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Reuter KL. Noninvasive Identification of Metabolic Dysfunction-associated Steatohepatitis Globally. Radiology 2024; 310:e240436. [PMID: 38501949 DOI: 10.1148/radiol.240436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Karen L Reuter
- From the Department of Radiology, Tufts University School of Medicine, Boston, Mass; and Commonwealth Radiology Associates, Tufts New England Medical Center, 800 Washington St, Boston, MA 02116
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Huang ZH, Wang LK, Cai SY, Chen HX, Zhou Y, Cheng LK, Lin YW, Zheng MH, Zheng YP. Palm-Sized Wireless Transient Elastography System with Real-Time B-Mode Ultrasound Imaging Guidance: Toward Point-of-Care Liver Fibrosis Assessment. Diagnostics (Basel) 2024; 14:189. [PMID: 38248066 PMCID: PMC11154523 DOI: 10.3390/diagnostics14020189] [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: 12/23/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Transient elastography (TE), recommended by the WHO, is an established method for characterizing liver fibrosis via liver stiffness measurement (LSM). However, technical barriers remain towards point-of-care application, as conventional TE requires wired connections, possesses a bulky size, and lacks adequate imaging guidance for precise liver localization. In this work, we report the design, phantom validation, and clinical evaluation of a palm-sized TE system that enables simultaneous B-mode imaging and LSM. The performance of this system was validated experimentally using tissue-equivalent reference phantoms (1.45-75 kPa). Comparative studies against other liver elastography techniques, including conventional TE and two-dimensional shear wave elastography (2D-SWE), were performed to evaluate its reliability and validity in adults with various chronic liver diseases. Intra- and inter-operator reliability of LSM were established by an elastography expert and a novice. A good agreement was observed between the Young's modulus reported by the phantom manufacturer and this system (bias: 1.1-8.6%). Among 121 patients, liver stiffness measured by this system and conventional TE were highly correlated (r = 0.975) and strongly agreed with each other (mean difference: -0.77 kPa). Inter-correlation of this system with conventional TE and 2D-SWE was observed. Excellent-to-good operator reliability was demonstrated in 60 patients (ICCs: 0.824-0.913). We demonstrated the feasibility of employing a fully integrated phased array probe for reliable and valid LSM, guided by real-time B-mode imaging of liver anatomy. This system represents the first technical advancement toward point-of-care liver fibrosis assessment. Its small footprint, along with B-mode guidance capability, improves examination efficiency and scales up screening for liver fibrosis.
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Affiliation(s)
- Zi-Hao Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (Z.-H.H.); (L.-K.W.); (L.-K.C.)
| | - Li-Ke Wang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (Z.-H.H.); (L.-K.W.); (L.-K.C.)
| | - Shang-Yu Cai
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzhen 518000, China; (S.-Y.C.); (H.-X.C.); (Y.Z.)
| | - Hao-Xin Chen
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzhen 518000, China; (S.-Y.C.); (H.-X.C.); (Y.Z.)
| | - Yongjin Zhou
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzhen 518000, China; (S.-Y.C.); (H.-X.C.); (Y.Z.)
| | - Lok-Kan Cheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (Z.-H.H.); (L.-K.W.); (L.-K.C.)
| | - Yi-Wei Lin
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-W.L.); (M.-H.Z.)
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-W.L.); (M.-H.Z.)
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou 325000, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (Z.-H.H.); (L.-K.W.); (L.-K.C.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
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Funada K, Kusano Y, Gyotoku Y, Shirahashi R, Suda T, Tamano M. Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and Fib-4 index. World J Gastroenterol 2023; 29:3703-3714. [PMID: 37398885 PMCID: PMC10311609 DOI: 10.3748/wjg.v29.i23.3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Shear wave speed (SWS), shear wave dispersion (SWD), and attenuation imaging (ATI) are new diagnostic parameters for non-alcoholic fatty liver disease. To differentiate between non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver (NAFL), we developed a clinical index we refer to as the “NASH pentagon” consisting of the 3 abovementioned parameters, body mass index (BMI), and Fib-4 index.
AIM To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.
METHODS This non-invasive, prospective, observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography, SWD, and ATI were measured. Histological diagnosis based on liver biopsy was performed in 31 patients. The large pentagon group (LP group) and the small pentagon group (SP group), using an area of 100 as the cutoff, were compared; the NASH diagnosis rate was also investigated. In patients with a histologically confirmed diagnosis, receiver-operating characteristic (ROC) curve analyses were performed.
RESULTS One hundred-seven patients (61 men, 46 women; mean age 55.1 years; mean BMI 26.8 kg/m2) were assessed. The LP group was significantly older (mean age: 60.8 ± 15.2 years vs 46.4 ± 13.2 years; P < 0.0001). Twenty-five patients who underwent liver biopsies were diagnosed with NASH, and 6 were diagnosed with NAFL. On ROC curve analyses, the areas under the ROC curves for SWS, dispersion slope, ATI value, BMI, Fib-4 index, and the area of the NASH pentagon were 0.88000, 0.82000, 0.58730, 0.63000, 0.59333, and 0.93651, respectively; the largest was that for the area of the NASH pentagon.
CONCLUSION The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.
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Affiliation(s)
- Kei Funada
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Yumi Kusano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Yoshinori Gyotoku
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Ryosaku Shirahashi
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Toshikuni Suda
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Masaya Tamano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
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Wang HP, Zheng PC, Wang XM, Sang L. Artifacts in two-dimensional shear wave elastography of liver. World J Gastroenterol 2023; 29:3318-3327. [PMID: 37377588 PMCID: PMC10292141 DOI: 10.3748/wjg.v29.i21.3318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/23/2023] [Accepted: 05/06/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Artifacts are common when using two-dimensional shear wave elastography (2-D SWE) to measure liver stiffness (LS), but they are poorly recognized.
AIM To investigate the presence and influence of artifacts in 2-D SWE of liver.
METHODS We included 158 patients with chronic liver disease, who underwent 2-D SWE examination by a novice and an expert. A cross line at the center of the elastogram was drawn and was divided it into four locations: top-left, top-right, bottom-left, and bottom-right. The occurrence frequency of artifacts in different locations was compared. The influence of artifacts on the LS measurements was evaluated by comparing the elastogram with the most artifacts (EMA) and the elastogram with the least artifacts (ELA).
RESULTS The percentage of elastograms with artifacts in the novice (51.7%) was significantly higher than that of the expert (19.6%) (P < 0.001). It was found that both operators had the highest frequency of artifacts at bottom-left, followed by top-left and bottom-right, and top-right had the lowest frequency. The LS values (LSVs) and standard deviation values of EMAs were significantly higher than those of ELAs for both operators. An intraclass correlation coefficient value of 0.96 was found in the LSVs of EMAs of the two operators, and it increased to 0.98 when the LSVs of the ELAs were used. Both operators had lower stability index values for EMAs than ELAs, but the difference was only statistically significant for the novice.
CONCLUSION Artifacts are common when using 2-D SWE to measure LS, especially for the novice. Artifacts may lead to the overestimation of LS and reduce the repeatability and reliability of LS measurements.
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Affiliation(s)
- Hui-Peng Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Peng-Chao Zheng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xue-Mei Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Liang Sang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Wang X, Li Y, Jiang L, Zhou M, Zhang X, Wen H. Performance of 2D-shear wave elastography in autoimmune hepatitis-primary biliary cholangitis overlap syndrome. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1290-1297. [PMID: 36792725 DOI: 10.1007/s00261-023-03840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To evaluate the diagnostic values of liver stiffness (LS) measured by 2D-SWE, fibrosis index based on the four factors (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), and GGT to PLT ratio (GPR) for assessing liver fibrosis and high-risk esophageal varices (EVs) in patients with autoimmune hepatitis-primary biliary cholangitis (AIH-PBC) overlap syndrome. METHODS Data of 141 patients were retrospectively collected. Liver fibrosis was staged according to the Scheuer scoring system. The Spearman correlation coefficient was used for correlation analysis. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance. RESULTS LS and FIB-4 were positively correlated with the fibrosis stage (r = 0.555 and 0.198, respectively). LS had significantly higher areas under the ROC curves (AUROCs) values than FIB-4 for predicting advanced fibrosis (0.818 vs. 0.567, P < 0.001), cirrhosis (0.879 vs. 0.637, P < 0.001), whereas LS and FIB-4 similarly predicted significant fibrosis (0.748 vs. 0.638, P = 0.071) and high-risk EVs (0.731 vs. 0.659, P = 0.303). The optimal cut-off values of 2D-SWE for detecting significant fibrosis, advanced fibrosis, cirrhosis, and high-risk EVs were 8.7 kPa, 12.8 kPa, 14.0 kPa, and 11.0 kPa, respectively. LS values were influenced by fibrosis stage, serum GGT, albumin, and total bilirubin levels. The overall concordance rate of the liver stiffness vs. Scheuer stages was 49.65%. CONCLUSIONS 2D-SWE shows significantly greater diagnostic accuracy than serum fibrosis indexes for diagnosing advanced fibrosis and cirrhosis in patients with AIH-PBC overlap syndrome.
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Affiliation(s)
- Xuexin Wang
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yingxia Li
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Libin Jiang
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Mingxia Zhou
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaopeng Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hongtao Wen
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Zhang X, Zheng Y, Li J, Zhang B. Application of the shear wave elastography in the assessment of carotid body tumors: A preliminary study. Front Oncol 2023; 12:1053236. [PMID: 36686815 PMCID: PMC9853190 DOI: 10.3389/fonc.2022.1053236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives To evaluate the elasticity of carotid body tumors (CBTs) by two-dimensional shear wave elastography (SWE). Methods 22 pathologically or clinically confirmed CBTs in 16 patients were scanned by SWE. The maximum elasticity value (Emax) and its standard deviation (SDmax) in kPa and m/s for CBTs were obtained by placing a round ROI (2-3 mm) on the stiffest region of the CBTs. Elasticity value was compared between hard and soft groups at manual palpation, benign and malignant groups and among three Shamblin types. The area under the receiver operating characteristic curve (AUC) analysis was performed to evaluate the performance of SWE in the malignancy prediction of CBTs. Sensitivity, specificity and accuracy were calculated. The cut-off value was obtained by using the Youden index. Results There were 19 benign CBTs and 3 malignant CBTs. Emax (kPa and m/s) and SDmax (kPa) were significantly higher in the hard group than in the soft group at manual palpation (P<0.05); The distribution of Emax in kPa and m/s and SDmax in kPa were different in the three Shamblin types (P<0.05), Emax (kPa and m/s)increased from shambling I to Shambling II and Shambling III; Emax (kPa and m/s) were significantly higher in the malignant CBTs than in the benign ones (P<0.05). Emax in kPa and m/s had the similar AUC value (AUC=0.947, P=1.0000) for the prediction of malignant CBTs. Emax in kPa with the cut-off 124.9kPa showed a sensitivity of 100.0%, specificity of 94.7%, and an accuracy of 95.5% (Z=8.500, P<0.0001); Emax in m/s with the cut-off 5.9m/s showed a sensitivity of 100.0%, specificity of 89.5% and an accuracy of 90.9% for the prediction of malignant CBTs (Z=9.143, P<0.0001). Conclusions Quantitative analysis of SWE obtained the good performance in the elasticity assessment of CBTs.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Jianchu Li, ; Bo Zhang,
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China,*Correspondence: Jianchu Li, ; Bo Zhang,
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Gatos I, Yarmenitis S, Theotokas I, Koskinas J, Manesis E, Zoumpoulis SP, Zoumpoulis PS. Comparison of Visual Transient Elastography, Vibration Controlled Transient Elastography, Shear Wave Elastography and Sound Touch Elastography in Chronic liver Disease assessment using liver biopsy as ‘Gold Standard’. Eur J Radiol 2022; 157:110557. [DOI: 10.1016/j.ejrad.2022.110557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/03/2022]
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Fang C, Rafailidis V, Konstantatou E, Yusuf GT, Barrow I, Pagkalidou E, Romanos O, Agarwal K, Quaglia A, Sidhu PS. Comparison Between Different Manufacturers' 2-D and Point Shear Wave Elastography Techniques in Staging Liver Fibrosis in Chronic Liver Disease Using Liver Biopsy as the Reference Standard: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2229-2236. [PMID: 36008215 DOI: 10.1016/j.ultrasmedbio.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/04/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to assess the utility of 2-D shear wave elastography (SWE) in assessing liver fibrosis in patients with chronic liver disease by comparing its performance with that of point shear wave elastography (pSWE) using liver histological staging as the reference standard. In this ethics committee-approved, single-institution prospective study, pSWE and 2-D SWE velocity measurements were obtained in 121 adult patients (age: 18-70 y, median: 45 y) immediately before a liver biopsy for chronic liver disease. Shear wave velocity (SWV) and Ishak scores were compared using the Kruskal-Wallis test, Spearman's correlation and receiver operating characteristic (ROC) curve analysis. Youden's index was used to determine the optimal cutoff point. There was no technical failure using pSWE and 2-D SWE. The mean difference for SWV between pSWE and 2-D SWE was 0.0223 (limits of agreement: -1.1009, 1.1145). Values for both pSWE and 2-D SWE were significantly correlated with fibrosis stage (Spearman's ρ = 0.606, p < 0.0001; ρ = 0.722, p < 0.001 respectively). The area under the ROC curve differentiating F ≥3 was 0.855 (95% confidence interval: 0.778-0.932) for pSWE and 0.884 (95% CI: 0.817-0.951) for 2-D SWE. The AUC for differentiating F ≥5 was 0.890 (95% CI: 0.826-0.954) for pSWE and 0.926 (95% CI: 0.88-0.973) for 2-D SWE. This study indicates that 2-D SWE provides feasible and accurate assessment of liver fibrosis, comparable to that provided by pSWE from two different manufacturers' machines.
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Affiliation(s)
- Cheng Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK.
| | - Vasileios Rafailidis
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Eleni Konstantatou
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Gibran T Yusuf
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ian Barrow
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Eirini Pagkalidou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Odyssefs Romanos
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, SE5 9RS, United Kingdom
| | - Alberto Quaglia
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, SE5 9RS, United Kingdom; Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK; UCL Cancer Institute, University College London, London, UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
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Parasaram V, Civale J, Bamber JC, Robinson SP, Jamin Y, Harris E. Preclinical Three-Dimensional Vibrational Shear Wave Elastography for Mapping of Tumour Biomechanical Properties In Vivo. Cancers (Basel) 2022; 14:4832. [PMID: 36230755 PMCID: PMC9564290 DOI: 10.3390/cancers14194832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/06/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Preclinical investigation of the biomechanical properties of tissues and their treatment-induced changes are essential to support drug-discovery, clinical translation of biomarkers of treatment response, and studies of mechanobiology. Here we describe the first use of preclinical 3D elastography to map the shear wave speed (cs), which is related to tissue stiffness, in vivo and demonstrate the ability of our novel 3D vibrational shear wave elastography (3D-VSWE) system to detect tumour response to a therapeutic challenge. We investigate the use of one or two vibrational sources at vibrational frequencies of 700, 1000 and 1200 Hz. The within-subject coefficients of variation of our system were found to be excellent for 700 and 1000 Hz and 5.4 and 6.2%, respectively. The relative change in cs measured with our 3D-VSWE upon treatment with an anti-vascular therapy ZD6126 in two tumour xenografts reflected changes in tumour necrosis. U-87 MG drug vs vehicle: Δcs = −24.7 ± 2.5 % vs 7.5 ± 7.1%, (p = 0.002) and MDA-MB-231 drug vs vehicle: Δcs = −12.3 ± 2.7 % vs 4.5 ± 4.7%, (p = 0.02). Our system enables rapid (<5 min were required for a scan length of 15 mm and three vibrational frequencies) 3D mapping of quantitative tumour viscoelastic properties in vivo, allowing exploration of regional heterogeneity within tumours and speedy recovery of animals from anaesthesia so that longitudinal studies (e.g., during tumour growth or following treatment) may be conducted frequently.
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Affiliation(s)
| | | | | | | | | | - Emma Harris
- Division of Radiotherapy and Imaging, Centre for Cancer Imaging, Institute of Cancer Research, London SM2 5NG, UK
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Point Shear Wave Elastography and 2-Dimensional Shear Wave Elastography as a Non-Invasive Method in Differentiating Benign from Malignant Liver Lesions. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.
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Yan Y, Xing X, Lu Q, Wang X, Luo X, Yang L. Two-dimensional shear wave elastography for sparing endoscopy screening in patients with HBV-related compensated advanced chronic liver disease. Expert Rev Gastroenterol Hepatol 2022; 16:89-96. [PMID: 34939906 DOI: 10.1080/17474124.2022.2020644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of liver stiffness (LS) measured by 2D-SWE for predicting esophageal varices (EV) and high-risk varices (HRV) in patients with hepatitis B virus (HBV)-related compensated advanced chronic liver disease (cACLD). METHODS In total, 268 patients with HBV-related cACLD who underwent 2D-SWE and esophagogastroduodenoscopy (EGD) were retrospectively evaluated. The new criteria for ruling out HRV were tested in the training cohort with 175 patients and validated in the validation cohort with 93 patients. RESULTS The AUROCs of LS for predicting EV and HRV were 0.90(0.86-0.95) and 0.93(0.89-0.96) respectively. LS (OR, 1.64 (95% CI: 1.31-2.07); P < 0.0001), PLT (OR, 0.94 (95% CI: 0.91-0.97); P < 0.0001) and albumin (OR, 0.75 (95% CI: 0.62-0.90); P = 0.02) were independent factors for the presence of HRV. The Baveno VI criteria of LS < 20 kPa and PLT > 150 × 109 /L saved 15.1%-17.1% EGD screening with 0-4.3% HRV miss rate. LS < 16 kPa and PLT > 60 × 109 /L spared 51.4%-52.7% EGD screening with 3.8%-4.3% HRV miss rate. CONCLUSION Baveno VI criteria is suitable for 2D-SWE to rule out HRV. LS < 16 kPa and PLT > 60 × 109 /L could be a reliable model for ruling out HRV in patients with HBV-related cACLD.
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Affiliation(s)
- Yuling Yan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, People's Republic of China.,West China Hospital, Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, People's Republic of China
| | - Xian Xing
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, People's Republic of China.,West China Hospital, Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, People's Republic of China
| | - Qiang Lu
- Department of Ultrasonography, West China Hospital, Sichuan University, People's Republic of China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, People's Republic of China.,West China Hospital, Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, People's Republic of China
| | - Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, People's Republic of China.,West China Hospital, Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, People's Republic of China
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, People's Republic of China.,West China Hospital, Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, People's Republic of China
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12
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Yamada K, Ishikawa T, Kawashima H, Ohno E, Iida T, Ishikawa E, Mizutani Y, Sawada T, Maeda K, Yamamura T, Kakushima N, Furukawa K, Nakamura M, Ishigami M, Fujishiro M. Evaluation of ulcerative colitis activity using transabdominal ultrasound shear wave elastography. Quant Imaging Med Surg 2022; 12:618-626. [PMID: 34993106 DOI: 10.21037/qims-21-403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transabdominal ultrasound (US) has been reported to be effective in the evaluation of ulcerative colitis (UC). US can measure shear wave elastography (SWE) and shear wave dispersion (SWD), which may be correlated with inflammation and necrosis. We aimed to investigate the relationship between UC activity and SWE and SWD. METHODS Patients with UC who underwent US within 2 days before or after a colonoscopy between April 2019 and March 2020 were included. SWE and SWD were measured in the sigmoid colon; the correlations of SWE and SWD with the Lichtiger index and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) were investigated. We also compared SWE and SWD between patients with mucosal healing and those in the active phase according to the UCEIS. RESULTS Twenty-six UC patients were enrolled. The median Lichtiger index, UCEIS, SWE values, and SWD values were 8 [interquartile range (IQR), 5.3-10.8], 4 (IQR, 3.3-5), 1.69 (IQR, 1.49-2.16) m/s, and 11.9 (IQR, 10.9-13.3) (m/s)/kHz, respectively. The Lichtiger index and UCEIS were negatively correlated with the SWE values (rs=-0.404 and rs=-0.506) but not with the SWD values (rs=0.004 and rs=0.002). The SWE values differed significantly between the mucosal healing and active phase groups [2.40 (IQR, 2.18-3.38) vs. 1.62 (IQR, 1.44-1.95) m/s, P=0.007], whereas the SWD values did not [13.1 (IQR, 7.05-21.6) vs. 11.9 (IQR, 11.1-13.2) (m/s)/kHz, P=0.918]. CONCLUSIONS SWE may be useful for the evaluation of UC activity and could be a noninvasive method of assessing disease severity.
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Affiliation(s)
- Kenta Yamada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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A Cross-Machine Comparison of Shear-Wave Speed Measurements Using 2D Shear-Wave Elastography in the Normal Female Breast. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Quantitative measures of radiation-induced breast stiffness are required to support clinical studies of novel breast radiotherapy regimens and exploration of personalised therapy, however, variation between shear-wave elastography (SWE) machines may limit the usefulness of shear-wave speed (cs) for this purpose. Mean cs measured in four healthy volunteers’ breasts and a phantom using 2D-SWE machines Acuson S2000 (Siemens Medical Solutions) and Aixplorer (Supersonic Imagine) were compared. Shear-wave speed was measured in the skin region, subcutaneous adipose tissue and parenchyma. cs estimates were on average 2.3% greater when using the Aixplorer compared to S2000 in vitro. In vivo, cs estimates were on average 43.7%, 36.3% and 49.9% significantly greater (p << 0.01) when using the Aixplorer compared to S2000, for skin region, subcutaneous adipose tissue and parenchyma, respectively. In conclusion, despite relatively small differences between machines observed in vitro, large differences in absolute measures of shear wave speed measured were observed in vivo, which may prevent pooling of cross-machine data in clinical studies of the breast.
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14
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Dong B, Huang S, Chang J, Chen X, Yan J. Comparison of Sound Touch Elastography, Sound Touch Quantify, and 4 Serum Fibrosis Indexes for the Diagnosis of Liver Fibrosis in Patients With Chronic Hepatitis B. Ultrasound Q 2021; 37:123-128. [PMID: 34057912 DOI: 10.1097/ruq.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT The aim of this research was to compare the use of shear wave elastography (sound touch elastography [STE] and sound touch quantify [STQ]) and serum liver fibrosis indexes in the evaluation and staging of chronic hepatitis B (CHB) liver fibrosis. Sound touch elastography is a form of 2-dimensional shear wave elastography, and STQ is a form of point shear wave elastography. Between June 2018 and March 2019, 122 patients with CHB were assessed using STE and STQ. Serum liver biomarkers tests were undertaken, and liver biopsy was performed, and these were used to assign a pathological stage based on the Scheuer scoring system. A receiver operating characteristic curve was used to analyze the diagnostic value of noninvasive methods for evaluating and staging liver fibrosis. The cutoff values of STE for liver fibrosis stages S2 to S4 were 8.85, 9.97, and 10.29 kPa, respectively, and the areas under the receiver operating characteristic (AUCs) curve were 0.703, 0.821, and 0.900, respectively. The cutoff values of STQ for liver fibrosis stages S2 to S4 were 11.31, 13.81, and 20.60 kPa, respectively, and the AUCs were 0.674, 0.807, and 0.893, respectively. The AUCs of STE and STQ in diagnosing fibrosis stage were significantly higher than those of liver serum biomarkers (P < 0.05). The AUCs for the ability of the aspartate transaminase-to-platelet ratio index, the fibrosis index based on the 4 factors, the King score, and the Forns index to diagnose S2 fibrosis were 0.502, 0.624, 0.542, and 0.616, respectively, and the AUCs for their ability to diagnose S4 fibrosis were 0.856, 0.861, 0.883, and 0.823, respectively. Both STE and STQ are noninvasive methods for the assessment of liver fibrosis in CHB patients, with better diagnostic performances than those of 4 serum fibrosis indexes.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University
| | - Shu Huang
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University
| | - Jiandong Chang
- Department of Ultrasound, Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Xiaoyan Chen
- Department of Ultrasound, Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Jianping Yan
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University
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15
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Nowotny F, Schmidberger J, Schlingeloff P, Binzberger A, Kratzer W. Comparison of point and two-dimensional shear wave elastography of the spleen in healthy subjects. World J Radiol 2021; 13:137-148. [PMID: 34141093 PMCID: PMC8188838 DOI: 10.4329/wjr.v13.i5.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few systematic comparative studies of the different methods of physical elastography of the spleen are currently available.
AIM To compare point shear wave and two-dimensional elastography of the spleen considering the anatomical location (upper, hilar, and lower pole).
METHODS As part of a prospective clinical study, healthy volunteers were examined for splenic elasticity using four different ultrasound devices between May 2015 and April 2017. The devices used for point shear wave elastography were from Siemens (S 3000) and Philips (Epiq 7), and those used for two-dimensional shear wave elastography were from GE (Logiq E9) and Toshiba (Aplio 500). In addition, two different software versions (5.0 and 6.0) were evaluated for the Toshiba ultrasound device (Aplio 500). The study consisted of three arms: A, B, and C.
RESULTS In study arm A, 200 subjects were evaluated (78 males and 122 females, mean age 27.9 ± 8.1 years). In study arm B, 113 subjects were evaluated (38 men and 75 women, mean age 26.0 ± 6.3 years). In study arm C, 44 subjects were enrolled. A significant correlation of the shear wave velocities at the upper third of the spleen (r = 0.33088, P < 0.0001) was demonstrated only for the Philips Epiq 7 device compared to the Siemens Acuson S 3000. In comparisons of the other ultrasound devices (GE, Siemens, Toshiba), no comparable results could be obtained for any anatomical position of the spleen. The influencing factors age, gender, and body mass index did not show a clear correlation with the measured shear wave velocities.
CONCLUSION The absolute values of the shear wave elastography measurements of the spleen and the two different elastography methods are not comparable between different manufacturers or models.
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Affiliation(s)
- Friederike Nowotny
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | | | - Andreas Binzberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
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16
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Woo JH, Ko EY, Han BK. Comparison of 2 shear wave elastography systems in reproducibility and accuracy using an elasticity phantom. Medicine (Baltimore) 2021; 100:e24921. [PMID: 33847610 PMCID: PMC8052081 DOI: 10.1097/md.0000000000024921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to compare the accuracy and inter- and intra-observer reproducibility of the measured elasticity between 2 shear wave elastography systems. Three breast radiologists examined 8 targets of 4 different levels of stiffness (size: 11 mm, 4 mm) in an elasticity phantom (Customized 049A Elasticity QA Phantom, CIRS, Norfolk, VA, USA) using 2 different shear wave ultrasound elastography systems: SuperSonic Imagine (SSI) (SSI, Aix en Provence, France) and ShearScan (RS-80A, Samsung Medison, Seoul, Korea). Three radiologists performed ultrasound (US) elastography examinations for the phantom lesions using 2 equipment over a 1-week interval. Intra- and inter-observer reproducibility and the accuracy of the measured elasticity were analyzed and compared between the 2 systems. The accuracy of shape was also analyzed by shape-matching between B-mode and elastography color image. Intra-class correlation coefficients (ICC) were used in statistical analysis. For measured elasticity, the intra-observer and inter-observer reproducibility were excellent in both SSI and ShearScan (0.994 and 0.998). The overall accuracy was excellent in both systems, but the accuracy in small lesions (4 mm target) was lower in SSI than ShearScan (0.780 vs 0.967). The accuracy of shape-matching on the elastography image was 59.0% and 81.4% in the SSI and ShearScan, respectively. In conclusion, the SSI and ShearScan showed excellent intra- and inter-observer reproducibility. The accuracy of the Young's modulus was high in both the SSI and ShearScan, but the SSI showed decreased accuracy in measurement of elasticity in small targets and poor shape-matching between the B-mode image and color-coded elastography image.
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17
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Wong A, Yusuf GT, Malbrain MLNG. Future developments in the imaging of the gastrointestinal tract: the role of ultrasound. Curr Opin Crit Care 2021; 27:147-156. [PMID: 33560015 DOI: 10.1097/mcc.0000000000000815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the utilization and most recent developments with regard to the use of ultrasound when imaging the abdomen and gastrointestinal tract. RECENT FINDINGS Although the use of ultrasound to assess the anatomy of the various abdominal organs is well established within radiology and critical care, its use as part of functional and physiological assessment is still evolving. Recent developments have extended the use of ultrasound beyond standard B-mode/2D imaging techniques to incorporate more functional and haemodynamic assessment. These include the use of contrast-enhanced ultrasound (CEUS), elastography, and colour Doppler techniques. SUMMARY Whilst Doppler techniques are reasonably well established within critical care ultrasound (CCUS), especially in echocardiography, CEUS and elastography are less well known. CEUS utilizes a purely intravascular contrast agent whilst elastography measures the degree of deformation or stiffness in various organs. Whilst their use individually may be limited; they may play a role in a multiparametric assessment. Mirroring the overall trends in critical care ultrasound development, abdominal ultrasound assessment is best integrated in a holistic approach and adapted to the individual patient.
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Affiliation(s)
| | | | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics, VUB, Brussels, Belgium
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18
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Lim Z, Whitaker T, DeColle K, Barrett K, Harlton C, Paskar L, Low G. Interobserver and Intraobserver Reliability of Hepatic Shear Wave Elastography and the Influence of Fasted Versus Nonfasted States in Healthy Volunteers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:259-267. [PMID: 32686849 DOI: 10.1002/jum.15395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The primary objective of this study was to assess the effect of fasting versus ingestion of food and water on hepatic measurements by shear wave elastography (SWE) in healthy participants. The secondary objective was to assess inter- and intra-reader reliability of hepatic elastography in healthy participants. METHODS Twenty healthy participants were enrolled in this prospective study and underwent quantitative SWE under fasting conditions and after the ingestion of water and food and water. Two blinded sonographers each independently performed a total of 6 sessions of hepatic SWE in each participant. Sessions 1 to 3 were performed on day 0 and sessions 4 to 6 on day 7. Statistical tests used included the Wilcoxon signed ranks test, the intraclass correlation coefficient, and Bland-Altman plots. RESULTS There were no significant differences in hepatic SWE measurements after the ingestion of water versus the fasting state. Statistical significance was assessed as P < 0.05. The postprandial status had a statistically significant effect on hepatic SWE measurements at 1 hour (P = .04) but not at 3 hours (P = .08). By the intraclass correlation coefficient, there was poor-to-moderate inter-reader agreement and minimal-to-moderate intra-reader agreement. The median inter-reader difference in SWE measurements ranged from 0.66 to 0.96 kPa. The median intra-reader difference ranged from 0.43 to 0.55 kPa. CONCLUSIONS Our study shows that the ingestion of water has no effect on hepatic SWE measurements in healthy participants. The postprandial state had a significant effect on SWE measurements at 1 hour after ingestion but not at 3 hours. The inter-reader and intra-reader agreements were variable and moderate at best.
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Affiliation(s)
- Zerlene Lim
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | | | | | | | - Lee Paskar
- MIC Medical Imaging, Edmonton, Alberta, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
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Pennisi G, Celsa C, Giammanco A, Spatola F, Petta S. The Relevance of Noninvasive Tools To Assess Fibrosis in Non-Alcoholic Fatty Liver Disease. Curr Pharm Des 2021; 26:3928-3938. [PMID: 32436818 DOI: 10.2174/1381612826666200521133307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a growing cause of chronic liver diseases worldwide, involving about 25% of people. NAFLD incorporates a large spectrum of pathological conditions, from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis and its complications include hepatic decompensation and hepatocellular carcinoma (HCC). This progression occurs, over many years, in an asymptomatic way, until advanced fibrosis appears. Thus, the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis are key issues. To date, the histological assessment of fibrosis with liver biopsy is the gold standard, but obviously, invasiveness is the greater threshold. In addition, rare but potentially life-threatening complications, poor acceptability, sampling variability and cost maybe restrict its use. Furthermore, due to the epidemic of NAFLD worldwide and several limitations of liver biopsy evaluation, noninvasive assessment tools to detect fibrosis in NAFLD patients are needed.
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Affiliation(s)
- Grazia Pennisi
- Sezione di Gastroenterologia e Epatologia, PROMISE, University of Palermo, Palermo, Italy
| | - Ciro Celsa
- Sezione di Gastroenterologia e Epatologia, PROMISE, University of Palermo, Palermo, Italy
| | - Antonina Giammanco
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Federica Spatola
- Sezione di Gastroenterologia e Epatologia, PROMISE, University of Palermo, Palermo, Italy
| | - Salvatore Petta
- Sezione di Gastroenterologia e Epatologia, PROMISE, University of Palermo, Palermo, Italy
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20
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Kagadis GC, Drazinos P, Gatos I, Tsantis S, Papadimitroulas P, Spiliopoulos S, Karnabatidis D, Theotokas I, Zoumpoulis P, Hazle JD. Deep learning networks on chronic liver disease assessment with fine-tuning of shear wave elastography image sequences. Phys Med Biol 2020; 65:215027. [PMID: 32998480 DOI: 10.1088/1361-6560/abae06] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic liver disease (CLD) is currently one of the major causes of death worldwide. If not treated, it may lead to cirrhosis, hepatic carcinoma and death. Ultrasound (US) shear wave elastography (SWE) is a relatively new, popular, non-invasive technique among radiologists. Although many studies have been published validating the SWE technique either in a clinical setting, or by applying machine learning on SWE elastograms, minimal work has been done on comparing the performance of popular pre-trained deep learning networks on CLD assessment. Currently available literature reports suggest technical advancements on specific deep learning structures, with specific inputs and usually on a limited CLD fibrosis stage class group, with limited comparison on competitive deep learning schemes fed with different input types. The aim of the present study is to compare some popular deep learning pre-trained networks using temporally stable and full elastograms, with or without augmentation as well as propose suitable deep learning schemes for CLD diagnosis and progress assessment. 200 liver biopsy validated patients with CLD, underwent US SWE examination. Four images from the same liver area were saved to extract elastograms and processed to exclude areas that were temporally unstable. Then, full and temporally stable masked elastograms for each patient were separately fed into GoogLeNet, AlexNet, VGG16, ResNet50 and DenseNet201 with and without augmentation. The networks were tested for differentiation of CLD stages in seven classification schemes over 30 repetitions using liver biopsy as the reference. All networks achieved maximum mean accuracies ranging from 87.2%-97.4% and area under the receiver operating characteristic curves (AUCs) ranging from 0.979-0.990 while the radiologists had AUCs ranging from 0.800-0.870. ResNet50 and DenseNet201 had better average performance than the other networks. The use of the temporal stability mask led to improved performance on about 50% of inputs and network combinations while augmentation led to lower performance for all networks. These findings can provide potential networks with higher accuracy and better setting in the CLD diagnosis and progress assessment. A larger data set would help identify the best network and settings for CLD assessment in clinical practice.
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Affiliation(s)
- George C Kagadis
- 3DMI Research Group, Department of Medical Physics, School of Medicine, University of Patras, Rion GR 26504, Greece. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
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21
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Fang C, Sidhu PS. Ultrasound-based liver elastography: current results and future perspectives. Abdom Radiol (NY) 2020; 45:3463-3472. [PMID: 32918106 PMCID: PMC7593307 DOI: 10.1007/s00261-020-02717-x] [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: 06/03/2020] [Revised: 06/03/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
Chronic liver disease affects 185 million population worldwide. It encompasses a heterogenous disease spectrum, but all can lead to the development of liver fibrosis. The degree of liver fibrosis is not only a prognosticator, but has also been used to guide the treatment strategy and to evaluate treatment response. Traditionally, staging of liver fibrosis is determined on histological analysis using samples obtained from an invasive liver biopsy. Ultrasound-based liver elastography is a non-invasive method of assessing diffuse liver disease in patients with known chronic liver disease. The use of liver elastography has led to a significant reduction in the number of liver biopsies performed to assess the severity of liver fibrosis and a liver biopsy is now reserved for only select sub-groups of patients. The aim of this review article is to discuss the key findings and current evidence for ultrasound-based elastography in diffuse liver disease as well as the technical challenges and to evaluate the potential research direction.
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22
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Ronot M, Ferraioli G, Müller HP, Friedrich-Rust M, Filice C, Vilgrain V, Cosgrove D, Lim AK. Comparison of liver stiffness measurements by a 2D-shear wave technique and transient elastography: results from a European prospective multi-centre study. Eur Radiol 2020; 31:1578-1587. [PMID: 32902745 DOI: 10.1007/s00330-020-07212-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare liver stiffness measurement (LSM) provided by Canon 2D-shear wave elastography (2D-SWE) and transient elastography (TE), the latter being the reference method. METHODS Prospective study conducted in four European centres from 2015 to 2016 including patients with various chronic liver diseases who had LSMs with both 2D-SWE and TE on the same day. Median of 10 valid measurements (in kPa) was used for comparison using paired t test, Pearson correlation, intraclass correlation coefficient (ICC) and Bland-Altman plot. The ability of 2D-SWE to stratify patient according to recognised LSM-TE thresholds was assessed by ROC curve analysis. RESULTS Six hundred forty patients were scanned, where 593 (92.7%), 572 (89.4%) and 537 (83.9%) had reliable LSMs by TE, 2D-SWE and both combined, respectively. In the latter (n = 537, 310 [57.7%] male, mean 55.3 ± 14.8 years), median LSM-TE and LSM-2D-SWE had a mean of 10.1 ± 9.4 kPa (range 2.4-75) and 9.1 ± 6.1 kPa (range 3.6-55.7) (paired t test: p < 0.001), respectively. These were significantly correlated (Pearson r = 0.932, p < 0.001, ICC 0.850 (0.825-0.872), bias 0.99 ± 4.33 kPa [95% limits of agreement - 9.48 to + 7.49] with proportional error towards higher LSM values). LSM-2D-SWE values significantly increased with TE categories (ANOVA: p < 0.001). AUROCs ranged from 0.935 ± 0.010 (95% CI 0.910-0.954) to 0.973 ± 0.009 (95% CI 0.955-0.985), resulting in correct classification of 390/537 (73%) patients. Three 2D-SWE measurements were sufficient for reliable LSMs. CONCLUSION LSM using 2D-SWE correlates well with TE. It tends to underestimate higher stages of liver fibrosis but correctly classifies the majority of patients. It may be used in TE-derived algorithms to manage patients. KEY POINTS • Liver stiffness measurement (LSM) by 2D-shear wave elastography (2D-SWE) and transient elastography (TE) are strongly correlated. • 2D-SWE shows proportionately lower LSM values compared to TE, particularly with the higher LSM range. • Three individual measurements by 2D-SWE are sufficient to assess LSM reliably.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, Beaujon University Hospital, APHP.Nord, Clichy, France. .,Université de Paris, Paris, France.
| | - Giovanna Ferraioli
- Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Hans-Peter Müller
- Department of Hepatology and Imaging, Charité Hospital, University of Berlin, Berlin, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, Division of Gastroenterology and Hepatology, Goethe University Hospital, Frankfurt, Germany
| | - Carlo Filice
- Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Valérie Vilgrain
- Department of Radiology, Beaujon University Hospital, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - David Cosgrove
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Adrian K Lim
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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23
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Masand PM, Narkewicz MR, Leung DH. The Emergence of Elastography for Cystic Fibrosis Liver Disease. J Cyst Fibros 2020; 19:339-341. [PMID: 32600654 DOI: 10.1016/j.jcf.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P M Masand
- Prakash M Masand, Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
| | - M R Narkewicz
- Digestive Health Institute, Children's Hospital Colorado and Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - D H Leung
- Division of Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Joo I, Kim SY, Park HS, Lee ES, Kang HJ, Lee JM. Validation of a New Point Shear-Wave Elastography Method for Noninvasive Assessment of Liver Fibrosis: A Prospective Multicenter Study. Korean J Radiol 2020; 20:1527-1535. [PMID: 31606957 PMCID: PMC6791814 DOI: 10.3348/kjr.2019.0109] [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: 02/08/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To validate the diagnostic value of a new point shear-wave elastography method, S-shearwave elastography (S-SWE; Samsung Medison Co., Ltd.), in noninvasive assessment of liver fibrosis. Materials and Methods In this prospective multicenter study, liver stiffness (LS) measurements for 600 participants were obtained with both S-SWE and transient elastography (TE). The rates of unsuccessful LS measurements in S-SWE and TE were compared, and correlations between S-SWE and TE measurements were assessed. In 107 patients with histologic reference data, the optimal LS cut-off values for predicting severe fibrosis and cirrhosis on S-SWE were determined using receiver operating characteristic (ROC) curve analysis. The LS cut-off values in S-SWE were then validated in 463 patients without histologic reference data by using TE values as the reference standard, and the sensitivity and specificity of the cut-off values for predicting severe fibrosis and cirrhosis were calculated. Results The frequency of unsuccessful LS measurements on TE (4.5%, 27/600) was significantly higher than that (0.7%, 4/600) on S-SWE (p < 0.001). LS measurements on S-SWE showed a significant correlation with TE values (r = 0.880, p < 0.001). In 107 patients with histological reference data, the areas under the ROC curves on S-SWE were 0.845 and 0.850, with optimal cut-offs of 7.0 kilopascals (kPa) and 9.7 kPa, for the diagnosis of severe fibrosis and cirrhosis, respectively. Using these cut-off values, S-SWE showed sensitivities of 92.9% and 97.4% and specificities of 89.5% and 83.1% in TE-based evaluations of severe fibrosis and cirrhosis, respectively. Conclusion LS measurements on S-SWE were well correlated with those on TE. In addition, S-SWE provided good diagnostic performance for staging of hepatic fibrosis, with a lower rate of unsuccessful LS measurements compared with TE.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital and Seoul National College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Hyo Jeong Kang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and Seoul National College of Medicine, Seoul, Korea
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Kim DW, Suh CH, Kim KW, Pyo J, Park C, Jung SC. Technical Performance of Two-Dimensional Shear Wave Elastography for Measuring Liver Stiffness: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 20:880-893. [PMID: 31132814 PMCID: PMC6536798 DOI: 10.3348/kjr.2018.0812] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To assess the technical performance of two-dimensional shear wave elastography (2D-SWE) for measuring liver stiffness. Materials and Methods The Ovid-MEDLINE and EMBASE databases were searched for studies reporting the technical performance of 2D-SWE, including concerns with technical failures, unreliable measurements, interobserver reliability, and/or intraobserver reliability, published until June 30, 2018. The pooled proportion of technical failure and unreliable measurements was calculated using meta-analytic pooling via the random-effects model and inverse variance method for calculating weights. Subgroup analyses were performed to explore potential causes of heterogeneity. The pooled intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated using the Hedges-Olkin method with Fisher's Z transformation of the correlation coefficient. Results The search yielded 34 articles. From 20 2D-SWE studies including 6196 patients, the pooled proportion of technical failure was 2.3% (95% confidence interval [CI], 1.3–3.9%). The pooled proportion of unreliable measurements from 20 studies including 6961 patients was 7.5% (95% CI, 4.7–11.7%). In the subgroup analyses, studies conducting more than three measurements showed fewer unreliable measurements than did those with three measurements or less, but no intergroup difference was found in technical failure. The pooled ICCs for interobserver reliability (from 10 studies including 517 patients) and intraobserver reliability (from 7 studies including 679 patients) were 0.87 (95% CI, 0.82–0.90) and 0.93 (95% CI, 0.89–0.95), respectively, suggesting good to excellent reliability. Conclusion 2D-SWE shows good technical performance for assessing liver stiffness, with high technical success and reliability. Future studies should establish the quality criteria and optimal number of measurements.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Junhee Pyo
- WHO Collaborating Center for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht University, Utrecht, Netherlands
| | - Chan Park
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems. Invest Radiol 2020; 55:191-199. [DOI: 10.1097/rli.0000000000000627] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Wegner M, Iskender E, Azzarok A, Sagir A. Comparison of acoustic radiation force impulse imaging with the convex probe 6C1 and linear probe 9L4. Medicine (Baltimore) 2020; 99:e19701. [PMID: 32311951 PMCID: PMC7220701 DOI: 10.1097/md.0000000000019701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acoustic radiation force impulse imaging (ARFI) is a noninvasive method to detect liver fibrosis. The aims of the study were to evaluate the difference between 2 different probes, 6 C1 and 9 L4, and to study inter- and intraobserver reproducibility for the probes. METHODS We enrolled 100 patients in this cross-sectional comparative study. All patients underwent liver stiffness measurement with both probes. Intraobserver, interobserver, intralobe, and interlobe agreement was analyzed using the intraclass correlation coefficient. RESULTS A significant difference in success rates was observed for both probes between the right and left liver lobes. A success rate of 91% was observed in the right liver lobe compared with 77% in the left liver for the convex probe (P = .007), and 91% vs 68% for the linear probe (P < .001). There was a significant correlation in ARFI-shear wave velocity (ARFI-SWV) between both probes in the right liver lobe (P = .01; r = .508) and in the left liver lobe (P = .05; r = .278); however, there was no significant correlation in ARFI-SWV between the liver lobes for both probes (convex probe r = .19 P = .112; linear probe r = .144 P = .23). Good or excellent inter- and intraobserver was detected for both probes. Poor agreement was found only for the interobserver agreement in the left lobe with the convex probe (ICC = .320). CONCLUSION ARFI can be performed successfully with both probes in both liver lobes. There was no significant correlation in ARFI between the liver lobes for both probes; however, the right liver lobe should be favored. Standardization of the procedure is needed for the comparability of different studies.
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Petzold G, Hofer J, Ellenrieder V, Neesse A, Kunsch S. Liver Stiffness Measured by 2-Dimensional Shear Wave Elastography: Prospective Evaluation of Healthy Volunteers and Patients With Liver Cirrhosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1769-1777. [PMID: 30536601 DOI: 10.1002/jum.14866] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to establish normal values for liver stiffness measurement, performed by 2-dimensional shear wave elastography (LOGIQ E9; GE Healthcare, Wauwatosa, WI), in healthy volunteers, patients with nonhepatic morbidities, and patients with histologically confirmed liver cirrhosis. METHODS A total of 175 participants were included between July 2016 and February 2018. Three cohorts were analyzed: healthy volunteers (n = 68), patients with healthy livers but nonhepatic morbidities (n = 57), and patients with liver cirrhosis (n = 50). Liver stiffness measurement was performed by 2 observers with different levels of experience to determine interobserver agreement. RESULTS Of the 175 participants included, 91 were male, and the mean age ± SD was 44.4 ± 19.4 years. The success rate for 175 liver stiffness measurements was 95.4%. The number of unsuccessful measurements was significantly higher in the liver cirrhosis cohort (P = .04). The interobserver agreement was excellent (intraclass correlation coefficient, 0.87). Liver stiffness in the healthy-liver patient cohort (4.93 ± 0.83 kPa) was not significantly different from that in the healthy-volunteer cohort (5.19 ± 1.03 kPa; P = .13). Apart from male sex in the healthy-volunteer cohort, age, body mass index, mild steatosis, and nonhepatic morbidities had no significant impact on liver stiffness. Liver stiffness values in participants without liver disease (healthy volunteers and healthy-liver patients; n = 125) ranged from 3.62 to 7.02 kPa (2.5th-97.5th percentiles). Notably, there was no overlap of liver stiffness measurements between the patients without liver disease and the cirrhosis cohort (13.29 ± 3.27 kPa [7.76-19.49 kPa]). CONCLUSIONS Liver stiffness values in healthy individuals vary widely and are not dependent on age, body mass index, or specific nonhepatic comorbidities. Liver stiffness values within the normal range can noninvasively rule out cirrhosis, as liver stiffness is significantly higher in cirrhotic patients (P < .001). Two-dimensional shear wave elastography has excellent interobserver agreement.
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Affiliation(s)
- Golo Petzold
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes Hofer
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Volker Ellenrieder
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Albrecht Neesse
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Steffen Kunsch
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
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Ryu H, Ahn SJ, Yoon JH, Lee JM. Inter-platform reproducibility of liver stiffness measured with two different point shear wave elastography techniques and 2-dimensional shear wave elastography using the comb-push technique. Ultrasonography 2019; 38:345-354. [PMID: 31500403 PMCID: PMC6769187 DOI: 10.14366/usg.19001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/23/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to compare the technical success rate and reliability of measurements made using three shear wave elastography (SWE) techniques and to assess the inter-platform reproducibility of the resultant liver stiffness measurements. Methods This prospective study included 54 patients with liver disease. Liver stiffness (LS) measurements were obtained using 2-point SWE techniques (Virtual Touch Quantification and S-Shearwave) and 2-dimensional (2D) SWE, with transient elastography (TE) serving as the reference standard. The technical success rates and measurement reliability of the three techniques were compared. LS values measured using the three SWE techniques and TE were compared using Spearman correlation coefficients and 95% Bland-Altman limits of agreement. Intra-class correlation coefficients (ICC) were used to analyze the inter-platform reproducibility of LS measurements. Results The three SWE techniques and TE showed similar technical success rates (P=0.682) but demonstrated significant differences in the reliability of LS measurements (P=0.006) and mean LS measurements (P<0.001). Despite strong correlations (r=0.73-0.94) between SWE systems, various degrees of inter-platform reproducibility (ICC, 0.58-0.92) were observed for the three SWE techniques. The best agreement was observed between S-Shearwave and TE (ICC, 0.92), and the worst agreement was observed between 2D-SWE and TE (ICC, 0.58). In the Bland-Altman analysis, a tendency toward lower LS values with the three SWE techniques than with TE in patients with F3 and F4 disease was observed. Conclusion Significant inter-system variability was observed in LS measurements made using the three SWE techniques. Therefore, LS values measured using different SWE techniques should not be used interchangeably for longitudinal follow-up.
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Affiliation(s)
- Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Joa Ahn
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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30
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Ferraioli G, Wong VWS, Castera L, Berzigotti A, Sporea I, Dietrich CF, Choi BI, Wilson SR, Kudo M, Barr RG. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2419-2440. [PMID: 30209008 DOI: 10.1016/j.ultrasmedbio.2018.07.008] [Citation(s) in RCA: 293] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the prior guidelines, there have been several advances in technology. The recommendations are based on the international published literature, and the strength of each recommendation is judged according to the Oxford Centre for Evidence-Based Medicine. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Laurent Castera
- Service d'Hepatologie, Hopital Beaujon, Clichy, Assistance Publique-Hopitaux de Paris, INSERM UMR 1149 CRI, Universite Denis Diderot Paris-VII, Paris, France
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka Sayama, Japan
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University and Southwoods Imaging, Youngstown, Ohio, USA.
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Ryu H, Ahn SJ, Yoon JH, Lee JM. Reproducibility of liver stiffness measurements made with two different 2-dimensional shear wave elastography systems using the comb-push technique. Ultrasonography 2018; 38:246-254. [PMID: 30744303 PMCID: PMC6595128 DOI: 10.14366/usg.18046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/23/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to retrospectively compare the technical success and reliability of the measurements made using two 2-dimensional (2D) shear wave elastography (SWE) systems using the comb-push technique from the same manufacturer and to assess the intersystem reproducibility of the resultant liver stiffness (LS) measurements. Methods Ninety-four patients with suspected chronic liver diseases were included in this retrospective study. LS measurements were obtained using two 2D-SWE systems (LOGIQ E9 and LOGIQ S8) from the same manufacturer, with transient elastography (TE) serving as the reference standard, on the same day. The technical success rates and reliability of the measurements of the two 2D-SWE systems were compared. LS values measured using the two 2D-SWE systems and TE were correlated using Spearman correlation coefficients and 95% Bland-Altman limits of agreement. Thereafter, Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs) were used to analyze the intersystem reproducibility of LS measurements. Results The two 2D-SWE systems showed similar technical success rates (98.9% for both) and reliability of LS measurements (92.3% for the LOGIQ E9, 91.2% for the LOGIQ S8; P=0.185). Despite the excellent correlation (ICC=0.92), the mean LS measurements obtained by the two 2D-SWE systems were significantly different (LOGIQ E9, 6.57±2.33 kPa; LOGIQ S8, 6.90±6.64 kPa; P=0.018). Conclusion Significant intersystem variability was observed in the LS measurements made using the two 2D-SWE systems. Therefore, even 2D-SWE systems from the same manufacturer should not be used interchangeably in longitudinal follow-up.
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Affiliation(s)
- Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Joa Ahn
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Byenfeldt M, Elvin A, Fransson P. On Patient Related Factors and Their Impact on Ultrasound-Based Shear Wave Elastography of the Liver. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1606-1615. [PMID: 29735314 DOI: 10.1016/j.ultrasmedbio.2018.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
The aim of the study was to investigate patient-related factors associated with either reliable or poorly reliable measurement results of ultrasound-based shear wave elastography (SWE) of the liver. A total of 188 patients were analyzed prospectively with binary logistic regression using the interquartile range/median as cutoff to define two groups based on reliable and poorly reliable SWE results. SWE results correlated significantly with liver biopsy. Factors associated with reliable SWE results (i.e., no negative impact on measurements) were age, sex, cirrhosis, antiviral and/or cardiovascular medication, smoking habits and body mass index. Factors associated with poorly reliable SWE results were increased skin-to-liver capsule distance (odds ratio = 3.08, 95% confidence interval: 1.70-5.60) and steatosis (odds ratio = 2.89, 95% confidence interval: 1.33-6.28). These findings indicate that the interquartile range/median as a quality parameter is useful in avoiding poorly reliable SWE results. How best to examine patients with increased skin-to-liver capsule distance is a matter of some controversy, as the incidences of obesity, diabetes and metabolic syndrome are increasing worldwide; however, our results indicate that reliable SWE results can be obtained in this group of patients by using ultrasound-based SWE.
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Affiliation(s)
| | - Anders Elvin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Per Fransson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Fang C, Jaffer OS, Yusuf GT, Konstantatou E, Quinlan DJ, Agarwal K, Quaglia A, Sidhu PS. Reducing the Number of Measurements in Liver Point Shear-Wave Elastography: Factors that Influence the Number and Reliability of Measurements in Assessment of Liver Fibrosis in Clinical Practice. Radiology 2018. [DOI: 10.1148/radiol.2018172104] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Cheng Fang
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Ounali S. Jaffer
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Gibran T. Yusuf
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Eleni Konstantatou
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Daniel J. Quinlan
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Kosh Agarwal
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Alberto Quaglia
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Paul S. Sidhu
- From the Department of Radiology (C.F., O.S.J., G.T.Y., E.K., D.J.Q., P.S.S.) and Institute of Liver Studies (K.A., A.Q.), King’s College Hospital, Denmark Hill, London, SE5 9RS, England
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Albayrak E, Kasap T. Evaluation of Neonatal Brain Parenchyma Using 2-Dimensional Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:959-967. [PMID: 28850723 DOI: 10.1002/jum.14366] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/15/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the stiffness of the neonatal brain using 2-dimensional shear wave elastography in term and preterm neonates and to investigate possible stiffness differences between groups. METHODS A total of 83 neonates, including 44 term and 39 preterm, were included in the study. Shear wave elastographic measurements of the thalamus and occipital periventricular white matter were conducted via the anterior fontanel. The Pearson correlation coefficient was used to determine the association between the birth week and stiffness values of the thalamus and periventricular white matter. A receiver operating characteristic analysis was applied to determine the power of the stiffness of the thalamus and periventricular white matter in predicting a significant preterm classification. P < .05 was considered significant. RESULTS The brain parenchymal stiffness values measured from both the thalamus and periventricular white matter were found to be significantly lower in the preterm group compared with the term group. The periventricular white matter stiffness values were found to be lower than thalamus stiffness values in both groups. According to the receiver operating characteristic curve, the optimal cutoff values for determining prematurity were defined to be less than 8.28 kPa for the mean thalamus stiffness and less than 6.59 kPa for the periventricular white matter. CONCLUSIONS This study shows that differences between brain stiffness values in preterm and term neonates can be shown by using 2-dimensional shear wave elastography, and the results may be reference points for evaluating neonatal brain stiffness in research on patients with various illnesses.
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Affiliation(s)
- Eda Albayrak
- Department of Radiology, Gaziosmanpasa University, Medical Faculty, Tokat, Turkey
| | - Tuba Kasap
- Department of Pediatrics, Gaziosmanpasa University, Medical Faculty, Tokat, Turkey
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