1
|
García-Mejido JA, García-Jimenez R, Fernández-Conde C, García-Pombo S, Fernández-Palacín F, Sainz-Bueno JA. The Application of Shear Wave Elastography to Determine the Elasticity of the Levator Ani Muscle and Vaginal Tissue in Patients With Pelvic Organ Prolapse. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:913-921. [PMID: 38284137 DOI: 10.1002/jum.16422] [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: 11/20/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP. METHODS Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM. RESULTS A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P: .012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P: .03) and the middle third of the anorectal canal (P: .019). CONCLUSION It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP.
Collapse
Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
| | | | | | - Sara García-Pombo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | | | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
| |
Collapse
|
2
|
Huang J, Peng J, Long H, Ruan S, Yao L, Xie X, Lin M, Zhang X. Feasibility and Measurement Value of Pancreatic 2-D Shear Wave Elastography in Healthy Adults: Evaluation, Influencing Factors, Reference Range, Measurement Stability and Reproducibility. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:184-190. [PMID: 37880058 DOI: 10.1016/j.ultrasmedbio.2023.09.015] [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: 06/27/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE The present study was aimed at assessing the success rate and measurement value, determining the influencing factors and reference range and examining the intra-operator stability and inter-operator reproducibility of pancreatic 2-D shear wave elastography (SWE) measurement in healthy adults. METHODS In 2022, 387 healthy adults were prospectively recruited. Logistic regression and linear regression analyses were used to explore the factors influencing the success rate and the measurement value of pancreatic 2-D SWE measurement, respectively. A two-sided 95% reference range was estimated accordingly. The intraclass correlation coefficient was calculated to evaluate the intra-operator stability and inter-operator reproducibility of the pancreatic 2-D SWE measurement. RESULTS The pancreatic body (89.6%) bore the highest while the tail (72.8%) bore the lowest success rate of pancreatic 2-D SWE measurement. Sex and body mass index (BMI) were the independent factors influencing measurement success rate in all three parts of the pancreas. Mean measurement values (Emean) were not the same in the three parts of the pancreas of the same participant. BMI and image depth were the independent factors influencing Emean in the pancreatic body, while region of interest depth and BMI were the only independent factors influencing Emean in the pancreatic head and tail, respectively. The intra-operator stability of pancreatic 2-D SWE measurement was found to be excellent, whereas its inter-operator reproducibility was poor to good. CONCLUSION Pancreatic 2-D SWE is a reliable technique for evaluating pancreatic stiffness in healthy adults, but its success rate and measurement value are influenced by multiple factors.
Collapse
Affiliation(s)
- Jiayao Huang
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Jianyun Peng
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Haiyi Long
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Simin Ruan
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Lu Yao
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Manxia Lin
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
Qiang B, Xu Q, Pan Y, Wang J, Shen C, Peng X, Shen W, Zhang Y, Zhu X. Shear wave elastography: A noninvasive approach for assessing acute kidney injury in critically ill patients. PLoS One 2024; 19:e0296411. [PMID: 38206919 PMCID: PMC10783713 DOI: 10.1371/journal.pone.0296411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Traditional markers, such as serum creatinine and blood urea nitrogen, frequently show delayed elevations following acute kidney injury (AKI), limiting their utility for prompt detection and timely intervention in AKI management. Shear wave elastography (SWE) exhibits potential for AKI diagnosis by measuring tissue stiffness. Our study aimed to evaluate the diagnostic performance of SWE in detecting AKI by measuring the stiffness of kidney tissue. Between July 2022 and December 2022, a total of 103 consecutive participants who met the eligibility criteria were prospectively enrolled, underwent SWE measurements, and were classified into AKI or non-AKI groups based on the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A receiver operating characteristic (ROC) curve was drawn to examine the feasibility of differentiating between AKI and non-AKI patients and assessing diagnostic performance. The effects of tissue anisotropy on SWE measurements were also examined. Our results revealed that patients in the AKI group exhibited significantly increased stiffness values in specific kidney regions compared with those in the non-AKI group. For the diagnosis of AKI, the optimal cut-off values were identified as 9.9 kPa, 2.9 kPa, and 4.4 kPa for the upper pole medulla, middle cortex, and middle medulla, respectively, in the longitudinal plane. Correspondingly, the areas under the ROC curves for these regions were 0.737 (95% confidence interval [CI]: 0.637, 0.822), 0.736 (95% CI: 0.637, 0.821), and 0.784 (95% CI: 0.688, 0.861). Additionally, we observed a significant variability in stiffness values due to tissue anisotropy, specifically in the segments of the upper pole cortex, and medulla across both longitudinal and transverse planes. SWE serves as a noninvasive approach for the quantification of tissue stiffness and shows promise as an adjunctive tool for the assessment of AKI.
Collapse
Affiliation(s)
- Banghong Qiang
- Anhui Medical University, Hefei, Anhui, China
- Department of Ultrasound Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China
- Department of Ultrasound Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Qiancheng Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China
| | - Youjun Pan
- Department of Critical Care Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Junli Wang
- Department of Ultrasound Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Chunyun Shen
- Department of Ultrasound Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Xiaozhuang Peng
- Department of Critical Care Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Wenwen Shen
- Department of Critical Care Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Yu Zhang
- Department of Ultrasound Medicine, Wuhu Hospital, East China Normal University (The Second People’s Hospital, Wuhu), Wuhu, Anhui, China
| | - Xiangming Zhu
- Anhui Medical University, Hefei, Anhui, China
- Department of Ultrasound Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China
| |
Collapse
|
4
|
Stiver ML, Mirjalili SA, Agur AMR. Measuring Shear Wave Velocity in Adult Skeletal Muscle with Ultrasound 2-D Shear Wave Elastography: A Scoping Review. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1353-1362. [PMID: 36958957 DOI: 10.1016/j.ultrasmedbio.2023.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 05/11/2023]
Abstract
Ultrasound 2-D shear wave elastography (US 2D-SWE) is a non-invasive, cost-effective tool for quantifying tissue stiffness. Amidst growing interest in US 2D-SWE for musculoskeletal research, it has been recommended that shear wave velocity (SWV) should be reported instead of elastic moduli to avoid introducing unwanted error into the data. This scoping review examined the evolving use of US 2D-SWE to measure SWV in skeletal muscle and identified strengths and weaknesses to guide future research. We searched electronic databases and key review reference lists to identify articles published between January 2000 and May 2021. Two reviewers assessed the eligibility of records during title/abstract and full-text screening, and one reviewer extracted and coded the data. Sixty-six studies met the eligibility criteria, of which 58 were published in 2017 or later. We found a striking lack of consensus regarding the effects of age and sex on skeletal muscle SWV, and widely variable reliability values. Substantial differences in methodology between studies suggest a pressing need for developing standardized, validated scanning protocols. This scoping review illustrates the breadth of application for US 2D-SWE in musculoskeletal research, and the data synthesis exposed several notable inconsistencies and gaps in current literature that warrant consideration in future studies.
Collapse
Affiliation(s)
- Mikaela L Stiver
- Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
Impact of Breathing Phase, Liver Segment, and Prandial State on Ultrasound Shear Wave Speed, Shear Wave Dispersion, and Attenuation Imaging of the Liver in Healthy Volunteers. Diagnostics (Basel) 2023; 13:diagnostics13050989. [PMID: 36900133 PMCID: PMC10001107 DOI: 10.3390/diagnostics13050989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES Measurement location and patient state can impact noninvasive liver assessment and change clinical staging in ultrasound examinations. Research into differences exists for Shear Wave Speed (SWS) and Attenuation Imaging (ATI), but not for Shear Wave Dispersion (SWD). The aim of this study is to assess the effect of breathing phase, liver lobe, and prandial state on SWS, SWD, and ATI ultrasound measurements. METHODS Two experienced examiners performed SWS, SWD, and ATI measurements in 20 healthy volunteers using a Canon Aplio i800 system. Measurements were taken in the recommended condition (right lobe, following expiration, fasting state), as well as (a) following inspiration, (b) in the left lobe, and (c) in a nonfasting state. RESULTS SWS and SWD measurements were strongly correlated (r = 0.805, p < 0.001). Mean SWS was 1.34 ± 0.13 m/s in the recommended measurement position and did not change significantly under any condition. Mean SWD was 10.81 ± 2.05 m/s/kHz in the standard condition and significantly increased to 12.18 ± 1.41 m/s/kHz in the left lobe. Individual SWD measurements in the left lobe also had the highest average coefficient of variation (19.68%). No significant differences were found for ATI. CONCLUSION Breathing and prandial state did not significantly affect SWS, SWD, and ATI values. SWS and SWD measurements were strongly correlated. SWD measurements in the left lobe showed a higher individual measurement variability. Interobserver agreement was moderate to good.
Collapse
|
6
|
Leong SS, Jalalonmuhali M, Md Shah MN, Ng KH, Vijayananthan A, Hisham R, Wong JHD. Ultrasound shear wave elastography for the evaluation of renal pathological changes in adult patients. Br J Radiol 2023; 96:20220288. [PMID: 36802861 PMCID: PMC10078884 DOI: 10.1259/bjr.20220288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/10/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Many studies have conflicting findings in using shear wave elastography (SWE) to assess renal fibrosis. This study reviews the use of SWE to evaluate pathological changes in native kidneys and renal allografts. It also tries to elucidate the confounding factors and care taken to ensure the results are consistent and reliable. METHODS The review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature search was conducted in Pubmed, Web of Science and Scopus database up to 23 October 2021. To evaluate risk and bias applicability, the Cochrane risk-of bias tool and GRADE was used. The review was registered under PROSPERO CRD42021265303. RESULTS A total of 2921 articles were identified. 104 full texts were examined and 26 studies included in systematic review. 11 studies performed on native kidneys and 15 studies on transplanted kidney. A wide range of impact factors was found that affect the accuracy of SWE of renal fibrosis in adult patients. CONCLUSIONS Compared to point SWE, two-dimensional SWE with elastogram could enable better selection of the region of interest in kidneys, leading to reproducible results. Tracking waves were attenuated as the depth from skin to region of interest increased, therefore, SWE is not recommended for overweight or obese patients. Variable transducer forces might also affect SWE reproducibility, thus, training of operators to ensure consistent operator-dependent transducer forces may be helpful. ADVANCES IN KNOWLEDGE This review provides a holistic insight on the efficiency of using SWE in evaluating pathological changes in native and transplanted kidneys, thereby contributing to the knowledge of its utilisation in clinical practice.
Collapse
Affiliation(s)
- Sook Sam Leong
- Centre for Medical Imaging Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
| | | | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | - Ranitha Hisham
- University Malaya Library, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
7
|
Rajaram N, Thelen BJ, Hamilton JD, Zheng Y, Morgan T, Funes-Lora MA, Yessayan L, Shih AJ, Henke P, Osborne N, Bishop B, Krishnamurthy VN, Weitzel WF. Semiautomated Software to Improve Stability and Reduce Operator-Induced Variation in Vascular Ultrasound Speckle Tracking. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2755-2766. [PMID: 35170801 DOI: 10.1002/jum.15960] [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: 10/18/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Ultrasound is useful in predicting arteriovenous fistula (AVF) maturation, which is essential for hemodialysis in end-stage renal disease patients. We developed ultrasound software that measures circumferential vessel wall strain (distensibility) using conventional ultrasound Digital Imaging and Communications in Medicine (DICOM) data. We evaluated user-induced variability in measurement of arterial wall distensibility and upon finding considerable variation we developed and tested 2 methods for semiautomated measurement. METHODS Ultrasound scanning of arteries of 10 subjects scheduled for AVF surgery were performed. The top and bottom of the vessel wall were tracked using the Kanade-Lucas-Tomasi (KLT) feature-tracking algorithm over the stack of images in the DICOM cine loops. The wall distensibility was calculated from the change of vessel diameter over time. Two semiautomated methods were used for comparison. RESULTS The location of points selected by users for the cine loops varied significantly, with a maximum spread of up to 120 pixels (7.8 mm) for the top and up to 140 pixels (9.1 mm) for the bottom of the vessel wall. This variation in users' point selection contributed to the variation in distensibility measurements (ranging from 5.63 to 41.04%). Both semiautomated methods substantially reduced variation and were highly correlated with the median distensibility values obtained by the 10 users. CONCLUSIONS Minimizing user-induced variation by standardizing point selection will increase reproducibility and reliability of distensibility measurements. Our recent semiautomated software may help expand use in clinical studies to better understand the role of vascular wall compliance in predicting the maturation of fistulas.
Collapse
Affiliation(s)
- Nirmala Rajaram
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian J Thelen
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, Michigan, USA
| | - James D Hamilton
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Yihao Zheng
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Timothy Morgan
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
| | | | - Lenar Yessayan
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Henke
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Osborne
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brandie Bishop
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Venkataramu N Krishnamurthy
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Radiology, Case Western Reserve, Cleveland, Ohio, USA
| | - William F Weitzel
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
Selcuk Can T, Ozdemir S, Yilmaz BK. Shear-Wave Elastography of Patellar Ligament and Achilles Tendon in Semiprofessional Athletes: Comparing With Nonexercising Individuals. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2237-2246. [PMID: 34862639 DOI: 10.1002/jum.15908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare semiprofessional athletes and nonexercising individuals in terms of p-SWE properties of the patellar ligament and the Achilles tendon. METHODS This case-control study was conducted in University of Health Sciences, Haseki Education and Research Hospital. A total of 58 individuals, with 29 in each group (according to power analysis), were included in the study. All relevant findings, including demographic characteristics, body mass index (BMI), and exercise (km run per week, km/w) were recorded. The MyLab 9 (Esaote, Genova, Italy) device was used for SWE. The QElaXto-p-SWE software was utilized for P-SWE interpretation and analyses. RESULTS The mean age was 47.21 ± 12.16 years (range 22-70). Weight (P = .001) and BMI (P < .001) values were significantly higher in the nonathlete group than in the athlete group. There were no significant differences between groups in terms of age, gender, and height. Median SWE values of bilateral patellar ligaments (P < .001 and P < .001) and bilateral Achilles tendons (P < .001 and P < .001) were significantly higher in the athlete group than in the nonathlete group. CONCLUSIONS We revealed normal p-SWE characteristics for the patellar ligament and Achilles tendon, which are frequently injured in athletes. These scores are important in early detection and follow-up of injuries in athletes.
Collapse
Affiliation(s)
- Tuba Selcuk Can
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sevim Ozdemir
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Behice Kaniye Yilmaz
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Effect of Depth on Ultrasound Point Shear Wave Elastography in an Elasticity Phantom. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Phantom studies are widely used to assess variability in measurements. This study aimed to assess the reliability and accuracy of point Shear Wave elastography (pSWE) measurements of an elasticity phantom. Methods: Measurements were obtained by an experienced certified clinical sonographer at three different depth levels in kPa, using a curvilinear 5-1MHz transducer of the EPIQ7 ultrasound imaging system. Results: A total of 180 pSWE measurements were obtained at three different depth levels (three cm, five cm, and seven cm) of the phantom background. The mean CV of pSWE was low at all depths (3 cm: 8.8%; 5 cm: 7%; 7 cm: 7.2%). There was a significant difference between measurements at depths of 3 cm vs. 7 cm (MD: −0.85, 95% CI −1.5, −0.11, p = 0.024) and measurements at depths 5 cm vs. 7 cm (MD: −1.1, 95% CI −1.7, −0.47, p = 0.001). An overestimation of mean pSWE measurements at a depth of 7 cm was noted compared to the manufacturer’s value (2.7%, p = 0.006). Conclusions: Superficial phantom SWE measurements in this study had low variability compared to deep measurement. pSWE measurements at deep levels can be overestimated.
Collapse
|
10
|
Biomechanical Properties of Strictures in Crohn’s Disease: Can Dynamic Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography Predict Stiffness? Diagnostics (Basel) 2022; 12:diagnostics12061370. [PMID: 35741180 PMCID: PMC9221822 DOI: 10.3390/diagnostics12061370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Strictures and abdominal pain often complicate Crohn’s disease (CD). The primary aim was to explore whether parameters obtained by preoperative contrast-enhanced (CE) ultrasonography (US) and dynamic CE MR Enterography (DCE-MRE) of strictures associates with biomechanical properties. CD patients undergoing elective small intestinal surgery were preoperatively examined with DCE-MRE and CEUS. The excised intestine was distended utilizing a pressure bag. Luminal and outer bowel wall cross-sectional areas were measured with US. The circumferential stricture stiffness (Young’s modulus E) was computed. Stiffness was associated with the initial slope of enhancement on DCE-MRE (ρ = 0.63, p = 0.007), reflecting active disease, but lacked association with CEUS parameters. For structural imaging parameters, inflammation and stricture stiffness were associated with prestenotic dilatation on US (τb = 0.43, p = 0.02) but not with MRE (τb = 0.01, p = 1.0). Strictures identified by US were stiffer, 16.8 (14.0–20.1) kPa, than those graded as no or uncertain strictures, 12.6 (10.5–15.1) kPa, p = 0.02. MRE global score (activity) was associated with E (ρ = 0.55, p = 0.018). Elastography did not correlate with circumferential stiffness. We conclude that increasing activity defined by the initial slope of enhancement on DCE-MRE and MRE global score were associated with stricture stiffness. Prestenotic dilatation on US could be a potential biomarker of CD small intestinal stricture stiffness.
Collapse
|
11
|
Xiang H, Ling W, Ma L, Yang L, Lin T, Luo Y. Shear wave elastography using sound touch elastography and supersonic shear imaging for liver measurements: a comparative study. Quant Imaging Med Surg 2022; 12:2855-2865. [PMID: 35502377 PMCID: PMC9014163 DOI: 10.21037/qims-21-863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/19/2022] [Indexed: 08/26/2023]
Abstract
BACKGROUND Measurements of liver stiffness obtained with 2-dimensional shear wave elastography (2D-SWE) have been widely used to clinically assess liver fibrosis. However, differences between different 2D-SWE systems can lead to confusion when interpreting measurements. This study investigated the variability between a recently released sound touch elastography (STE) system and a supersonic shear imaging (SSI) system and assessed the degree of intersystem discrepancy using the different liver stiffness value (LSV) thresholds recommended by the Society of Radiologists in Ultrasound (SRU) for assessing liver fibrosis. METHODS A total of 4,152 patients who had undergone STE and SSI on the same day were enrolled in this retrospective study. First, intrasystem agreement for STE and SSI was assessed. Then, intraclass correlation coefficients (ICCs) and the Bland-Altman method were used to assess intersystem variability for all cases, classified according to the thresholds recommended by the SRU. The effects of age, gender, and body-mass index (BMI) were evaluated using multivariate linear regression analysis and attributive intervals were computed for STE and SSI at each of the different thresholds. RESULTS The ICCs for STE and SSI intrasystem agreement were 0.94 [95% confidence interval (CI): 0.937-0.943; P<0.001] and 0.984 (95% CI: 0.984-0.985; P<0.001), respectively. The 95% limit of agreement (LOA) for all cases ranged from -6.96 to 7.44 kPa. The 95% LOA increased as the threshold values rose, and intersystem variability was obvious, even at the smallest threshold (the 95% LOA at values ≤5 kPa was -0.85 to 2.08 kPa, while that at values >17 kPa was -20.81 to 14.71 kPa). The adjusted R2 for age, gender, and BMI was only 0.018 (all P value <0.05). CONCLUSIONS There was clear variability between STE and SSI, in contrast with some previous studies with small sample sizes, and consistent with others. Intersystem variability increased with the elevation of the LSV thresholds recommended by the SRU. Gender and BMI had little effect on intersystem variability. Future research could compare STE and SSI in different liver diseases, assessing the feasibility of the SRU-recommended thresholds in proven pathologies and evaluating the test-retest repeatability.
Collapse
Affiliation(s)
- Hongjin Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Lulu Yang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Tang Lin
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
12
|
Wang J, Wu M, Linghu R, Chang J, Wu M, Feng C, Ren X, Liu C, Lin J, Song T, Gu J, Zhang Y, Fang Y, Ma S, Hu P, Wu L, Han X, Chen K, Shi Q, Zhang R, Zhou Q, Du R, Gao Y, Jing X, Yang S, Zhou C, Zheng J, Liang P, Zheng RQ. Usefulness of New Shear Wave Elastography Technique for Noninvasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B: A Prospective Multicenter Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e1-e10. [PMID: 33910257 DOI: 10.1055/a-1376-6734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To explore the usefulness of liver stiffness measurements (LSMs) by sound touch elastography (STE) and sound touch quantification (STQ) in chronic hepatitis B (CHB) patients for staging fibrosis. METHODS This prospective multicenter study recruited normal volunteers and CHB patients between May 2018 and October 2019. The volunteers underwent LSM by STE and supersonic shear imaging (SSI) or by STQ and acoustic radiation force impulse imaging (ARFI). CHB patients underwent liver biopsy and LSM by both STE/STQ. The areas under the receiver operating characteristic curves (AUCs) for staging fibrosis were calculated. RESULTS Overall, 97 volunteers and 524 CHB patients were finally eligible for the study. The successful STE and STQ measurement rates were both 100 % in volunteers and 99.4 % in CHB patients. The intraclass correlation coefficients (ICCs) for the intra-observer stability of STE and STQ (0.94; 0.90) were similar to those of SSI and ARFI (0.95; 0.87), respectively. STE and STQ showed better accuracy than the aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) (AUC: 0.87 vs 0.86 vs 0.73 vs 0.77) in staging cirrhosis. However, both STE and STQ were not superior to APRI and FIB-4 in staging significant fibrosis (AUC: 0.76 vs 0.73 vs 0.70 vs 0.71, all P-values > 0.05). CONCLUSION STE and STQ are convenient techniques with a reliable LSM value. They have a similar diagnostic performance and are superior to serum biomarkers in staging cirrhosis in CHB patients.
Collapse
Affiliation(s)
- Jinfen Wang
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Manli Wu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Runze Linghu
- Ultrasound Department of Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiandong Chang
- Department of Ultrasound, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Min Wu
- Department of Ultrasound, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Cheng Feng
- Department of Ultrasound, National Clinical Research Center for Infectious Disease, Department of Ultrasound, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Xinping Ren
- Department of ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Changzhu Liu
- Department of Ultrasound, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jie Lin
- Department of Ultrasound, Mianyang Center Hospital, Mianyang, China
| | - Tao Song
- Department of abdominal ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jionghui Gu
- Department of Ultrasound, First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, China
| | - Yao Zhang
- Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ye Fang
- Department of Ultrasound, Ningbo Yinzhou No 2 Hospital, Ningbo, China
| | - Sumei Ma
- Department of Ultrasound, The First Hospital of Lanzhou University, Lanzhou, China
| | - Pingxiang Hu
- Ultrasound Imaging Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Linsong Wu
- Department of Ultrasound, Fuyang People's Hospital, Fuyang, China
| | - Xue Han
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kaixuan Chen
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qiusheng Shi
- Department of Medical Ultrasonography, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruifang Zhang
- Department of Ultrasound, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Qi Zhou
- Department of Ultrasound, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Ruiqing Du
- Ultrasonography, Shijiazhuang Fifth Hospital, Shijiazhuang, China
| | - Yongyan Gao
- Ultrasound Department, Third Medical Center of PLA General Hospital, Beijing, China
| | - Xiang Jing
- Department of Ultrasound, The Third Central Hospital of Tianjin, China
| | - Shunshi Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Zhou
- Department of Ultrasound, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Jian Zheng
- Department of Medical Ultrasound, Third Hospital of Longgang, Shenzhen, China
| | - Ping Liang
- Ultrasound Department of Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rong-Qin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
13
|
Li MD, Cheng MQ, Chen LD, Hu HT, Zhang JC, Ruan SM, Huang H, Kuang M, Lu MD, Li W, Wang W. Reproducibility of radiomics features from ultrasound images: influence of image acquisition and processing. Eur Radiol 2022; 32:5843-5851. [PMID: 35314881 DOI: 10.1007/s00330-022-08662-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/20/2022] [Accepted: 02/13/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically assess the reproducibility of radiomics features from ultrasound (US) images during image acquisition and processing. MATERIALS AND METHODS A standardized phantom was scanned to obtain US images. Reproducibility of radiomics features from US images, also known as ultrasomics features, was explored via (a) intra-US machine: changing the US acquisition parameters including gain, focus, and frequency; (b) inter-US machine: comparing three different scanners; (c) changing segmentation locations; and (d) inter-platform: comparing features extracted by the Ultrasomics and PyRadiomics algorithm platforms. Reproducible ultrasomics features were selected based on coefficients of variation. RESULTS A total of 108 US images from three scanners were obtained; 5253 ultrasomics features including seven categories of features were extracted and evaluated for each US image. From intra-US machine analysis, 37.0-38.8% of features showed good reproducibility. From inter-US machine analysis, 42.8% (2248/5253) of features exhibited good reproducibility. From segmentation location analysis, 55.7-57.6% of features showed good reproducibility. No significant difference in the normalized feature ranges was found between the 100 features extracted by the Ultrasomics and PyRadiomics platforms with the same algorithm (p = 0.563). A total of 1452 (27.6%) ultrasomics features were reproducible whenever intra-/inter-US machine or segmentation location were changed, most of which were wavelet and shearlet features. CONCLUSIONS Different acquisition parameters, US scanners, segmentation locations, and feature extraction platforms affected the reproducibility of ultrasomics features. Wavelet and shearlet features showed the best reproducibility across all procedures. KEY POINTS • Different acquisition parameters, US scanners, segmentation locations, and feature extraction platforms affected the reproducibility of ultrasomics features. • A total of 1452 (27.6%) ultrasomics features were reproducible whenever intra-/inter-US machine or segmentation location were changed. • Wavelet and shearlet features showed the best reproducibility across all procedures.
Collapse
Affiliation(s)
- Ming-De Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Mei-Qing Cheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Jian-Chao Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Hui Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China.
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China.
| |
Collapse
|
14
|
Selcuk Can T, Kaniye Yilmaz B, Ozdemir S. Multifidus Muscle Stiffness in Single-level Unilateral Lumbar Disc Herniation: Comparison of Two Shear-wave Elastography Methods. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2021.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
15
|
Yu-rim K, Su-hyeon L, Im-mee S, Jae-un K, Jae-hwan K, Ki-dong E. Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles. Am J Vet Res 2021. [DOI: 10.2460/ajvr.82.12.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs).
ANIMALS
11 healthy Beagles.
PROCEDURES
For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined.
RESULTS
SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent.
CONCLUSIONS AND CLINICAL RELEVANCE
SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.
Collapse
Affiliation(s)
- Kang Yu-rim
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Lee Su-hyeon
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Seo Im-mee
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Ko Jae-un
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Kim Jae-hwan
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Eom Ki-dong
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| |
Collapse
|
16
|
Kang YR, Lee SH, Seo IM, Ko JU, Kim JH, Eom KD. Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles. Am J Vet Res 2021:1-7. [PMID: 34727068 DOI: 10.2460/ajvr.20.12.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs). ANIMALS 11 healthy Beagles. PROCEDURES For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined. RESULTS SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent. CONCLUSIONS AND CLINICAL RELEVANCE SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.
Collapse
Affiliation(s)
- Yu-Rim Kang
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Su-Hyeon Lee
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Im-Mee Seo
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Jae-Un Ko
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Jae-Hwan Kim
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Ki-Dong Eom
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| |
Collapse
|
17
|
Hwang J, Kim HW, Kim PH, Suh CH, Yoon HM. Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2639-2653. [PMID: 33599306 DOI: 10.1002/jum.15654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To estimate the technical performance of acoustic radiation force impulse (ARFI) imaging (two-dimensional shear wave elastography [2D-SWE] and point shear wave elastography [p-SWE]) for measuring renal parenchymal stiffness. METHODS EMBASE and PubMed databases were searched for studies reporting technical performance of ARFI imaging in terms of technical failure, interobserver agreement, and/or intraobserver agreement. The proportion of technical failure and intraclass correlation coefficients (ICCs) for interobserver and intraobserver agreement was pooled. The pooled estimates of native and transplanted kidneys were obtained separately. Meta-regression and subgroup analyses were conducted to explore heterogeneity. RESULTS Twenty-four studies (2993 patients) were included. The pooled proportions of technical failure were 4.3% (95% confidence interval [CI] 2.2-8.5%) and 6.6% (95% CI 4.0-10.7%) in native and transplanted kidneys, respectively. The pooled ICCs of interobserver agreement were 0.70 (95% CI 0.68-0.83) and 0.81 (95% CI 0.68-0.89), indicating moderate and good agreement in native and transplanted kidneys, respectively. The pooled ICC showed good (0.77; 95% CI 0.49-0.91) intraobserver agreement in native kidneys. Regarding interobserver agreement in transplanted kidneys, ROI location (mid pole only versus others) was a significant factor of heterogeneity (P = .04). CONCLUSIONS The ARFI-based SWE techniques show good technical performance for measuring renal parenchymal stiffness. The wide range of SWE protocols necessitates development of standardized guidelines on the use of renal ARFI imaging.
Collapse
Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Republic of Korea
| | - Hae Won Kim
- Department of Radiology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
18
|
Favril S, de Rooster H, Broeckx BJG, Stock E, Vanderperren K. Shear wave velocity measurements obtained in different regions are repeatable for presumed normal canine lymph nodes: A pilot study. Vet Radiol Ultrasound 2021; 63:102-110. [PMID: 34605120 DOI: 10.1111/vru.13021] [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: 02/02/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022] Open
Abstract
Shear wave elastography (SWE) has been applied as a noninvasive method for predicting regional lymph node (LN) metastases in human and veterinary patients. However, published studies describing standardized protocols and repeatability of this technique are currently lacking. The objective of this prospective, pilot, observer agreement study was to determine whether different shear wave velocity (SWV) measurements obtained in different regions of presumed normal canine LNs would be repeatable. Two imagers consecutively performed shear wave elastography of submandibular, superficial inguinal, and popliteal LNs in 10, clinically healthy adult dogs. Ten elastograms of each LN were acquired by each imager. In each adequate elastogram, three regions of interest (ROIs) were placed in the softest and stiffest region of the LN. Additionally, one ROI was drawn covering the entire LN. In each ROI, mean, median, and maximum SWVs were calculated. Mean values for the mean, median, and maximum SWVs varied from 2.33 to 3.10 m/s, 2.32 to 3.10 m/s, and 2.61 to 4.09 m/s, respectively. Intra- and interobserver agreements were acceptable. Superficial inguinal LNs demonstrated the highest intra- and interobserver agreement, followed by the popliteal and the submandibular LNs, respectively. Using the different measurements (mean, median, or maximum SWVs) had no significant effect on the intra- and interobserver variability, neither did the region (softest, stiffest, or entire LN). Findings indicated that all evaluated measurements and regions could be used to obtain reliable elastography data of presumed normal canine LNs. Clinical trials in dogs with cancer are necessary to compare SWVs of metastatic LNs with the reported SWVs and evaluate whether various measurements and regions can also be used in metastatic LNs.
Collapse
Affiliation(s)
- Sophie Favril
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent, Ghent, Belgium
| | - Bart J G Broeckx
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Katrien Vanderperren
- Department of Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
19
|
Usumura M, Kishimoto R, Ishii K, Hotta E, Kershaw J, Higashi T, Obata T, Suga M. Longitudinal stability of a multimodal visco-elastic polyacrylamide gel phantom for magnetic resonance and ultrasound shear-wave elastography. PLoS One 2021; 16:e0250667. [PMID: 34019551 PMCID: PMC8139483 DOI: 10.1371/journal.pone.0250667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
We evaluated the long-term stability of a newly developed viscoelastic phantom made of polyacrylamide (PAAm) gel for magnetic resonance elastography (MRE) and ultrasound-based shear-wave elastography (US SWE). The stiffness of the cylindrical phantom was measured at 0, 13 and 18 months. Storage and loss moduli were measured with MRE, and shear-wave speed (SWS) was measured with US SWE. Long-term stability was evaluated in accordance with the Quantitative Imaging Biomarker Alliance (QIBA) profiles for each modality. The initial storage and loss moduli of the phantom were 5.01±0.22 and 1.11±0.15 respectively, and SWS was 2.57±0.04 m/s. The weight of the phantom decreased by 0.6% over the 18 months. When measured with MRE, the stiffness of the phantom decreased and changes to the storage and loss moduli were -3.0% and -4.6% between 0 and 13 months, and -4.3% and 0.0% between 0 and 18 months. The US measurements found that SWS decreased by 2.4% over the first 13 months and 3.6% at 18 months. These changes were smaller than the tolerances specified in the QIBA profiles, so the viscoelastic PAAm gel phantom fulfilled the condition for long-term stability. This new phantom has the potential to be used as a quality assurance and quality control phantom for MRE and US SWE.
Collapse
Affiliation(s)
- Masashi Usumura
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Riwa Kishimoto
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- * E-mail:
| | - Koki Ishii
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Eika Hotta
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Jeff Kershaw
- Applied MRI Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Takayuki Obata
- Applied MRI Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Mikio Suga
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| |
Collapse
|
20
|
Adamczewski Z, Stasiak M, Stasiak B, Adamczewska M, Lewiński A. Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue. J Clin Med 2021; 10:jcm10020214. [PMID: 33435276 PMCID: PMC7827397 DOI: 10.3390/jcm10020214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 12/24/2022] Open
Abstract
Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane—transverse vs. longitudinal—on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results.
Collapse
Affiliation(s)
- Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
| | - Bartłomiej Stasiak
- Institute of Information Technology, Lodz University of Technology, 90-924 Lodz, Poland;
| | - Magdalena Adamczewska
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-271–11-42
| |
Collapse
|
21
|
Castro L, García-Mejido JA, Arroyo E, Carrera J, Fernández-Palacín A, Sainz JA. Influence of epidemiological characteristics (age, parity and other factors) in the assessment of healthy uterine cervical stiffness evaluated through shear wave elastography as a prior step to its use in uterine cervical pathology. Arch Gynecol Obstet 2020; 302:753-762. [PMID: 32712928 DOI: 10.1007/s00404-020-05671-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate stiffness changes occurring in the healthy uterine cervix according to age, parity, phase of the menstrual cycle and other factors by shear wave elastography (SWE). METHODS Evaluations of cervical speed and stiffness measurements were performed in 50 non-pregnant patients without gynaecological pathology using SWE transvaginal ultrasound. We performed the evaluation in the midsagittal plane of the uterine cervix with measurements at 0.5, 1 and 1.5 cm from external cervical os, at both anterior and posterior cervical lips. RESULTS We evaluated 44 patients by SWE and obtained a total average velocity of 3.48 ± 1.08 m/s and stiffness of 42.39 ± 25.33 kPa. We found differences in speed and stiffness according to the cervical lip and depth evaluated; thus, we observed a velocity of 2.70 m/s at 0.5 cm of depth in the anterior lip and 3.53 m/s at 1.5 cm of depth in the posterior lip (p < 0.05). We observed differences according to parity, obtaining a wave transmission speed of 2.67 m/s and 4.41 m/s at the cervical canal of nulliparous and multiparous patients, respectively (p < 0 0.002). We observed differences according to patient age (from a speed of 2.75 m/s at the cervical canal in the age group of 20-35 years to 5.05 m/s in the age group > 50 years) (p < 0.008). We did not observe differences in speed or stiffness according to the phase of the menstrual cycle, BMI, smoking status or the presence or absence of non-HPV infections. CONCLUSIONS The wave transmission speed and stiffness of the uterine cervix evaluated by SWE varies according to the cervical lip and depth of the evaluation as well as according to the parity and age of the patient.
Collapse
Affiliation(s)
- Laura Castro
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain.
| | - Eva Arroyo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Jara Carrera
- 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 Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| |
Collapse
|
22
|
Peña-Solórzano CA, Albrecht DW, Bassed RB, Gillam J, Harris PC, Dimmock MR. Semi-supervised labelling of the femur in a whole-body post-mortem CT database using deep learning. Comput Biol Med 2020; 122:103797. [PMID: 32658723 DOI: 10.1016/j.compbiomed.2020.103797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 01/16/2023]
Abstract
A deep learning pipeline was developed and used to localize and classify a variety of implants in the femur contained in whole-body post-mortem computed tomography (PMCT) scans. The results provide a proof-of-principle approach for labelling content not described in medical/autopsy reports. The pipeline, which incorporated residual networks and an autoencoder, was trained and tested using n = 450 full-body PMCT scans. For the localization component, Dice scores of 0.99, 0.96, and 0.98 and mean absolute errors of 3.2, 7.1, and 4.2 mm were obtained in the axial, coronal, and sagittal views, respectively. A regression analysis found the orientation of the implant to the scanner axis and also the relative positioning of extremities to be statistically significant factors. For the classification component, test cases were properly labelled as nail (N+), hip replacement (H+), knee replacement (K+) or without-implant (I-) with an accuracy >97%. The recall for I- and H+ cases was 1.00, but fell to 0.82 and 0.65 for cases with K+ and N+. This semi-automatic approach provides a generalized structure for image-based labelling of features, without requiring time-consuming segmentation.
Collapse
Affiliation(s)
- C A Peña-Solórzano
- Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Rd, Clayton, Melbourne, VIC, 3800, Australia.
| | - D W Albrecht
- Clayton School of Information Technology, Monash University, Wellington Rd, Clayton, Melbourne, VIC, 3800, Australia.
| | - R B Bassed
- Victorian Institute of Forensic Medicine, 57-83 Kavanagh St., Southbank, Melbourne, VIC, 3006, Australia; Department of Forensic Medicine, Monash University, Wellington Rd, Clayton, Melbourne, VIC, 3800, Australia.
| | - J Gillam
- Land Division, Defence Science and Technology Group, Fishermans Bend, Melbourne, VIC, 3207, Australia.
| | - P C Harris
- The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia; Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Gordon St, Footscray, Melbourne, VIC, 3011, Australia.
| | - M R Dimmock
- Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Rd, Clayton, Melbourne, VIC, 3800, Australia.
| |
Collapse
|
23
|
Transfer learning radiomics based on multimodal ultrasound imaging for staging liver fibrosis. Eur Radiol 2020; 30:2973-2983. [PMID: 31965257 PMCID: PMC7160214 DOI: 10.1007/s00330-019-06595-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Objectives To propose a transfer learning (TL) radiomics model that efficiently combines the information from gray scale and elastogram ultrasound images for accurate liver fibrosis grading. Methods Totally 466 patients undergoing partial hepatectomy were enrolled, including 401 with chronic hepatitis B and 65 without fibrosis pathologically. All patients received elastography and got liver stiffness measurement (LSM) 2–3 days before surgery. We proposed a deep convolutional neural network by TL to analyze images of gray scale modality (GM) and elastogram modality (EM). The TL process was used for liver fibrosis classification by Inception-V3 network which pretrained on ImageNet. The diagnostic performance of TL and non-TL was compared. The value of single modalities, including GM and EM alone, and multimodalities, including GM + LSM and GM + EM, was evaluated and compared with that of LSM and serological indexes. Receiver operating characteristic curve analysis was performed to calculate the optimal area under the curve (AUC) for classifying fibrosis of S4, ≥ S3, and ≥ S2. Results TL in GM and EM demonstrated higher diagnostic accuracy than non-TL, with significantly higher AUCs (all p < .01). Single-modal GM and EM both performed better than LSM and serum indexes (all p < .001). Multimodal GM + EM was the most accurate prediction model (AUCs are 0.950, 0.932, and 0.930 for classifying S4, ≥ S3, and ≥ S2, respectively) compared with GM + LSM, GM and EM alone, LSM, and biomarkers (all p < .05). Conclusions Liver fibrosis can be staged by a transfer learning modal based on the combination of gray scale and elastogram ultrasound images, with excellent performance. Key Points • Transfer learning consists in applying to a specific deep learning algorithm that pretrained on another relevant problem, expected to reduce the risk of overfitting due to insufficient medical images. • Liver fibrosis can be staged by transfer learning radiomics with excellent performance. • The most accurate prediction model of transfer learning by Inception-V3 network is the combination of gray scale and elastogram ultrasound images. Electronic supplementary material The online version of this article (10.1007/s00330-019-06595-w) contains supplementary material, which is available to authorized users.
Collapse
|
24
|
Bae SJ, Youk JH, Yoon CI, Park S, Cha CH, Lee HW, Ahn SG, Lee SA, Son EJ, Jeong J. A nomogram constructed using intraoperative ex vivo shear-wave elastography precisely predicts metastasis of sentinel lymph nodes in breast cancer. Eur Radiol 2019; 30:789-797. [PMID: 31696293 PMCID: PMC6957551 DOI: 10.1007/s00330-019-06473-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/28/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop a nomogram and validate its use for the intraoperative evaluation of nodal metastasis using shear-wave elastography (SWE) elasticity values and nodal size METHODS: We constructed a nomogram to predict metastasis using ex vivo SWE values and ultrasound features of 228 axillary LNs from fifty-five patients. We validated its use in an independent cohort comprising 80 patients. In the validation cohort, a total of 217 sentinel LNs were included. RESULTS We developed the nomogram using the nodal size and elasticity values of the development cohort to predict LN metastasis; the area under the curve (AUC) was 0.856 (95% confidence interval (CI), 0.783-0.929). In the validation cohort, 15 (7%) LNs were metastatic, and 202 (93%) were non-metastatic. The mean stiffness (23.54 and 10.41 kPa, p = 0.005) and elasticity ratio (3.24 and 1.49, p = 0.028) were significantly higher in the metastatic LNs than those in the non-metastatic LNs. However, the mean size of the metastatic LNs was not significantly larger than that of the non-metastatic LNs (8.70 mm vs 7.20 mm, respectively; p = 0.123). The AUC was 0.791 (95% CI, 0.668-0.915) in the validation cohort, and the calibration plots of the nomogram showed good agreement. CONCLUSIONS We developed a well-validated nomogram to predict LN metastasis. This nomogram, mainly based on ex vivo SWE values, can help evaluate nodal metastasis during surgery. KEY POINTS • A nomogram was developed based on axillary LN size and ex vivo SWE values such as mean stiffness and elasticity ratio to easily predict axillary LN metastasis during breast cancer surgery. • The constructed nomogram presented high predictive performance of sentinel LN metastasis with an independent cohort. • This nomogram can reduce unnecessary intraoperative frozen section which increases the surgical time and costs in breast cancer patients.
Collapse
Affiliation(s)
- Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Ik Yoon
- Department of Surgery, St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soeun Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Chi Hwan Cha
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hak Woo Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Seung Ah Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
| |
Collapse
|