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Rizzo L, L'Abbate L, Attanasio M, Montineri A, Magliocco S, Calvaruso V. Depth effect on point shear wave velocity elastography: Evidence in a chronic hepatitis C patient cohort. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:53-61. [PMID: 38314023 PMCID: PMC10836232 DOI: 10.1177/1742271x231183370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 02/06/2024]
Abstract
Background and Aims This study investigated the depth-related bias and the influence of scan plane angle on performance of point-shear-wave elastometry in a chronic hepatitis C patient cohort. Materials and Methods We included 104 patients affected by chronic liver disease related to the hepatitis C virus. Liver surface nodularity was the reference to diagnose cirrhosis. The ultrasound platform was the Siemens S2000, equipped with point-shear-wave elastometry software. Measurements were obtained in left lateral decubitus from the liver surface to the maximum depth of 8 cm in two orthogonal scan planes according to a standard sampling plane. Scatterplot and box plots explored the depth-related bias graphically. The area under the receiver operating characteristic was used to determine the point-shear-wave elastometry diagnostic performance at progressive depths according to liver surface nodularity. Results Of the 104 patients, 68 were cirrhotics. Depth-related bias equally modified point-shear-wave elastometry in the two orthogonal scan planes. A better point-shear-wave elastometry diagnostic performance was observed between depths of 4 and 5 cm. The frontal scan plane assured better discrimination between cirrhotic patients and non-cirrhotic patients. Conclusion Depth is crucial for point-shear-wave elastometry performance. Excellent diagnostic performance at a depth between 4 and 5 cm can also be obtained with a smaller number of measurements than previously recommended.
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Affiliation(s)
| | - Luca L'Abbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Massimo Attanasio
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | - Arturo Montineri
- Department of Infectious Diseases and Tropical Medicine, AOU Policlinico 'G. Rodolico - San Marco', Catania, Italy
| | - Salvatore Magliocco
- Department of Infectious Diseases and Tropical Medicine, AOU Policlinico 'G. Rodolico - San Marco', Catania, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
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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.
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Roccarina D, Iogna Prat L, Pallini G, Guerrero Misas M, Buzzetti E, Saffioti F, Aricò FM, Mantovani A, Koutli E, Goyale A, Rosselli M, Luong TV, Pinzani M, Tsochatzis EA. Comparison of point-shear wave elastography (ElastPQ) and transient elastography (FibroScan) for liver fibrosis staging in patients with non-alcoholic fatty liver disease. Liver Int 2022; 42:2195-2203. [PMID: 35635761 DOI: 10.1111/liv.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS ElastPQ is a point shear wave elastography technique used to non-invasively assess liver fibrosis. We compared liver stiffness measurements (LSM) by ElastPQ and fibroscan transient elastography (F-TE) in a cohort of patients with non-alcoholic fatty liver disease (NAFLD). We further evaluated the performance of ElastPQ in a subgroup of patients with available liver histology. MATERIALS AND METHODS We included patients with NAFLD who presented in a dedicated multidisciplinary clinic. Anthropometric parameters, blood tests and elastography measurements were obtained using F-TE and ElastPQ as part of routine clinical care. RESULTS We enrolled 671 patients with NAFLD, mean age 55.8 ± 13 years, body mass index (BMI) 31.5 ± 5.7 kg/m2 , 56.6% males, 41% diabetes, 53.7% hypertension, 68% dyslipidaemia. ElastPQ showed an excellent correlation with F-TE (Spearman's r = 0.80, p < .001), which was better for mild/moderate stages of fibrosis. Independent predictors of a >2 kPa discrepancy between the two techniques were a larger waist circumference and F-TE ≥10 kPa. In the subgroup of 159 patients with available histology, ElastPQ showed similar diagnostic accuracy with F-TE in staging liver fibrosis (ElastPQ area under the curves 0.84, 0.83, 0.86 and 0.95, for F ≥ 1, F ≥ 2, F ≥ 3 and F = 4 respectively). Optimal cut-off values of ElastPQ for individual fibrosis stages were lower than those of F-TE. CONCLUSIONS ElastPQ shows an excellent correlation with F-TE in patients with NAFLD, which was better for lower LSM. The optimal cut-off values of ElastPQ are lower than those of F-TE for individual stages of fibrosis. ElastPQ has similar diagnostic accuracy to F-TE for all stages of fibrosis.
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Affiliation(s)
- Davide Roccarina
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Laura Iogna Prat
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Giada Pallini
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Marta Guerrero Misas
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Elena Buzzetti
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Division of Medicine and CeMEF, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Saffioti
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Division of Clinical and Molecular Hepatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco M Aricò
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Department of Internal Medicine, University Hospital and School of Medicine of Messina, Messina, Italy
| | - Anna Mantovani
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.,Division of General Medicine and Hypertension, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Evangelia Koutli
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Atul Goyale
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Matteo Rosselli
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Tu Vinh Luong
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
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Boursier J, Decraecker M, Bourlière M, Bureau C, Ganne-Carrié N, de Lédinghen V. Quality criteria for the measurement of liver stiffness. Clin Res Hepatol Gastroenterol 2022; 46:101761. [PMID: 34325013 DOI: 10.1016/j.clinre.2021.101761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
Liver elastography offers the possibility of a quick, non-invasive, and painless evaluation of the liver with immediate results at bedside. Transient elastography is the most validated technology, and many others such as point shear wave elastography, 2D-shear wave elastography, or magnetic resonance elastography have been developed. To ensure the best evaluation, several conditions of examination must be respected for liver stiffness measurement. Indeed, patient, operator and examination characteristics have all been shown to influence the result of liver stiffness measurement. Food intake increases liver stiffness, whereas withdrawal in alcoholics is associated with a decrease in elastography results. Inter-observer reproducibility of the measurement seems suboptimal, and the influence of the operator experience is still being debated. The measurement site and the FibroScan® probe must be correctly chosen. Finally, the intrinsic characteristics and quality criteria of the measurement, especially the interquartile range/median ratio, must be carefully checked to avoid overestimation of liver stiffness. Most of the results come from studies which have evaluated transient elastography, with less data available for the other technologies. Liver stiffness measurement could appear as a simple way to explore the liver, but several conditions must be met before deciding the patient management according to its result.
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Affiliation(s)
- Jérôme Boursier
- Laboratoire HIFIH, UPRES EA3859, SFR ICAT 4208, Université d'Angers, Angers, France.
| | - Marie Decraecker
- Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux, France
| | - Marc Bourlière
- Service d'hépato-gastroentérologie, Hôpital Saint Joseph & INSERM UMR 1252 IRD SESSTIM Aix Marseille Université, Marseille, France
| | - Christophe Bureau
- Service d'hépatologie, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Avicenne, APHP, Université Sorbonne Paris Nord, Bobigny & INSERM UMR 1138, Centre de Recherche des Cordeliers, Université de Paris, France
| | - Victor de Lédinghen
- Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux, France
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Al-Mutairi FF, Chung EM, Moran CM, Ramnarine KV. A Novel Elastography Phantom Prototype for Assessment of Ultrasound Elastography Imaging Performance. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2749-2758. [PMID: 34144833 DOI: 10.1016/j.ultrasmedbio.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
The aims of this study were firstly to manufacture and evaluate a novel elastography test phantom and secondly to assess the performance of an elastography system using this phantom. A novel Leicester-St. Thomas' Elastography Pipe (L-STEP) test phantom consisting of five soft polyvinyl acrylic-cryogel pipes of varying diameters (2-12 mm), embedded at 45° within an agar-based tissue-mimicking material was developed. A shear-wave elastography (SWE) scanner was used by two blinded operators to image and assess longitudinal sections of the pipes. Young's modulus estimates were dependent on the diameter of pipes and at superficial depths were greater than deeper depths (mean 98 kPa vs. 59 kPa) and had lower coefficients of variation (mean 21% vs. 53%). The penetration depth (maximum depth at which a SWE signal was obtained) increased with increasing pipe diameter. Penetration depth measurements had excellent inter- and intra-operator reproducibility (intra-class correlation coefficients >0.8) and coefficient of variation range of 2%-12%. A new metric, called the summative performance index, was defined as the sum of the ratios of the penetration depth/pipe diameter. The L-STEP phantom is suitable for assessing key aspects of elastography imaging performance: resolution, accuracy, reproducibility, depth dependence, sensitivity and our novel summative performance index.
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Affiliation(s)
- Fahad F Al-Mutairi
- Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University (KAU), Jeddah, Saudi Arabia; Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Emma Ml Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom; Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Carmel M Moran
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kumar V Ramnarine
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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Nowotny F, Schmidberger J, Schlingeloff P, Binzberger A, Kratzer W. Comparison of point and two-dimensional shear wave elastography of the spleen in healthy subjects. World J Radiol 2021; 13:137-148. [PMID: 34141093 PMCID: PMC8188838 DOI: 10.4329/wjr.v13.i5.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few systematic comparative studies of the different methods of physical elastography of the spleen are currently available.
AIM To compare point shear wave and two-dimensional elastography of the spleen considering the anatomical location (upper, hilar, and lower pole).
METHODS As part of a prospective clinical study, healthy volunteers were examined for splenic elasticity using four different ultrasound devices between May 2015 and April 2017. The devices used for point shear wave elastography were from Siemens (S 3000) and Philips (Epiq 7), and those used for two-dimensional shear wave elastography were from GE (Logiq E9) and Toshiba (Aplio 500). In addition, two different software versions (5.0 and 6.0) were evaluated for the Toshiba ultrasound device (Aplio 500). The study consisted of three arms: A, B, and C.
RESULTS In study arm A, 200 subjects were evaluated (78 males and 122 females, mean age 27.9 ± 8.1 years). In study arm B, 113 subjects were evaluated (38 men and 75 women, mean age 26.0 ± 6.3 years). In study arm C, 44 subjects were enrolled. A significant correlation of the shear wave velocities at the upper third of the spleen (r = 0.33088, P < 0.0001) was demonstrated only for the Philips Epiq 7 device compared to the Siemens Acuson S 3000. In comparisons of the other ultrasound devices (GE, Siemens, Toshiba), no comparable results could be obtained for any anatomical position of the spleen. The influencing factors age, gender, and body mass index did not show a clear correlation with the measured shear wave velocities.
CONCLUSION The absolute values of the shear wave elastography measurements of the spleen and the two different elastography methods are not comparable between different manufacturers or models.
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Affiliation(s)
- Friederike Nowotny
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | | | - Andreas Binzberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
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Lee A, Joo DJ, Han WK, Jeong HJ, Oh MJ, Kim YS, Oh YT. Renal tissue elasticity by acoustic radiation force impulse: A prospective study of healthy kidney donors. Medicine (Baltimore) 2021; 100:e23561. [PMID: 33545931 PMCID: PMC7837974 DOI: 10.1097/md.0000000000023561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Some studies reported the correlations between renal parenchymal stiffness measured by transient elastography or acoustic radiation force impulse (ARFI) and the extent of interstitial fibrosis. This study was prospectively designed to evaluate the correlation between clinical, histological findings and the kidney shear wave velocity (SWV, m/s) assessed by ARFI elastography to identify factors affecting the kidney SWV in normal patients. METHODS Seventy-three adult living kidney transplantation donors were enrolled in our center between September 2010 and January 2013. Before transplantation, all donors were evaluated by ARFI elastography to identify the range of SWV in kidneys. Time-zero biopsies were performed on all graft kidneys before implantation. RESULTS Mean age of donors was 42.0 ± 11.3 years. The mean SWV and depth were 2.21 ± 0.58 m/s and 5.37 ± 1.06 cm. All histological findings showed mild degree of the Banff score, only grade I. In univariate analyses, the SWV was not associated with all histological parameters. Age (r = -0.274, P = .019) diastolic blood pressure (DBP, r = -0.255, P = .030) and depth for SWV measurement (r = -0.345, P = .003) were significantly correlated with the SWV. In multivariate linear regression analysis, age, gender, body mass index (BMI), and depth for SWV measurement were significantly correlated with the SWV (P = .003, .005, .002, and .004, respectively). CONCLUSIONS We demonstrated that all histological findings are not correlated with the SWV of donor kidney. Otherwise, factors influencing the kidney SWV assessed by ARFI elastography are age, gender, BMI, and depth for the SWV measurement in donors for kidney transplantation.
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Affiliation(s)
- Alan Lee
- Department of Surgery, Devision of surgical critical care and trauma, Korea University Guro hospital
- Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Joo
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System
- Research Institute for Transplantation, Yonsei University College of Medicine
| | - Woong Kyu Han
- Department of Urology, Severance Hospital, Yonsei University Health System
| | - Hyeon Joo Jeong
- Department of Pathology, Severance Hospital, Yonsei University Health System
| | - Min Jung Oh
- Biostatistics Collaboration Unit, Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon
| | - Yu Seun Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System
- Research Institute for Transplantation, Yonsei University College of Medicine
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Yonsei University Health System, Seoul, Korea
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Nitta N, Yamakawa M, Hachiya H, Shiina T. A review of physical and engineering factors potentially affecting shear wave elastography. J Med Ultrason (2001) 2021; 48:403-414. [PMID: 34453649 PMCID: PMC8578095 DOI: 10.1007/s10396-021-01127-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/15/2021] [Indexed: 01/01/2023]
Abstract
It has been recognized that tissue stiffness provides useful diagnostic information, as with palpation as a screening for diseases such as cancer. In recent years, shear wave elastography (SWE), a technique for evaluating and imaging tissue elasticity quantitatively and objectively in diagnostic imaging, has been put into practical use, and the amount of clinical knowledge about SWE has increased. In addition, some guidelines and review papers regarding technology and clinical applications have been published, and the status as a diagnostic technology is in the process of being established. However, there are still unclear points about the interpretation of shear wave speed (SWS) and converted elastic modulus in SWE. To clarify these, it is important to investigate the factors that affect the SWS and elastic modulus. Therefore, physical and engineering factors that potentially affect the SWS and elastic modulus are discussed in this review paper, based on the principles of SWE and a literature review. The physical factors include the propagation properties of shear waves, mechanical properties (viscoelasticity, nonlinearity, and anisotropy), and size and shape of target tissues. The engineering factors include the region of interest depth and signal processing. The aim of this review paper is not to provide an answer to the interpretation of SWS. It is to provide information for readers to formulate and verify the hypothesis for the interpretation. Therefore, methods to verify the hypothesis for the interpretation are also reviewed. Finally, studies on the safety of SWE are discussed.
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Affiliation(s)
- Naotaka Nitta
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-2-1 Namiki, Tsukuba, Ibaraki, 305-8564, Japan.
| | - Makoto Yamakawa
- Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Hiroyuki Hachiya
- School of Engineering, Tokyo Institute of Technology, Meguro, Tokyo, 152-8552, Japan
| | - Tsuyoshi Shiina
- Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
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Hwang JA, Jeong WK, Song KD, Kang KA, Lim HK. 2-D Shear Wave Elastography for Focal Lesions in Liver Phantoms: Effects of Background Stiffness, Depth and Size of Focal Lesions on Stiffness Measurement. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3261-3268. [PMID: 31493955 DOI: 10.1016/j.ultrasmedbio.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine the factors influencing stiffness and conspicuity of focal lesions in deep organs by focusing on target properties using 2-D shear wave elastography (SWE). Two normal (4 ± 1 kPa) and cirrhotic (16 ± 2 kPa) liver-mimicking phantoms with spherical inclusions (23 ± 3 kPa) were used. Inclusions of three sizes (20, 15 and 10 mm in diameter) were arranged in a row at depths of 3, 5 and 7 cm. Two observers acquired quantitative stiffness values and a qualitative five-grade morphologic score at each inclusion using SWE. The coefficients of variation (CVs) of stiffness were calculated to assess measurement reliability. The generalized estimating equation was used to identify whether stiffness, CV and morphologic score were independent of background stiffness, depth and size of inclusions and observer. In the quantitative assessment, stiffness of the inclusion and CV were dependent on the type of phantom and depth of inclusion (p < 0.001). There were no significant differences in stiffness and CV according to the observer. Morphologic score differed significantly only in the size of the inclusion (p < 0.001). When the depth of the inclusion was 7 cm, the stiffness was the highest, and the 10 mm-sized inclusions had lower morphologic scores than the other inclusions (all p values < 0.001). In conclusion, 2-D SWE assessment of focal lesions could be affected by background stiffness and depth of focal lesions, and may be limited in evaluating focal hepatic lesions.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo K Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Simkin P, Rattansingh A, Liu K, Hudson JM, Atri M, Jang HJ, Kim TK, Khalili K. Reproducibility of 2 Liver 2-Dimensional Shear Wave Elastographic Techniques in the Fasting and Postprandial States. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1739-1745. [PMID: 30536401 DOI: 10.1002/jum.14862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the reliability and agreement of 2 methods of 2-dimensional (2D) shear wave elastography (SWE) on liver stiffness in healthy volunteers. We also assessed effects of the prandial state and operator experience on measurements. METHODS Two operators, 1 experienced and 1 novice, independently examined 20 healthy volunteers with 2D SWE on 2 ultrasound machines (Aixplorer [SuperSonic Imagine, Aix-en-Provence, France] and Aplio 500 [Canon Medical Systems Corporation, Otawara, Japan]). Volunteers were scanned 8 times by the operators using both machines in fasting and postprandial states. Agreement was evaluated by a Bland-Altman analysis, and the correlation was assessed by the Pearson correlation and intraclass correlation coefficients (ICCs). An analysis of variance was conducted to determine the contribution of the machine, prandial state, and operator experience to the variability. RESULTS Agreement assessed by Bland-Altman plots showed no statistically significant difference in measured liver stiffness between the machines (mean difference, -0.8%; 95% confidence interval, -3.7%, 2.1%), with a critical difference of 1.36 kPa. The correlation was good to excellent for both the crude overall Pearson coefficient and the ICC, both measuring 0.88 (95% confidence interval, 0.82, 0.92). Subclass ICCs for the fasting state, postprandial state, novice operator, and experienced operator were 0.89, 0.88, 0.90, and 0.86, respectively. The 2-way mixed effect analysis of variance showed that the volunteers accounted for 86.3% of variation in median liver stiffness, with no statistically significant contribution from operator experience, the prandial state, or the machine (P = .108, .067, and .296, respectively). CONCLUSIONS Our study showed that the 2D SWE techniques had a high degree of reliability and agreement in measurement of liver stiffness in a healthy population. Operator experience and the prandial state did not impart significant variability to stiffness measurements.
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Affiliation(s)
- Paul Simkin
- Departments of Medical Imaging, Toronto, Ontario, Canada
| | | | - Kuan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Mostafa Atri
- Departments of Medical Imaging, Toronto, Ontario, Canada
| | - Hyun-Jung Jang
- Departments of Medical Imaging, Toronto, Ontario, Canada
| | - Tae Kyoung Kim
- Departments of Medical Imaging, Toronto, Ontario, Canada
| | - Korosh Khalili
- Departments of Medical Imaging, Toronto, Ontario, Canada
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Zhu ZH, Peng KP, Liu MH, Tian GX. Acoustic Radiation Force Impulse Imaging With Virtual Touch Tissue Quantification Enables Characterization of Mild Hypoxic-Ischemic Brain Damage in Neonatal Rats. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1797-1805. [PMID: 30480831 DOI: 10.1002/jum.14869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/25/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether the measurement of brain tissue stiffness using acoustic radiation force impulse (ARFI) elastography with virtual touch tissue quantification can improve the early detection of neonatal hypoxic-ischemic brain damage in rats. METHODS Seven-day-old Sprague-Dawley rats were randomly assigned to 3 groups: the mild asphyxia (n = 30), moderate asphyxia (n = 30), and sham control (n = 10) groups. Rats in the mild and moderate asphyxia groups were exposed to 8% oxygen (hypoxia) for 30 and 60 minutes, respectively, at 1 hour after ligation of the right common carotid artery. An ultrasound diagnostic instrument was used to obtain 2-dimensional ultrasound images, and ARFI with virtual touch tissue quantification was used to measure shear wave velocity preoperatively and at 12, 24, 48, and 72 hours postoperatively. Hematoxylin-eosin staining was used to evaluate brain damage. RESULTS Two-dimensional ultrasound imaging detected swelling and increased echogenicity at 48 to 72 hours in the mild asphyxia group and at 24 to 72 hours in the moderate asphyxia group. The shear wave velocity substantially increased from 0.65 ± 0.04 m/s preoperatively to 0.78 ± 0.07 m/s at 72 hours in the moderate asphyxia group and from 0.64 ± 0.04 m/s preoperatively to 0.70 ± 0.03 m/s at 72 hours in the mild asphyxia group. The changes in the shear wave velocity coincided with the histopathologic changes in the brain, which included neuronal demyelination, hyperplasia, and necrosis; edema around vascular structures; and hemorrhage in the ependymal and periventricular areas. CONCLUSION Shear wave velocity data obtained with the virtual touch tissue quantification technique may be used for early diagnosis of neonatal hypoxic-ischemic brain damage.
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Affiliation(s)
- Zhen-Hua Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital, Hunan University of Chinese Medical, Hunan Province, China
| | - Ke-Ping Peng
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital, Hunan University of Chinese Medical, Hunan Province, China
| | - Ming-Hui Liu
- Department of Ultrasound, The Second Xiangya Hospital, Central South University, Hunan Province, China
| | - Gui-Xiang Tian
- Department of Ultrasound, The Second Xiangya Hospital, Central South University, Hunan Province, China
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Carbonell G, Berná-Serna JDD, Oltra L, Martínez CM, Garcia-Carrillo N, Guzmán-Aroca F, Salazar FJ, Tudela J, Berná-Mestre JDD. Evaluation of rat liver with ARFI elastography: In vivo and ex vivo study. PLoS One 2019; 14:e0217297. [PMID: 31120974 PMCID: PMC6532896 DOI: 10.1371/journal.pone.0217297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare in vivo vs ex vivo liver stiffness in rats with acoustic radiation force impulse (ARFI) elastography using the histological findings as the gold standard. METHODS Eighteen male Wistar rats aged 16-18 months were divided into a control group (n = 6) and obese group (n = 12). Liver stiffness was measured with shear wave velocity (SWV) using the ARFI technique both in vivo and ex vivo. The degree of fibrosis, steatosis and liver inflammation was evaluated in the histological findings. Pearson's correlation coefficient was applied to relate the SWV values to the histological parameters. RESULTS The SWV values acquired in the ex vivo study were significantly lower than those obtained in vivo (P < 0.004). A significantly higher correlation value between the degree of liver fibrosis and the ARFI elastography assessment was observed in the ex vivo study (r = 0.706, P < 0.002), than the in vivo study (r = 0.623, P < 0.05). CONCLUSION Assessment of liver stiffness using ARFI elastography yielded a significant correlation between SWV and liver fibrosis in both the in vivo and ex vivo experiments. We consider that by minimising the influence of possible sources of artefact we could improve the accuracy of the measurements acquired with ARFI.
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Affiliation(s)
- Guillermo Carbonell
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- * E-mail:
| | - Juan de Dios Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Lidia Oltra
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Department of Physiology, School of Medicine, University of Murcia, Murcia, Spain
| | - Carlos M. Martínez
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Nuria Garcia-Carrillo
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Preclinical Imaging Unit, Laboratory Animal Service, University of Murcia, Murcia, Spain
| | - Florentina Guzmán-Aroca
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Francisco Javier Salazar
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Department of Physiology, School of Medicine, University of Murcia, Murcia, Spain
| | - José Tudela
- GENZ-Group of Research on Enzymology, Department of Biochemistry and Molecular Biology-A, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, Spain
| | - Juan de Dios Berná-Mestre
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
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Dhyani M, Xiang F, Li Q, Chen L, Li C, Bhan AK, Anthony B, Grajo JR, Samir AE. Ultrasound Shear Wave Elastography: Variations of Liver Fibrosis Assessment as a Function of Depth, Force and Distance from Central Axis of the Transducer with a Comparison of Different Systems. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2209-2222. [PMID: 30143339 PMCID: PMC6594152 DOI: 10.1016/j.ultrasmedbio.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 05/10/2023]
Abstract
We evaluated variation in fibrosis staging caused by depth, pre-load force and measurement off-axis distance on different ultrasound shear wave elastography (SWE) systems prospectively in 20 patients with diffuse liver disease. Shear wave speed (SWS) was measured with transient elastography, acoustic radiation force impulse (ARFI) and 2-D shear wave elastography (SWE). ARFI and 2-D-SWE measurements were obtained at different depths (3, 5 and 7 cm), with different pre-load forces (4, 7 and 10N and variable) and at 0, 2 and 4cm off the central axis of the transducer. A single, blinded pathologist staged fibrosis using the METAVIR system (F0-F4). Area under the receiver operating characteristic curve was charted to differentiate significant fibrosis (F ≥ 2). Depth was the only factor found to influence ARFI-derived values; no acquisition factors were found to affect 2-D-SWE SWS values. ARFI and 2-D-SWE for diagnosis of significant fibrosis at a depth of 7cm along the central axis had good diagnostic performance (areas under the receiver operating characteristic curve: 0.92 and 0.82, respectively), comparable to that of transient elastography. Further investigation of this finding will likely be of interest.
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Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Feixiang Xiang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Luzeng Chen
- Peking University First Hospital Ultrasound Center, Beijing, China
| | - Changtian Li
- Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, China
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Anthony
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Bob F, Grosu I, Sporea I, Bota S, Popescu A, Sima A, Şirli R, Petrica L, Timar R, Schiller A. Ultrasound-Based Shear Wave Elastography in the Assessment of Patients with Diabetic Kidney Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2159-2166. [PMID: 28720285 DOI: 10.1016/j.ultrasmedbio.2017.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 05/28/2023]
Abstract
In previous studies of acoustic radiation force impulse (ARFI) elastography, using Virtual Touch tissue quantification (VTQ) (Siemens Acuson S2000), it was reported that the measurement of renal shear wave speed in patients with chronic kidney disease (CKD) is not influenced exclusively by renal fibrosis. The purpose of the present study was to analyze the role of VTQ in patients with diabetic kidney disease, considered the main cause of CKD. The study group included 164 patients: 80 patients with diabetic kidney disease (DKD) and 84 without renal disease or diabetes mellitus. In each subject in lateral decubitus, five valid VTQ measurements were performed in each kidney and a median value was calculated, the result being expressed in meters/second. The following means of the median values were obtained In DKD patients, the means of the median values were for VTQ right kidney, 2.21 ± 0.71 m/s, and for VTQ left kidney, 2.13 ± 0.72 m/s, whereas in the normal controls statistically significant higher values were obtained: 2.58 ± 0.78 m/s for VTQ right kidney (p = 0.0017) and 2.46 ± 0.81 m/s for VTQ left kidney (p = 0.006). Patients with an estimated glomerular filtration rate (eGFR) >60 mL/min (DKD stages 1 and 2 together with normal controls) had a significantly higher kidney shear wave speed compared with patients with an eGFR <60 mL/min (2.53 m/s vs. 2.09 m/s, p < 0.05). In the DKD group, there was a significant correlation between eGFR and VTQ levels for the right kidney (r = 0.28, p = 0.04). There was no correlation of VTQ values with proteinuria level, stage of diabetic retinopathy or glycated hemoglobin. Our study indicates that shear wave speed values in patients with diabetic kidney disease and eGFRs <60 mL/min are significantly lower compared with those of patients with eGFRs >60 mL/min (either normal controls or diabetic patients with DKD stages 1 and 2), and values decrease with the decrease in eGFR. However, proteinuria, diabetic retinopathy and glycated hemoglobin have no influence on VTQ.
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Affiliation(s)
- Flaviu Bob
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Iulia Grosu
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania.
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Simona Bota
- Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt am Worthersee, Klagenfurt am Wortersee, Austria
| | - Alina Popescu
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Alexandra Sima
- Department of Diabetes, Nutrition and Metabolic Diseases, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Roxana Şirli
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Ligia Petrica
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Romulus Timar
- Department of Diabetes, Nutrition and Metabolic Diseases, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Adalbert Schiller
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
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Acoustic Radiation Force Impulse Elastography in Determining the Effects of Type 1 Diabetes on Pancreas and Kidney Elasticity in Children. AJR Am J Roentgenol 2017; 209:1143-1149. [PMID: 28871805 DOI: 10.2214/ajr.17.18170] [Citation(s) in RCA: 14] [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
OBJECTIVE The aim of this study is to determine the effects of type 1 diabetes on pancreas and kidney elasticity in children, using acoustic radiation force impulse ultrasound elastography. SUBJECTS AND METHODS Sixty autoantibody-positive patients with type 1 diabetes (45% girls; mean [± SD] age, 11.7 ± 4.4 years; range, 1.9-19.3 years) admitted to the pediatric endocrinology outpatient clinic and 32 healthy children (50% girls; mean age, 10.2 ± 3.8 years; range, 2.1-17.3 years) were included in the study. Acoustic radiation force impulse elastography measurements were performed of the kidneys and pancreas in both groups. Body mass index, duration of diabetes, HbA1c levels, and insulin dosage of patients with type 1 diabetes were recorded. RESULTS The mean shear-wave velocities of the pancreas were 0.99 ± 0.25 m/s in patients with type 1 diabetes and 1.09 ± 0.22 m/s in healthy control subjects; the difference was not significant (p = 0.08). The median shear-wave velocities of the right and left kidneys in patients with type 1 diabetes were 2.43 ± 0.29 and 2.47 ± 0.25 m/s, respectively. There were no significant differences in the shear-wave velocities of the right and left kidneys between the patients with type 1 diabetes and the healthy control subjects (p = 0.91 and p = 0.73, respectively). Correlation analysis showed no correlation between the shear-wave velocities of the pancreas and kidney versus HbA1c level, duration of diabetes, insulin dosage, height, weight, and body mass index of the patients with type 1 diabetes. CONCLUSION The current study showed no significant difference in the shear-wave velocity of kidneys in children with type 1 diabetes with normoalbuminuria compared with the healthy control subjects. We also observed that the shear-wave velocity of the pancreas in children with type 1 diabetes and healthy control subjects did not differ significantly.
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Hollerieth K, Gaßmann B, Wagenpfeil S, Kemmner S, Heemann U, Stock KF. Does standoff material affect acoustic radiation force impulse elastography? A preclinical study of a modified elastography phantom. Ultrasonography 2017; 37:140-148. [PMID: 29032665 PMCID: PMC5885480 DOI: 10.14366/usg.17002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/26/2017] [Accepted: 07/28/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This study was conducted to determine the influence of standoff material on acoustic radiation force impulse (ARFI) measurements in an elasticity phantom by using two different probes. METHODS Using ARFI elastography, 10 observers measured the shear wave velocity (SWV, m/sec) in different lesions of an elasticity phantom with a convex 4C1 probe and a linear 9L4 probe. The experimental setup was expanded by the use of an interposed piece of porcine muscle as standoff material. The probe pressure on the phantom was registered. RESULTS Faulty ARFI measurements occurred more often when quantifying the hardest lesion (74.0 kPa 4.97 m/sec) by the 9L4 probe with the porcine muscle as a standoff material interposed between the probe and the phantom. The success rate for ARFI measurements in these series was 52.4%, compared with 99.5% in the other series. The SWV values measured with the 9L4 probe were significantly higher (3.33±1.39 m/sec vs. 2.60±0.74 m/sec, P<0.001 in the group without muscle) and were closer to the reference value than those measured with the 4C1 probe (0.25±0.23 m/sec vs. 0.85±1.21 m/sec, P<0.001 in the same group). The SWV values measured when using the muscle as a standoff material were lower than those without the muscle (significant for 9L4, P=0.040). The deviation from the reference value and the variance increased significantly with the 9L4 probe if the muscle was in situ (B=0.27, P=0.004 and B=0.32, P<0.001). In our study, the pressure exerted by the operator had no effect on the SWV values. CONCLUSION The presence of porcine muscle acting as a standoff material influenced the occurrence of failed measurements as well as the variance and the accuracy of the measured values. The linear high-frequency probe was particularly affected.
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Affiliation(s)
- Katharina Hollerieth
- Department of Nephrology, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | | | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Saar, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Konrad Friedrich Stock
- Department of Nephrology, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
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Tang Y, Zhao J, Yu H, Wu H, Niu N. Acoustic Radiation Force Impulse and Doppler Ultrasonography: Comprehensive Evaluation of Acute Rejection After Liver Transplantation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1137-1145. [PMID: 28244127 DOI: 10.7863/ultra.16.05052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of our study was to evaluate the clinical application of color Doppler flow imaging (CDFI) and acoustic radiation force impulse (ARFI) for the diagnosis of acute rejection after liver transplantation. METHODS B-Mode CDFI and ARFI assessments were performed in 76 patients who underwent biopsy after liver transplantation at our institution, between October 2011 and October 2014. The study group included 56 patients with acute rejection confirmed by biopsy, with 20 patients whose liver function recovered within 1 month of transplantation forming the control group. Anteroposterior diameter of the liver, hemodynamic index (consisting of the portal vein diameter, portal vein flow velocity, and hepatic vein flow waveform), and ARFI shear wave velocity (SWV) were measured. We used logistic regression modeling and receiver operating curve to evaluate between-group differences. RESULTS Compared with the control group, patients with acute rejection exhibited increased anteroposterior diameter (P = .035) and change in hemodynamic index (P = .021), including increased portal vein diameter, decreased portal vein flow, and loss of triphasic waveform of hepatic vein flow. Acoustic radiation force impulse SWV was markedly increased in the acute rejection group (P < .001). The correlation r-value of measured parameters to acute rejection diagnosis was 0.253 for anterioposterior diameters, 0.271 for change in hemodynamic index, and 0.721 for increased SWV. Shear wave velocity and change in the hemodynamic index had diagnostic value, with an area under the receiver operating curve of 0.933. CONCLUSIONS Combining CDFI with ARFI was useful for the diagnosis of acute rejection after liver transplantation.
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Affiliation(s)
- Ying Tang
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Jingwen Zhao
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Huimin Yu
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Hongtao Wu
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Ningning Niu
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
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Murphy IG, Graves MJ, Reid S, Patterson AJ, Patterson I, Priest AN, Lomas DJ. Comparison of breath-hold, respiratory navigated and free-breathing MR elastography of the liver. Magn Reson Imaging 2017; 37:46-50. [DOI: 10.1016/j.mri.2016.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/13/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
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Petitclerc L, Sebastiani G, Gilbert G, Cloutier G, Tang A. Liver fibrosis: Review of current imaging and MRI quantification techniques. J Magn Reson Imaging 2016; 45:1276-1295. [PMID: 27981751 DOI: 10.1002/jmri.25550] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/27/2016] [Indexed: 12/13/2022] Open
Abstract
Liver fibrosis is characterized by the accumulation of extracellular matrix proteins such as collagen in the liver interstitial space. All causes of chronic liver disease may lead to fibrosis and cirrhosis. The severity of liver fibrosis influences the decision to treat or the need to monitor hepatic or extrahepatic complications. The traditional reference standard for diagnosis of liver fibrosis is liver biopsy. However, this technique is invasive, associated with a risk of sampling error, and has low patient acceptance. Imaging techniques offer the potential for noninvasive diagnosis, staging, and monitoring of liver fibrosis. Recently, several of these have been implemented on ultrasound (US), computed tomography, or magnetic resonance imaging (MRI). Techniques that assess changes in liver morphology, texture, or perfusion that accompany liver fibrosis have been implemented on all three imaging modalities. Elastography, which measures changes in mechanical properties associated with liver fibrosis-such as strain, stiffness, or viscoelasticity-is available on US and MRI. Some techniques assessing liver shear stiffness have been adopted clinically, whereas others assessing strain or viscoelasticity remain investigational. Further, some techniques are only available on MRI-such as spin-lattice relaxation time in the rotating frame (T1 ρ), diffusion of water molecules, and hepatocellular function based on the uptake of a liver-specific contrast agent-remain investigational in the setting of liver fibrosis staging. In this review, we summarize the key concepts, advantages and limitations, and diagnostic performance of each technique. The use of multiparametric MRI techniques offers the potential for comprehensive assessment of chronic liver disease severity. LEVEL OF EVIDENCE 5 J. MAGN. RESON. IMAGING 2017;45:1276-1295.
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Affiliation(s)
- Léonie Petitclerc
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Giada Sebastiani
- Department of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Guillaume Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada.,MR Clinical Science, Philips Healthcare Canada, Markham, Ontario, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Institute of Biomedical Engineering, Université de Montréal, CP 6128, Succursale Centre-ville, Montréal, Québec, Canada.,Laboratory of Biorheology and Medical Ultrasonics, CRCHUM, 900 Saint-Denis, Montréal, Québec, Canada
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Institute of Biomedical Engineering, Université de Montréal, CP 6128, Succursale Centre-ville, Montréal, Québec, Canada
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Bruno C, Minniti S, Bucci A, Pozzi Mucelli R. ARFI: from basic principles to clinical applications in diffuse chronic disease-a review. Insights Imaging 2016; 7:735-46. [PMID: 27553006 PMCID: PMC5028343 DOI: 10.1007/s13244-016-0514-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/05/2016] [Accepted: 07/19/2016] [Indexed: 12/11/2022] Open
Abstract
Abstract The many factors influencing the shear wave velocity (SWV) measured with Acoustic Radiation Force Impulse (ARFI) are examined in order to define the most correct examination technique. In particular, attention is given to the information achieved by experimental models, such as phantoms and animal studies. This review targets the clinical applications of ARFI in the evaluation of chronic diffuse disease, especially of liver and kidneys. The contribution of ARFI to the clinical workout of these patients and some possible perspectives are described. Teaching Points • Stiffness significantly varies among normal and abnormal biological tissues. • In clinical applications physical, geometrical, anatomical and physiological factors influence the SWV. • Elastographic techniques can quantify fibrosis, which is directly related to stiffness. • ARFI can be useful in chronic diffuse disease of liver and kidney.
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Affiliation(s)
- Costanza Bruno
- Department of Radiology, Verona University, P.le LA Scuro 10, 37134, Verona, Italy.
| | | | - Alessandra Bucci
- Department of Radiology, Verona University, P.le LA Scuro 10, 37134, Verona, Italy
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Hollerieth K, Gaßmann B, Wagenpfeil S, Moog P, Vo-Cong MT, Heemann U, Stock KF. Preclinical evaluation of acoustic radiation force impulse measurements in regions of heterogeneous elasticity. Ultrasonography 2016; 35:345-52. [PMID: 27599889 PMCID: PMC5040141 DOI: 10.14366/usg.16024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 01/02/2023] Open
Abstract
Purpose The purpose of this study was to compare the reliability of ultrasound-based shear wave elastography in regions of homogeneous versus heterogeneous elasticity by using two different probes. Methods Using acoustic radiation force impulse (ARFI) elastography, we measured the shear wave velocity (SWV) in different lesions of an elastography phantom with the convex 4C1 probe and the linear 9L4 probe. The region of interest (ROI) was positioned in such a way that it was partly filled by one of the lesions (0%, 25%, 50%, 75%, and 100%) and partly by the background of the phantom (100%, 75%, 50%, 25%, and 0%, respectively). Results The success rate was 98.5%. The measured value and the reference value of SWV correlated significantly (r=0.89, P<0.001). Further, a comparison of the two probes revealed that there was no statistical difference in either the mean or the variance values. However, the deviation of SWV from the reference was higher in the case of the 9L4 probe than in the case of the 4C1 probe, both overall and in measurements in which the ROI contained structures of different elasticity (P=0.021 and P=0.002). Taking into account all data, for both probes, we found that there was a greater spread and deviation of the SWV from the reference value when the ROI was positioned in structures having different elastic properties (standard deviation, 0.02±0.01 m/sec vs. 0.04±0.04 m/sec; P=0.010; deviation from the reference value, 0.21±0.12 m/sec vs. 0.38±0.27 m/sec; P=0.050). Conclusion Quantitative ARFI elastography was achievable in structures of different elasticity; however, the validity and the reliability of the SWV measurements decreased in comparison to those of the measurements performed in structures of homogeneous elasticity. Therefore, a convex probe is preferred for examining heterogeneous structures.
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Affiliation(s)
- Katharina Hollerieth
- Nephrology Department, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | | | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg (Saar), Homburg, Germany
| | - Philipp Moog
- Nephrology Department, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Minh-Truc Vo-Cong
- Nephrology Department, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Nephrology Department, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Konrad Friedrich Stock
- Nephrology Department, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
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Park JE, Choi YJ, Lee SS, Lee JH, Baek JH. Assessment of Measurement Repeatability and Reliability With Virtual Touch Tissue Quantification Imaging in Cervical Lymphadenopathy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:927-932. [PMID: 27022174 DOI: 10.7863/ultra.15.06067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to prospectively assess the repeatability and reliability of 2 measurements of cervical lymphadenopathy using Virtual Touch tissue quantification (VTQ) imaging (Siemens Medical Solutions, Mountain View, CA) and to analyze the factors affecting the reliability of the measurements, including pathologic findings, lesion size and location, and shear wave velocities (SWVs). METHODS In this Institutional Review Board-approved prospective study, 92 patients underwent conventional sonography and 2 VTQ measurements by acoustic radiation force impulse imaging in a single session. The repeatability and reliability of the SWV measurement was determined by using an average coefficient of variation (standard deviation/mean) and intraclass correlation coefficient (ICC), respectively. By comparing ICCs with a 95% confidence interval, the effects of pathologic findings, depth, size, SWV, and distance from the carotid artery on reliability were assessed. RESULTS The mean age of the 92 patients included in the study was 51 years (range, 14-77 years). The average coefficient of variation was 19.4%. The overall reliability of the 2 measurements was excellent (ICC, 0.837), but ICCs were significantly decreased in lymph nodes in a superficial location (<1 cm) and those with a low SWV (<1.8 m/s). No significant effect was found on reliability in relation to pathologic findings, lesion size, or distance from the carotid artery to the lymph nodes. CONCLUSIONS For SWV measurement by VTQ imaging, the repeatability was 19.4%, and reliability was excellent. However, caution is warranted in the use of VTQ imaging for superficial soft cervical lymph nodes, as both a superficial location and a soft composition tend to be characterized by low reliability of SWV findings.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Gao J, Zheng X, Zheng YY, Zuo GQ, Ran HT, Auh YH, Waldron L, Chan T, Wang ZG. Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:951-958. [PMID: 27036168 DOI: 10.7863/ultra.15.07009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assess the feasibility of splenic shear wave elastography in monitoring transjugular intrahepatic portosystemic shunt (TIPS) function. METHODS We measured splenic shear wave velocity (SWV), main portal vein velocity (PVV), and splenic vein velocity (SVV) in 33 patients 1 day before and 3 days to 12 months after TIPS placement. We also measured PVV, SVV, and SWV in 10 of 33 patients with TIPS dysfunction 1 day before and 3 to 6 days after TIPS revision. Analyses included differences in portosystemic pressure gradient (PPG), PVV, SVV, and mean SWV before and after TIPS procedures; comparison of median SWV before and after TIPS procedures; differences in PVV, SVV, and SWV before and at different times up to 12 months after TIPS placement; accuracy of PVV, SVV, and SWV in determining TIPS dysfunction; and correlation between PPG and SWV. RESULTS During 12 months of follow-up, 23 of 33 patients had functioning TIPS, and 10 had TIPS dysfunction. The median SWV was significantly different before and after primary TIPS placement (3.60 versus 3.05 m/s; P = .005), as well as before and after revision (3.73 versus 3.06 m/s; P = .003). The PPG, PVV, and SVV were also significantly different before and after TIPS placement and revision (P < .001). The PPG and SWV decreased, whereas PVV and SVV increased, after successful TIPS procedures. A positive correlation was observed between PPG and SWV (r = 0.70; P < .001), and a negative correlation was observed between PPG and PVV and SVV (r = -0.65; P < .001). The areas under the receiver operating characteristic curve for PVV, SVV, and SWV in determining TIPS dysfunction were 0.82, 0.84, and 0.81, respectively. CONCLUSIONS Splenic SWV is compatible with splenoportal venous velocity in quantitatively monitoring TIPS function and determining TIPS dysfunction.
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Affiliation(s)
- Jing Gao
- Department of Radiology, Well Cornel Medical College, New York, New York USA
| | - Xiao Zheng
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuan-Yi Zheng
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guo-Qing Zuo
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hai-Tao Ran
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yong Ho Auh
- Department of Radiology, Well Cornel Medical College, New York, New York USA
| | - Levi Waldron
- City University of New York, School of Public Health, Hunter College, New York, New York USA
| | - Tiffany Chan
- City University of New York, School of Public Health, Hunter College, New York, New York USA
| | - Zhi-Gang Wang
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Porra L, Swan H, Ho C. The effect of applied transducer force on acoustic radiation force impulse quantification within the left lobe of the liver. Australas J Ultrasound Med 2015; 18:100-106. [PMID: 28191250 PMCID: PMC5024960 DOI: 10.1002/j.2205-0140.2015.tb00208.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Acoustic Radiation Force Impulse (ARFI) Quantification measures shear wave velocities (SWVs) within the liver. It is a reliable method for predicting the severity of liver fibrosis and has the potential to assess fibrosis in any part of the liver, but previous research has found ARFI quantification in the right lobe more accurate than in the left lobe. A lack of standardised applied transducer force when performing ARFI quantification in the left lobe of the liver may account for some of this inaccuracy. The research hypothesis of this present study predicted that an increase in applied transducer force would result in an increase in SWVs measured. Methods: ARFI quantification within the left lobe of the liver was performed within a group of healthy volunteers (n = 28). During each examination, each participant was subjected to ARFI quantification at six different levels of transducer force applied to the epigastric abdominal wall. Results: A repeated measures ANOVA test showed that ARFI quantification was significantly affected by applied transducer force (p = 0.002). Significant pairwise comparisons using Bonferroni correction for multiple comparisons showed that with an increase in applied transducer force, there was a decrease in SWVs. Conclusion: Applied transducer force has a significant effect on SWVs within the left lobe of the liver and it may explain some of the less accurate and less reliable results in previous studies where transducer force was not taken into consideration. Future studies in the left lobe of the liver should take this into account and control for applied transducer force.
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Affiliation(s)
| | - Hans Swan
- School of Dentistry and Health Sciences Charles Sturt University Wagga Wagga New South Wales Australia
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25
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Yang C, Hu M, Zhu T, He W. Evaluation of kidney allograft status using novel ultrasonic technologies. Asian J Urol 2015; 2:142-150. [PMID: 29264134 PMCID: PMC5730712 DOI: 10.1016/j.ajur.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 01/26/2023] Open
Abstract
Early diagnosis of kidney allograft injury contributes to proper decisions regarding treatment strategy and promotes the long-term survival of both the recipients and the allografts. Although biopsy remains the gold standard, non-invasive methods of kidney allograft evaluation are required for clinical practice. Recently, novel ultrasonic technologies have been applied in the evaluation and diagnosis of kidney allograft status, including tissue elasticity quantification using acoustic radiation force impulse (ARFI) and contrast-enhanced ultrasonography (CEUS). In this review, we discuss current opinions on the application of ARFI and CEUS for evaluating kidney allograft function and their possible influencing factors, advantages and limitations. We also compare these two technologies with other non-invasive diagnostic methods, including nuclear medicine and radiology. While the role of novel non-invasive ultrasonic technologies in the assessment of kidney allografts requires further investigation, the use of such technologies remains highly promising.
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Affiliation(s)
- Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Mushuang Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Imaging Medicine, Shanghai, China
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26
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Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, Cosgrove D, Dietrich CF, Amy D, Bamber JC, Barr R, Chou YH, Ding H, Farrokh A, Friedrich-Rust M, Hall TJ, Nakashima K, Nightingale KR, Palmeri ML, Schafer F, Shiina T, Suzuki S, Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1161-79. [PMID: 25800942 DOI: 10.1016/j.ultrasmedbio.2015.03.007] [Citation(s) in RCA: 443] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced these guidelines for the use of elastography techniques in liver disease. For each available technique, the reproducibility, results, and limitations are analyzed, and recommendations are given. Finally, recommendations based on the international literature and the findings of the WFUMB expert group are established as answers to common questions. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Carlo Filice
- Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Clichy, Assistance Publique-Hôpitaux de Paris, INSERM U 773 CRB3, Université Denis Diderot Paris-VII, Paris, France
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timişoara, Romania
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - David Cosgrove
- Division of Radiology, Imperial and Kings Colleges, London, UK
| | | | - Dominique Amy
- Breast Center, 21 ave V. Hugo, 13100 Aix-en-Provence, France
| | - Jeffrey C Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Richard Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA
| | - Yi-Hong Chou
- Department of Radiology, Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Andre Farrokh
- Department of Gynecology and Obstetrics, Franziskus Hospital, Bielefeld, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | | | - Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Fritz Schafer
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - Tsuyoshi Shiina
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Suzuki
- Department of Endocrinology and Surgery, Fukushima University, Fukushima, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan.
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Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions. AJR Am J Roentgenol 2015; 205:33-40. [PMID: 25905762 DOI: 10.2214/ajr.15.14553] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of the article is to review the diagnostic performance of ultra-sound and MR elastography techniques for detection and staging of liver fibrosis, the main current clinical applications of elastography in the abdomen. CONCLUSION Technical and instrument-related factors and biologic and patient-related factors may constitute potential confounders of stiffness measurements for assessment of liver fibrosis. Future developments may expand the scope of elastography for monitoring liver fibrosis and predict complications of chronic liver disease.
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28
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Tomita H, Fuchimoto Y, Ohkuma K, Hoshino K, Fujino A, Kato M, Fujimura T, Ishihama H, Takahashi N, Tanami Y, Nakatsuka S, Ebinuma H, Saito H, Shinoda M, Kitagawa Y, Kuroda T. Spleen stiffness measurements by acoustic radiation force impulse imaging after living donor liver transplantation in children: a potential quantitative index for venous complications. Pediatr Radiol 2015; 45:658-66. [PMID: 25501257 DOI: 10.1007/s00247-014-3215-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/18/2014] [Accepted: 10/20/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Living donor liver transplantation in children often results in venous complications, leading to portal hypertension. Spleen stiffness measurements have been recently proposed as a new, noninvasive parameter for portal hypertension in cirrhotic patients. OBJECTIVE To evaluate the diagnostic value of spleen stiffness measurements by acoustic radiation force impulse (ARFI) imaging in diagnosing venous complications after pediatric living donor liver transplantation. MATERIALS AND METHODS We prospectively enrolled 69 patients after pediatric living donor liver transplantation using a left-side liver allograft. Around the time of the protocol liver biopsy examination, spleen stiffness measurements by ARFI imaging were performed via the left intercostal space at the center of the spleen parenchyma and repeated five times. Imaging examinations around the time of the spleen stiffness measurements were retrospectively reviewed. Regarding venous complications, significant portal and hepatic venous stenosis was defined as >50% stenosis on multiphasic computed tomography. RESULTS After post hoc exclusion, 62 patients were studied. Portal and hepatic venous stenosis was identified in three and two patients, respectively. The median spleen stiffness values were 2.70 and 4.00 m/s in patients without and with venous complications, respectively (P < 0.001). Spleen stiffness measurements showed good diagnostic power for venous complications, and the cutoff value was determined as 2.93 m/s, with 100% sensitivity and 78.9% specificity. Spleen stiffness measurements decreased with the relief of venous stenosis resulting from an interventional radiology procedure. CONCLUSION Spleen stiffness measurements by ARFI imaging might provide a useful quantitative index for venous complications after pediatric living donor liver transplantation.
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Affiliation(s)
- Hirofumi Tomita
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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29
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Novelli PM, Cho K, Rubin JM. Sonographic assessment of spleen stiffness before and after transjugular intrahepatic portosystemic shunt placement with or without concurrent embolization of portal systemic collateral veins in patients with cirrhosis and portal hypertension: a feasibility study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:443-449. [PMID: 25715365 DOI: 10.7863/ultra.34.3.443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine the feasibility of spleen stiffness measurement in the evaluation of portal hemodynamics in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. METHODS We prospectively correlated the spleen stiffness as measured by the shear wave velocity with the portal pressure and portosystemic gradient in patients undergoing TIPS procedures. Twenty-three consecutive patients referred for placement of a TIPS were enrolled. Included in our study were 19 patients in whom a spleen stiffness measurement was obtained before, immediately after, and 1 to 3 days after placement. Spleen stiffness was measured by calculating the Young modulus estimated from the shear wave velocity. A 2-tailed nonparametric Mann-Whitney U test was used to assess statistically significant differences in spleen stiffness measurement after TIPS placement, and regression analysis was used to correlate spleen stiffness measurement with portal pressure. RESULTS After TIPS placement, the spleen stiffness measurement increased, with a mean increase in the Young modulus ± SD of 6.54 ± 6.29 kPa in 42% of patients (8 of 19). In the remaining 58% (11 of 19), the spleens became softer after TIPS placement (Young modulus decreased by 9.57 ± 8.82 kPa). Eight patients, including 5 with concurrent embolization or thrombosis of competitive shunts, had increased spleen stiffness. The mean change in the median spleen stiffness before and after TIPS placement between the patients with and without competitive shunts was statistically significantly different (P < .04, nonparametric Mann-Whitney U test). There was no measurable correlation between spleen stiffness measurement and portal pressure before and after TIPS placement. CONCLUSIONS This study demonstrates the feasibility of a noninvasive spleen stiffness measurement, which could complement conventional sonography with additional functional information in patients undergoing TIPS procedures.
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Affiliation(s)
- Paula M Novelli
- Department of Radiology, Divisions of Vascular and Interventional Radiology (P.M.N., K.C.) and Abdominal Imaging (J.M.R.), University of Michigan Health System, Ann Arbor, Michigan USA.
| | - Kyung Cho
- Department of Radiology, Divisions of Vascular and Interventional Radiology (P.M.N., K.C.) and Abdominal Imaging (J.M.R.), University of Michigan Health System, Ann Arbor, Michigan USA
| | - Jonathan M Rubin
- Department of Radiology, Divisions of Vascular and Interventional Radiology (P.M.N., K.C.) and Abdominal Imaging (J.M.R.), University of Michigan Health System, Ann Arbor, Michigan USA
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30
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Bota S, Bob F, Sporea I, Şirli R, Popescu A. Factors that influence kidney shear wave speed assessed by acoustic radiation force impulse elastography in patients without kidney pathology. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1-6. [PMID: 25438855 DOI: 10.1016/j.ultrasmedbio.2014.07.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 07/12/2014] [Accepted: 07/31/2014] [Indexed: 05/28/2023]
Abstract
Our aim was to assess kidney shear wave speed by means of acoustic radiation force impulse (ARFI) elastography in patients without kidney pathology ("normal" patients) and to identify the factors that influence it. We analyzed 91 "normal" patients in whom kidney shear wave speed was assessed by means of ARFI elastography. Five valid ARFI elastographic measurements were obtained in all "normal" patients in both kidneys. In univariate analysis, age (r = -0.370, p = 0.003), gender (female vs. male, r = -0.305, p = 0.003) and measurement depth (r = -0.285, p = 0.01) were significantly correlated with kidney shear wave speed values assessed by ARFI elastography, whereas body mass index, kidney length and renal parenchyma thickness were not correlated. In multivariate analysis, only age (p = 0.006) and gender (p = 0.03) were significantly correlated with kidney shear wave speed values. In conclusion, kidney shear wave speed values assessed by ARFI elastography in "normal" patients are influenced mainly by age and gender and less by measurement depth.
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Affiliation(s)
- Simona Bota
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Flaviu Bob
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania.
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Roxana Şirli
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
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31
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Holdsworth A, Bradley K, Birch S, Browne WJ, Barberet V. Elastography of the normal canine liver, spleen and kidneys. Vet Radiol Ultrasound 2014; 55:620-7. [PMID: 24842271 DOI: 10.1111/vru.12169] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/02/2014] [Indexed: 12/12/2022] Open
Abstract
Elastography is a simple, expedient and noninvasive technique that may be used to assess the elasticity or stiffness of a tissue, in conjunction with traditional B-mode ultrasonography. Quantitative assessment of tissue stiffness can be made which involves measurement of the shear wave velocity within the tissue of interest. The goal of this study was to assess the feasibility of elastography for clinical use in the abdomen of conscious small animals and to investigate factors that affect shear wave velocity measurement. Elastography was performed on the liver, spleen, and kidneys of 15 dogs at predefined depths within the parenchyma. Breed, age, gender, neuter status, and weight were documented for each animal. Depth at which measurements were taken had a significant negative relationship with the shear wave velocity value obtained. Individual dog effects, such as weight and gender, also appeared to have a significant effect on the shear wave velocity measurement for specific organs; weight had a significant positive effect on the shear wave velocity for each of the organs examined, whereas the effect of gender was inconsistent between organs (having a positive effect for the liver and a negative effect for the spleen). It is hoped that these results may act as a baseline to guide further work into the field of elastography in companion animals.
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Affiliation(s)
- Andrew Holdsworth
- Radiology Department, University of Bristol Veterinary Hospital, Bristol, BS40 5DU, UK
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32
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Fontanilla T, Cañas T, Macia A, Alfageme M, Gutierrez Junquera C, Malalana A, Luz Cilleruelo M, Roman E, Miralles M. Normal values of liver shear wave velocity in healthy children assessed by acoustic radiation force impulse imaging using a convex probe and a linear probe. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:470-477. [PMID: 24361222 DOI: 10.1016/j.ultrasmedbio.2013.10.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/26/2013] [Accepted: 10/30/2013] [Indexed: 06/03/2023]
Abstract
Acoustic radiation force impulse (ARFI) is an image-guided ultrasound elastography method that allows quantification of liver stiffness by measurement of shear wave velocity. One purpose of the work described in this article was to determine the normal liver stiffness values of healthy children using ARFI with two different probes, 4 C1 and 9 L4. Another purpose was to evaluate the effects of site of measurement, age, gender and body mass index on liver stiffness values. This prospective study included 60 healthy children (newborn to 14 y) divided into four age groups. One thousand two hundred ARFI measurements were performed, that is, 20 measurements per patient (5 measurements in each lobe, with each probe). Means, standard deviations (SD) and confidence intervals for velocity were calculated for each hepatic lobe and each probe in each age group and for the whole group. Mean shear wave velocity measured in the right lobe was 1.19 ± 0.04 m/s (SD = 0.13) with the 4 C1 transducer and 1.15 ± 0.04 m/s (SD = 0.15) with the 9 L4 transducer. Age had a small effect on shear wave measurements. Body mass index and sex had no significant effects on ARFI values, whereas site of measurement had a significant effect, with lower ARFI values in the right hepatic lobe. ARFI is a non-invasive technique that is feasible to perform in children with both the 4 C1 and 9 L4 probes. The aforementioned velocity values obtained in the right lobe may be used as reference values for normal liver stiffness in children.
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Affiliation(s)
- Teresa Fontanilla
- Radiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | | | | | - Marta Alfageme
- Radiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Ana Malalana
- Pediatrics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Luz Cilleruelo
- Pediatrics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Enriqueta Roman
- Pediatrics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Miralles
- Radiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Wang CZ, Zheng J, Huang ZP, Xiao Y, Song D, Zeng J, Zheng HR, Zheng RQ. Influence of measurement depth on the stiffness assessment of healthy liver with real-time shear wave elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:461-469. [PMID: 24361224 DOI: 10.1016/j.ultrasmedbio.2013.10.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to determine the measurement depth range within which liver stiffness can be reliably assessed using real-time shear wave elastography (SWE) technology. Measurements were performed on phantoms and healthy volunteers. In the first group of patients, measurements were performed at depths of 2-8 cm from the probe surface. In the second group of patients, measurements were conducted 0-7 cm below the liver capsule. Success rate of measurements (SRoM), success rate of patients (SRoS) and coefficients of variation (CVs) of repeated measurements were compared. The SRoMs at 3-7 cm and the CVs at 2-5 cm from the probe surface were significantly higher and lower than those at other depths (p < 0.001), respectively. SRoS was zero 0-1 cm below the liver capsule. Furthermore, the features of 2-D stiffness mapping images were also found to change with depth. According to our results, the depth range for the most reliable liver stiffness assessment using SWE should be 3-5 cm from the probe surface and simultaneously 1-2 cm below the liver capsule.
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Affiliation(s)
- Cong-Zhi Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jian Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ze-Ping Huang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Dan Song
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jie Zeng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hai-Rong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Rong-Qin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Bruno C, Caliari G, Zaffanello M, Brugnara M, Zuffante M, Cecchetto M, Minniti S, Pedot A, Talamini G, Pozzi-Mucelli R. Acoustic radiation force impulse (ARFI) in the evaluation of the renal parenchymal stiffness in paediatric patients with vesicoureteral reflux: preliminary results. Eur Radiol 2013; 23:3477-84. [PMID: 23881301 DOI: 10.1007/s00330-013-2959-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 06/04/2013] [Accepted: 06/07/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To prospectively evaluate acoustic radiation force impulse (ARFI) imaging of the kidneys in children with and without chronic renal disease. METHODS Twenty-eight children (age range 9-16 years) with primary or secondary vesicoureteral reflux (≥ grade III) underwent scintigraphy and ultrasound with ARFI. Kidneys were divided-according to scintigraphy-into "affected" and "contralateral"; the results were compared with 16 age-matched healthy subjects. An ARFI value, expressed as speed (m/s) of wave propagation through the tissue, was calculated for each kidney through the mean of the values obtained at the upper, middle and lower third. The Wilcoxon test was used; P values <0.05 were considered statistically significant. RESULTS The mean ARFI values obtained in the "affected" kidneys (5.70 ± 1.71 m/s) were significantly higher than those measured in both "contralateral" (4.09 ± 0.97, P < 0.0001) and "healthy" kidneys (3.13 ± 0.09, P < 0.0001). The difference between values in the "contralateral" kidneys and "healthy" ones was significant (P < 0.0001). The "affected" kidneys with secondary reflux had mean ARFI values (6.59 ± 1.45) significantly higher than those with primary reflux (5.35 ± 1.72). CONCLUSIONS ARFI values decrease from kidneys with secondary vesicoureteral reflux to kidneys with primary reflux to unaffected kidneys contralateral to reflux to normal kidneys.
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Affiliation(s)
- Costanza Bruno
- Department of Radiology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy,
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Behrens CB, Langholz JH, Eiler J, Jenewein R, Naehrlich L, Fuchs K, Harth S, Krombach GA, Alzen GFP. A pilot study of the characterization of hepatic tissue strain in children with cystic-fibrosis-associated liver disease (CFLD) by acoustic radiation force impulse imaging. Pediatr Radiol 2013. [PMID: 23192669 DOI: 10.1007/s00247-012-2560-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Progressive fibrotic alterations of liver tissue represent a major complication in children with cystic fibrosis. Correct assessment of cystic-fibrosis-associated liver disease (CFLD) in clinical routine is a challenging issue. Sonographic elastography based on acoustic radiation force impulse imaging (ARFI) is a new noninvasive approach for quantitatively assessing in vivo elasticity of biological tissues in many organs. OBJECTIVE To characterize ARFI elastography as a diagnostic tool to assess alteration of liver tissue elasticity related to cystic fibrosis in children. MATERIALS AND METHODS ARFI elastography and B-mode US imaging were performed in 36 children with cystic fibrosis. The children's clinical history and laboratory parameters were documented. According to the findings on conventional US, children were assigned to distinct groups indicating severity of hepatic tissue alterations. The relationship between US findings and respective elastography values was assessed. Additionally, differences between ARFI elastography values of each US group were statistically tested. RESULTS Children with sonomorphologic characteristics of fibrotic tissue remodeling presented significantly increased values for tissue elasticity. Children with normal B-mode US or discrete signs of hepatic tissue alterations showed a tendency toward increased tissue stiffness indicating early tissue remodeling. CONCLUSION Assessment of children with CFLD by means of ARFI elastography yields adequate results when compared to conventional US. For detection of early stages of liver disease with mild fibrotic reactions of hepatic tissue, ARFI elastography might offer diagnostic advantages over conventional US. Thus, liver stiffness measured by means of elastography might represent a valuable biological parameter for evaluation and follow-up of CFLD.
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Affiliation(s)
- Christopher B Behrens
- Department of Pediatric Radiology, University Hospital Giessen, Feulgenstrasse 10-12, 35392, Giessen, Germany.
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Ran HT, Ye XP, Zheng YY, Zhang DZ, Wang ZG, Chen J, Madoff D, Gao J. Spleen stiffness and splenoportal venous flow: assessment before and after transjugular intrahepatic portosystemic shunt placement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:221-228. [PMID: 23341376 DOI: 10.7863/jum.2013.32.2.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To prospectively assess changes in spleen stiffness and splenoportal venous flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. METHODS We prospectively evaluated spleen stiffness measured by the mean shear wave velocity with acoustic radiation force impulse imaging and the splenoportal venous velocity with color Doppler sonography in 12 patients (mean age ± SD, 42.6 ± 11.0 years; range, 29-65 years) who underwent TIPS placement for portal hypertension and gastroesophageal bleeding. The mean shear wave velocity and angle-corrected splenoportal venous velocity at the main portal and splenic veins were measured 1 day before and 3 to 9 days after TIPS placement (mean interval, 6.0 ± 1.95 days; range, 4-10 days) and were compared with portal vein pressure measured during the procedure. RESULTS There was a significant difference in portal vein pressure before and after TIPS (25.34 ± 6.21 versus 15.66 ± 6.07 mm Hg; P = .0005). After TIPS, the mean shear wave velocity decreased significantly in all 12 cases (3.50 ± 0.46 versus 3.15 ± 0.39 m/s before and after TIPS; P = .00015). The flow velocity at the main portal vein increased significantly after TIPS (22.21 ± 4.13 versus 47.25 ± 12.37 cm/s; P = .0000051). The splenic vein velocity and spleen index measured 25.57 ± 6.98 cm/s and 55.99 ± 21.27 cm(2), respectively, before TIPS and 35.72 ± 11.10 cm/s and 50.11 ± 21.12 cm(2) after TIPS (P = .0004 and .003). CONCLUSIONS A significant decrease in the mean shear wave velocity and increase in the splenoportal venous velocity occurred with reduced portal vein pressure after TIPS placement. Hence, both parameters can be used as noninvasive quantitative markers for monitoring TIPS function after placement.
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Affiliation(s)
- Hai-Tao Ran
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Yamanaka N, Kaminuma C, Taketomi-Takahashi A, Tsushima Y. Reliable measurement by virtual touch tissue quantification with acoustic radiation force impulse imaging: phantom study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1239-1244. [PMID: 22837288 DOI: 10.7863/jum.2012.31.8.1239] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the factors that may affect shear wave velocity (SWV) measurements by using a phantom. METHODS The SWVs (meters per second) of 4 phantom targets and background, each of different hardness (Young modulus, 8-80 kPa), were measured in the virtual touch tissue quantification mode. Ten SWV measurements were performed on each target, and the mean SWV and its standard deviation were calculated. To assess the effect of the distance between the probe and region of interest (ROI) settings, mean SWV measurements of the background at 5 to 80 mm in depth were performed with a convex probe and at 5 to 40 mm with a high-frequency linear probe. RESULTS The linear correlation between the nominal Young modulus of the phantom and those calculated from the mean SWV was highly significant for the linear probe (y = 0.98x - 0.70; r(2) = 0.99; P = .0007). For the convex probe, the linear correlation between the nominal Young modulus of the phantom and those calculated from the mean SWV was highly significant between 8 and 40 kPa (y =1.26x + 1.01; r(2) = 0.98; P = .011). Measurement variations for the linear probe were little influenced by the distance between the probe and ROI, but those for the convex probe were dependent on the distance. CONCLUSIONS The accuracy of the mean SWV measurement was dependent on the probe used and the distance between the probe and ROI settings. The linear probe provides accurate measurements throughout its range for all but its deepest limit. Measurements of 40 mm or deeper are better performed with a convex probe. Probe selection should be based on individual lesion depth.
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Affiliation(s)
- Noriko Yamanaka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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The stiffness of the liver and spleen on ARFI Imaging pre and post TIPS placement: a preliminary observation. Clin Imaging 2012; 36:135-41. [PMID: 22370134 DOI: 10.1016/j.clinimag.2011.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE To prospectively assess the stiffness of the liver and spleen with acoustic radiation force impulse (ARFI) imaging pre and post transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIAL AND METHODS Between February, 2011 and September, 2011, we prospectively measured stiffness of the liver and spleen with mean shear wave velocity (MSV, m/s) on ARFI imaging in 10 healthy volunteers (mean age 32.2 ± 10.3 years, age range 23-53 years) and 10 patients (mean age, 38.6 ± 6.4 years, age range 30-48 years) who underwent TIPS placement for treatment of portal hypertension (PHTN). The portal vein pressure was measured while placing the TIPS. To assess the changes in the stiffness of the liver and spleen following TIPS placement, we measured MSV of the liver and spleen one day before TIPS insertion and 4-9 days after TIPS placement (mean interval 5.9 ± 2.0 days, interval range 5 to 10 days). RESULTS There was significant difference in portal vein pressure pre (27.67 ± 5.86 mmHg) and post (18.00 ± 6.93 mmHg) TIPS insertion (P<.01). The MSV of the liver in healthy subjects, patients with PHTN pre TIPS and patients with PHTN post TIPS measured 1.16 ± 0.06 m/s, 2.48 ± 0.39 m/s, and 2.37 ± 0.28 m/s, respectively. The MSV of the spleen in healthy subjects, patients with PHTN pre TIPS and patients with PHTN post TIPS measured 2.22 ± 0.22 m/s, 3.65 ± 0.32 m/s, and 3.27 ± 0.30 m/s, respectively. There were significant differences in MSV of the liver and spleen between healthy subjects and patients with PHTN (all P<.001). There was no significant difference in MSV of the liver pre and post TIPS placement (P>.05). However, a statistically significant difference in MSV of the spleen pre and Post TIPS placement (P<.001) was demonstrated. In addition, we observed a significant difference in spleen index between healthy subjects and patients with PHTN (P<.001), as well as between pre and post TIPS placement (P<.01). CONCLUSION The MSV of the spleen measured with ARFI correlates well with portal vein pressure. Hence, the spleen stiffness by means of MSV on ARFI imaging can be used as a quantitative marker in monitoring the portal vein pressure as the function of the TIPS.
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Barr RG, Zhang Z. Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:895-902. [PMID: 22644686 DOI: 10.7863/jum.2012.31.6.895] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Elastography of the breast is a new technique for characterization of breast lesions. The reproducibility of elastographic techniques has been questioned. Precompression is known to effect elastographic results. This study determined the effect of precompression on clinical images and proposes a method to semiquantify the amount of precompression applied. METHODS Ten patients with different breast tissue types were evaluated with shear wave and strain elastography with varying amounts of precompression. The changes in the shear wave speed and images were documented. A semiquantitative method for determining the amount of precompression applied is presented. The reproducibility of the technique was determine by repeated measurements by 3 sonographers. RESULTS Precompression substantially changes the elastographic results of patient images on both strain and shear wave elastography. Fat can have the same elasticity as cancer with clinically possible amounts of precompression. The proposed method for determining the amount of precompression applied has variability of less than 10%, which is within the error of the technique and would not affect clinical results. Four zones of precompression are identified, which are useful for explaining the effects of precompression on both strain and shear wave imaging. CONCLUSIONS Precompression is a substantial factor in obtaining accurate results with elastography. A proposed simple, easily applied technique can be used to semiquantify the amount of precompression applied. Precompression should be minimized in obtaining breast clinical images.
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Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Zhao H, Song P, Urban MW, Kinnick RR, Yin M, Greenleaf JF, Chen S. Bias observed in time-of-flight shear wave speed measurements using radiation force of a focused ultrasound beam. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1884-92. [PMID: 21924817 PMCID: PMC3199321 DOI: 10.1016/j.ultrasmedbio.2011.07.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/03/2011] [Accepted: 07/23/2011] [Indexed: 05/12/2023]
Abstract
Measurement of shear wave propagation speed has important clinical applications because it is related to tissue stiffness and health state. Shear waves can be generated in tissues by the radiation force of a focused ultrasound beam (push beam). Shear wave speed can be measured by tracking its propagation laterally from the push beam focus using the time-of-flight principle. This study shows that shear wave speed measurements with such methods can be transducer, depth and lateral tracking range dependent. Three homogeneous phantoms with different stiffness were studied using curvilinear and linear array transducer. Shear wave speed measurements were made at different depths, using different aperture sizes for push and at different lateral distance ranges from the push beam. The curvilinear transducer shows a relatively large measurement bias that is depth dependent. The possible causes of the bias and options for correction are discussed. These bias errors must be taken into account to provide accurate and precise time-of-flight shear wave speed measurements for clinical use.
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Affiliation(s)
- Heng Zhao
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Pengfei Song
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Matthew W. Urban
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Randall R. Kinnick
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Meng Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - James F. Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Shigao Chen
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
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