu G, Yao MH, Pu H, Fang Y, Xiang LH, Wu R. Association of conventional ultrasound, elastography and clinicopathological factors with axillary lymph node status in invasive ductal breast carcinoma with sizes > 10 mm. Oncotarget 2018; 9:2819-2828. [PMID: 29416814 PMCID: PMC5788682 DOI: 10.18632/oncotarget.18969] [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: 11/22/2016] [Accepted: 06/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate whether conventional ultrasound, elastography [conventional strain elastography of elasticity imaging, acoustic radiation force impulse induced strain elastography of virtual touch tissue imaging, and a novel two-dimensional shear wave elastography of virtual touch tissue imaging quantification] and clinicopathological factors are associated with axillary lymph node metastasis in invasive ductal breast carcinoma with sizes > 10 mm. Materials and Methods We evaluated 150 breast lesions from 148 patients using the above methods and the clinicopathological factors. Univariate and multivariate logistic regression analysis were performed to determine the axillary lymph node metastasis risk factors. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. Results Sixty-three tumors (42%) were node-positive, 87 (58%) were node-negative. Aspect ratio, virtual touch tissue imaging grade, shear wave velocity, pathological invasive tumor size, and histological grade maintained independent significance in predicting nodal involvement. The mean tumor shear wave velocitys (4.60, 6.49, 7.16) increased in proportion to metastatic node number (0, 1-3, ≥ 4, respectively; P < 0.001). For all tumors in this study, the cut-off shear wave velocity was 6.16 m/s and was associated with 64.1% sensitivity, 78.0% specificity and an area under the ROC curve of 0.799 (95% confidence interval, 0.731-0.868). Conclusions Aspect ratio, virtual touch tissue imaging grade, shear wave velocity, pathological invasive tumor size and histological grade are independently associated with axillary lymph node metastasis in invasive ductal breast carcinoma with sizes > 10 mm.
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Affiliation(s)
- Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Ming-Hua Yao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Yan Fang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
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Khamis ME, Ismail AAA, Alaa El-deen AM, Amin MF. Additional value of qualitative strain ultrasound elastography and strain ratio in predicting thyroid malignancy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hu X, Liu Y, Qian L. Diagnostic potential of real-time elastography (RTE) and shear wave elastography (SWE) to differentiate benign and malignant thyroid nodules: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8282. [PMID: 29068996 PMCID: PMC5671829 DOI: 10.1097/md.0000000000008282] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Real-time elastography (RTE) and shear wave elastography (SWE) are noninvasive and easily available imaging techniques that measure the tissue strain, and it has been reported that the sensitivity and the specificity of elastography were better in differentiating between benign and malignant thyroid nodules than conventional technologies. METHODS Relevant articles were searched in multiple databases; the comparison of elasticity index (EI) was conducted with the Review Manager 5.0. Forest plots of the sensitivity and specificity and SROC curve of RTE and SWE were performed with STATA 10.0 software. In addition, sensitivity analysis and bias analysis of the studies were conducted to examine the quality of articles; and to estimate possible publication bias, funnel plot was used and the Egger test was conducted. RESULTS Finally 22 articles which eventually satisfied the inclusion criteria were included in this study. After eliminating the inefficient, benign and malignant nodules were 2106 and 613, respectively. The meta-analysis suggested that the difference of EI between benign and malignant nodules was statistically significant (SMD = 2.11, 95% CI [1.67, 2.55], P < .00001). The overall sensitivities of RTE and SWE were roughly comparable, whereas the difference of specificities between these 2 methods was statistically significant. In addition, statistically significant difference of AUC between RTE and SWE was observed between RTE and SWE (P < .01). CONCLUSION The specificity of RTE was statistically higher than that of SWE; which suggests that compared with SWE, RTE may be more accurate on differentiating benign and malignant thyroid nodules.
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Affiliation(s)
- Xiangdong Hu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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You J, Chen J, Xiang F, Song Y, Khamis S, Lu C, Lv Q, Zhang Y, Xie M. The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules. J Med Ultrason (2001) 2017; 45:251-259. [PMID: 28905143 DOI: 10.1007/s10396-017-0819-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed at evaluating the diagnostic performance of quantitative shear wave elastography (SWE) in differentiating metastatic cervical lymph nodes from benign nodes in patients with thyroid nodules. METHODS One hundred and forty-one cervical lymph nodes from 39 patients with thyroid nodules that were diagnosed as papillary thyroid cancer had been imaged with SWE. The shear elasticity modulus, which indicates the stiffness of the lymph nodes, was measured in terms of maximum shear elasticity modulus (maxSM), minimum shear elasticity modulus (minSM), mean shear elasticity modulus (meanSM), and standard deviation (SD) of the shear elasticity modulus. RESULTS All the patients underwent thyroid surgery, 50 of the suspicious lymph nodes were resected, and 91 lymph nodes were followed up for 6 months. The maxSM value, minSM value, meanSM value, and SD value of the metastatic lymph nodes were significantly higher than those of the benign nodes. The area under the curve of the maxSM value, minSM value, meanSM value, and SD value were 0.918, 0.606, 0.865, and 0.915, respectively. CONCLUSIONS SWE can differentiate metastasis from benign cervical lymph nodes in patients with thyroid nodules, and the maxSM, meanSM, and SD may be valuable quantitative indicators for characterizing cervical lymph nodes.
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Affiliation(s)
- Jun You
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Juan Chen
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Feixiang Xiang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yue Song
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Simai Khamis
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chengfa Lu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yanrong Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China. .,Department of Radiology, Neuroradiology Section, Stanford University, Palo Alto, CA, USA.
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Li LJ, Yao JY, Zhou XC, Zhao XB, Zhong WJ, Ou B, Luo BM, Hao SY, Zhi H. What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions? ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:903-910. [PMID: 28256344 DOI: 10.1016/j.ultrasmedbio.2017.01.004] [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: 04/12/2016] [Revised: 12/02/2016] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Abstract
On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.
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Affiliation(s)
- Lu-Jing Li
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Ji-Yi Yao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xin-Chuan Zhou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xin-Bao Zhao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Wen-Jing Zhong
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Bao-Ming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Shao-Yun Hao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hui Zhi
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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Abstract
OBJECTIVE To investigate the significance of ultrasound elastography for evaluating the optic nerve in patients with primary open angle glaucoma (POAG). METHODS This prospective, comparative case series included 40 eyes of 40 patients. Twenty eyes with POAG comprised the POAG group, and 20 eyes of 20 patients without glaucoma who admitted to general eye clinic for near vision glasses comprised the control group. All real-time sonographicelastographic examinations were performed by the same physician. The ratio of orbital fat to optic nerve head (ROFON) and lateral rectus to optic nerve head (RLRON) were determined. Statistical analyses were performed using Student t test, Kolmogorov-Smirnov test, and χ test. RESULTS The mean ages of the patients in the study and the control groups were 65.10 ± 7.88 years (range, 48-80 years), and 69.15 ± 7.92 years (range, 55-89 years), respectively (P = 0.113). Mean ROFONs were 1.85 and 6.42 (P < 0.05), and mean RLRONs were 0.65 and 1.07 (P < 0.05) in the control and POAG groups, respectively. CONCLUSIONS Real-time elastography showed increased ROFON and RLRON in POAG patients. This can help to understand optic nerve head biomechanics and clarify glaucoma damage in early glaucoma cases.
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Xu X, Chung Y, Brooks AD, Shih WH, Shih WY. Development of array piezoelectric fingers towards in vivo breast tumor detection. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2016; 87:124301. [PMID: 28040934 PMCID: PMC5148765 DOI: 10.1063/1.4971325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
We have investigated the development of a handheld 4 × 1 piezoelectric finger (PEF) array breast tumor detector system towards in vivo patient testing, particularly, on how the duration of the DC applied voltage, the depression depth of the handheld unit, and breast density affect the PEF detection sensitivity on 40 patients. The tests were blinded and carried out in four phases: with DC voltage durations 5, 3, 2, to 0.8 s corresponding to scanning a quadrant, a half, a whole breast, and both breasts within 30 min, respectively. The results showed that PEF detection sensitivity was unaffected by shortening the applied voltage duration from 5 to 0.8 s nor was it affected by increasing the depression depth from 2 to 6 mm. Over the 40 patients, PEF detected 46 of the 48 lesions (46/48)-with the smallest lesion detected being 5 mm in size. Of 28 patients (some have more than one lesion) with mammography records, PEF detected 31/33 of all lesions (94%) and 14/15 of malignant lesions (93%), while mammography detected 30/33 of all lesions (91%) and 12/15 of malignant lesions (80%), indicating that PEF could detect malignant lesions not detectable by mammography without significantly increasing false positives. PEF's detection sensitivity is also shown to be independent of breast density, suggesting that PEF could be a potential tool for detecting breast cancer in young women and women with dense breasts.
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Affiliation(s)
- Xin Xu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Youngsoo Chung
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Ari D Brooks
- Department of Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Wei-Heng Shih
- Department of Materials Science and Engineering, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Wan Y Shih
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Schwab F, Redling K, Siebert M, Schötzau A, Schoenenberger CA, Zanetti-Dällenbach R. Inter- and Intra-Observer Agreement in Ultrasound BI-RADS Classification and Real-Time Elastography Tsukuba Score Assessment of Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2622-2629. [PMID: 27503826 DOI: 10.1016/j.ultrasmedbio.2016.06.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/02/2016] [Accepted: 06/08/2016] [Indexed: 06/06/2023]
Abstract
Our aim was to prospectively evaluate inter- and intra-observer agreement between Breast Imaging Reporting and Data System (BI-RADS) classifications and Tsukuba elasticity scores (TSs) of breast lesions. The study included 164 breast lesions (63 malignant, 101 benign). The BI-RADS classification and TS of each breast lesion was assessed by the examiner and twice by three reviewers at an interval of 2 months. Weighted κ values for inter-observer agreement ranged from moderate to substantial for BI-RADS classification (κ = 0.585-0.738) and was substantial for TS (κ = 0.608-0.779). Intra-observer agreement was almost perfect for ultrasound (US) BI-RADS (κ = 0.847-0.872) and TS (κ = 0.879-0.914). Overall, individual reviewers are highly self-consistent (almost perfect intra-observer agreement) with respect to BI-RADS classification and TS, whereas inter-observer agreement was moderate to substantial. Comprehensive training is essential for achieving high agreement and minimizing the impact of subjectivity. Our results indicate that breast US and real-time elastography can achieve high diagnostic performance.
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Affiliation(s)
- Fabienne Schwab
- Department of Gynecology and Obstetrics, University Hospital of Basel, Basel, Switzerland
| | - Katharina Redling
- Department of Gynecology and Obstetrics, University Hospital of Basel, Basel, Switzerland
| | - Matthias Siebert
- Department of Gynecology and Obstetrics, University Hospital of Basel, Basel, Switzerland
| | - Andy Schötzau
- Statistics, Department of Gynecology and Obstetrics, University Hospital of Basel, Basel, Switzerland
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Teke M, Teke F, Alan B, Türkoğlu A, Hamidi C, Göya C, Hattapoğlu S, Gumus M. Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging. J Med Ultrason (2001) 2016; 44:109-115. [PMID: 27787642 DOI: 10.1007/s10396-016-0749-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Differentiation of idiopathic granulomatous mastitis (IGM) from carcinoma with routine imaging methods, such as ultrasonography (US) and mammography, is difficult. Therefore, we evaluated the value of a newly developed noninvasive technique called acoustic radiation force impulse imaging in differentiating IGM versus malignant lesions in the breast. METHODS Four hundred and eighty-six patients, who were referred to us with a presumptive diagnosis of a mass, underwent Virtual Touch tissue imaging (VTI; Siemens) and Virtual Touch tissue quantification (VTQ; Siemens) after conventional gray-scale US. US-guided percutaneous needle biopsy was then performed on 276 lesions with clinically and radiologically suspicious features. Malignant lesions (n = 122) and IGM (n = 48) were included in the final study group. RESULTS There was a statistically significant difference in shear wave velocity marginal and internal values between the IGM and malignant lesions. The median marginal velocity for IGM and malignant lesions was 3.19 m/s (minimum-maximum 2.49-5.82) and 5.05 m/s (minimum-maximum 2.09-8.46), respectively (p < 0.001). The median internal velocity for IGM and malignant lesions was 2.76 m/s (minimum-maximum 1.14-4.12) and 4.79 m/s (minimum-maximum 2.12-8.02), respectively (p < 0.001). CONCLUSION The combination of VTI and VTQ as a complement to conventional US provides viscoelastic properties of tissues, and thus has the potential to increase the specificity of US.
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Affiliation(s)
- Memik Teke
- Department of Radiology, Medical School, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
| | - Fatma Teke
- Department of Radiation Oncology, Medical School, Dicle University, Diyarbakir, Turkey
| | - Bircan Alan
- Department of Radiology, Medical School, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey
| | - Ahmet Türkoğlu
- Department of General Surgery, Medical School, Dicle University, Diyarbakir, Turkey
| | - Cihad Hamidi
- Department of Radiology, Medical School, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey
| | - Cemil Göya
- Department of Radiology, Medical School, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey
| | - Salih Hattapoğlu
- Department of Radiology, Medical School, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey
| | - Metehan Gumus
- Department of General Surgery, Medical School, Dicle University, Diyarbakir, Turkey
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Xiao X, Jiang Q, Wu H, Guan X, Qin W, Luo B. Diagnosis of sub-centimetre breast lesions: combining BI-RADS-US with strain elastography and contrast-enhanced ultrasound—a preliminary study in China. Eur Radiol 2016; 27:2443-2450. [DOI: 10.1007/s00330-016-4628-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/21/2022]
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Wu Q, Li Y, Wang Y. Diagnostic value of “absent” pattern in contrast-enhanced ultrasound for the differentiation of thyroid nodules. Clin Hemorheol Microcirc 2016; 63:325-334. [DOI: 10.3233/ch-152020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Tanaka T, Tada Y, Ohnishi T, Watanabe S. Usefulness of real-time tissue elastography for detecting the border of basal cell carcinomas. J Dermatol 2016; 44:438-443. [DOI: 10.1111/1346-8138.13578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Takamitsu Tanaka
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
| | - Yayoi Tada
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
| | - Takamitsu Ohnishi
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
| | - Shinichi Watanabe
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
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Ozsoy A, Acar D, Barca A, Aktas H, Araz L, Ozkaraoglu O, Yuksel E. Diagnostic performance of real-time strain sonoelastography in BI-RADS 4 and 5 breast masses. Diagn Interv Imaging 2016; 97:883-9. [DOI: 10.1016/j.diii.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/16/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022]
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Ormeci T, Güler O, Malkoc M, Keskinbora M, Güngören FZ, Mahirogulları M. Diagnostic Value of Elastography in the Diagnosis of Intermetatarsal Neuroma. J Foot Ankle Surg 2016; 55:720-6. [PMID: 26964696 DOI: 10.1053/j.jfas.2016.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Indexed: 02/03/2023]
Abstract
The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = -3.964, p = .0001 and Z = -3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis.
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Affiliation(s)
- Tugrul Ormeci
- Assistant Professor, Department of Radiology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
| | - Olcay Güler
- Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Melih Malkoc
- Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Mert Keskinbora
- Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Fatma Zeynep Güngören
- Resident, Department of Radiology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Mahir Mahirogulları
- Professor and Chairman, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
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Ramião NG, Martins PS, Rynkevic R, Fernandes AA, Barroso M, Santos DC. Biomechanical properties of breast tissue, a state-of-the-art review. Biomech Model Mechanobiol 2016; 15:1307-23. [DOI: 10.1007/s10237-016-0763-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023]
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Cesario V, Accogli E, Domanico A, Di Lascio FML, Napoleone L, Gasbarrini A, Arienti V. Percutaneous real-time sonoelastography as a non-invasive tool for the characterization of solid focal liver lesions: A prospective study. Dig Liver Dis 2016; 48:182-8. [PMID: 26687030 DOI: 10.1016/j.dld.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/23/2015] [Accepted: 11/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Real-time sonoelastography is currently used for the characterization of superficial solid lesions such as thyroid and breast masses. This study evaluates the usefulness of percutaneous sonoelastography for the characterization of solid focal liver lesions. METHODS 30 out of 43 patients with 38 known liver lesions were included in a prospective, diagnostic study. Qualitative analysis (pattern of deformation, elasticity type of liver tumour) and semi-quantitative measurements (strain ratio, hardness percentage, histogram) were evaluated. Sensitivity, specificity, positive and negative predictive values were calculated and the area under the receiver operating characteristics curve was constructed. RESULTS Patterns A and C-D are specific of benign lesions and metastases respectively. The patterns for haemangiomas, focal nodular hyperplasia and metastases were significantly different to each other in terms of strain ratio, hardness percentage and histogram (p<0.05). A statistically significant difference (p<0.001) was observed between the median values of the 3 measured parameters for benign (1.02; 12%; 47) and malignant lesions (1.66; 65%; 20.5) respectively. The area under the receiver operating characteristics curve values for strain ratio, hardness percentage and histogram were 0.88, 0.89, and 0.86 respectively for cut-off values of 1.2, 45, and 30. CONCLUSIONS By percutaneous sonoelastography it is possible to differentiate benign versus malignant focal liver lesions, metastases in particular, with good diagnostic performance.
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Affiliation(s)
- Valentina Cesario
- Internal Medicine and Gatroenterology Department, UCSC, Policlinico Gemelli, Rome, Italy.
| | - Esterita Accogli
- Internal Medicine A Department, Ospedale Maggiore, Bologna, Italy
| | - Andrea Domanico
- Internal Medicine A Department, Ospedale Maggiore, Bologna, Italy
| | - F Marta L Di Lascio
- Faculty of Economics and Management, Free University of Bozen, Bolzano, Italy
| | - Laura Napoleone
- Internal Medicine Department, Università La Sapienza, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gatroenterology Department, UCSC, Policlinico Gemelli, Rome, Italy
| | - Vincenzo Arienti
- Internal Medicine A Department, Ospedale Maggiore, Bologna, Italy
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Kuehlmann B, Prantl L, Michael Jung E. Imaging of idle breast implants with ultrasound-strain elastography- A first experimental study to establish criteria for accurate imaging of idle implants via ultrasound-strain elastography. Clin Hemorheol Microcirc 2016; 61:645-56. [DOI: 10.3233/ch-151963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Britta Kuehlmann
- Center for Plastic, Aesthetic, Hand &Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Center for Plastic, Aesthetic, Hand &Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of DiagnosticRadiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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Sazuka T, Akai T, Uesato M, Horibe D, Kuboshima M, Kitabayashi H, Matsunaga A, Kagaya A, Muto Y, Takeshita N, Maruyama T, Miyazawa Y, Shuto K, Shiratori T, Kono T, Akutsu Y, Hoshino I, Matsubara H. Assessment for diagnosis of lymph node metastasis in esophageal cancer using endoscopic ultrasound elastography. Esophagus 2016; 13:254-263. [PMID: 27429608 PMCID: PMC4923115 DOI: 10.1007/s10388-016-0521-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/06/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND We performed endoscopic ultrasound real-time tissue elastography to more accurately diagnose lymph node metastasis of esophageal cancer. The aim of this study was to evaluate the ability of EUS elastography to distinguish benign from malignant lymph nodes in esophageal cancer patients. METHODS The present study had two steps. As the first step (study 1), we developed diagnostic criteria for metastatic lymph nodes using elastography and verified the validity of the criteria. Three hundred and twenty-two lymph nodes from 35 patients treated by surgical resection were included in the study. As the second step (study 2), we preoperatively examined the lymph nodes of esophageal cancer patients with EUS elastography and compared its diagnostic performance with that of the conventional B-mode EUS images. A total of 115 lymph nodes from 31 patients were included. RESULTS In study 1, lymph nodes were considered malignant if 50 % or more of the node appeared blue, or if the peripheral part of the lesion was blue and the central part was red/yellow/green. The sensitivity and specificity of the elastography were 79.7 and 97.6 % with an accuracy of 93.8 %, which was significantly higher than the values for conventional B-mode imaging. In study 2, the sensitivity and specificity of the EUS elastography were 91.2 and 94.5 % with an accuracy of 93.9 %, which was also significantly higher than the values for conventional B-mode EUS imaging. CONCLUSIONS The present study demonstrated that EUS elastography is useful for diagnosing lymph node metastasis of esophageal cancer.
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Affiliation(s)
- Tetsutaro Sazuka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Takashi Akai
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Daisuke Horibe
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Mari Kuboshima
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Hiroyuki Kitabayashi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Akinao Matsunaga
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Akiko Kagaya
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Yorihiko Muto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Nobuyoshi Takeshita
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Tetsuro Maruyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Yukimasa Miyazawa
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Kiyohiko Shuto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Toru Shiratori
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Tsuguaki Kono
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Yasunori Akutsu
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Isamu Hoshino
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
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Hao SY, Ou B, Li LJ, Peng YL, Wang Y, Liu LS, Xiao Y, Liu SJ, Wu CJ, Jiang YX, Parajuly SS, Xu P, Hao Y, Li J, Zhi H, Luo BM. Could ultrasonic elastography help the diagnosis of breast cancer with the usage of sonographic BI-RADS classification? Eur J Radiol 2015; 84:2492-500. [DOI: 10.1016/j.ejrad.2015.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 07/06/2015] [Accepted: 08/26/2015] [Indexed: 12/21/2022]
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Parmar BJ, Yang X, Chaudhry A, Shajudeen PS, Nair SP, Weiner BK, Tasciotti E, Krouskop TA, Righetti R. Ultrasound elastography assessment of bone/soft tissue interface. Phys Med Biol 2015; 61:131-50. [PMID: 26611328 DOI: 10.1088/0031-9155/61/1/131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report on the use of elastographic imaging techniques to assess the bone/soft tissue interface, a region that has not been previously investigated but may provide important information about fracture and bone healing. The performance of axial strain elastograms and axial shear strain elastograms at the bone/soft tissue interface was studied ex vivo on intact and fractured canine and ovine tibias. Selected ex vivo results were corroborated on intact sheep tibias in vivo. The elastography results were statistically analyzed using elastographic image quality tools. The results of this study demonstrate distinct patterns in the distribution of the normalized local axial strains and axial shear strains at the bone/soft tissue interface with respect to the background soft tissue. They also show that the relative strength and distribution of the elastographic parameters change in the presence of a fracture and depend on the degree of misalignment between the fracture fragments. Thus, elastographic imaging modalities might be used in the future to obtain information regarding the integrity of bones and to assess the severity of fractures, alignment of bone fragments as well as to follow bone healing.
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Affiliation(s)
- Biren J Parmar
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77840, USA
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Kim SY, Park JS, Koo HR. Combined Use of Ultrasound Elastography and B-Mode Sonography for Differentiation of Benign and Malignant Circumscribed Breast Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1951-1959. [PMID: 26384609 DOI: 10.7863/ultra.14.11027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/04/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of combined B-mode sonography and ultrasound elastography for differentiation between benign and malignant breast masses with circumscribed margins. METHODS We analyzed 109 pathologically proven circumscribed breast masses. Two radiologists retrospectively reviewed B-mode sonograms and elastograms in consensus. Based on the American College of Radiology Breast Imaging Reporting and Data System, we determined categories of the masses on B-mode sonography. Elastographic scores were assessed by a 3-point scale (negative, 0; equivocal, 1; and positive, 2). When the elastographic score for a lesion was 0 or 2, we downgraded or upgraded the B-mode category, respectively; thus, the reclassified Breast Imaging Reporting and Data System category was defined as the "reclassification category." Mean category values for benign and malignant lesions were compared by a Student t test. The diagnostic performance of B-mode, elastographic, and reclassification assessments was compared by receiver operating characteristic curve analysis. RESULTS The mean B-mode category (2.5 versus 1.7), elastographic score (1.7 versus 0.8), and reclassification category (3.2 versus 1.6) were significantly higher in malignant than benign lesions (P < .001). The area under the curve for reclassification assessment was significantly higher than that for B-mode sonography (0.916 versus 0.795; P < .05). With a cutoff value between 1 and 2, the specificity was increased from 26.5% to 42.9% after reclassification. CONCLUSIONS For differentiation between benign and malignant circumscribed breast masses, combined use of B-mode sonography and elastography could provide a better diagnostic performance than B-mode sonography alone.
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Affiliation(s)
- Soo-Yeon Kim
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea (S.-Y.K.); and Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea (J.S.P., H.R.K.)
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea (S.-Y.K.); and Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea (J.S.P., H.R.K.).
| | - Hye Ryoung Koo
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea (S.-Y.K.); and Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea (J.S.P., H.R.K.)
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Hayashi N, Yamamoto T, Hayashi A, Yoshimatsu H. Correlation between indocyanine green (ICG) patterns and real-time elastography images in lower extremity lymphedema patients. J Plast Reconstr Aesthet Surg 2015; 68:1592-9. [DOI: 10.1016/j.bjps.2015.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/18/2015] [Accepted: 06/21/2015] [Indexed: 01/08/2023]
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