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Zecevic M, Hasenstab KA, Wang K, Dhyani M, Cunha GM. Signal Intensity Trajectories Clustering for Liver Vasculature Segmentation and Labeling (LiVaS) on Contrast-Enhanced MR Images: A Feasibility Pilot Study. J Imaging Inform Med 2024; 37:873-883. [PMID: 38319438 PMCID: PMC11031533 DOI: 10.1007/s10278-024-00970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
This study aims to develop a semiautomated pipeline and user interface (LiVaS) for rapid segmentation and labeling of MRI liver vasculature and evaluate its time efficiency and accuracy against manual reference standard. Retrospective feasibility pilot study. Liver MR images from different scanners from 36 patients were included, and 4/36 patients were randomly selected for manual segmentation as referenced standard. The liver was segmented in each contrast phase and masks registered to the pre-contrast segmentation. Voxel-wise signal trajectories were clustered using the k-means algorithm. Voxel clusters that best segment the liver vessels were selected and labeled by three independent radiologists and a research scientist using LiVaS. Segmentation times were compared using a paired-sample t-test on log-transformed data. The agreement was analyzed qualitatively and quantitatively using DSC for hepatic and portal vein segmentations. The mean segmentation time among four readers was significantly shorter than manual (3.6 ± 1.4 vs. 70.0 ± 29.2 min; p < 0.001), even when using a higher number of clusters to enhance accuracy. The DSC for portal and hepatic veins reached up to 0.69 and 0.70, respectively. LiVaS segmentations were overall of good quality, with variations in performance related to the presence/severity of liver disease, acquisition timing, and image quality. Our semi-automated pipeline was robust to different MRI vendors in producing segmentation and labeling of liver vasculature in agreement with expert manual annotations, with significantly higher time efficiency. LiVaS could facilitate the creation of large, annotated datasets for training and validation of neural networks for automated MRI liver vascularity segmentation. HIGHLIGHTS: Key Finding: In this pilot feasibility study, our semiautomated pipeline for segmentation of liver vascularity (LiVaS) on MR images produced segmentations with simultaneous labeling of portal and hepatic veins in good agreement with the manual reference standard but at significantly shorter times (mean LiVaS 3.6 ± 1.4 vs. mean manual 70.0 ± 29.2 min; p < 0.001). Importance: LiVaS was robust in producing liver MRI vascular segmentations across images from different scanners in agreement with expert manual annotations, with significant ly higher time efficiency, and therefore potential scalability.
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Affiliation(s)
- Mladen Zecevic
- Department of Radiology, University of Washington, 1705 NE Pacific St, BB308, Seattle, WA, 98195, USA
| | - Kyle A Hasenstab
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA
| | - Kang Wang
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Manish Dhyani
- Department of Radiology, University of Washington, 1705 NE Pacific St, BB308, Seattle, WA, 98195, USA
| | - Guilherme Moura Cunha
- Department of Radiology, University of Washington, 1705 NE Pacific St, BB308, Seattle, WA, 98195, USA.
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Serai SD, Panganiban J, Dhyani M, Degnan AJ, Anupindi SA. Imaging Modalities in Pediatric NAFLD. Clin Liver Dis (Hoboken) 2021; 17:200-208. [PMID: 33868666 PMCID: PMC8043697 DOI: 10.1002/cld.994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Suraj D. Serai
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Jennifer Panganiban
- Department of Gastroenterology, Hepatology and NutritionThe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Manish Dhyani
- Department of RadiologyLahey Hospital and Medical CenterBurlingtonMA
| | - Andrew J. Degnan
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Sudha A. Anupindi
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
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Ozturk A, Zubajlo RE, Dhyani M, Grajo JR, Mercaldo N, Anthony BW, Samir AE. Variation of Shear Wave Elastography With Preload in the Thyroid: Quantitative Validation. J Ultrasound Med 2021; 40:779-786. [PMID: 32951229 DOI: 10.1002/jum.15456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Thyroid shear wave elastography (SWE) has been shown to have advantages compared to biopsy or other imaging modalities in the evaluation of thyroid nodules. However, studies show variability in its assessment. The objective of this study was to evaluate whether stiffness measurements of the normal thyroid, as estimated by SWE, varied due to preload force or the pressure applied between the transducer and the patient. METHODS In this study, a measurement system was attached to the ultrasound transducer to measure the applied load. Shear wave elastographic measurements were obtained from the left lobe of the thyroid at applied transducer forces between 2 and 10 N. A linear mixed-effects model was constructed to quantify the association between the preload force and stiffness while accounting for correlations between repeated measurements within each participant. The preload force effect on elasticity was modeled by both linear and quadratic terms to account for a possible nonlinear association between these variables. RESULTS Nineteen healthy volunteers without known thyroid disease participated in the study. The participants had a mean age ± SD of 36 ± 8 years; 74% were female; 74% had a normal body mass index; and 95% were white non-Hispanic/Latino. The estimated elastographic value at a 2-N preload force was 16.7 kPa (95% confidence interval, 14.1-19.3 kPa), whereas the value at 10 N was 29.9 kPa (95% confidence interval, 24.9-34.9 kPa). CONCLUSIONS The preload force was significantly and nonlinearly associated with SWE estimates of thyroid stiffness. Quantitative standardization of preload forces in the assessment of thyroid nodules using elastography is an integral factor for improving the accuracy of thyroid nodule evaluation.
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Affiliation(s)
- Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca E Zubajlo
- Department of Mechanical Engineering, Massachusetts Institutes of Technology, Cambridge, Massachusetts, USA
| | - Manish Dhyani
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nathaniel Mercaldo
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian W Anthony
- Department of Mechanical Engineering, Massachusetts Institutes of Technology, Cambridge, Massachusetts, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Palmeri ML, Milkowski A, Barr R, Carson P, Couade M, Chen J, Chen S, Dhyani M, Ehman R, Garra B, Gee A, Guenette G, Hah Z, Lynch T, Macdonald M, Managuli R, Miette V, Nightingale KR, Obuchowski N, Rouze NC, Morris DC, Fielding S, Deng Y, Chan D, Choudhury K, Yang S, Samir AE, Shamdasani V, Urban M, Wear K, Xie H, Ozturk A, Qiang B, Song P, McAleavey S, Rosenzweig S, Wang M, Okamura Y, McLaughlin G, Chen Y, Napolitano D, Carlson L, Erpelding T, Hall TJ. Radiological Society of North America/Quantitative Imaging Biomarker Alliance Shear Wave Speed Bias Quantification in Elastic and Viscoelastic Phantoms. J Ultrasound Med 2021; 40:569-581. [PMID: 33410183 PMCID: PMC8082942 DOI: 10.1002/jum.15609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To quantify the bias of shear wave speed (SWS) measurements between different commercial ultrasonic shear elasticity systems and a magnetic resonance elastography (MRE) system in elastic and viscoelastic phantoms. METHODS Two elastic phantoms, representing healthy through fibrotic liver, were measured with 5 different ultrasound platforms, and 3 viscoelastic phantoms, representing healthy through fibrotic liver tissue, were measured with 12 different ultrasound platforms. Measurements were performed with different systems at different sites, at 3 focal depths, and with different appraisers. The SWS bias across the systems was quantified as a function of the system, site, focal depth, and appraiser. A single MRE research system was also used to characterize these phantoms using discrete frequencies from 60 to 500 Hz. RESULTS The SWS from different systems had mean difference 95% confidence intervals of ±0.145 m/s (±9.6%) across both elastic phantoms and ± 0.340 m/s (±15.3%) across the viscoelastic phantoms. The focal depth and appraiser were less significant sources of SWS variability than the system and site. Magnetic resonance elastography best matched the ultrasonic SWS in the viscoelastic phantoms using a 140 Hz source but had a - 0.27 ± 0.027-m/s (-12.2% ± 1.2%) bias when using the clinically implemented 60-Hz vibration source. CONCLUSIONS Shear wave speed reconstruction across different manufacturer systems is more consistent in elastic than viscoelastic phantoms, with a mean difference bias of < ±10% in all cases. Magnetic resonance elastographic measurements in the elastic and viscoelastic phantoms best match the ultrasound systems with a 140-Hz excitation but have a significant negative bias operating at 60 Hz. This study establishes a foundation for meaningful comparison of SWS measurements made with different platforms.
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Affiliation(s)
| | | | - Richard Barr
- The Surgical Hospital at Southwoods, Boardman, Ohio, USA
| | - Paul Carson
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jun Chen
- Mayo Clinic, Rochester, Minnesota, USA
| | | | - Manish Dhyani
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Brian Garra
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Albert Gee
- Zonare Medical Systems, Mountain View, California, USA
| | - Gilles Guenette
- Toshiba Medical Research Institute, Redmond, Washington, USA
| | | | | | | | | | | | | | | | - Ned C Rouze
- Duke University, Durham, North Carolina, USA
| | | | | | - Yufeng Deng
- Duke University, Durham, North Carolina, USA
| | - Derek Chan
- Duke University, Durham, North Carolina, USA
| | | | - Siyun Yang
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Keith Wear
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Hua Xie
- Philips Research, Cambridge, Massachusetts, USA
| | - Arinc Ozturk
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bo Qiang
- Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | - Yuling Chen
- Zonare Medical Systems, Mountain View, California, USA
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Brattain LJ, Ozturk A, Telfer BA, Dhyani M, Grajo JR, Samir AE. Image Processing Pipeline for Liver Fibrosis Classification Using Ultrasound Shear Wave Elastography. Ultrasound Med Biol 2020; 46:2667-2676. [PMID: 32622685 PMCID: PMC7483774 DOI: 10.1016/j.ultrasmedbio.2020.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to develop an automated method for classifying liver fibrosis stage ≥F2 based on ultrasound shear wave elastography (SWE) and to assess the system's performance in comparison with a reference manual approach. The reference approach consists of manually selecting a region of interest from each of eight or more SWE images, computing the mean tissue stiffness within each of the regions of interest and computing a resulting stiffness value as the median of the means. The 527-subject database consisted of 5526 SWE images and pathologist-scored biopsies, with data collected from a single system at a single site. The automated method integrates three modules that assess SWE image quality, select a region of interest from each SWE measurement and perform machine learning-based, multi-image SWE classification for fibrosis stage ≥F2. Several classification methods were developed and tested using fivefold cross-validation with training, validation and test sets partitioned by subject. Performance metrics were area under receiver operating characteristic curve (AUROC), specificity at 95% sensitivity and number of SWE images required. The final automated method yielded an AUROC of 0.93 (95% confidence interval: 0.90-0.94) versus 0.69 (95% confidence interval: 0.65-0.72) for the reference method, 71% specificity with 95% sensitivity versus 5% and four images per decision versus eight or more. In conclusion, the automated method reported in this study significantly improved the accuracy for ≥F2 classification of SWE measurements as well as reduced the number of measurements needed, which has the potential to reduce clinical workflow.
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Affiliation(s)
- Laura J Brattain
- MIT Lincoln Laboratory, Lexington, Massachusetts, USA; Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Manish Dhyani
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Joseph R Grajo
- Abdominal Imaging Division, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Affiliation(s)
- Jeremy R. Wortman
- From the Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805
| | - Manish Dhyani
- From the Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805
| | - Sarah M. Ali
- From the Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805
| | - Francis J. Scholz
- From the Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805
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Wortman JR, Dhyani M, Ali SM, Scholz FJ. Pearls and Pitfalls in Multimodality Imaging of Colonic Volvulus. Radiographics 2020. [DOI: 10.1148/rg.2020200009.pres] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ozturk A, Mohammadi R, Pierce TT, Kamarthi S, Dhyani M, Grajo JR, Corey KE, Chung RT, Bhan AK, Chhatwal J, Samir AE. Diagnostic Accuracy of Shear Wave Elastography as a Non-invasive Biomarker of High-Risk Non-alcoholic Steatohepatitis in Patients with Non-alcoholic Fatty Liver Disease. Ultrasound Med Biol 2020; 46:972-980. [PMID: 32005510 PMCID: PMC7034057 DOI: 10.1016/j.ultrasmedbio.2019.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/31/2019] [Accepted: 12/19/2019] [Indexed: 05/12/2023]
Abstract
In this study, we evaluated the diagnostic accuracy of shear wave elastography (SWE) for differentiating high-risk non-alcoholic steatohepatitis (hrNASH) from non-alcoholic fatty liver and low-risk non-alcoholic steatohepatitis (NASH). Patients with non-alcoholic fatty liver disease scheduled for liver biopsy underwent pre-biopsy SWE. Ten SWE measurements were obtained. Biopsy samples were reviewed using the NASH Clinical Research Network Scoring System and patients with hrNASH were identified. Receiver operating characteristic curves for SWE-based hrNASH diagnosis were charted. One hundred sixteen adult patients underwent liver biopsy at our institution for the evaluation of non-alcoholic fatty liver disease. The area under the receiver operating characteristic curve of SWE for hrNASH diagnosis was 0.73 (95% confidence interval: 0.61-0.84, p < 0.001). The Youden index-based optimal stiffness cutoff value for hrNASH diagnosis was calculated as 8.4 kPa (1.67 m/s), with a sensitivity of 77% and specificity of 66%. SWE may be useful for the detection of NASH patients at risk of long-term liver-specific morbidity and mortality.
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Affiliation(s)
- Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ramin Mohammadi
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Theodore T Pierce
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sagar Kamarthi
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Manish Dhyani
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kathleen E Corey
- Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond T Chung
- Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Brattain LJ, Telfer BA, Dhyani M, Grajo JR, Samir AE. Objective Liver Fibrosis Estimation from Shear Wave Elastography. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2018:1-5. [PMID: 30440285 DOI: 10.1109/embc.2018.8513011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diffuse liver disease is common, primarily driven by high prevalence of non-alcoholic fatty liver disease (NAFLD). It is currently assessed by liver biopsy to determine fibrosis, often staged as F0 (normal) - F4 (cirrhosis). A noninvasive assessment method will allow a broader population to be monitored longitudinally, facilitating risk stratification and treatment efficacy assessment. Ultrasound shear wave elastography (SWE) is a promising noninvasive technique for measuring tissue stiffness that has been shown to correlate with fibrosis stage. However, this approach has been limited by variability in stiffness measurements. In this work, we developed and evaluated an automated framework, called SWE-Assist, that checks SWE image quality, selects a region of interest (ROI), and classifies the ROI to determine whether the fibrosis stage is at or exceeds F2, which is important for clinical decisionmaking. Our database consists of 3,392 images from 328 cases. Several classifiers, including random forest, support vector machine, and convolutional neural network (CNN)) were evaluated. The best approach utilized a CNN and yielded an area under the receiver operating curve (AUROC) of 0.89, compared to the conventional stiffness only based AUROC of 0.74. Moreover, the new method is based on single image per decision, vs. 10 images per decision for the baseline. A larger dataset is needed to further validate this approach, which has the potential to improve the accuracy and efficiency of non-invasive liver fibrosis staging.
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Dhyani M, Joshi N, Bemelman WA, Gee MS, Yajnik V, D’Hoore A, Traverso G, Donowitz M, Mostoslavsky G, Lu TK, Lineberry N, Niessen HG, Peer D, Braun J, Delaney CP, Dubinsky MC, Guillory AN, Pereira M, Shtraizent N, Honig G, Polk DB, Hurtado-Lorenzo A, Karp JM, Michelassi F. Challenges in IBD Research: Novel Technologies. Inflamm Bowel Dis 2019; 25:S24-S30. [PMID: 31095703 PMCID: PMC6787667 DOI: 10.1093/ibd/izz077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 12/15/2022]
Abstract
Novel technologies is part of five focus areas of the Challenges in IBD research document, which also includes preclinical human IBD mechanisms, environmental triggers, precision medicine and pragmatic clinical research. The Challenges in IBD research document provides a comprehensive overview of current gaps in inflammatory bowel diseases (IBD) research and delivers actionable approaches to address them. It is the result of a multidisciplinary input from scientists, clinicians, patients, and funders, and represents a valuable resource for patient centric research prioritization. In particular, the novel technologies section is focused on prioritizing unmet clinical needs in IBD that will benefit from novel technologies applied to: 1) non-invasive detection and monitoring of active inflammation and assessment of treatment response; 2) mucosal targeted drug delivery systems; and 3) prevention of post-operative septic complications and treatment of fistulizing complications. Proposed approaches include development of multiparametric imaging modalities and biosensors, to enable non invasive or minimally invasive detection of pro-inflammatory signals to monitor disease activity and treatment responses. Additionally, technologies for local drug delivery to control unremitting disease and increase treatment efficacy while decreasing systemic exposure are also proposed. Finally, research on biopolymers and other sealant technologies to promote post-surgical healing; and devices to control anastomotic leakage and prevent post-surgical complications and recurrences are also needed.
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Affiliation(s)
- Manish Dhyani
- Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Nitin Joshi
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Michael S Gee
- Massachusetts General Hospital, Boston, Massachusetts
| | - Vijay Yajnik
- Takeda Pharmaceutical Company, Boston, Massachusetts
| | - André D’Hoore
- University Hospital Gasthuisberg and University of Leuven, Leuven, Belgium
| | - Giovanni Traverso
- Brigham and Women’s Hospital, Harvard Medical School and Massachusetts Institute of Technology, Boston, Massachusetts
| | - Mark Donowitz
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Timothy K Lu
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Heiko G Niessen
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Dan Peer
- School of Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Braun
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai, Los Angeles, California
| | | | | | | | | | | | - Gerard Honig
- Crohn’s & Colitis Foundation, New York, New York
| | - David Brent Polk
- Department of Biochemistry and Molecular Biology, University of Southern California,Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Andrés Hurtado-Lorenzo
- Crohn’s & Colitis Foundation, New York, New York,Address correspondence to: Andrés Hurtado-Lorenzo, PhD, 733 3rd Ave Suite 510, New York, NY USA 10017 ()
| | - Jeffrey M Karp
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard-MIT Division of Health Sciences and Technology, Broad Institute and Harvard Stem Cell Institute, Boston, Massachusetts
| | - Fabrizio Michelassi
- New York-Presbyterian Hospital and Weill Cornell School of Medicine, New York, New York
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Li C, Dhyani M, Bhan AK, Grajo JR, Pratt DS, Gee MS, Samir AE. Diagnostic Performance of Shear Wave Elastography in Patients With Autoimmune Liver Disease. J Ultrasound Med 2019; 38:103-111. [PMID: 29761535 PMCID: PMC6586413 DOI: 10.1002/jum.14668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To assess performance of shear wave elastography for evaluation of fibrosis and the histologic stage in patients with autoimmune liver disease (ALD) and to validate previously established advanced fibrosis cutoff values in this cohort. METHODS Shear wave elastography was performed on patients with ALD with an Aixplorer ultrasound system (SuperSonic Imagine, Aix-en-Provence, France) using an SC6-1 transducer. The median estimated tissue Young modulus was calculated from sets of 8 to 10 elastograms. A blinded, subspecialty-trained pathologist reviewed biopsy specimens. The METAVIR classification was used to stage liver fibrosis and necroinflammation. Steatosis was graded from 0 to 4+. The Kendall τ-b correlation test was performed to identify the correlation between the estimated tissue Young modulus and fibrosis, steatosis, and the necroinflammatory score. The Spearman correlation test was performed to identify the correlation between the estimated tissue Young modulus and clinical data. The diagnostic performance of shear wave elastography for differentiating METAVIR stage F2 or higher from F0 and F1 fibrosis was evaluated by a receiver operating characteristic (ROC) curve analysis. RESULTS Fifty-one patients with ALD were analyzed. The estimated tissue Young modulus was positively correlated with the fibrosis stage and necroinflammation score (r = 0.386; P < .001; r = 0.338; P = .002, respectively) but not steatosis (r = -0.091; P = .527). Serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin values were positively correlated with the estimated tissue Young modulus (r = 0.501; P < .001; r = 0.44; P = .001; r = 0.291; P = .038). The serum albumin value was negatively correlated (r = -0.309; P = .033). The area under the ROC curve was 0.781 (95% confidence interval, 0.641-0.921) for distinguishing F2 or greater fibrosis from F0 and F1 fibrosis. Based on the ROC curve, an optimal cutoff value of 9.15 kPa was identified (sensitivity, 83.3%; specificity, 72.7%). CONCLUSIONS Shear wave elastography is a novel noninvasive adjunct to liver biopsy in evaluation and staging of patients with ALD, showing the potential for serial evaluations of disease progression and treatment responses.
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Affiliation(s)
- Changtian Li
- Department of Ultrasound, The Southern Building, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Manish Dhyani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Daniel S Pratt
- Autoimmune and Cholestatic Liver Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Benjamin A, Zubajlo RE, Dhyani M, Samir AE, Thomenius KE, Grajo JR, Anthony BW. Surgery for Obesity and Related Diseases: I. A Novel Approach to the Quantification of the Longitudinal Speed of Sound and Its Potential for Tissue Characterization. Ultrasound Med Biol 2018; 44:2739-2748. [PMID: 30228044 PMCID: PMC6662181 DOI: 10.1016/j.ultrasmedbio.2018.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 05/26/2023]
Abstract
Described here is a method to determine the longitudinal speed of sound in speckle-dominated ultrasound images. The method is based on the concept that the quality of an ultrasound image is maximized when the beamformer's speed of sound matches the speed in the medium. The method captures the quality of the ultrasound image using two quantitative image-quality metrics: image brightness and sharpness around the intended focal zone. The proposed method requires no calibration, is computationally efficient and is deployable on commercial ultrasound systems without hardware or software modifications. Ex vivo testing on tissue-mimicking phantoms indicates the method's accuracy in predicting the true speed of sound to within 1% of ground truth values.
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Affiliation(s)
- Alex Benjamin
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Rebecca E Zubajlo
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Manish Dhyani
- Center for Ultrasound Research and Translation Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Internal Medicine, Steward Carney Hospital, Dorchester, Massachusetts, USA
| | - Anthony E Samir
- Center for Ultrasound Research and Translation Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kai E Thomenius
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Brian W Anthony
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
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Zubajlo RE, Benjamin A, Grajo JR, Kaliannan K, Kang JX, Bhan AK, Thomenius KE, Anthony BW, Dhyani M, Samir AE. Experimental Validation of Longitudinal Speed of Sound Estimates in the Diagnosis of Hepatic Steatosis (Part II). Ultrasound Med Biol 2018; 44:2749-2758. [PMID: 30266215 PMCID: PMC6661157 DOI: 10.1016/j.ultrasmedbio.2018.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 05/12/2023]
Abstract
This study validates a non-invasive, quantitative technique to diagnose steatosis within tissue. The proposed method is based on two fundamental concepts: (i) the speed of sound in a fatty liver is lower than that in a healthy liver and (ii) the quality of an ultrasound image is maximized when the beamformer's speed of sound matches the speed in the medium under examination. The method uses image brightness and sharpness as quantitative image-quality metrics to predict the true sound speed and capture the effects of fat infiltration, while accounting for the transmission through subcutaneous fat. Ex vivo testing on sheep liver, mouse livers and tissue-mimicking phantoms indicated the technique's ability to predict the true speed of sound with errors less than 0.5% and to quantify the inverse correlation between fat content and speed of sound.
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Affiliation(s)
- Rebecca E. Zubajlo
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alex Benjamin
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joseph R. Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Kanakaraju Kaliannan
- Laboratory for Lipid Medicine and Technology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jing X. Kang
- Laboratory for Lipid Medicine and Technology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Atul K. Bhan
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02139, USA
| | - Kai E. Thomenius
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Brian W. Anthony
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Corresponding Author: Manish Dhyani: Tel: +1 617 852 8909,
| | - Manish Dhyani
- Center for Ultrasound Research and Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA 02139, USA
- Department of Internal Medicine, Steward Carney Hospital, Dorchester, MA 02124, USA
| | - Anthony E. Samir
- Center for Ultrasound Research and Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA 02139, USA
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Ozturk A, Grajo JR, Gee MS, Benjamin A, Zubajlo RE, Thomenius KE, Anthony BW, Samir AE, Dhyani M. Quantitative Hepatic Fat Quantification in Non-alcoholic Fatty Liver Disease Using Ultrasound-Based Techniques: A Review of Literature and Their Diagnostic Performance. Ultrasound Med Biol 2018; 44:2461-2475. [PMID: 30232020 PMCID: PMC6628698 DOI: 10.1016/j.ultrasmedbio.2018.07.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 05/08/2023]
Abstract
Non-alcoholic fatty liver disease is a condition that is characterized by the presence of >5% fat in the liver and affects more than one billion people worldwide. If adequate and early precautions are not taken, non-alcoholic fatty liver disease can progress to cirrhosis and death. The current reference standard for detecting hepatic steatosis is a liver biopsy. However, because of the potential morbidity associated with liver biopsies, non-invasive imaging biomarkers have been extensively investigated. Magnetic resonance imaging-based methods have proven accuracy in quantifying liver steatosis; however, these techniques are costly and have limited availability. Ultrasound-based quantitative imaging techniques are increasingly utilized because of their widespread availability, ease of use and relative cost-effectiveness. Several ultrasound-based liver fat quantification techniques have been investigated, including techniques that measure changes in the acoustic properties of the liver caused by the presence of fat. In this review, we focus on quantitative ultrasound approaches and their diagnostic performance in the realm of non-alcoholic fatty liver disease.
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Affiliation(s)
- Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex Benjamin
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Rebecca E Zubajlo
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kai E Thomenius
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Brian W Anthony
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manish Dhyani
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; (¶) Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA.
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Dhyani M, Xiang F, Li Q, Chen L, Li C, Bhan AK, Anthony B, Grajo JR, Samir AE. Ultrasound Shear Wave Elastography: Variations of Liver Fibrosis Assessment as a Function of Depth, Force and Distance from Central Axis of the Transducer with a Comparison of Different Systems. Ultrasound Med Biol 2018; 44:2209-2222. [PMID: 30143339 PMCID: PMC6594152 DOI: 10.1016/j.ultrasmedbio.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 05/10/2023]
Abstract
We evaluated variation in fibrosis staging caused by depth, pre-load force and measurement off-axis distance on different ultrasound shear wave elastography (SWE) systems prospectively in 20 patients with diffuse liver disease. Shear wave speed (SWS) was measured with transient elastography, acoustic radiation force impulse (ARFI) and 2-D shear wave elastography (SWE). ARFI and 2-D-SWE measurements were obtained at different depths (3, 5 and 7 cm), with different pre-load forces (4, 7 and 10N and variable) and at 0, 2 and 4cm off the central axis of the transducer. A single, blinded pathologist staged fibrosis using the METAVIR system (F0-F4). Area under the receiver operating characteristic curve was charted to differentiate significant fibrosis (F ≥ 2). Depth was the only factor found to influence ARFI-derived values; no acquisition factors were found to affect 2-D-SWE SWS values. ARFI and 2-D-SWE for diagnosis of significant fibrosis at a depth of 7cm along the central axis had good diagnostic performance (areas under the receiver operating characteristic curve: 0.92 and 0.82, respectively), comparable to that of transient elastography. Further investigation of this finding will likely be of interest.
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Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Feixiang Xiang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Luzeng Chen
- Peking University First Hospital Ultrasound Center, Beijing, China
| | - Changtian Li
- Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, China
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Anthony
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Li Q, Dhyani M, Grajo JR, Sirlin C, Samir AE. Current status of imaging in nonalcoholic fatty liver disease. World J Hepatol 2018; 10:530-542. [PMID: 30190781 PMCID: PMC6120999 DOI: 10.4254/wjh.v10.i8.530] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases of simple steatosis are non-progressive, whereas nonalcoholic steatohepatitis may result in chronic liver injury and progressive fibrosis in a significant minority. Effective risk stratification and management of NAFLD requires evaluation of hepatic parenchymal fat, fibrosis, and inflammation. Liver biopsy remains the current gold standard; however, non-invasive imaging methods are rapidly evolving and may replace biopsy in some circumstances. These methods include well-established techniques, such as conventional ultrasonography, computed tomography, and magnetic resonance imaging and newer imaging technologies, such as ultrasound elastography, quantitative ultrasound techniques, magnetic resonance elastography, and magnetic resonance-based fat quantitation techniques. The aim of this article is to review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability.
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Affiliation(s)
- Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Manish Dhyani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, United States
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Claude Sirlin
- Altman Clinical Translational Research Institute, University of California, San Diego, CA 92103, United States
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
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Abstract
Ultrasound (US) imaging is the most commonly performed cross-sectional diagnostic imaging modality in the practice of medicine. It is low-cost, non-ionizing, portable, and capable of real-time image acquisition and display. US is a rapidly evolving technology with significant challenges and opportunities. Challenges include high inter- and intra-operator variability and limited image quality control. Tremendous opportunities have arisen in the last decade as a result of exponential growth in available computational power coupled with progressive miniaturization of US devices. As US devices become smaller, enhanced computational capability can contribute significantly to decreasing variability through advanced image processing. In this paper, we review leading machine learning (ML) approaches and research directions in US, with an emphasis on recent ML advances. We also present our outlook on future opportunities for ML techniques to further improve clinical workflow and US-based disease diagnosis and characterization.
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Affiliation(s)
| | - Brian A Telfer
- MIT Lincoln Laboratory, 244 Wood St, Lexington, MA, 02420, USA
| | - Manish Dhyani
- Department of Internal Medicine, Steward Carney Hospital, Boston, MA, 02124, USA
- Division of Ultrasound, Department of Radiology, Center for Ultrasound Research & Translation, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anthony E Samir
- Division of Ultrasound, Department of Radiology, Center for Ultrasound Research & Translation, Massachusetts General Hospital, Boston, MA, 02114, USA
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18
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Abstract
Tissue stiffness has long been known to be a biomarker of tissue pathology. Ultrasound elastography measures tissue mechanical properties by monitoring the response of tissue to acoustic energy. Different elastographic techniques have been applied to many different tissues and diseases. Depending on the pathology, patient-based factors, and ultrasound operator-based factors, these techniques vary in accuracy and reliability. In this review, we discuss the physical principles of ultrasound elastography, discuss differences between different ultrasound elastographic techniques, and review the advantages and disadvantages of these techniques in clinical practice.
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Benjamin A, Zubajlo R, Thomenius K, Dhyani M, Kaliannan K, Samir AE, Anthony BW. Non-invasive diagnosis of non-alcoholic fatty liver disease (NAFLD) using ultrasound image echogenicity. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:2920-2923. [PMID: 29060509 DOI: 10.1109/embc.2017.8037468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper introduces a non-invasive, quantitative technique to diagnose the progression of non-alcoholic fatty liver disease (NAFLD). The method is predicated on two fundamental principles: 1) the speed of sound in a fatty liver is lower than that in a healthy liver and 2) the quality of an ultrasound image is maximized when the beamformer's speed of sound matches the true speed of sound in the tissue being examined. The proposed method uses the echogenicity of an ultrasound image as a quantitative measure to estimate the true speed of sound within the liver parenchyma and capture its correlation with the underlying fat content. The proposed technique was evaluated in simulations and then tested ex vivo on sheep liver, mice liver (healthy and fatty) and tissue-mimicking phantoms. In the case of the phantom and sheep liver, the method was able to estimate the true speed of sound with errors of less than 0.5%; in the case of the mice livers, the method was able to accurately estimate the speed of sound within the livers (less than 1% error) and capture the correlation between fat content and speed of sound. Thereby, demonstrating the capability of ultrasound technology to non-invasively, quantitatively, and accurately diagnose NAFLD at point of care.
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Dhyani M, Roll SC, Gilbertson MW, Orlowski M, Anvari A, Li Q, Anthony B, Samir AE. A pilot study to precisely quantify forces applied by sonographers while scanning: A step toward reducing ergonomic injury. Work 2017; 58:241-247. [DOI: 10.3233/wor-172611] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew W. Gilbertson
- Department of Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Melanie Orlowski
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Arash Anvari
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Brian Anthony
- Department of Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Anthony E. Samir
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
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Dhyani M, Grajo JR, Bhan AK, Corey K, Chung R, Samir AE. Validation of Shear Wave Elastography Cutoff Values on the Supersonic Aixplorer for Practical Clinical Use in Liver Fibrosis Staging. Ultrasound Med Biol 2017; 43:1125-1133. [PMID: 28341490 PMCID: PMC5610928 DOI: 10.1016/j.ultrasmedbio.2017.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/14/2017] [Accepted: 01/26/2017] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to determine the validity of previously established ultrasound shear wave elastography (SWE) cut-off values (≥F2 fibrosis) on an independent cohort of patients with chronic liver disease. In this cross-sectional study, approved by the institutional review board and compliant with the Health Insurance Portability and Accountability Act, 338 patients undergoing liver biopsy underwent SWE using an Aixplorer ultrasound machine (SuperSonic Imagine, Aix-en-Provence, France). Median SWE values were calculated from sets of 10 elastograms. A single blinded pathologist evaluated METAVIR fibrosis staging as the gold standard. The study analyzed 277 patients with a mean age of 48 y. On pathologic examination, 212 patients (76.5%) had F0-F1 fibrosis, whereas 65 (23.5%) had ≥F2 fibrosis. Spearman's correlation of fibrosis with SWE was 0.456 (p < 0.001). A cut-off value of 7.29 kPa yielded sensitivity of 95.4% and specificity of 50.5% for the diagnosis of METAVIR stage ≥F2 liver fibrosis in patients with liver disease using the SuperSonic Imagine Aixplorer SWE system.
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Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Corey
- Department of Hepatology, Liver and GI Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond Chung
- Department of Hepatology, Liver and GI Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Dhyani M, Grajo JR, Rodriguez D, Chen Z, Feldman A, Tambouret R, Gervais DA, Arellano RS, Hahn PF, Samir AE. Aorta-Lesion-Attenuation-Difference (ALAD) on contrast-enhanced CT: a potential imaging biomarker for differentiating malignant from benign oncocytic neoplasms. Abdom Radiol (NY) 2017; 42:1734-1743. [PMID: 28197683 DOI: 10.1007/s00261-017-1061-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate whether the Aorta-Lesion-Attenuation-Difference on contrast-enhanced CT can aid in the differentiation of malignant and benign oncocytic renal neoplasms. MATERIALS AND METHODS Two independent cohorts-an initial (biopsy) dataset and a validation (surgical) dataset-with oncocytomas and chromophobe renal cell carcinomas (chRCC) were included in this IRB-approved retrospective study. A region of interest was placed on the renal mass and abdominal aorta on the same CT image slice to calculate an Aorta-Lesion-Attenuation-Difference (ALAD). ROC curves were plotted for different enhancement phases, and diagnostic performance of ALAD for differentiating chRCC from oncocytomas was calculated. RESULTS Seventy-nine renal masses (56 oncocytomas, 23 chRCC) were analyzed in the initial (biopsy) dataset. Thirty-six renal masses (16 oncocytomas, 20 chRCC) were reviewed in the validation (surgical) cohort. ALAD showed a statistically significant difference between oncocytomas and chromophobes during the nephrographic phase (p < 0.001), early excretory phase (p < 0.001), and excretory phase (p = 0.029). The area under the ROC curve for the nephrographic phase was 1.00 (95% CI: 1.00-1.00) for the biopsy dataset and showed the narrowest confidence interval. At a threshold value of 25.5 HU, sensitivity was 100 (82.2%-100%) and specificity was 81.5 (61.9%-93.7%). When tested on the validation dataset on measurements made by an independent reader, the AUROC was 0.93 (95% CI: 0.84-1.00) with a sensitivity of 100 (80.0%-100%) and a specificity of 87.5 (60.4%-97.8%). CONCLUSIONS Nephrographic phase ALAD has potential to differentiate benign and malignant oncocytic renal neoplasms on contrast-enhanced CT if histologic evaluation on biopsy is indeterminate.
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Trifanov DS, Dhyani M, Bledsoe JR, Misdraji J, Bhan AK, Chung RT, Samir AE. Amyloidosis of the liver on shear wave elastography: case report and review of literature. ACTA ACUST UNITED AC 2016; 40:3078-83. [PMID: 26254907 DOI: 10.1007/s00261-015-0519-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Amyloidosis is extremely rare, with an estimated 2225 new US cases reported annually. Signs and symptoms of the disease are subtle and imaging findings are not pathognomonic. Currently, diagnosis requires biopsy to demonstrate the deposition of amyloid. Elastography is a new imaging modality that evaluates tissue elasticity. It has shown to have efficacy in characterizing thyroid nodules, detecting prostate cancer, and staging liver fibrosis. We present a case of hepatic amyloidosis in a 51-year-old male that demonstrates significantly increased stiffness with a median value of 99.1 kPa (range 25.7-188.9 kPa) on shear-wave elastography (SWE) imaging, which is significantly higher than the cut-off range reported for cirrhosis on SWE (10.4-11.5 kPa). This finding raises the possibility that elastographic imaging may be sensitive to tissue mechanical changes induced by amyloid deposition.
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Affiliation(s)
- Dmitry S Trifanov
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Manish Dhyani
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Jacob R Bledsoe
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Atul K Bhan
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Raymond T Chung
- Department of Hepatology, Medicine, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA
| | - Anthony E Samir
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Gupta R, Dhyani M, Kendzerska T, Pandi-Perumal SR, BaHammam AS, Srivanitchapoom P, Pandey S, Hallett M. Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta Neurol Scand 2016; 133:320-9. [PMID: 26482928 DOI: 10.1111/ane.12520] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 02/01/2023]
Abstract
Restless legs syndrome (RLS) is a common sleep disorder that may be associated with pregnancy. Studies have found that the prevalence of RLS among pregnant women ranged from 10 to 34%. Typically, there is complete remission of symptoms soon after parturition; however, in some patients, they may continue postpartum. RLS has been shown to be associated with a number of complications in pregnancy including preeclampsia and increased incidence of Cesarean sections. Although multiple hypotheses have been proposed to explain this association, each individual hypothesis cannot completely explain the whole pathogenesis. Present understanding suggests that a strong family history, low serum iron and ferritin level, and high estrogen level during pregnancy might play important roles. Vitamin D deficiency and calcium metabolism may also play a role. Medical treatment of RLS during pregnancy is difficult and challenging considering the risks to mother and fetus. However, in some cases, the disease may be severe enough to require treatment.
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Affiliation(s)
- R. Gupta
- Department of Psychiatry and Sleep Clinic; Himalayan Institute of Medical Sciences; Dehradun India
| | - M. Dhyani
- Department of Psychiatry and Sleep Clinic; Himalayan Institute of Medical Sciences; Dehradun India
| | - T. Kendzerska
- Institute for Clinical Evaluative Sciences; Sunnybrook Health Sciences Center; Toronto ON Canada
| | | | - A. S. BaHammam
- Department of Medicine; The University Sleep Disorders Center; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Strategic Technologies Program of the National Plan for Sciences, Technology and Innovation Riyadh; Riyadh Saudi Arabia
| | - P. Srivanitchapoom
- Human Motor Control Section; National Institute of Neurological Disorders and Stroke; National Institutes of Health; Bethesda MD USA
- Department of Medicine; Faculty of Medicine; Siriraj Hospital Mahidol University; Bangkok Thailand
| | - S. Pandey
- Govind Ballabh Pant Institute of Postgraduate Medical Education & Research; New Delhi India
| | - M. Hallett
- Human Motor Control Section; National Institute of Neurological Disorders and Stroke; National Institutes of Health; Bethesda MD USA
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25
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Abstract
Ultrasound elastography, also termed sonoelastography, is being used increasingly in clinical practice to aid the diagnosis and management of diffuse liver disease. Elastography has been shown to be capable of differentiating advanced and early-stage liver fibrosis, and consequently a major application in clinical liver care includes progression to cirrhosis risk stratification through (1) assessment of liver fibrosis stage in HCV and HBV patients, (2) distinguishing non-alcoholic steatohepatitis from simple steatosis in non-alcoholic fatty liver disease patients, and (3) prognostic evaluation of liver disease is autoimmune liver disease. In addition, elastographic characterization of focal liver lesions and evaluation of clinically significant portal hypertension have the potential to be clinically useful and are areas of active clinical research.
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Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA,
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Anvari A, Barr RG, Dhyani M, Samir AE. Clinical application of sonoelastography in thyroid, prostate, kidney, pancreas, and deep venous thrombosis. ACTA ACUST UNITED AC 2015; 40:709-22. [PMID: 25750099 DOI: 10.1007/s00261-015-0383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article reviews the clinical applications of current ultrasound elastography methods in non-hepatic conditions including thyroid nodules, prostate cancer, chronic kidney disease, solid renal lesions, pancreatic lesions, and deep vein thrombosis. Pathophysiology alters tissue mechanical properties via ultrastructural changes including fibrosis, increased cellularity, bleeding, and necrosis, creating a target biomarker, which can be imaged qualitatively or quantitatively with US elastography. US elastography methods can add information to conventional US methods and improve the diagnostic performance of conventional US in a range of disease processes.
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Affiliation(s)
- Arash Anvari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Dhyani M, Gee MS, Misdraji J, Israel EJ, Shah U, Samir AE. Feasibility study for assessing liver fibrosis in paediatric and adolescent patients using real-time shear wave elastography. J Med Imaging Radiat Oncol 2015; 59:687-94; quiz 751. [PMID: 26503488 DOI: 10.1111/1754-9485.12388] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/30/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the feasibility of shear wave elastography (SWE), as a non-invasive means of assessing liver fibrosis stage in paediatric and adolescent patients. MATERIALS AND METHODS Consecutive paediatric and adolescent subjects scheduled for liver biopsy (LB) evaluation of known or suspected diffuse liver disease were included after informed guardian consent and subject assent in this IRB-approved single institution study. Elastograms were acquired prior to liver biopsy, from the liver under a breath-hold after normal inspiration when possible. Biopsy specimens underwent blinded pathologist review using the METAVIR scoring system. RESULTS Twenty-four patients (M : F = 13:11) with a mean age of 17 years (range: 1-21 years) underwent liver biopsy. The distribution of fibrosis on pathological examination was: F0 = 10, F1 = 9, F2 = 1, F3 = 3, and F4 = 1. Subjects with stages F0 and F1 fibrosis had a mean SWE value of 6.93 kPa (95% CI: 6.33-7.44 kPa) and 8.33 kPa (95% CI: 6.83-10.80 kPa) respectively. The SWE value for the one subject with stage F2 fibrosis was 6.36 kPa, whereas for F3 and F4 were 8.86 (95% CI: 5.70-11.40) and 17.85 kPa respectively. The correlation between SWE values and fibrosis grade was strong (r = 0.58, P = 0.003), and the area under the ROC curve differentiatiang ≥F2 fibrosis was 0.62 (95% CI: 0.26-0.98). CONCLUSION Estimation of liver stiffness using real-time SWE is feasible using the SC6-1 ultrasound probe in paediatric and adolescent patients and strongly correlates with the stage of fibrosis.
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Affiliation(s)
- Manish Dhyani
- Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA
| | - Esther Jacobowitz Israel
- Department of Pediatrics, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA
| | - Uzma Shah
- Department of Pediatrics, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA
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Samir AE, Allegretti AS, Zhu Q, Dhyani M, Anvari A, Sullivan DA, Trottier CA, Dougherty S, Williams WW, Babitt JL, Wenger J, Thadhani RI, Lin HY. Shear wave elastography in chronic kidney disease: a pilot experience in native kidneys. BMC Nephrol 2015; 16:119. [PMID: 26227484 PMCID: PMC4521488 DOI: 10.1186/s12882-015-0120-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/22/2015] [Indexed: 12/17/2022] Open
Abstract
Background There currently is a need for a non-invasive measure of renal fibrosis. We aim to explore whether shear wave elastography (SWE)-derived estimates of tissue stiffness may serve as a non-invasive biomarker that can distinguish normal and abnormal renal parenchymal tissue. Methods Participants with CKD (by estimated GFR) and healthy volunteers underwent SWE. Renal elasticity was estimated as Young’s modulus (YM) in kilopascals (kPa). Univariate Wilcoxon rank-sum tests were used. Results Twenty-five participants with CKD (median GFR 38 mL/min; quartile 1, quartile 3 28, 42) and 20 healthy controls without CKD underwent SWE performed by a single radiologist. CKD was associated with increased median YM (9.40 [5.55, 22.35] vs. 4.40 [3.68, 5.70] kPa; p = 0.002) and higher median intra-subject inter-measurement estimated YM’s variability (4.27 [2.89, 9.90] vs. 1.51 [1.21, 2.05] kPa; p < 0.001). Conclusions SWE-derived estimates of renal stiffness and intra-subject estimated stiffness variability are higher in patients with CKD than in healthy controls. Renal fibrosis is a plausible explanation for the observed difference in YM. Further studies are required to determine the relationship between YM, estimated renal stiffness, and renal fibrosis severity. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0120-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Andrew S Allegretti
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Qingli Zhu
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Manish Dhyani
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Arash Anvari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Dorothy A Sullivan
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Caitlin A Trottier
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Sarah Dougherty
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Winfred W Williams
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Jodie L Babitt
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Julia Wenger
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Ravi I Thadhani
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
| | - Herbert Y Lin
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, 185 Cambridge St, Suite 8.216, Boston, MA, 02114, USA.
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Samir AE, Dhyani M, Anvari A, Prescott J, Halpern EF, Faquin WC, Stephen A. Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane. Radiology 2015; 277:565-73. [PMID: 25955578 DOI: 10.1148/radiol.2015141627] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate the diagnostic accuracy of shear-wave elastography (SWE) for the diagnosis of malignancy in follicular lesions and to identify the optimal SWE measurement plane. MATERIALS AND METHODS The institutional review board approved this HIPAA-compliant, single-institution, prospective pilot study. Subjects scheduled for surgery after a previous fine-needle aspiration report of "atypia of undetermined significance" or "follicular lesion of undetermined significance," "suspicion for follicular neoplasm," or "suspicion for Hurthle cell neoplasm," were enrolled after obtaining informed consent. Subjects underwent conventional ultrasonography (US), Doppler evaluation, and SWE preoperatively, and their predictive value for thyroid malignancy was evaluated relative to the reference standard of surgical pathologic findings. RESULTS Thirty-five patients (12 men, 23 women) with a mean age of 55 years (range, 23-85 years) and a fine-needle aspiration diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (n = 16), suspicion for follicular neoplasm (n = 14), and suspicion for Hurthle cell neoplasm (n = 5) were enrolled in the study. Male sex was a statistically significant (P = .02) predictor of malignancy, but age was not. No sonographic morphologic parameter, including nodule size, microcalcification, macrocalcification, halo sign, taller than wide dimension, or hypoechogenicity, was associated with malignancy. Similarly, no Doppler feature, including intranodular vascularity, pulsatility index, resistive index, or peak-systolic velocity, was associated with malignancy. Higher median SWE tissue Young modulus estimates from the transverse insonation plane were associated with malignancy, yielding an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.62, 1.00) for differentiation of malignant from benign nodules. At a cutoff value of 22.3 kPa, sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 88%, 75%, and 91%, respectively, were observed. CONCLUSION This prospective pilot study indicates that SWE may be a valuable tool in preoperative malignancy risk assessment of follicular-patterned thyroid nodules.
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Affiliation(s)
- Anthony E Samir
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Manish Dhyani
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Arash Anvari
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Jason Prescott
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Elkan F Halpern
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - William C Faquin
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Antonia Stephen
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
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Samir AE, Dhyani M, Vij A, Bhan AK, Halpern EF, Méndez-Navarro J, Corey KE, Chung RT. Shear-wave elastography for the estimation of liver fibrosis in chronic liver disease: determining accuracy and ideal site for measurement. Radiology 2014; 274:888-96. [PMID: 25393946 DOI: 10.1148/radiol.14140839] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the accuracy of shear-wave elastography (SWE) for staging liver fibrosis in patients with diffuse liver disease (including patients with hepatitis C virus [HCV]) and to determine the relative accuracy of SWE measurements obtained from different hepatic acquisition sites for staging liver fibrosis. MATERIALS AND METHODS The institutional review board approved this single-institution prospective study, which was performed between January 2010 and March 2013 in 136 consecutive patients who underwent SWE before their scheduled liver biopsy (age range, 18-76 years; mean age, 49 years; 70 men, 66 women). Informed consent was obtained from all patients. SWE measurements were obtained at four sites in the liver. Biopsy specimens were reviewed in a blinded manner by a pathologist using METAVIR criteria. SWE measurements and biopsy results were compared by using the Spearman correlation and receiver operating characteristic (ROC) curve analysis. RESULTS SWE values obtained at the upper right lobe showed the highest correlation with estimation of fibrosis (r = 0.41, P < .001). Inflammation and steatosis did not show any correlation with SWE values except for values from the left lobe, which showed correlation with steatosis (r = 0.24, P = .004). The area under the ROC curve (AUC) in the differentiation of stage F2 fibrosis or greater, stage F3 fibrosis or greater, and stage F4 fibrosis was 0.77 (95% confidence interval [CI]: 0.68, 0.86), 0.82 (95% CI: 0.75, 0.91), and 0.82 (95% CI: 0.70, 0.95), respectively, for all subjects who underwent liver biopsy. The corresponding AUCs for the subset of patients with HCV were 0.80 (95% CI: 0.67, 0.92), 0.82 (95% CI: 0.70, 0.95), and 0.89 (95% CI: 0.73, 1.00). The adjusted AUCs for differentiating stage F2 or greater fibrosis in patients with chronic liver disease and those with HCV were 0.84 and 0.87, respectively. CONCLUSION SWE estimates of liver stiffness obtained from the right upper lobe showed the best correlation with liver fibrosis severity and can potentially be used as a noninvasive test to differentiate intermediate degrees of liver fibrosis in patients with liver disease.
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Affiliation(s)
- Anthony E Samir
- From the Department of Radiology (A.E.S., M.D.), Department of Pathology (A.K.B.), Institute for Technology Assessment (E.F.H.), and Department of Hepatology, Liver and GI Division, Department of Medicine (K.E.C., R.T.C.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (A.V.); and Department of Gastroenterology, National Medical Center, Hospital de Especialidades, CMN Siglo XXI, IMSS, Mexico City, Mexico (J.M.N.)
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Dhyani M, Faquin W, Lubitz CC, Daniels GH, Samir AE. How to interpret thyroid fine-needle aspiration biopsy reports: a guide for the busy radiologist in the era of the Bethesda Classification System. AJR Am J Roentgenol 2013; 201:1335-9. [PMID: 24261375 DOI: 10.2214/ajr.13.10537] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Fine-needle aspiration biopsy (FNAB) is the current primary test to risk stratify thyroid nodules. However, in up to one third of biopsies, cytology is indeterminate. The Bethesda System for Reporting Thyroid Cytopathology categorizes thyroid cytology findings into six groups, with each group assigned a putative malignancy risk. This article reviews the Bethesda System, emphasizing the key facts necessary to understand thyroid biopsy results and effectively manage patients after FNAB. CONCLUSION It is important to diagnose and stratify the risk of malignancy in thyroid nodules. A working knowledge of the Bethesda System permits accurate, evidence-based risk stratification of patients with thyroid nodules and thereby facilitates their management. Because it is a uniform diagnostic approach, the Bethesda System allows comparisons of different management strategies across different institutions.
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Affiliation(s)
- Manish Dhyani
- 1 Department of Radiology, Abdominal Imaging & Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114
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Trivedi JK, Dhyani M, Goel D, Sharma S, Singh AP, Sinha PK, Tandon R. Neurocognitive dysfunction in patients with obsessive compulsive disorder. ACTA ACUST UNITED AC 2012; 11:204-9. [PMID: 19588044 DOI: 10.4314/ajpsy.v11i3.30270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although a dysfunctional prefrontal-striatal system is presupposed in obsessive-compulsive disorder (OCD), this is not unequivocally supported by neuropsychological studies. This study aims to study the neurocognitive dysfunctions in OCD patients, compared to controls; to study the variations in neurocognitive deficits with the duration of illness, as well as, the severity of the disease. METHOD Thirty OCD patients were compared with thirty, age and education matched control subjects on computer based tests measuring executive functions, vigilance and spatial working memory. RESULTS OCD patients performed poorly on all the neuro-cognitive parameters as compared to controls. The severity of illness had a positive correlation with poorer performance on CPT. There were no significant correlations between duration of illness and any parameters of cognition. CONCLUSION The results suggest that OCD patients perform significantly worse on cognitive measures than controls. This is consistent with their poorer functional outcome. The results further indicate that on the basis of severity OCD patients are qualitatively distinguishable in neuropsychological terms, given their difference in the profiles of cognitive impairment.
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Affiliation(s)
- J K Trivedi
- Department of Psychiatry, King George's Medical University, Lucknow, India
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