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Mastroianni R, Chiacchio G, Perpepaj L, Tuderti G, Brassetti A, Anceschi U, Ferriero M, Misuraca L, D’Annunzio S, Bove AM, Guaglianone S, Flammia RS, Proietti F, Pula M, Milanese G, Leonardo C, Galosi AB, Simone G. Comparison of Perioperative, Functional, and Oncologic Outcomes of Open vs. Robot-Assisted Off-Clamp Partial Nephrectomy: A Propensity Scored Match Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:2822. [PMID: 38732928 PMCID: PMC11086121 DOI: 10.3390/s24092822] [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: 03/22/2024] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
Off-clamp partial nephrectomy represents one of the latest developments in nephron-sparing surgery, with the goal of preserving renal function and reducing ischemia time. The aim of this study was to evaluate and compare the functional, oncologic, and perioperative outcomes between off-clamp robot-assisted partial nephrectomy (off-C RAPN) and off-clamp open partial nephrectomy (off-C OPN) through a propensity score-matched (PSM) analysis. A 1:1 PSM analysis was used to balance variables potentially affecting postoperative outcomes. To report surgical quality, 1 year trifecta was used. Univariable Cox regression analysis was performed to identify predictors of trifecta achievement. The Kaplan-Meier method was used to compare cancer-specific survival (CSS), overall survival (OS), disease-free survival (DFS), and metastasis-free survival (MFS) probabilities between groups. Overall, 542 patients were included. After PSM analysis, two homogeneous cohorts of 147 patients were obtained. The off-C RAPN cohort experienced shorter length of stay (LoS) (3.4 days vs. 5.4 days; p < 0.001), increased likelihoods of achieving 1 year trifecta (89.8% vs. 80.3%; p = 0.03), lower postoperative Clavien-Dindo ≤ 2 complications (1.3% vs. 18.3%, p < 0.001), and lower postoperative transfusion rates (3.4% vs. 12.2%, p = 0.008). At univariable analysis, the surgical approach (off-C RAPN vs. off-C OPN, OR 2.22, 95% CI 1.09-4.46, p = 0.02) was the only predictor of 1 year trifecta achievement. At Kaplan-Meier analysis, no differences were observed between the two groups in terms of OS (log-rank p = 0.451), CSS (log-rank p = 0.476), DFS (log-rank p = 0.678), and MFS (log-rank p = 0.226). Comparing RAPN and OPN in a purely off-clamp scenario, the minimally invasive approach proved to be a feasible and safe surgical approach, with a significantly lower LoS and minor rate of postoperative complications and transfusions as a result of improved surgical quality expressed by higher 1 year trifecta achievement.
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Affiliation(s)
- Riccardo Mastroianni
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Giuseppe Chiacchio
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Leonard Perpepaj
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Gabriele Tuderti
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Aldo Brassetti
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Umberto Anceschi
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Mariaconsiglia Ferriero
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Leonardo Misuraca
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Simone D’Annunzio
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Alfredo Maria Bove
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Salvatore Guaglianone
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Rocco Simone Flammia
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Flavia Proietti
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Marco Pula
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Giulio Milanese
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Costantino Leonardo
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Andrea Benedetto Galosi
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Giuseppe Simone
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
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Jesrani AK, Faiq SM, Rashid R, Kalwar TA, Mohsin R, Aziz T, Khan NA, Mubarak M. Comparison of resistive index and shear-wave elastography in the evaluation of chronic kidney allograft dysfunction. World J Transplant 2024; 14:89255. [PMID: 38576755 PMCID: PMC10989465 DOI: 10.5500/wjt.v14.i1.89255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Detection of early chronic changes in the kidney allograft is important for timely intervention and long-term survival. Conventional and novel ultrasound-based investigations are being increasingly used for this purpose with variable results. AIM To compare the diagnostic performance of resistive index (RI) and shear wave elastography (SWE) in the diagnosis of chronic fibrosing changes of kidney allograft with histopathological results. METHODS This is a cross-sectional and comparative study. A total of 154 kidney transplant recipients were included in this study, which was conducted at the Departments of Transplantation and Radiology, Sindh Institute of Urology and Transplan tation, Karachi, Pakistan, from August 2022 to February 2023. All consecutive patients with increased serum creatinine levels and reduced glomerular filtration rate (GFR) after three months of transplantation were enrolled in this study. SWE and RI were performed and the findings of these were evaluated against the kidney allograft biopsy results to determine their diagnostic utility. RESULTS The mean age of all patients was 35.32 ± 11.08 years. Among these, 126 (81.8%) were males and 28 (18.2%) were females. The mean serum creatinine in all patients was 2.86 ± 1.68 mg/dL and the mean estimated GFR was 35.38 ± 17.27 mL/min/1.73 m2. Kidney allograft biopsy results showed chronic changes in 55 (37.66%) biopsies. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SWE for the detection of chronic allograft damage were 93.10%, 96.87%%, 94.73%, and 95.87%, respectively, and the diagnostic accuracy was 95.45%. For RI, the sensitivity, specificity, PPV, and NPV were 76.92%, 83.33%, 70.17%, and 87.62%, respectively, and the diagnostic accuracy was 81.16%. CONCLUSION The results from this study show that SWE is more sensitive and specific as compared to RI in the evaluation of chronic allograft damage. It can be of great help during the routine follow-up of kidney transplant recipients for screening and early detection of chronic changes and selecting patients for allograft biopsy.
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Affiliation(s)
- Ameet Kumar Jesrani
- Department of Radiology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Syed M Faiq
- Department of Radiology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Rahma Rashid
- Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Tariq Ali Kalwar
- Department of Transplantation, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Rehan Mohsin
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Tahir Aziz
- Department of Transplantation, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Nida Amin Khan
- Department of Radiology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Muhammed Mubarak
- Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
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Zhang AY, Dong YX, Tan YD, Dian-Shen, Heng-Sun, Nie ST, Shao YY, Feng-Xian, Hu WS, Li XY, Tao-Xu, Li AN, Liang-Xu, Chang-Zhou. Ultrasound elastography predicts anticoagulation in lower extremity deep vein thrombosis. Clin Hemorheol Microcirc 2024; 87:171-185. [PMID: 38607754 DOI: 10.3233/ch-232031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To investigate predictors of anticoagulation efficacy in deep venous thrombosis (DVT) by ultrasound elastography (UE). METHODS The basic clinical, laboratory and ultrasound treatment data of fifty-eight patients with DVT were collected and analyzed. Then the results of ultrasound after 3-month anticoagulation treatment were compared among different groups. Multiple logistic regression analysis was used to identify independent risk factors that affected anticoagulation efficacy. The predictive efficacy of each independent risk factor was accessed by drawing operating characteristic (ROC) curves. RESULTS According to the regression analysis, the elastic modulus (OR = 0.631, P = 0.001) and strain rate ratio (OR = 0.332, P = 0.006) were identified as independent risk factors for the effectiveness of anticoagulation therapy in patients with DVT. According to the ROC curves, elastic modulus and strain rate ratio could predict effective anticoagulation therapy for DVT, and the optimal threshold values were 22.10 kPa and 1.80 respectively. The corresponding AUC values were 0.879 and 0.854, with a sensitivity of 71.4% and 59.5%, a specificity of 93.7%, and a Youden index of 65.1% and 62.7%, respectively. CONCLUSIONS The elastic modulus (≤22.10 kPa) or strain rate ratio (≤1.80) of the thrombus were independent predictors for the effectiveness of anticoagulation therapy.
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Affiliation(s)
- Ao-Yi Zhang
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Ya-Xin Dong
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Yan-Di Tan
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Dian-Shen
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Heng-Sun
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Shu-Ting Nie
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Yuan-Yuan Shao
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Feng-Xian
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Wen-Shu Hu
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Xin-Yi Li
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Tao-Xu
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - An-Ni Li
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Liang-Xu
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
| | - Chang-Zhou
- Department of Ultrasound, the First Clinical Medical Science College of China Three Gorges University and Yichang Central People's Hospital, Yi chang, Hubei, China
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Accuracy of B-mode ultrasound and ARFI elastography in predicting malignancy of canine splenic lesions. Sci Rep 2022; 12:4252. [PMID: 35277580 PMCID: PMC8917151 DOI: 10.1038/s41598-022-08317-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
The objective was to evaluate the accuracy of B-mode ultrasonography and ARFI elastography in detecting malignancy in canine splenic lesions. Thirty-seven spleens with abnormalities (16 benign and 21 malignant) from dogs of different breeds and ages were evaluated. Echogenicity, echotexture, organ length and height were evaluated using B-mode. By ARFI elastography, tissue stiffness was evaluated qualitatively (elastogram) and quantitatively (measuring the shear wave velocity-SWV). Lesions were classified as diffuse, focal or multifocal (cranial, medial or caudal portion) and comparisons of the SWV between the injured and non-injured areas were performed. In the B-mode, no features were associated to malignancy (P > 0.05). In the elastogram, 35 spleens were non-deformable and 2 deformable, having no association with malignancy. The greater SWV was observed in malignant lesions (3.4 ± 0.6 m/s), followed by areas free from alterations (2.1 ± 0.3 m/s) and benign lesions (1.7 ± 0.5 m/s), with difference between groups (P < 0.0001). It was found that a SWV > 2.6 m/s indicates malignancy of canine splenic lesions (sensitivity of 95%, specificity of 100%, PPV of 100%, NPV of 94% and accuracy of 97%), concluding that ARFI elastography is a promising technique for differentiating malignancy in these lesions.
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Thanaboonnipat C, Sutayatram S, Buranakarl C, Choisunirachon N. Renal ultrasonographic shear-wave elastography and urinary procollagen type III amino-terminal propeptide in chronic kidney disease dogs. Vet World 2020; 13:1955-1965. [PMID: 33132611 PMCID: PMC7566241 DOI: 10.14202/vetworld.2020.1955-1965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background and Aim: Renal fibrosis is a well-established pathological alteration associated with chronic kidney disease (CKD) in several species and progresses as CKD advances. Although a renal biopsy is the gold standard for determining renal fibrosis, it is an invasive, impractical method for clinical practice. In humans, ultrasonographic shear-wave elastography (SWE), a novel advanced diagnostic imaging tool, can evaluate renal parenchyma stiffness, and urinary procollagen type III amino-terminal propeptide (uPIIINP), a promising renal fibrosis biomarker in humans, has increasingly been use applied to reduce the biopsies. This study compares renal tissue elasticity observed through SWE Young’s modulus (E) values between healthy dogs (HD) and those with CKD. Materials and Methods: The E value acquired by SWE, uPIIINP levels, and renal function were evaluated in 15 CKD dogs and 15 HD. Results: The renal cortical E values were significantly higher than the renal medullary E values in both groups (p<0.001). Renal cortical and medullary E values in CKD dogs were significantly higher than in HD (p<0.01). Cortical E values had greater significant correlations with renal functional parameters than the medullary E values and had a significant positive correlation with concentrations of plasma creatinine (Cr) (p<0.001); blood urea nitrogen (p<0.01); urine protein Cr ratio (p<0.01); and fractional excretions of sodium (p<0.05), potassium (p<0.05), chloride (p<0.05), and magnesium (p<0.001) while they had a negative correlation with urine specific gravity (p<0.05) and urine osmolality to plasma osmolality ratio (p<0.05). The uPIIINP to Cr (uPIIINP/Cr) ratios of CKD dogs were higher than those of HD (p<0.001). Moreover, the uPIIINP/Cr levels presented significant correlations with the renal cortical E values (p<0.01) and also the renal functional parameters. Conclusion: SWE offers a complementary, non-invasive diagnostic imaging tool for evaluating renal tissue stiffness in CKD dogs with renal function deterioration. In addition, uPIIINP levels are associated with renal function and structural changes in dogs. Therefore, the uPIIINP level might be a non-invasive, complementary, and promising biomarker for evaluating renal fibrosis in canine CKD.
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Affiliation(s)
- Chutimon Thanaboonnipat
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Saikaew Sutayatram
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chollada Buranakarl
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Nan Choisunirachon
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
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Thanaboonnipat C, Sutayatram S, Buranakarl C, Choisunirachon N. Renal ultrasonographic strain elastography and symmetric dimethylarginine (SDMA) in canine and feline chronic kidney disease. J Vet Med Sci 2020; 82:1104-1112. [PMID: 32554935 PMCID: PMC7468054 DOI: 10.1292/jvms.19-0496] [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] [Indexed: 11/22/2022] Open
Abstract
Chronic kidney disease (CKD) is a common renal disease in dogs and cats. Renal fibrosis
is a main pathologic process leading of CKD progression. Renal biopsy is the gold standard
for renal fibrosis assessment. However, it is not routinely performed in clinic due to its
invasiveness. Therefore, the aim of this study was to evaluate the use of ultrasonographic
strain elastography (SE), which is a non-invasive method for renal tissue stiffness
determination and its association with renal function. Renal strain ratios and renal
function were evaluated in 13 CKD dogs (CKDD), 38 healthy dogs (HD), 17 CKD cats (CKDC)
and 26 healthy cats (HC). There were significantly lower renal cortical strain ratios than
medullary strain ratios in all groups (HD; P<0.01, HC;
P<0.01, CKDD and CKDC; P<0.05) and significantly
lower cortical and medullary strain ratios in both CKDD and CKDC than in healthy control
animals of both species (P<0.0001). In dogs, the renal cortical and
medullary strain ratios significantly negatively correlated with plasma creatinine
(P<0.05), blood urea nitrogen (BUN; P<0.05;
P<0.01, respectively), and symmetric dimethylarginine (SDMA;
P<0.01). In cats, similar correlations were found for plasma
creatinine (P<0.001), BUN (P<0.05;
P<0.001, respectively) and SDMA (P<0.05). SE
might be a promising imaging diagnostic tool for renal-elasticity evaluation, also
correlating with renal functional impairment in canine and feline CKD.
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Affiliation(s)
- Chutimon Thanaboonnipat
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, Thailand.,Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, Thailand
| | - Saikaew Sutayatram
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, Thailand
| | - Chollada Buranakarl
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, Thailand
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Nabavizadeh A, Payen T, Iuga AC, Sagalovskiy IR, Desrouilleres D, Saharkhiz N, Palermo CF, Sastra SA, Oberstein PE, Rosario V, Kluger MD, Schrope BA, Chabot JA, Olive KP, Konofagou EE. Noninvasive Young's modulus visualization of fibrosis progression and delineation of pancreatic ductal adenocarcinoma (PDAC) tumors using Harmonic Motion Elastography (HME) in vivo. Theranostics 2020; 10:4614-4626. [PMID: 32292518 PMCID: PMC7150482 DOI: 10.7150/thno.37965] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aims: Poor specificity and predictive values of current cross-sectional radiological imaging methods in evaluation of pancreatic adenocarcinoma (PDAC) limit the clinical capability to accurately stage the tumor pre-operatively and provide optimal surgical treatment and improve patient outcomes. Methods: In this study, we applied Harmonic Motion Elastography (HME), a quantitative ultrasound-based imaging method to calculate Young's modulus (YM) in PDAC mouse models (n = 30) and human pancreatic resection specimens of PDAC (n=32). We compared the YM to the collagen assessment by Picrosirius red (PSR) stain on corresponding histologic sections. Results: HME is capable of differentiating between different levels of fibrosis in transgenic mice. In mice without pancreatic fibrosis, the measured YM was 4.2 ± 1.3 kPa, in fibrotic murine pancreata, YM was 5.5 ± 2.0 kPa and in murine PDAC tumors, YM was 11.3 ± 1.7 kPa. The corresponding PSR values were 2.0 ± 0.8 %, 9.8 ± 3.4 %, and 13.2 ± 1.2%, respectively. In addition, three regions within each human surgical PDAC specimen were assessed: tumor, which had both the highest Young's modulus (YM > 40 kPa) and collagen density (PSR > 40 %); non-neoplastic adjacent pancreas, which had the lowest Young's modulus (YM < 15 kPa) and collagen density (PSR < 10%) and a transitional peri-lesional region between the tumor and non-neoplastic pancreas with an intermediate value of measured Young's modulus (15 kPa < YM < 40 kPa) and collagen density (15% < PSR < 35 %). Conclusion: In conclusion, a non-invasive, quantitative imaging tool for detecting, staging and delineating PDAC tumor margins based on the change in collagen density was developed.
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Abstract
OBJECTIVE There are different imaging techniques to assess the parotid glands (i.e., sialography, salivary gland scintigraphy) in patients with Sjögren syndrome (SS). However, their use is limited by the invasive character or high cost. Ultrasound (US) is gaining interest by rheumatologists as a complementary diagnostic tool for SS. To date, there is an increasing body of evidence supporting its sensitivity in the assessment of salivary glands in SS. The aim of our study was to analyze the potential role of US as a diagnostic and prognostic tool in SS and to discuss existing evidence to support its application use. METHODS A systematic search was performed in the electronic database PubMed, using the following search terms: (salivary glands OR parotid glands OR submandibular glands) AND Sjögren's syndrome AND (ultrasonography OR ultrasound OR sonography). Titles, abstracts, and full reports were systematically screened. RESULTS The results of the studies analyzed in this review show encouraging results in terms of accuracy, validity, and diagnostic value, which leads us to believe that in the future US could become the reference imaging tool to assess SS. The studies include a small cohort of patients, and there is no standardized approach in terms of US techniques for the assessment of salivary glands. CONCLUSIONS Ultrasound of major salivary glands is a useful tool for diagnosis, prognostic evaluation, and response to treatment in SS. The use of this imaging technology is still under development, and more multicentric studies are needed to validate this tool.
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Cai Y, Li F, Li Z, Du L, Wu R. Diagnostic Performance of Ultrasound Shear Wave Elastography in Solid Small (≤4 cm) Renal Parenchymal Masses. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2328-2337. [PMID: 31196747 DOI: 10.1016/j.ultrasmedbio.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
The aim of the study was to analyze the diagnostic performance of shear wave elastography (SWE) in differentiating between malignant and benign solid renal parenchymal masses ≤4 cm, compared with conventional ultrasound. A total of 20 healthy volunteers and 117 patients had been included in this study. Conventional ultrasound and SWE were performed in all volunteers and patients. The elasticity of healthy cortex and the elastic parameters of tumors such as mean elasticity (Emean), minimum elasticity (Emin), maximum elasticity (Emax), standard deviation and elasticity ratio of the lesion to surrounding cortex (Eratio) were measured on SWE images. Diagnostic performance of SWE was compared with that of conventional ultrasound. The cortical elasticity values of healthy right and left kidneys were 4.7 ± 1.7 and 4.5 ± 1.5 kPa, respectively. Of the 117 renal tumors, 68 were renal cell carcinomas (RCCs) and 49 were benign. Emean, Emin and Eratio were significantly lower in RCCs compared with benign lesions: Emean 7.2 ± 2.5 kPa versus 10.0 ± 2.4 kPa, Emin 2.5 ± 2.4 kPa versus 5.6 ± 2.3 kPa, Eratio 1.6 ± 0.5 versus 2.2 ± 0.6 (all p values < 0.001). The cutoff values of 9.15 kPa for Emean, 3.55 kPa for Emin and 1.99 for Eratio had the highest areas under the receiver operating characteristics curve (0.801 for Emean, 0.832 for Emin and 0.806 for Eratio). Combining Emean, Emin and Eratio with conventional ultrasound improved the specificity for predicting RCCs to 87.8%, but the sensitivity was not increased.
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Affiliation(s)
- Yingyu Cai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaojun Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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García-Figueiras R, Baleato-González S, Padhani AR, Luna-Alcalá A, Vallejo-Casas JA, Sala E, Vilanova JC, Koh DM, Herranz-Carnero M, Vargas HA. How clinical imaging can assess cancer biology. Insights Imaging 2019; 10:28. [PMID: 30830470 PMCID: PMC6399375 DOI: 10.1186/s13244-019-0703-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
Human cancers represent complex structures, which display substantial inter- and intratumor heterogeneity in their genetic expression and phenotypic features. However, cancers usually exhibit characteristic structural, physiologic, and molecular features and display specific biological capabilities named hallmarks. Many of these tumor traits are imageable through different imaging techniques. Imaging is able to spatially map key cancer features and tumor heterogeneity improving tumor diagnosis, characterization, and management. This paper aims to summarize the current and emerging applications of imaging in tumor biology assessment.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN, UK
| | - Antonio Luna-Alcalá
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
- MRI Unit, Clínica Las Nieves, Health Time, Jaén, Spain
| | - Juan Antonio Vallejo-Casas
- Unidad de Gestión Clínica de Medicina Nuclear. IMIBIC. Hospital Reina Sofía. Universidad de Córdoba, Córdoba, Spain
| | - Evis Sala
- Department of Radiology and Cancer Research UK Cambridge Center, Cambridge, CB2 0QQ, UK
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona and IDI, Lorenzana 36, 17002, Girona, Spain
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital & Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - Michel Herranz-Carnero
- Nuclear Medicine Department, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Galicia, Spain
- Molecular Imaging Program, IDIS, USC, Santiago de Compostela, Galicia, Spain
| | - Herbert Alberto Vargas
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Radiology, 1275 York Av. Radiology Academic Offices C-278, New York, NY, 10065, USA
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Mumoli N, Mastroiacovo D, Giorgi-Pierfranceschi M, Pesavento R, Mochi M, Cei M, Pomero F, Mazzone A, Vitale J, Ageno W, Dentali F. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis. J Thromb Haemost 2018; 16:2482-2491. [PMID: 30225971 DOI: 10.1111/jth.14297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Essentials Ultrasound elastography uses tissue deformation to assess the relative quantification of its elasticity. Compression and duplex ultrasonography may be unable to correctly determine the thrombus age. Ultrasound elastography may be useful to distinguish between acute and chronic deep vein thrombosis. The exact determination of the thrombus age could have both therapeutic and prognostic implications. BACKGROUND: Background Ultrasound elastography (UE) imaging is a novel sonographic technique that is commonly employed for relative quantification of tissue elasticity. Its applicability to venous thromboembolic events has not yet been fully established; in particular, it is unclear whether this technique may be useful in determining the age of deep vein thrombosis (DVT). Thus, the aim of this study was to assess the role of UE in distinguishing acute from chronic DVT. Methods Consecutive patients with a first unprovoked acute and chronic (3 months old) DVT of the lower limbs were analyzed. Patients with recurrent DVT or with a suspected recurrence were excluded. The mean elasticity index (EI) values of acute and chronic popliteal and femoral vein thrombosis were compared. The accuracy of the EI in distinguishing acute from chronic DVT was also assessed by measuring the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results One-hundred and forty-nine patients (mean age 63.9 years, standard deviation 13.6; 73 males) with acute and chronic DVT were included. The mean EI of acute femoral DVT was higher than that of chronic femoral DVT (5.09 versus 2.46), and the mean EI of acute popliteal DVT was higher than that of chronic popliteal DVT (4.96 versus 2.48). An EI value of > 4 resulted in a sensitivity of 98.9% (95% confidence interval [CI] 93.3-99.9), a specificity of 99.1% (95% CI 94.8-99.9), a positive predictive value of 91.1% (95% CI 77.9-97.1), a negative predictive value of 98.6% (95% CI 91.3-99.9), a positive likelihood ratio of 13.23 (95% CI 93-653) and a negative likelihood ratio of 0.001 (95% CI 0.008-0.05) for acute DVT. Conclusions UE appears to be a promising technique for distinguishing between acute and chronic DVT. Larger prospective studies are warranted to confirm our preliminary findings.
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Affiliation(s)
- N Mumoli
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - D Mastroiacovo
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | | | - R Pesavento
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - M Mochi
- General Electric Healthcare, Milano, Italy
| | - M Cei
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - F Pomero
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - A Mazzone
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - J Vitale
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - W Ageno
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - F Dentali
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
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Johannsen S, Schick M, Roewer N, Schuster F. Microdialysis and ultrasound elastography for monitoring of localized muscular reaction after pharmacological stimulation in rats. BMC Res Notes 2018; 11:636. [PMID: 30176920 PMCID: PMC6122639 DOI: 10.1186/s13104-018-3742-6] [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: 06/19/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Halothane and caffeine are known to cause skeletal muscular contractions in vitro and have been proven to induce circumscribed metabolic reactions when injected into rat skeletal muscle. In this study 26 rats were investigated by either continuous application of calcium 160 mM or bolus injection of caffeine 160 mM or halothane 10% vol via a microdialysis probe in the tibialis anterior muscle. Tissue elasticity at the injection site was monitored by ultrasound strain elastography. Aim of this study was to detect (I) changes in local lactate concentrations and (II) whether these can be attributed to a muscular contraction detected by ultrasound elastography. Results Localized metabolic reactions were verified by increasing intramuscular lactate concentrations following continuous application of calcium (0.6 [0.3;0.6] to 3.6 [3.0;4.3] mmol/l after 60 min) and bolus application of caffeine (0.2 [0.2;0.3] to 1.6 [0.9;1.9] mmol/l after 30 min) and halothane (0.3 [0.1;0.3] to 4.7 [4.3;6.3] mmol/l after 30 min). However, ultrasound elastography did not detect any differences in tissue elasticity compared to control animals. The authors identified potential limitations of the study conditions, which might be crucial to avoid for future investigations. Electronic supplementary material The online version of this article (10.1186/s13104-018-3742-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephan Johannsen
- Department of Anaesthesia and Critical Care, University of Würzburg, Oberduerrbacher Str. 6, Würzburg, Germany.
| | - Martin Schick
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, Germany
| | - Norbert Roewer
- Department of Anaesthesia and Critical Care, University of Würzburg, Oberduerrbacher Str. 6, Würzburg, Germany
| | - Frank Schuster
- Department of Anaesthesia and Critical Care, University of Würzburg, Oberduerrbacher Str. 6, Würzburg, Germany
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Ben Z, Gao S, Wu W, Chen S, Fu S, Zhang J, Chen Y. Clinical value of the VTIQ technology in the differential diagnosis of superficially enlarged lymph nodes. Acta Radiol 2018; 59:836-844. [PMID: 28927297 DOI: 10.1177/0284185117732601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Lymph node enlargement is a common clinical finding in clinical practice with different treatment strategies. Purpose To investigate the application of Virtual Touch Image Quantification (VTIQ) to diagnose benign and malignant superficial enlarged lymph nodes. Material and Methods Between December 2015 and August 2016, 116 superficial enlarged lymph nodes were examined by VTIQ. Maximum (Vmax), minimum (Vmin), and average (Vmean) shear wave velocities (SWV) were obtained from the lymph nodes and from normal muscular tissues (Vn) located at the same level and within 5 mm from the target lymph node. The pathological results were used as the gold standard to evaluate VTIQ. Results All 116 patients underwent fine-needle aspiration biopsy for pathological examination. Forty patients had malignant lymph nodes and 76 patients had benign lymph nodes. Lymph node characteristics on B-mode ultrasound showed no differences between malignant and benign lymph nodes, but there were differences in VTIQ parameters (all P < 0.001). Compared with pathological diagnosis as the gold standard, the area under the ROC curves of Vmax, Vmin, and Vmean were 0.815, 0.746, and 0.795. The Vmax cutoff value to diagnose benign from malignant lymph nodes was 3.045 m/s. The sensitivity, specificity, and positive and negative predictive values were 70%, 78.9%, 63.6%, and 83.3%. Conclusion VTIQ has a clinical application in the differential diagnosis of superficial enlarged lymph nodes.
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Affiliation(s)
- Zhifei Ben
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
| | - Shanshan Gao
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
| | - Wenjing Wu
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
| | - Saijun Chen
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
| | - Shuping Fu
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
| | - Jianli Zhang
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
| | - Yunwen Chen
- Department of Ultrasound, Ningbo No. 2 Hospital, Ningbo, Zhejiang, PR China
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Bae SJ, Park JT, Park AY, Youk JH, Lim JW, Lee HW, Lee HM, Ahn SG, Son EJ, Jeong J. Ex Vivo Shear-Wave Elastography of Axillary Lymph Nodes to Predict Nodal Metastasis in Patients with Primary Breast Cancer. J Breast Cancer 2018; 21:190-196. [PMID: 29963115 PMCID: PMC6015987 DOI: 10.4048/jbc.2018.21.2.190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/20/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose There is still a clinical need to easily evaluate the metastatic status of lymph nodes during breast cancer surgery. We hypothesized that ex vivo shear-wave elastography (SWE) would predict precisely the presence of metastasis in the excised lymph nodes. Methods A total of 63 patients who underwent breast cancer surgery were prospectively enrolled in this study from May 2014 to April 2015. The excised axillary lymph nodes were examined using ex vivo SWE. Metastatic status was confirmed based on the final histopathological diagnosis of the permanent section. Lymph node characteristics and elasticity values measured by ex vivo SWE were assessed for possible association with nodal metastasis. Results A total of 274 lymph nodes, harvested from 63 patients, were examined using ex vivo SWE. The data obtained from 228 of these nodes from 55 patients were included in the analysis. Results showed that 187 lymph nodes (82.0%) were nonmetastatic and 41 lymph nodes (18.0%) were metastatic. There was significant difference between metastatic and nonmetastatic nodes with respect to the mean (45.4 kPa and 17.7 kPa, p<0.001) and maximum (55.3 kPa and 23.2 kPa, p<0.001) stiffness. The elasticity ratio was higher in the metastatic nodes (4.36 and 1.57, p<0.001). Metastatic nodes were significantly larger than nonmetastatic nodes (mean size, 10.5 mm and 7.5 mm, p<0.001). The size of metastatic nodes and nodal stiffness were correlated (correlation coefficient of mean stiffness, r=0.553). The area under curve of mean stiffness, maximum stiffness, and elasticity ratio were 0.794, 0.802, and 0.831, respectively. Conclusion Ex vivo SWE may be a feasible method to predict axillary lymph node metastasis intraoperatively in patients undergoing breast cancer surgery.
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Affiliation(s)
- Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Tae Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Park
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Lim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Woo Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Min Lee
- Department of Surgery, International St. Mary' Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Manzoor I, Bacha R, Gilani SA. Diagnostic accuracy of sonoelastography in different diseases. J Ultrason 2018; 18:29-36. [PMID: 29844938 PMCID: PMC5911716 DOI: 10.15557/jou.2018.0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body.
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Affiliation(s)
| | - Raham Bacha
- (UIRSMIT) FAHS Department, University of Lahore, Lahore, Pakistan
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Beamish JA, Chen E, Putnam AJ. Engineered extracellular matrices with controlled mechanics modulate renal proximal tubular cell epithelialization. PLoS One 2017; 12:e0181085. [PMID: 28715434 PMCID: PMC5513452 DOI: 10.1371/journal.pone.0181085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is common and associated with significant morbidity and mortality. Recovery from many forms of AKI involves the proliferation of renal proximal tubular epithelial cells (RPTECs), but the influence of the microenvironment in which this recovery occurs remains poorly understood. Here we report the development of a poly(ethylene glycol) (PEG) hydrogel platform to study the influence of substrate mechanical properties on the proliferation of human RPTECs as a model for recovery from AKI. PEG diacrylate based hydrogels were generated with orthogonal control of mechanics and cell-substrate interactions. Using this platform, we found that increased substrate stiffness promotes RPTEC spreading and proliferation. RPTECs showed similar degrees of apoptosis and Yes-associated protein (YAP) nuclear localization regardless of stiffness, suggesting these were not key mediators of the effect. However, focal adhesion formation, cytoskeletal organization, focal adhesion kinase (FAK) activation, and extracellular signal-regulated kinase (ERK) activation were all enhanced with increasing substrate stiffness. Inhibition of ERK activation substantially attenuated the effect of stiffness on proliferation. In long-term culture, hydrogel stiffness promoted the formation of more complete epithelial monolayers with tight junctions, cell polarity, and an organized basement membrane. These data suggest that increased stiffness potentially may have beneficial consequences for the renal tubular epithelium during recovery from AKI.
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Affiliation(s)
- Jeffrey A. Beamish
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Evan Chen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrew J. Putnam
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
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Borysewicz-Sanczyk H, Dzieciol J, Sawicka B, Bossowski A. Practical Application of Elastography in the Diagnosis of Thyroid Nodules in Children and Adolescents. Horm Res Paediatr 2017; 86:39-44. [PMID: 27372081 DOI: 10.1159/000447490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasound elastography is a noninvasive method of imaging based on the estimation of the mechanical properties of tissue. Data in adults indicate that decreased flexibility in comparison to the surrounding healthy tissue is characteristic of malignancy (in most thyroid carcinomas, except for follicular thyroid carcinoma). The purpose of our study was to assess the deformation of thyroid nodules and to evaluate the usefulness of elastography in predicting malignant thyroid nodules in adolescent patients. METHODS We examined 47 children with 62 thyroid nodules. All patients underwent elastography and fine needle aspiration cytology (FNAC). RESULTS Thirty-seven girls (79%) and 10 boys (21%) were included in the study. A strain ratio <2 was observed in 17 nodules (27% of the study group), a strain ratio between 2 and 4.9 in 34 nodules (55%) and a strain ratio >5 in 11 nodules (18%). According to cytological examination, 3 nodules (4.8% of the study group) were malignant. Two of them were hard (strain ratio ≥5), and 1 nodule had a strain ratio of 2. CONCLUSIONS Our results suggest that elastography can be complementary to conventional ultrasonography and useful while making a decision about FNAC. At the same time, it should not replace the cytological assessment of thyroid nodules in children and adolescents.
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Affiliation(s)
- Hanna Borysewicz-Sanczyk
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Division, Medical University of Biax0142;ystok, Biax0142;ystok, Poland
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Sigrist RM, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017; 7:1303-1329. [PMID: 28435467 PMCID: PMC5399595 DOI: 10.7150/thno.18650] [Citation(s) in RCA: 907] [Impact Index Per Article: 129.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 12/15/2022] Open
Abstract
Elastography-based imaging techniques have received substantial attention in recent years for non-invasive assessment of tissue mechanical properties. These techniques take advantage of changed soft tissue elasticity in various pathologies to yield qualitative and quantitative information that can be used for diagnostic purposes. Measurements are acquired in specialized imaging modes that can detect tissue stiffness in response to an applied mechanical force (compression or shear wave). Ultrasound-based methods are of particular interest due to its many inherent advantages, such as wide availability including at the bedside and relatively low cost. Several ultrasound elastography techniques using different excitation methods have been developed. In general, these can be classified into strain imaging methods that use internal or external compression stimuli, and shear wave imaging that use ultrasound-generated traveling shear wave stimuli. While ultrasound elastography has shown promising results for non-invasive assessment of liver fibrosis, new applications in breast, thyroid, prostate, kidney and lymph node imaging are emerging. Here, we review the basic principles, foundation physics, and limitations of ultrasound elastography and summarize its current clinical use and ongoing developments in various clinical applications.
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Affiliation(s)
- Rosa M.S. Sigrist
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Joy Liau
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Maria Cristina Chammas
- Department of Ultrasound, Institute of Radiology, Hospital das Clínicas, Medical School of University of São Paulo
| | - Juergen K. Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
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Paluch Ł, Nawrocka-Laskus E, Dąbrowska A, Popiela T, Walecki J. Ultrasound Elastography for Determination of the Age of Venous Thrombi. Evaluation of Thrombus Evolution in Patients After Sclerotherapy. Pol J Radiol 2017; 82:88-91. [PMID: 28289480 PMCID: PMC5321172 DOI: 10.12659/pjr.899517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/27/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Venous thrombosis is a multicausal disease involving intravenous clot formation. It may occur spontaneously or after provoking events, such as traumatic injuries to the pelvis, upper and lower extermities, immobilization, intravascular procedures, including venous catheterization or injection. Color Doppler ultrasonography is a rapid and non-invasive technique for evaluation of venous disease. It is a very sensitive method for detection of thrombi, but has some limitations, e.g. inability to distinguish between an old and fresh thrombus. Elastography as a method for evaluation of tissue elasticity and allows more accurate assessment of venous thombosis. The thrombus solidifies significantly during the process of remodeling, thereby changing elasticity, while the tissues located around the vessel remain unchanged. Moreover, the homogeneity of the thrombus is also changed. These factors allow for exact determination of the age of the thrombus depending on changes of its elasticity. MATERIAL/METHODS The object of this study was to assess thrombus age in patients with saphenous vein insufficiency treated with sclerotherapy. We examined 34 patients, 30 women and 4 men, aged 18-62 years. All short-listed patients with initial 7-8 mm vessel diameter underwent treatment with 3% Aetoxysklerol mixed with CO2 and other respiratory gases. Data acquisition was performed using an Esaote MyLab Twice device with LA523 linear probe. RESULTS On the sixth day after the treatment 31 patients presented uniform, hypoechogenic thrombus in B-mode image. Ultrasound-based elasticity images (elastography) showed significant predominant red and green areas. Blue area was either invisible or appeared in insignificant grade on examined area. The mosaic image of colors appeared on 2 patients. On the fourteenth day of study 21 patients still presented hypoechogenic thrombus, whereas mixed echogenicity of thrombus appeared on 11 patients. On 28 examined patients mosaics of red, green and blue colors were observed, with blue color significantly predominating over red color. 3 patients presented mosaics of colors without a predominate color. CONCLUSIONS Elastography as a method of thrombus evaluation, provides information about relative shrinkage of blood clot. It seems that elasatography can improve accurate assessment of the exact age of thrombus.
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Affiliation(s)
- Łukasz Paluch
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Ewa Nawrocka-Laskus
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Agnieszka Dąbrowska
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Tadeusz Popiela
- Department of Diagnostic Imaging, Injury Center of Emergency Medicine and Disaster, Jagiellonian University, Cracow, Poland
| | - Jerzy Walecki
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
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Trifanov DS, Dhyani M, Bledsoe JR, Misdraji J, Bhan AK, Chung RT, Samir AE. Amyloidosis of the liver on shear wave elastography: case report and review of literature. ACTA ACUST UNITED AC 2016; 40:3078-83. [PMID: 26254907 DOI: 10.1007/s00261-015-0519-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Amyloidosis is extremely rare, with an estimated 2225 new US cases reported annually. Signs and symptoms of the disease are subtle and imaging findings are not pathognomonic. Currently, diagnosis requires biopsy to demonstrate the deposition of amyloid. Elastography is a new imaging modality that evaluates tissue elasticity. It has shown to have efficacy in characterizing thyroid nodules, detecting prostate cancer, and staging liver fibrosis. We present a case of hepatic amyloidosis in a 51-year-old male that demonstrates significantly increased stiffness with a median value of 99.1 kPa (range 25.7-188.9 kPa) on shear-wave elastography (SWE) imaging, which is significantly higher than the cut-off range reported for cirrhosis on SWE (10.4-11.5 kPa). This finding raises the possibility that elastographic imaging may be sensitive to tissue mechanical changes induced by amyloid deposition.
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Affiliation(s)
- Dmitry S Trifanov
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Manish Dhyani
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Jacob R Bledsoe
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Raymond T Chung
- Department of Hepatology, Medicine, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Anthony E Samir
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Reliability of Shear-Wave Elastography Estimates of the Young Modulus of Tissue in Follicular Thyroid Neoplasms. AJR Am J Roentgenol 2016; 206:609-16. [PMID: 26901019 DOI: 10.2214/ajr.15.14676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the reliability of shear-wave elastographic estimates of the Young modulus in thyroid follicular neoplasms. SUBJECTS AND METHODS In this study, 35 adults with follicular nodules diagnosed by fine-needle aspiration (FNA) biopsy were enrolled. A single sonographer examined all nodules in three planes (sagittal, transverse, and transverse center). Two raters independently placed ROIs in each nodule. Intra- and interrater reliability were computed as intraclass correlation coefficients (ICCs) and were reported using the Guidelines for Reporting Reliability and Agreement Studies. RESULTS Thirty-five subjects with 35 follicular pattern nodules diagnosed by FNA biopsy were enrolled; 23 (65.7%) patients were female, with a mean age of 55.1 years (range, 23-85 years). For rater 1, intrarater agreement showed ICCs for single measurements of 0.87, 0.87, and 0.90 in the sagittal, transverse, and transverse center plans, respectively; ICCs for the median of multiple measurements were 0.97, 0.94, and 0.96 in the sagittal, transverse, and transverse center planes, respectively. For rater 2, intrarater agreement showed ICCs for single measurements of 0.94, 0.86, and 0.92 in the sagittal, transverse, and transverse center planes, respectively; ICCs for the median of multiple measurements were 0.97, 0.92, and 0.96 in the sagittal, transverse, and transverse center planes, respectively. Interrater agreement between measurements performed for the same subject showed ICCs for single measurements of 0.87, 0.87, and 0.80 in the sagittal, transverse, and transverse center planes, respectively; ICCs for the median of multiple measurements were 0.96, 0.93, and 0.92 in the sagittal, transverse, and transverse center planes, respectively. CONCLUSION ROI placement is a reliable method for estimating the Young modulus of tissue in follicular thyroid nodules.
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Esfahanian F, Aryan A, Ghajarzadeh M, Yazdi MH, Nobakht N, Burchi M. Application of Sonoelastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules. Int J Prev Med 2016; 7:55. [PMID: 27076893 PMCID: PMC4809115 DOI: 10.4103/2008-7802.178355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/15/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Sonoelastography is a new ultrasound method which could be helpful to determine which thyroid nodule is malignant. We designed this study to evaluate the accuracy of sonoelastography in differentiating of benign and malignant thyroid nodules in Iranian patients. Methods: Forty thyroid nodules in forty consecutive patients who had been referred for sonography-guided fine-needle aspiration biopsy were evaluated. Gray scale ultrasound and elastosonography by real-time, freehand technique applied for all patients. Elastography findings were classified into four groups. Nodules which were classified as patterns 1 or 2 in elastogram evaluation were classified as benign and probably malignant if elastogram scans were patterns 3 and 4 of elastogram scan. Results: Mean age ± standard deviation (SD) was 42.2 ± 12.6 years, and mean ± SD thyroid-stimulating hormone level was 1.4 ± 1.9 IU/ml. Thirty-five cases (87.5%) were female and 5 (12.5%) were male. Histological examination indicated 27 (67.5%) benign and 13 (32.5%) malignant nodules. The most elastogram score was 2 (50%) followed by score 3. The cut-off point of 2 considered as the best value to differentiate benign and malignant thyroid nodules with sensitivity and specificity of 61% and 78% (area under the curve = 0.76, 95% confidence interval: 0.6–0.92, P = 0.007). Conclusions: Sonoelastography could help to differentiate benign and malignant thyroid nodules. As our sample size was limited, larger studies are recommended.
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Affiliation(s)
- Fatemeh Esfahanian
- Department of Endocrinology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Aryan
- Department of Radiology, Medical Imaging Center, Advanced Diagnostic and Interventional Radiology Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghajarzadeh
- Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Meisam Hosein Yazdi
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasir Nobakht
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Burchi
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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