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Mishra A, Cleveland RO. Agarose as a Tissue Mimic for the Porcine Heart, Kidney, and Liver: Measurements and a Springpot Model. Bioengineering (Basel) 2024; 11:589. [PMID: 38927825 PMCID: PMC11200806 DOI: 10.3390/bioengineering11060589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Agarose gels are often used as a tissue mimic. The goal of this work was to determine the appropriate agarose concentrations that result in mechanical properties that match three different porcine organs. Strain tests were carried out with an amplitude varying from 0.01% to 10% at a frequency of 1 Hz on a range of agarose concentrations and porcine organs. Frequency sweep tests were performed from 0.1 Hz to a maximum of 9.5 Hz at a shear strain amplitude of 0.1% for agarose and porcine organs. In agarose samples, the effect of pre-compression of the samples up to 10% axial strain was considered during frequency sweep tests. The experimental measurements from agarose samples were fit to a fractional order viscoelastic (springpot) model. The model was then used to predict stress relaxation in response to a step strain of 0.1%. The prediction was compared to experimental relaxation data, and the results agreed within 12%. The agarose concentrations (by mass) that gave the best fit were 0.25% for the liver, 0.3% for the kidney, and 0.4% for the heart. At a frequency of 0.1 Hz and a shear strain of 0.1%, the agarose concentrations that best matched the shear storage modulus of the porcine organs were 0.4% agarose for the heart, 0.3% agarose for the kidney, and 0.25% agarose for the liver.
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Affiliation(s)
| | - Robin O. Cleveland
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK;
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Hänni O, Ruby L, Paverd C, Frauenfelder T, Rominger MB, Martin A. Comparison of Ultrasound Attenuation Imaging Using a Linear versus a Conventional Convex Probe: A Volunteer Study. Diagnostics (Basel) 2024; 14:886. [PMID: 38732301 PMCID: PMC11083206 DOI: 10.3390/diagnostics14090886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
The study aimed to investigate the feasibility of attenuation imaging (ATI) measurements using a linear probe on healthy volunteers and compare measurements with the conventional convex probe. Attenuation imaging measurements of the liver tissue were taken using ultrasound with a convex and a linear probe in 33 volunteers by two examining doctors, and the measurements were repeated 4-5 weeks later by one of them. The ATI values for the linear probe were in the range of the values for the convex probe for both examiners. Measurements did not change significantly for 32 out of 33 volunteers after 4-5 weeks when using the linear probe. The size of the region of interest (ROI) only impacted the ATI values for the convex probe; it did not affect the values taken with the linear probe. Healthy volunteers were measured, and their attenuation values were compared to those from a convex probe, commonly used in steatosis evaluation. When both probes were positioned in the same liver area, they showed good agreement in attenuation values, though depth significantly affected the measurements, with both probes providing different values at different depths. The study's results aligned with previous research using the same system. Operator A and B's results were compared, demonstrating similar ranges of values for both probes. The linear probe has been demonstrated to allow for superficial measurements and attain ATI values in line with that of the convex probe in the liver.
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Affiliation(s)
- Olivia Hänni
- Faculty of Medicine, University of Zurich, Dekanat Pestalozzistrasse 3, 8032 Zurich, Switzerland
| | - Lisa Ruby
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA (T.F.)
| | - Catherine Paverd
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA (T.F.)
| | - Thomas Frauenfelder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA (T.F.)
| | - Marga B. Rominger
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA (T.F.)
| | - Alexander Martin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA (T.F.)
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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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Shi LQ, Sun J, Yuan L, Wang XW, Li W, Cheng CY, Guo WD, Hong Y. Diagnostic performance of renal cortical elasticity by supersonic shear wave imaging in pediatric glomerular disease. Eur J Radiol 2023; 168:111113. [PMID: 37820521 DOI: 10.1016/j.ejrad.2023.111113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To explore the diagnostic performance of renal cortical elasticity expressed by Young's modulus (YM) using the supersonic shear wave imaging (SSI) technique in pediatric glomerular disease. MATERIALS AND METHODS Seventy-one children with glomerular disease confirmed by renal biopsy and sixty healthy volunteers were enrolled in this study. Conventional and SSI ultrasound examinations were performed in all individuals for both kidneys. We measured renal length, renal width, renal thickness, parenchyma thickness, interlobar arterial resistive index (RI) and the YM of the middle and lower pole. RESULTS Regardless of which pole and which side of the kidney, the YM in the disease group was significantly higher than that in the control group (P < 0.001). The YM of the middle pole in the left kidney demonstrated the largest AUC (0.936, P < 0.001), and the corresponding cut-off value was 15.48 kPa with a sensitivity of 87.3% and a specificity of 86.7%. There was no significant difference in the YM among different pathological types of pediatric glomerular disease in the disease group, and the same in different grades of patients with Immunoglobulin A (IgA) nephropathy by Lee classification and the Oxford Classification as well as Henoch-Schonlein purpura nephritis (HSPN) by International Study of Kidney Disease in Children (ISKDC) classification (P > 0.05). We found positive but weak correlations between the YM and renal length (r = 0.299, P = 0.001), renal width (r = 0.408, P < 0.001), renal thickness (r = 0.299, P = 0.001), and parenchyma thickness (r = 0.212, P = 0.015), whereas the YM had no significant correlations with age, sex, BMI, interlobar arterial RI, and laboratory findings (P > 0.05). CONCLUSIONS SSI technology is a non-invasive and feasible method for the diagnosis of pediatric glomerular disease. However, SSI did not show good performance in distinguishing different pathological types and disease grades in our study.
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Affiliation(s)
- Li-Qiong Shi
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
| | - Jie Sun
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
| | - Li Yuan
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China.
| | - Xiao-Wen Wang
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
| | - Wei Li
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
| | - Chun-Yue Cheng
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
| | - Wu-Dan Guo
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
| | - Yue Hong
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No. 100 Xianggang Road, Wuhan City, Hubei 430016, China
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Chen Q, Shi B, Zheng Y, Hu X. Analysis of influencing factors of shear wave elastography of the superficial tissue: A phantom study. Front Med (Lausanne) 2022; 9:943844. [PMID: 36004380 PMCID: PMC9393305 DOI: 10.3389/fmed.2022.943844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
Shear wave elastography (SWE) is widely used in clinical work. But there is no standard protocol and operation specification for SWE acquisition methods, which impacts the diagnosis and clinical staging. This study aimed to investigate the influence factors of diameter, depth, and stiffness on SWE using different probes at superficial depths and discuss SWE differences with two machines at superficial depths. We performed SWE on two elastic phantoms that each phantom contained six subjects with two stiffness (41.06 ± 4.62 kpa and 57.30 ± 4.31 kpa), three diameters (10, 15, and 18 mm), and two depths (15 and 25 mm). A total of 240 measurements were obtained by using two ultrasound machines (SuperSonic Imagine Aixplorer and Mindray Resona 7) and 4 probes (SL15-4 and SL10-2, L11-3, and L14-5). The measurements were compared among 4 probes, 3 diameters, and 2 depths. There was no significant difference in SWE measurements among the probes from the same machine. The SWE measurements were affected by diameter, and the degree of influence was related to the stiffness. The SWE measurements were unaffected at a 15–25 mm depth range.
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Affiliation(s)
- Qiyang Chen
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Baixue Shi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Zheng
- AML, Department of Engineering Mechanics, Institute of Biomechanics and Medical Engineering, Tsinghua University, Beijing, China
| | - Xiangdong Hu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiangdong Hu,
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Effect of Depth on Ultrasound Point Shear Wave Elastography in an Elasticity Phantom. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Phantom studies are widely used to assess variability in measurements. This study aimed to assess the reliability and accuracy of point Shear Wave elastography (pSWE) measurements of an elasticity phantom. Methods: Measurements were obtained by an experienced certified clinical sonographer at three different depth levels in kPa, using a curvilinear 5-1MHz transducer of the EPIQ7 ultrasound imaging system. Results: A total of 180 pSWE measurements were obtained at three different depth levels (three cm, five cm, and seven cm) of the phantom background. The mean CV of pSWE was low at all depths (3 cm: 8.8%; 5 cm: 7%; 7 cm: 7.2%). There was a significant difference between measurements at depths of 3 cm vs. 7 cm (MD: −0.85, 95% CI −1.5, −0.11, p = 0.024) and measurements at depths 5 cm vs. 7 cm (MD: −1.1, 95% CI −1.7, −0.47, p = 0.001). An overestimation of mean pSWE measurements at a depth of 7 cm was noted compared to the manufacturer’s value (2.7%, p = 0.006). Conclusions: Superficial phantom SWE measurements in this study had low variability compared to deep measurement. pSWE measurements at deep levels can be overestimated.
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Wang X, Zhu J, Gao J, Hu Y, Liu Y, Li W, Chen S, Liu F. Assessment of ultrasound shear wave elastography within muscles using different region of interest sizes, manufacturers, probes and acquisition angles: an ex vivo study. Quant Imaging Med Surg 2022; 12:3227-3237. [PMID: 35655847 PMCID: PMC9131342 DOI: 10.21037/qims-21-1072] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/11/2022] [Indexed: 08/29/2023]
Abstract
BACKGROUND The application of shear wave elastography (SWE) in assessment of the musculoskeletal system is affected by various factors. This study aimed to explore the influence of machines, probes, region of interest (ROI) sizes, and the acquisition angles on muscle shear wave speed (SWS). METHODS The SWS of ex vivo isolated muscles were acquired using 3 different machines (Aixplorer system, SuperSonic Imagine; Acuson S3000, Siemens Healthcare; Resona 7, Mindray) and 2 linear probes (Aixplorer system, SL 10-2 and SL 15-4). Also, 4 different ROI sizes (diameter 1-10 mm) and 9 different acquisition angles (0-40°) were tested. The SWS acquired under different conditions were compared, and the intra-class correlation coefficients (ICC) were used to evaluate reproducibility. RESULTS There was a significant difference in SWS acquired using the 3 different machines (P<0.001) or with 9 different angles (P=0.008). There was no significant difference in SWS acquired using 2 probes (P=0.053) or 4 different ROI sizes (P=0.874, 0.778, and 0.865 for 3 operators, respectively). All machines produced substantial intra-system reproducibility (ICC, 0.61-0.80). Both probes demonstrated an almost perfect degree of intra-system agreement (ICC, >0.80), and nearly all ROI sizes demonstrated an almost perfect degree of intra- and inter-operator agreement (ICC, >0.80). The measurement reliability was higher when the acquisition angles were no more than 20°. CONCLUSIONS The 3 machines had different SWS values. Attention should be paid when comparing SWS results using different machines. For the Aixplorer system, the ROI size had no effect on the SWS values. Angles larger than 25° will lead to SWS measurements with greater variability compared to smaller angles (≤20°).
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Affiliation(s)
- Xiuming Wang
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Junxue Gao
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Yue Hu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Yiqun Liu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Si Chen
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
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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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Koga A, Itoigawa Y, Suga M, Morikawa D, Uehara H, Maruyama Y, Kaneko K. Stiffness change of the supraspinatus muscle can be detected by magnetic resonance elastography. Magn Reson Imaging 2021; 80:9-13. [PMID: 33819499 DOI: 10.1016/j.mri.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 01/27/2023]
Abstract
Magnetic resonance elastography (MRE) and ultrasound shear wave elastography (SWE) are imaging techniques to measure stiffness of the soft tissue using magnetic resonance imaging (MRI) and ultrasound images, respectively. The purpose of this study was to explore the feasibility of the MRE measurement to evaluate the change in supraspinatus (SSP) muscle stiffness before and after rotator cuff tear, and to compare the result with those of SWE. Six swine shoulders were used. The skin and subcutaneous fat were removed, and the stiffness value of the SSP muscle was measured by MRE and SWE. The MRE measurement was performed with 0.3 T open MRI and the vibration from a pneumatic driver system with active driver to a passive driver to create the shear wave in the tissue. The passive driver was placed on the center of the SSP muscle. The stiffness was estimated from the wave images using local frequency estimation methods. In the SWE measurement, the probe of the ultrasound was placed on the center of the SSP muscle. The shear wave propagation speed was measured at a depth of 1 cm from the surface, and the stiffness was calculated. After those measurements, the rotator cuff tendon was detached from the greater tuberosity, and MRE and SWE measurements were then performed in the same manner again. The differences in the stiffness values were compared between before and after the rotator cuff tendon tear on both the MRE and SWE measurements. The results indicated that stiffness values on MRE and SWE were 9.3 ± 1.8 and 10.0 ± 1.2 kPa respectively before the rotator cuff tear, and 7.3 ± 1.3 and 8.0 ± 0.8 kPa respectively after the tendon detachment. Stiffness values were significantly lower after the tendon detachment on both the MRE and SWE measurements (p < 0.05). Our results demonstrated that stiffness values of the SSP muscle on MRE and SWE were lower after rotator cuff detachment. From this result, MRE may be a feasible method for quantification of the change in rotator cuff muscle stiffness.
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Affiliation(s)
- Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan.
| | - Mikio Suga
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
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Dietrich CF, Shi L, Wei Q, Dong Y, Cui XW, Löwe A, Worni M, Ferraioli G. What does liver elastography measure? Technical aspects and methodology. Minerva Gastroenterol (Torino) 2020; 67:129-140. [PMID: 33267564 DOI: 10.23736/s2724-5985.20.02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Elastography can be thought as an extension of the ancient technique of palpation. After giving a short introduction to the history of elastography, the different technologies that are nowadays available and the physics behind them, the article focuses on the assessment of liver stiffness in patients with diffuse liver disease using shear wave elastography (SWE). Practical advices on how to perform the SWE techniques and on the factors that should be considered for a correct interpretation of the results are given. This paper aimed to provide a practical guide for beginners and advanced clinical users to better understand technical aspects, methodologies and terminology.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland -
| | - Long Shi
- Department of Ultrasound, Jingmen N. 2 People's Hospital, Jingmen, China
| | - Qi Wei
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Axel Löwe
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland
| | - Mathias Worni
- Department of Visceral Surgery, Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara University Hospital, Basel, Switzerland.,Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Campus SLB, Bern, Switzerland.,Department of Surgery, Clinic Beau Site, Bern, Switzerland
| | - Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Individualized-thresholding Shear Wave Elastography combined with clinical factors improves specificity in discriminating breast masses. Breast 2020; 54:248-255. [PMID: 33188991 PMCID: PMC7670190 DOI: 10.1016/j.breast.2020.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the diagnostic role of new metrics, defined as individualized-thresholding of Shear Wave Elastography (SWE) parameters, in association with clinical factors (such as age, mammographic density, lesion size and depth) and the BI-RADS features in differentiating benign from malignant breast lesions. METHODS Of 644 consecutive patients (median age, 55 years), prospectively referred for evaluation, 659 ultrasound detected breast lesions underwent SWE measurements. Multivariable logistic regression analysis was used to estimate the probability of malignancy. The area under the curve (AUC), optimal cutoff value, and the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. RESULTS 265 of 659 (40.2%) masses were malignant. Using two Emean cutoffs, 69.6 kPa for large superficial lesions (size >10 mm, depth ≤5 mm) and 39.2 kPa for the rest, the overall specificity, sensitivity, PPV and NPV were 92.6%, 86.8%, 88.8% and 91.3%, respectively. Combining multiple factors, including Emean with two cutoffs, age and BI-RADS, the new ROC curve based on the malignancy probability calculation showed the highest AUC (0.954, 95% CI: 0.938-0.969). Using the optimal probability threshold of 0.514, the corresponding specificity, sensitivity, PPV and NPV were 92.9%, 89.1%, 89.4% and 92.7%, respectively. CONCLUSIONS The false-positive rate can be significantly reduced when applying two Emean cutoffs based on lesion size and depth. Moreover, the combination of age, Emean with two cutoffs and BI-RADS can further reduce the false negatives and false positives. Overall, this multifactorial analysis improves the specificity of ultrasound while maintaining a high sensitivity.
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Moalla S, Girot C, Franchi-Abella S, Ammari S, Balleyguier C, Lassau N, Pitre-Champagnat S. Methodological Study to Investigate the Potential of Ultrasound-Based Elastography and Texture as Biomarkers to Monitor Liver Tumors. Diagnostics (Basel) 2020; 10:E811. [PMID: 33066135 PMCID: PMC7602000 DOI: 10.3390/diagnostics10100811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS AND OBJECTIVES In order to evaluate the responses of hepatic lesions to treatment in terms of tissue stiffness and heterogeneity, this work investigated the robustness of 2D shear-wave elastography (2D SWE) stiffness measurements and texture analyses in vitro and in vivo in terms of repeatability and variability. METHODS AND MATERIALS A multioperator (n = 5) study was performed with an ultrasonic elastography device on two sets of phantoms. For the first set of phantoms, 10 measurements for each of the eight inclusions were performed by each observer, whereas the second set of phantoms was used to evaluate the influence of depth on the stiffness measurements. Variability of the stiffness measurements was evaluated in vivo on 10 healthy livers, with 10 measurements for each hepatic segment. Texture analyses were performed in B-mode, obtaining elastography images for every hepatic segment. RESULTS Stiffness measurements were influenced by depth, particularly when exceeding 7 cm. In vivo measurements demonstrated that measurements of segments I, VII, and VIII were less reliable, mainly due to their deeper locations. The protocols used were more flexible in terms of acquisition setup and probe placement than those currently used with Fibroscan®. For texture analysis on the B-mode images, 12 features showed low variability regardless of the evaluated hepatic segment. On elastogram, only two features showed low variability, but not in every segment. CONCLUSION We demonstrated the robustness of two methodologies for the quantification of liver stiffness and heterogeneity. Further clinical studies should evaluate whether these techniques can assess tumor responses to treatment and, therefore, have the potential to be used as imaging biomarkers.
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Affiliation(s)
- Salma Moalla
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
| | - Charly Girot
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
- Department of Paediatric radiology, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Samy Ammari
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Corinne Balleyguier
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Nathalie Lassau
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Stéphanie Pitre-Champagnat
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
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Abstract
The present study aimed to evaluate the reproducibility and accuracy of the optimized algorithm of shear-wave elastography (SWE) in diagnosing solid thyroid nodules. Two hundred and sixty-three solid thyroid nodules in 248 patients who underwent conventional ultrasound and SWE, respectively, by two operators were scheduled for fine-needle aspiration or surgery. Elasticity indices of the mean, minimum and maximum of nodules (EI) and thyroid parenchyma (EInorm) were measured respectively in the same frame of elastographic images for three times by both operators. The intraobserver and interobserver reproducibility of the optimized algorithm were assessed by intraclass correlation coefficients (ICC). Diagnostic performance of the optimized algorithm was compared with that of conventional SWE measurements by receiver-operating characteristic (ROC) curves. Among a total of 243 nodules included, 121 were benign nodules and 122 were papillary thyroid carcinoma (PTC). Intraobserver reliability for EId and EIr was nearly perfect (ICC>0.80). Interobserver agreement for MEANd, MAXd, MEANr and MAXr was nearly perfect (ICC>0.80). MAXd had the largest areas under the ROC curve which was 0.82. Compared with conventional SWE, the optimized algorithm of SWE shows better reproducibility and performance in diagnosing solid thyroid nodules.
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14
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Prager J, Adams CF, Delaney AM, Chanoit G, Tarlton JF, Wong LF, Chari DM, Granger N. Stiffness-matched biomaterial implants for cell delivery: clinical, intraoperative ultrasound elastography provides a 'target' stiffness for hydrogel synthesis in spinal cord injury. J Tissue Eng 2020; 11:2041731420934806. [PMID: 32670538 PMCID: PMC7336822 DOI: 10.1177/2041731420934806] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022] Open
Abstract
Safe hydrogel delivery requires stiffness-matching with host tissues to avoid
iatrogenic damage and reduce inflammatory reactions. Hydrogel-encapsulated cell
delivery is a promising combinatorial approach to spinal cord injury therapy,
but a lack of in vivo clinical spinal cord injury stiffness
measurements is a barrier to their use in clinics. We demonstrate that
ultrasound elastography – a non-invasive, clinically established tool – can be
used to measure spinal cord stiffness intraoperatively in canines with
spontaneous spinal cord injury. In line with recent experimental reports, our
data show that injured spinal cord has lower stiffness than uninjured cord. We
show that the stiffness of hydrogels encapsulating a clinically relevant
transplant population (olfactory ensheathing cells) can also be measured by
ultrasound elastography, enabling synthesis of hydrogels with comparable
stiffness to canine spinal cord injury. We therefore demonstrate
proof-of-principle of a novel approach to stiffness-matching hydrogel-olfactory
ensheathing cell implants to ‘real-life’ spinal cord injury values; an approach
applicable to multiple biomaterial implants for regenerative therapies.
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Affiliation(s)
- Jon Prager
- Bristol Veterinary School, University of Bristol, Bristol, UK.,The Royal Veterinary College, University of London, Hatfield, UK
| | - Christopher F Adams
- Cellular and Neural Engineering Group, Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | - Alexander M Delaney
- Cellular and Neural Engineering Group, Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | | | - John F Tarlton
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | | | - Divya M Chari
- Cellular and Neural Engineering Group, Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hatfield, UK
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15
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Alrashed AI, Alfuraih AM. Reproducibility of shear wave elastography among operators, machines, and probes in an elasticity phantom. Ultrasonography 2020; 40:158-166. [PMID: 32660213 PMCID: PMC7758105 DOI: 10.14366/usg.20011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/09/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This study was aimed to investigate the reproducibility of shear wave elastography (SWE) among operators, machines, and probes in a phantom, and to evaluate the effect of depth of the embedded inclusions and the accuracy of the measurements. METHODS In vitro stiffness measurements were made of six inclusions (10, 40, and 60 kPa) embedded at two depths (1.5 cm and 5 cm) in an elastography phantom. Measurements were obtained by two sonographers using two ultrasound machines (the SuperSonic Imagine Aixplorer with the XC6-1, SL10-2 and SL18-5 probes, and the General Electric LOGIQ E9 with the 9L-D probe). Variability was evaluated using the coefficient of variation. Reproducibility was calculated using intraclass correlation coefficients (ICCs). RESULTS For shallow inclusions, low variability was observed between operators (range, 0.9% to 5.4%). However, the variability increased significantly for deep inclusions (range, 2.4% to 80.8%). The measurement difference between the operators was 1%-15% for superficial inclusions and 3%-43% for deep inclusions. Inter-operator reproducibility was almost perfect (ICC>0.90). The measurement difference between machines was 0%-15% for superficial inclusions and 38.6%-82.9% for deep inclusions. For superficial inclusions, the reproducibility among the three probes was excellent (ICC>0.97). The mean stiffness values of the 10 kPa inclusion were overestimated by 16%, while those of the 40 kPa and 60 kPa inclusions were underestimated by 42% and 48%, respectively. CONCLUSION Phantom SWE measurements were only reproducible among operators, machines, and probes at superficial depths. SWE measurements acquired in deep regions should not be used interchangeably among operators, machines, or probes.
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Affiliation(s)
- Abdulaziz Ibrahim Alrashed
- Radiodiagnostics and Medical Imaging Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman M Alfuraih
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia
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Lee SM, Kim MJ, Yoon JH, Hong W, Ha HI, Lee K, Choe JY, Lee JW, Yoon SY, Han J. Comparison of point and 2-dimensional shear wave elastography for the evaluation of liver fibrosis. Ultrasonography 2020; 39:288-297. [PMID: 32311869 PMCID: PMC7315295 DOI: 10.14366/usg.19090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This study aimed to assess the technical performance of ElastQ Imaging compared with ElastPQ and to investigate the correlation between liver stiffness (LS) values obtained using these two techniques. METHODS This retrospective study included 249 patients who underwent LS measurements using both ElastPQ and ElastQ Imaging equipped on the same machine. The applicability, repeatability (coefficient of variation [CV]), acquisition time, and LS values were compared using the chi-square or Wilcoxon signed-rank tests. In the development group, the correlation between the LS values obtained by the two techniques was assessed with Spearman correlation coefficients and linear regression analysis. In the validation group, the agreement between the estimated and real LS values was evaluated using a Bland-Altman plot. RESULTS ElastQ Imaging had higher applicability (94.0% vs. 78.3%, P<0.001) and higher repeatability, with a lower median CV (0.127 vs. 0.164, P<0.001) than did ElastPQ. The median acquisition time of ElastQ Imaging was significantly shorter than that of ElastPQ (45.5 seconds vs. 96.5 seconds, P<0.001). The median LS value obtained using ElastQ Imaging was significantly higher than that obtained using ElastPQ (5.60 kPa vs. 5.23 kPa, P<0.001). The LS values between the two techniques exhibited a strong positive correlation (r=0.851, P<0.001) in the development group. The mean difference and 95% limits of agreement were 0.0 kPa (-3.9 to 3.9 kPa) in the validation group. CONCLUSION ElastQ Imaging may be more reliable and faster than ElastPQ, with strongly correlated LS measurements.
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Affiliation(s)
- Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Wonju Hong
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji-Young Choe
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jung Woo Lee
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sam-Youl Yoon
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, Korea
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Yang H, Sun Y, Tang Y, Lu Y, Hu B, Ying T. Shear-wave elastography of the liver in a healthy pediatric population. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:139-144. [PMID: 31846085 DOI: 10.1002/jcu.22794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/24/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to determine the elastic modulus values of normal liver tissue in school-age children by shear wave elastography (SWE) and to study the factors that influence these stiffness measurements. METHODS Six hundred and four school-age children (295 girls and 309 boys) who were recruited at a hospital and had normal results of specific laboratory tests and imaging studies underwent SWE examinations. The elastic modulus values were obtained in segment V and VI for each subject and comparisons were made between age groups. RESULTS The mean elastic modulus values for school-age children were 6.3 ± 1.1 kPa for segment V and 6.2 ± 1.1 kPa for segment VI. A positive linear trend in liver stiffness was found for the 6 to 9-year-old age group in segments V and VI (R2 = 0.076 vs R2 = 0.085, respectively, P < .05). No statistically significant difference in liver stiffness was found between genders and between segment groups (P > .05). CONCLUSION SWE is a feasible method to measure liver stiffness in the school-age population. We established a normal range of liver elastic modulus values in school-age children, which will provide a basis for evaluating the changes in liver stiffness caused by various diseases.
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Affiliation(s)
- Hanning Yang
- Department of Ultrasound, The Fourth Affiliated Hospital of Kunming Medical University, The Second People's Hospital of Yunnan Province, Kunming, PR China
| | - Yue Sun
- Department of Ultrasound, The Fourth Affiliated Hospital of Kunming Medical University, The Second People's Hospital of Yunnan Province, Kunming, PR China
| | - Yueyue Tang
- Department of Ultrasound, The Fourth Affiliated Hospital of Kunming Medical University, The Second People's Hospital of Yunnan Province, Kunming, PR China
| | - Yongping Lu
- Department of Ultrasound, The Fourth Affiliated Hospital of Kunming Medical University, The Second People's Hospital of Yunnan Province, Kunming, PR China
| | - Bing Hu
- Department of Ultrasound, Shanghai Six People's Hospital, Shanghai, PR China
| | - Tao Ying
- Department of Ultrasound, Shanghai Six People's Hospital, Shanghai, PR China
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Hwang J, Yoon HM, Jung AY, Lee JS, Cho YA. Comparison of 2-Dimensional Shear Wave Elastographic Measurements Using ElastQ Imaging and SuperSonic Shear Imaging: Phantom Study and Clinical Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:311-321. [PMID: 31392769 DOI: 10.1002/jum.15108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To compare the feasibility and clinical applicability of ElastQ imaging (Philips Healthcare, Best, the Netherlands) with that of SuperSonic shear imaging (SSI; SuperSonic Imagine, Aix-en-Provence, France) using an elastographic phantom and a pilot study of patients. METHODS Two-dimensional shear wave elastography measurement was performed by ElastQ imaging and SSI by 2 radiologists. An elastographic phantom with 5 target elasticities at 2 acquisition depths was used. The coefficients of variation and intraclass correlation coefficients (ICCs) were evaluated for repeatability and interobserver agreement, respectively. The mean elasticities of the systems at each target were compared. The proportions of measurements that were out of the range of expected values and measurement errors were calculated to determine accuracy. Liver stiffness (LS) was measured by both systems in 27 children and young adult patients with various liver diseases. RESULTS Both systems provided high repeatability in elasticity measurements of phantom targets (coefficients of variation, 0.69%-15.82%), and there was excellent interobserver agreement (ICC, 0.992). Most (90%) mean elasticities of targets were significantly different between the techniques (P ≤ .002) and acquisition depths (P ≤ .004). ElastQ imaging had significantly lower proportions of out-of-range measurements and measurement errors (P ≤ .003) than SSI. In patients with liver disease, LS measurements of the systems were strongly correlated (ρ = 0.955; P < .001) and had excellent agreement (ICC, 0.951; P < .001). CONCLUSIONS ElastQ imaging had comparably good results in terms of repeatability, interobserver agreement, and accuracy in the phantom model compared with SSI. The pilot patient study showed strong correlations in LS values between the systems.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Accuracy and precision of ultrasound shear wave elasticity measurements according to target elasticity and acquisition depth: A phantom study. PLoS One 2019; 14:e0219621. [PMID: 31295308 PMCID: PMC6622533 DOI: 10.1371/journal.pone.0219621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the accuracy and precision of ultrasound shear wave elasticity measurements as a function of target elasticity and acquisition depth. MATERIALS AND METHODS Using five ultrasound systems (VTQ, VTIQ, EPIQ 5, Aixplorer, and Aplio 500), two operators independently measured shear wave elasticities in two phantoms containing five different target elasticities (8±3, 14±4, 25±6, 45±8, and 80±12 kPa) at depths of 15, 30, 35, and 60 mm. Accuracy was assessed by evaluating measurement errors and the proportions of outliers, while factors affecting accuracy were assessed using logistic regression analysis. Measurement errors were defined as differences between the measured values and 1) the margins of the target elasticity, and 2) the median values of the target elasticity. Outliers were defined as measured values outside the margins of the target elasticity. Precision was assessed by calculating the reproducibility of measurements using the within-subject coefficient of variation (wCV). RESULTS Mean measurement errors and the proportions of outliers were higher for high than for low target elasticities (p<0.001), but did not differ in relation to acquisition depth, either within an elastography system or across the different systems. Logistic regression analysis showed that target elasticity (p<0.001) significantly affected accuracy, whereas acquisition depth (p>0.05) did not. The wCV for the 80±12 kPa target (31.33%) was significantly higher than that for lower elasticity targets (6.96-10.43 kPa; p<0.001). The wCV did not differ across acquisition depths. The individual elastography systems showed consistent results. CONCLUSIONS Targets with high elasticity showed lower accuracy and lower precision than targets with low elasticity, while acquisition depth did not show consistent patterns in either accuracy or precision.
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Value of shear wave arrival time contour display in shear wave elastography for breast masses diagnosis. Sci Rep 2017; 7:7036. [PMID: 28765627 PMCID: PMC5539095 DOI: 10.1038/s41598-017-07389-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 12/21/2022] Open
Abstract
To evaluate the diagnostic performance of shear wave arrival time contour (SWATC) display for the diagnosis of breast lesions and to identify factors associated with the quality of shear wave propagation (QSWP) in breast lesions. This study included 277 pathologically confirmed breast lesions. Conventional B-mode ultrasound characteristics and shear wave elastography parameters were computed. Using the SWATC display, the QSWP of each lesion was assigned to a two-point scale: score 1 (low quality) and score 2 (high quality). Binary logistic regression analysis was performed to identify factors associated with QSWP. The area under the receiver operating characteristic curve (AUROC) for QSWP to differentiate benign from malignant lesions was 0.913, with a sensitivity of 91.9%, a specificity of 90.7%, a positive predictive value (PPV) of 74.0%, and a negative predictive value (NPV) of 97.5%. Compared with using the standard deviation of shear wave speed (SWSSD) alone, SWSSD combined with QSWP increased the sensitivity from 75.8% to 93.5%, but decreased the specificity from 95.8% to 89.3% (P < 0.05). SWSSD was identified to be the strongest factor associated with the QSWP, followed by tumor malignancy and the depth of the lesion. In conclusion, SWATC display may be useful for characterization of breast lesions.
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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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Li S, Liu L, Lv G. Diagnostic value of strain elastography for differentiating benign and malignant soft tissue masses. Oncol Lett 2017; 14:2041-2044. [PMID: 28781646 PMCID: PMC5530143 DOI: 10.3892/ol.2017.6385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 03/30/2017] [Indexed: 11/28/2022] Open
Abstract
The aim of the current study was to investigate the importance of strain elastography (SE) in the differential diagnosis of benign and malignant soft tissue masses. SE was adopted to examine 61 patients with superficial masses, classify their elastic scores and assess their strain ratios (SRs) between the masses and the surrounding structures. Significantly increased SR values and elastic scores were observed in the malignant masses compared with the benign masses (5.42±3.47 vs. 1.80±2.10, P<0.001; 3.13±0.34 vs. 2.03±0.99, P<0.001). Area under receiver operating characteristic curve values of the SRs and elastic scores were 0.87 (P<0.001) and 0.805 (P=0.001), respectively. With an SR of >2.295 as the optimal threshold value, the sensitivity, specificity and positive and negative predictive values for diagnosing a malignant mass were 93.8, 80.5, 65.2 and 97.1%, respectively; whilst using an elastic score of ≥3 as the optimal threshold value, the sensitivity, specificity and positive and negative predictive values for diagnosing a malignant mass were 100, 51.6, 51.6 and 100%, respectively. SR values and elastic scores were significantly different between the malignant and benign soft tissue masses. Therefore, SE may be used to effectively differentiate between malignant and benign soft tissue masses.
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Affiliation(s)
- Shilin Li
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Lingfang Liu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Guorong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian 362000, P.R. China
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Liu BJ, Zhao CK, Xu HX, Zhang YF, Xu JM, Li DD, Bo XW, Li XL. Quality measurement on shear wave speed imaging: diagnostic value in differentiation of thyroid malignancy and the associated factors. Oncotarget 2017; 8:4848-4959. [PMID: 28002806 PMCID: PMC5354883 DOI: 10.18632/oncotarget.13996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022] Open
Abstract
To evaluate the associated factors for quality measurement (QM) on shear wave speed (SWS) imaging and the additional value of QM for differentiation of thyroid nodules. A consecutive series of 238 patients with 254 thyroid nodules were enrolled. They were all evaluated by conventional ultrasound and SWS imaging and were finally proven pathologically. QM was used to assess whether SWS propagation was authentic and was classified as high QM and Low QM. Twelve variables were analyzed to evaluate the associated factors for QM using binary logistic regression. Receiver operating characteristic (ROC) curve was plotted on SWS and SWS+QM. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and area under ROC curve (AUC) were calculated. The study included 170 benign thyroid nodules (160 high QM and 10 low QM) and 84 malignant thyroid nodules (56 high QM and 28 low QM) (P < 0.001). The mean SWS of benign and malignant nodules were 2.51 ± 0.47 m/s and 3.43 ± 1.21 m/s respectively (P < 0.001). The sensitivities, specificities, PPVs, NPVs, accuracies and AUCs were 77.4%, 80.0%, 65.7%, 87.7%, 79.1%, 0.82 for SWS alone with SWS ≥ 2.78 m/s; 33.3-34.5%, 91.2-94.1%, 65.9-73.7%, 73.8-74.1%, 72.4-74.0%, 0.63-0.64 for QM alone and 84.5-85.7%, 72.4-75.9%, 60.5-63.4%, 90.8-91.0%, 76.8-78.7%, 0.79-0.80 for SWS+QM. Nodule depth was identified to be the strongest associated factor for QM of SWS, followed by malignancy and SWS. In conclusion, QM for thyroid nodule is associated with nodule depth, malignancy, and SWS. QM improves the specificity in comparison with SWS alone, whereas SWS+QM does not improve the overall diagnostic performance.
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Affiliation(s)
- Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai Center for Thyroid Diseases, Shanghai 200072, China
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25
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Kishimoto R, Suga M, Koyama A, Omatsu T, Tachibana Y, Ebner DK, Obata T. Measuring shear-wave speed with point shear-wave elastography and MR elastography: a phantom study. BMJ Open 2017; 7:e013925. [PMID: 28057657 PMCID: PMC5223661 DOI: 10.1136/bmjopen-2016-013925] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To compare shear-wave speed (SWS) measured by ultrasound-based point shear-wave elastography (pSWE) and MR elastography (MRE) on phantoms with a known shear modulus, and to assess method validity and variability. METHODS 5 homogeneous phantoms of different stiffnesses were made. Shear modulus was measured by a rheometer, and this value was used as the standard. 10 SWS measurements were obtained at 4 different depths with 1.0-4.5 MHz convex (4C1) and 4.0-9.0 MHz linear (9L4) transducers using pSWE. MRE was carried out once per phantom, and SWSs at 5 different depths were obtained. These SWSs were then compared with those from a rheometer using linear regression analyses. RESULTS SWSs obtained with both pSWE as well as MRE had a strong correlation with those obtained by a rheometer (R2>0.97). The relative difference in SWS between the procedures was from -25.2% to 25.6% for all phantoms, and from -8.1% to 6.9% when the softest and hardest phantoms were excluded. Depth dependency was noted in the 9L4 transducer of pSWE and MRE. CONCLUSIONS SWSs from pSWE and MRE showed a good correlation with a rheometer-determined SWS. Although based on phantom studies, SWSs obtained with these methods are not always equivalent, the measurement can be thought of as reliable and these SWSs were reasonably close to each other for the middle range of stiffness within the measurable range.
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Affiliation(s)
- Riwa Kishimoto
- Hospital of the National Institute of Radiological Sciences, National Institutes of Quantum and Radiation Science and Technology, Chiba, Japan
| | - Mikio Suga
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Atsuhisa Koyama
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Tokuhiko Omatsu
- Hospital of the National Institute of Radiological Sciences, National Institutes of Quantum and Radiation Science and Technology, Chiba, Japan
| | - Yasuhiko Tachibana
- Hospital of the National Institute of Radiological Sciences, National Institutes of Quantum and Radiation Science and Technology, Chiba, Japan
| | - Daniel K Ebner
- Hospital of the National Institute of Radiological Sciences, National Institutes of Quantum and Radiation Science and Technology, Chiba, Japan
| | - Takayuki Obata
- Hospital of the National Institute of Radiological Sciences, National Institutes of Quantum and Radiation Science and Technology, Chiba, Japan
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26
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Onoyama T, Koda M, Fujise Y, Takata T, Kawata S, Okamoto T, Miyoshi K, Matono T, Sugihara T, Matsumoto K, Kawaguchi K, Harada K, Yashima K, Isomoto H. Utility of virtual touch quantification in the diagnosis of pancreatic ductal adenocarcinoma. Clin Imaging 2016; 42:64-67. [PMID: 27886609 DOI: 10.1016/j.clinimag.2016.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 10/28/2016] [Accepted: 11/16/2016] [Indexed: 12/21/2022]
Abstract
This study aimed to compare the tissue stiffness of pancreatic ductal adenocarcinoma (PDAC) with that of pancreatic parenchyma using virtual touch quantification (VTQ). SWV was measured in 34 PDAC lesions and in pancreatic parenchyma of both controls and patients. SWVs in PDAC lesions were significantly higher than in pancreatic parenchyma in both healthy controls and in patients with PDAC. The area under the ROC for diagnosis of PDAC was 0.94 for pancreatic parenchyma in healthy controls, and 0.85 for pancreatic parenchyma in patients with PDAC. VTQ can provide a useful and additional information for diagnosis of PDAC.
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Affiliation(s)
- Takumi Onoyama
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masahiko Koda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan.
| | - Yuki Fujise
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoaki Takata
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Soichiro Kawata
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Toshiaki Okamoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kennichi Miyoshi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomomitsu Matono
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takaaki Sugihara
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazuya Matsumoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Koichiro Kawaguchi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kenichi Harada
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazuo Yashima
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Mulabecirovic A, Vesterhus M, Gilja OH, Havre RF. In Vitro Comparison of Five Different Elastography Systems for Clinical Applications, Using Strain and Shear Wave Technology. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2572-2588. [PMID: 27570209 DOI: 10.1016/j.ultrasmedbio.2016.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
Several different platforms providing ultrasound elastography have emerged in recent years. In this in vitro study on a single tissue-mimicking phantom (CIRS Model 49), we aimed to compare the performance of quantitative elastography measurements from platforms running strain elastography and others running shear wave elastography. We evaluated five different elastography platforms using both linear and curvilinear probes. All measurements were performed in parallel by two independent investigators who recorded the elasticity quantitatively. We investigated intra- and inter-observer agreement by intra-class correlation analysis and coefficient of variation, by correlation and limits of agreement. The reproducibility of elasticity measurements was good to excellent for shear wave and strain elastography. All five elastography platforms had high intra-observer (intra-class correlation coefficient: 0.932-1.0) and inter-observer correlation (intra-class correlation coefficient: 0.845-0.996). All inclusions could be differentiated by quantitative elastography by all systems (p < 0.001). The use of a linear probe yielded more reproducible measurements compared with use of a convex probe in 3/4 platforms.
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Affiliation(s)
- Anesa Mulabecirovic
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway; Institute of Clinical Medicine, University of Bergen, N-5020, Bergen, Norway
| | - Mette Vesterhus
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway; Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway; Institute of Clinical Medicine, University of Bergen, N-5020, Bergen, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway.
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28
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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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30
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Shin HJ, Kim MJ, Kim HY, Roh YH, Lee MJ. Comparison of shear wave velocities on ultrasound elastography between different machines, transducers, and acquisition depths: a phantom study. Eur Radiol 2016; 26:3361-7. [PMID: 26815368 DOI: 10.1007/s00330-016-4212-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To investigate consistency in shear wave velocities (SWVs) on ultrasound elastography using different machines, transducers and acquisition depths. METHODS The SWVs were measured using an elasticity phantom with a Young's modulus of 16.9 kPa, with three recently introduced ultrasound elastography machines (A, B and C from different vendors) and two transducers (low and high frequencies) at four depths (2, 3, 4 and 5 cm). Mean SWVs from 15 measurements and coefficient of variations (CVs) were compared between three machines, two transducers and four acquisition depths. RESULTS The SWVs using the high frequency transducer were not acquired at 5 cm depth in machine B, and a high frequency transducer was not available in machine C. The mean SWVs in the three machines were different (p ≤ 0.002). The CVs were 0-0.09 in three machines. The mean SWVs between the two transducers were different (p < 0.001) except at 4 and 5 cm depths in machine A. The SWVs were affected by the acquisition depths in all conditions (p < 0.001). CONCLUSION There is considerable difference in SWVs on ultrasound elastography depending on different machines, transducers and acquisition depths. Caution is needed when using the cutoff values of SWVs in different conditions. KEY POINTS • The shear wave velocities (SWVs) are different between different ultrasound elastography machines • The SWVs are also different between different transducers and acquisition depths • Caution is needed when using the cutoff SWVs measured under different conditions.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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31
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Lu Q, Wen JX, Huang BJ, Xue LY, Wang WP. Virtual Touch quantification using acoustic radiation force impulse (ARFI) technology for the evaluation of focal solid renal lesions: preliminary findings. Clin Radiol 2015; 70:1376-81. [PMID: 26375726 DOI: 10.1016/j.crad.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 12/13/2022]
Abstract
AIM To evaluate potential value of Virtual Touch quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging for characterising focal solid renal lesions. MATERIALS AND METHODS Two independent operators performed 10 and five measurements of each lesion and adjacent renal cortex, respectively. Mean shear wave velocity (SWV) and shear wave velocity ratio (SWR) of histotypes were compared. RESULTS One hundred and ninety-seven renal lesions were evaluated, including 155 renal cell carcinomas (RCCs; 129 clear-cell RCCs [ccRCCs], 14 papillary RCCs [pRCCs], and 12 chromophobe RCCs [cRCCs]) and 42 angiomyolipomas (AMLs). The interoperator reproducibility of SWV of renal tumours and renal cortex were good (ICC=0.852, and 0.903, respectively). SWV of the renal cortex at a depth of <4 cm was significant higher than that at a depth of >4 cm. Regardless of the subtypes of RCC, SWV and SWR of RCCs differed significantly from those of AMLs (2.28±0.85 versus 1.98±0.85; 1.09±0.56 versus 0.78±0.34; p=0.045 and p<0.001, respectively). At cut-off points of SWV >1.87 m/s or SWR >0.84 to differentiate RCCs from AMLs, the sensitivity and specificity were 47.5%, 33.2% or 47.5%, 30.2%, respectively. When the subtypes of RCCs were taken into account, SWV and SWR of ccRCCs were significantly higher than those of pRCCs, cRCCs, and AMLs, while there was no significant difference among the latter. With SWV >1.98 m/s or SWR >0.80 as the cut-off point to differentiate ccRCCs from other renal tumours, the sensitivity and specificity were 69.8%, 65% or 76.8%, 73.4%, respectively. CONCLUSION The ARFI technique offers additional information regarding renal tumour elasticity with good reproducibility. SWV and SWR are potential biomarkers in this setting, helping to differentiate ccRCC from other renal tumour histotypes.
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Affiliation(s)
- Q Lu
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - J-X Wen
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - B-J Huang
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
| | - L-Y Xue
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - W-P Wang
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
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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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A comparative study of strain and shear-wave elastography in an elasticity phantom. AJR Am J Roentgenol 2015; 204:W236-42. [PMID: 25714307 DOI: 10.2214/ajr.14.13076] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the diagnostic accuracy of strain and shear-wave elastography for determining targets of varying stiffness in a phantom. The effect of target diameter on elastographic assessments and the effect of depth on shear-wave velocity were also investigated. MATERIALS AND METHODS. We examined 20 targets of varying diameters (2.5-16.7 mm) and stiffnesses (8, 14, 45, and 80 kPa) with a 4-9-MHz linear-array transducer. Targets were evaluated 10 times with three different methods-shear-wave elastography, strain ratio, and strain histogram analysis-yielding 600 evaluations. AUCs were calculated for data divided between different stiffnesses. A 1.5-6-MHz curved-array transducer was used to assess the effect of depth (3.5 vs 6 cm) on shear-wave elastography in 80 scans. Mixed model analysis was performed to assess the effect of target diameter and depth. RESULTS. Strain ratio and strain histogram AUCs were higher than the shear-wave velocity AUC (p < 0.001) in data divided as 80 versus 45, 14, and 8 kPa. In data divided as 80 and 45 versus 14 and 8 kPa, the methods were equal (p = 0.959 and p = 1.000, respectively). Strain ratios were superior (p = 0.030), whereas strain histograms were not significantly better (p = 0.083) than shear-wave elastography in data divided as 80, 45, and 14 versus 8 kPa. Target diameter had an effect on all three methods (p = 0.001). Depth had an effect on shear-wave velocity (p = 0.001). CONCLUSION. The ability to discern different target stiffnesses varies between shear-wave and strain elastography. Target diameter affected all methods. Shear-wave elastography is affected by target depth.
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Liao LY, Kuo KL, Chiang HS, Lin CZ, Lin YP, Lin CL. Acoustic radiation force impulse elastography of the liver in healthy patients: test location, reference range and influence of gender and body mass index. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:698-704. [PMID: 25638317 DOI: 10.1016/j.ultrasmedbio.2014.09.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 09/18/2014] [Accepted: 09/26/2014] [Indexed: 06/04/2023]
Abstract
The objective of this study was to evaluate the best test location and study factors associated with acoustic radiation force impulse (ARFI) elastography measurements in healthy individuals. When ARFI elastography was performed on 68 healthy patients after controlling for all known test condition factors except segmental location, the median shear wave velocities (SWVs) derived from five valid measurements in the area between S5 and S8 in patients in the supine position had a significantly lower mean and the narrowest 95% confidence interval, followed by those for the S8 supine and S8 semidecubitus locations (p = 0.045). Analysis of mean SWVs revealed similar, although statistically insignificant, findings (p = 0.078). Male patients had significantly higher median SWVs (p = 0.0073) and mean SWVs (p = 0.0043) than female patients. Patients with body mass indexes >22 had significantly lower median SWVs (p = 0.0033) and mean SWVs (p = 0.0008) than those with body mass indexes ≤22. S5/8 supine was the better test location for ARFI. The reference ranges for median and mean SWV were 0.81-1.27 and 0.82-1.27 m/s, respectively. Gender and body mass index, but not age, were the significant factors associated with ARFI SWV values.
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Affiliation(s)
- Li-Ying Liao
- Liver Center, Department of Gastroenterology, Taipei City Hospital Renai Branch, Taipei, Taiwan, Republic of China.
| | - Kuan-Liang Kuo
- Department of Family Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan, Republic of China
| | - Huei-Shin Chiang
- Liver Center, Department of Gastroenterology, Taipei City Hospital Renai Branch, Taipei, Taiwan, Republic of China
| | - Chong-Zong Lin
- Liver Center, Department of Gastroenterology, Taipei City Hospital Renai Branch, Taipei, Taiwan, Republic of China
| | - Yi-Ping Lin
- Taipei Databank for Public Health Analysis, Institute of Clinical Research and Training, Taipei City Hospital, Taipei, Taiwan, Republic of China
| | - Chih-Lin Lin
- Liver Center, Department of Gastroenterology, Taipei City Hospital Renai Branch, Taipei, Taiwan, Republic of China
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Reliability analysis of acoustic radiation force impulse ultrasound imaging with virtual touch tissue quantification: ex vivo ox liver. Ultrasound Q 2015; 31:59-62. [PMID: 25706366 DOI: 10.1097/ruq.0000000000000070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effect of scanning angle and region of interest (ROI) depth on shear-wave velocity (SWV) was investigated in this study. Shear-wave velocity of ox liver ex vivo was measured with different approaches. Region of interest was set underneath the liver capsule at depths of 1, 2, 3, 4, and 5 cm. Three groups of measurements were performed at different scanning angles. One group of measurement was conducted with a scanning angle of 0 to 15 degrees from the midline, and the other 2 groups were performed with scanning angles of 15 to 30 degrees and 30 to 45 degrees. The data on SWV from different scan angles and ROI depths were analyzed statistically. Scanning angle and ROI depth were found to be the 2 factors that affect SWV. Interaction was observed between the scan angle and ROI depth. The data at different depths within 0- to 15-degree scanning angles exhibited no significant difference. However, the reliability of SWV decreased with the increase in ROI depth. In the groups of 15 to 30 degrees and 30 to 45 degrees, a significant difference was found between the 2 different measured depths. Scanning angle and ROI depth affected the reliability of SWV measurement. The scanning angle should be confined within 15 degrees from the midline. Therefore, SWV from shallow ROI is more reliable than that at deep ROI.
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Huang Z, Zheng J, Zeng J, Wang X, Wu T, Zheng R. Normal liver stiffness in healthy adults assessed by real-time shear wave elastography and factors that influence this method. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2549-2555. [PMID: 25282481 DOI: 10.1016/j.ultrasmedbio.2014.05.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 06/03/2023]
Abstract
Real-time shear wave elastography (SWE) is a novel two-dimensional elastographic method that is used to estimate the severity of liver fibrosis. However, the normal range of liver stiffness (LS) and the possible factors that influence SWE are not well understood. The aims of the current study are to define the normal range of LS in healthy subjects and to explore the factors that may affect SWE. A total of 509 healthy subjects underwent SWE to determine the stiffness of their livers, and the effects of gender, age and body mass index (BMI) on LS were analyzed. The effects of different factors on SWE, including the testing position, measurement depth and size of the region of interest (ROI), were analyzed in 137 subjects. SWE imaging was successfully performed in 502 healthy subjects (98.6%, 502/509). The mean value of the SWE measurements in 502 individuals was 5.10 ± 1.02 kPa, and the 95% confidence interval was 5.02-5.19 kPa (range: 2.4-8.7 kPa). We found that the detective position within the liver had a significant impact on the liver stiffness measurement (LSM), and the lowest coefficient of variation (CV = 8%) was obtained for LSMs made at segment V. LS was greater at a depth >5 cm (5.78 ± 1.66 kPa) compared with depths ≤5 cm (4.66 ± 0.77 kPa, p < 0.001); LS was also greater in men than in women (5.45 ± 1.02 kPa vs. 4.89 ± 0.96 kPa, p < 0.001). However, there were no significant differences in the LS values regarding the size of the ROI, age or BMI (all p > 0.05). The mean LS value in all 502 healthy subjects was 5.10 ± 1.02 kPa. The mean LS value obtained by SWE was not influenced by the size of the ROI, age or BMI, but the mean value was significantly influenced by the different segments of the liver, the detection depth and gender.
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Affiliation(s)
- Zeping Huang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jian Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jie Zeng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoli Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
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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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