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Zhu J, Qiu L, Ta D, Hua X, Liu H, Zhang H, Li J, Wang Y, Xi Z, Zheng Y, Shan Y, Liu B, Huang W, Liu W, Hao S, Cui L, Cai J, Zhang W, Zhang C, Chen S, Wei A, Dong F. Chinese Ultrasound Doctors Association Guideline on Operational Standards for 2-D Shear Wave Elastography Examination of Musculoskeletal Tissues. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:175-183. [PMID: 37949764 DOI: 10.1016/j.ultrasmedbio.2023.10.005] [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: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
The Ultrasound Physician Branch of the Chinese Medical Doctor Association sought to develop evidence-based recommendations on the operational standards for 2-D shear wave elastography examination of musculoskeletal tissues. A consensus panel of 22 Chinese musculoskeletal ultrasound experts reviewed current scientific evidence and proposed a set of 12 recommendations for 13 key issues, including instruments, operating methods, influencing factors and image interpretation. A final consensus was reached through discussion and voting. On the basis of research evidence and expert opinions, the strength of recommendation for each proposition was assessed using a visual analog scale, while further emphasizing the best available evidence during the question-and-answer session. These expert consensus guidelines encourage facilitation of the standardization of clinical practices for collecting and reporting shear wave elastography data.
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Affiliation(s)
- Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China.
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Dean Ta
- Center for Biomedical Engineering, Fudan University, Shanghai, China
| | - Xing Hua
- Department of Ultrasound, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hongmei Liu
- Department of Ultrasound, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Huabin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital Affiliated with Tsinghua University, Beijing, China
| | - Jia Li
- Department of Ultrasound, Southeast University Zhongda Hospital, Nanjing, China
| | - Yuexiang Wang
- Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhanguo Xi
- Department of Functional Examination, Henan Provincial Orthopedic Hospital Zhengzhou Campus, Zhengzhou, China
| | - Yuanyi Zheng
- Department of Ultrasound, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yong Shan
- Department of Ultrasound, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bingyan Liu
- Department of Ultrasound, Hainan General Hospital, Haikou, China
| | - Weijun Huang
- Department of Interventional Ultrasound, First People's Hospital of Foshan, Foshan, China
| | - Weiyong Liu
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shaoyun Hao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Guangzhou, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Jin Cai
- Department of Ultrasound, Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shuqiang Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - An Wei
- Department of Ultrasound, Hunan Provincial People's Hospital, Changsha, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, China
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Yuan G, Xie F, Song Y, Li Q, Li R, Hu X, Zang M, Cheng X, Lu G, Huang J, Fan W, Rong X, Sun J, Chen J. Hepatic Tumor Stiffness Measured by Shear Wave Elastography Is Prognostic for HCC Progression Following Treatment With Anti-PD-1 Antibodies Plus Lenvatinib: A Retrospective Analysis of Two Independent Cohorts. Front Immunol 2022; 13:868809. [PMID: 35757765 PMCID: PMC9218245 DOI: 10.3389/fimmu.2022.868809] [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: 02/03/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background The clinical significance of liver stiffness (LS) measured by shear wave elastography (SWE) in programmed cell death protein-1 (PD-1) inhibitors treated advanced hepatocellular carcinoma (HCC) patients remains unknown. This study aimed to explore the prognostic value of baseline LS by SWE prior to PD-1 inhibitor treatment in combination with lenvatinib. Methods We retrospectively evaluated patients (n=133) with HCC who received anti-PD-1 antibodies plus lenvatinib at two high-volume medical centres, between January 2020 and June 2021. Univariate and multivariate logistic regression analysis were used to develop a novel nomogram. RNA sequencing and immunohistochemical staining were used to assess the heterogeneity of biological and immune characteristics associated with tumor stiffness. Results The objective response rate (ORR) and disease control rate (DCR) of the whole population were 23.4% and 72.2%, respectively. A LS value of the baseline tumorous foci of 19.53 kPa had the maximum sum of sensitivity and specificity, making it the optimal cut-off value for predicting PD-1 inhibitor efficacy. The nomogram comprised baseline tumor LS and albumin-bilirubin grade (ALBI), which provided favorable calibration and discrimination in the training dataset with an AUC of 0.840 (95%CI: 0.750-0.931) and a C-index of 0.828. Further, it showed acceptable discrimination in the validation cohort, with an AUC of 0.827 (95%CI: 0.673-0.980) and C-index of 0.803. The differentially expressed genes enriched in high stiffness tumors were predominantly associated with metabolic pathways, while those enriched in low stiffness tumors were related to DNA damage repair. Furthermore, patients with high stiffness tumors had a relatively lower infiltration of immune cells and histone deacetylase pathway inhibitors were identified as candidate drugs to promote the efficacy of immunotherapy. Conclusions Baseline LS value of tumorous foci by SWE—that is, before administration of a PD-1 inhibitor in combination with lenvatinib—is a convenient predictor of PD-1 inhibitor efficacy in patients with advanced HCC, which has potential to be used for pretreatment stratification to optimize treatment of advanced HCC.
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Affiliation(s)
- Guosheng Yuan
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fuli Xie
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yangda Song
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Li
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Li
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyun Hu
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengya Zang
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao Cheng
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guanting Lu
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Huang
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoxiang Rong
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Sun
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinzhang Chen
- Department of Infectious Diseases and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Han Y, Wu JQ, Hou XJ, Sun JW, Piao ZY, Teng F, Wang XL. Strain Imaging in the Evaluation of Thyroid Nodules: The Associated Factors Leading to Misdiagnosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3372-3383. [PMID: 34538708 DOI: 10.1016/j.ultrasmedbio.2021.08.016] [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: 03/30/2021] [Revised: 07/13/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
This study analyzed which imaging characteristics may contribute to misdiagnosis of benign and malignant thyroid nodules (TNs) through strain imaging (SI). We analyzed SI parameters and conventional ultrasound (CUS) characteristics of 264 nodules with histopathology results and we applied binary logistic regression analysis to select independent variables for incorrect SI results. The elastography imaging (EI) score and the virtual touch tissue imaging (VTI) score of malignant TNs were remarkably higher than that in benign TNs. VTI, of which the false-positive rate (FPR), the false-negative rate (FNR), and the cutoff value were 47.6% (39/82), 17.6% (32/182) and 3.5, presented higher diagnostic performance than EI. Aspect ratio (odd ratio [OR]: 14.208) and intra-nodular calcification (OR: 20.384) were significantly associated with false-positive VTI findings, while posterior acoustic feature (OR: 30.424) was significantly associated with false-negative VTI findings. Sex (OR: 0.221) and aspect ratio (OR: 0.268) were negatively associated with false-negative EI findings. In conclusion, sex and aspect ratio significantly affect the accuracy of EI results, while aspect ratio, intra-nodular calcification and posterior acoustic features notably affect the accuracy of VTI results. These CUS features of TNs should not be ignored before explaining SI examination results.
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Affiliation(s)
- Ye Han
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Jia-Qi Wu
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Xiu-Juan Hou
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Jia-Wei Sun
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Zhen-Ya Piao
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Fei Teng
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Xiao-Lei Wang
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China..
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