Usefulness of virtual touch tissue quantification for predicting the presence of esophageal varices in patients with liver cirrhosis

BACKGROUND AND AIM

Measuring the hepatic venous pressure gradient (HVPG) is an established technique to detect increased portal pressure and predict the presence of esophageal varices (EVs); however, the risk of the test is greater than the information it provides. This study aimed to clarify the usefulness of virtual touch tissue quantification (VTQ), which assesses liver stiffness, in predicting the presence of EVs in patients with liver cirrhosis by comparing it with HVPG.

METHODS

Two hundred seventeen patients with liver cirrhosis underwent VTQ, HVPG measurement, and upper endoscopy. Patients were divided into three groups: group V, hepatitis C virus liver cirrhosis (n = 40); group A, alcoholic liver cirrhosis (n = 116); and group N, other liver cirrhosis (n = 61). In each group, we performed linear regression analysis of VTQ and HVPG data. The accuracy of VTQ and HVPG measurement in predicting the presence of EVs and high-risk EVs (EV category F2 and F3) was assessed by area under the receiver operating characteristic curve (AUROC).

RESULTS

VTQ was significantly correlated with the HVPG in the whole patients and in each group, and both VTQ and HVPG values were significantly higher in patients with EVs and high-risk EVs than in those without. The AUROC for the presence of EVs for VTQ was 0.76 in the whole sample, 0.76 in group V, 0.79 in group A, and 0.67 in group N; and for HVPG, 0.92, 0.94, 0.93, and 0.88, respectively. For VTQ, the AUROC for the presence of high-risk EVs was 0.78 in the whole sample, 0.78 in group V, 0.73 in group A, and 0.73 in group N; and for HVPG, it was 0.85, 0.82, 0.85, and 0.82, respectively.

CONCLUSION

VTQ was reliable at predicting the presence of EVs and high-risk EVs. Therefore, we propose that VTQ is a useful, noninvasive tool for predicting the presence of EVs in daily medical care.

The value of automated breast volume scanner combined with virtual touch tissue quantification in the differential diagnosis of benign and malignant breast lesions: A comparative study with mammography

This study aimed to evaluate the diagnostic value of automated breast volume scanner (ABVS) combined with virtual touch tissue quantification (VTQ) in the differential diagnosis of breast lesions.In this retrospective study, 183 patients (mean age, 49.8 ± 8.2 years) with 218 breast lesions underwent ABVS, VTQ, and mammography (MG). All lesions were confirmed by postoperative histopathology. A logistic regression model was constructed to generate a receiver operating characteristic (ROC) curve, calculate the area under the ROC curve (AUC), and compare and evaluate the diagnostic performance of ABVS, VTQ, MG, and ABVS combined with VTQ (ABVS-VTQ).The sensitivity, specificity, and accuracy of ABVS, VTQ, MG, and ABVS-VTQ in diagnosing breast lesions were 94.01% (110/117), 96.03% (97/101), and 94.95% (207/218); 80.34% (94/117), 94.05% (95/101), and 86.69% (189/218); 70.08% (82/117), 68.31% (69/101), and 69.26% (151/218); and 96.58% (113/117), 96.03% (97/101), and 96.33% (210/218), respectively. The AUC of ABVS-VTQ was higher than that of the other examinations alone. The detection rate of ABVS (100%, 218/218) was higher than that of MG (78.89%, 172/218), and the difference was statistically significant (χ2 = 51.426, P < .001).The combined application of ABVS and VTQ can improve the accuracy and specificity of the diagnosis and is a promising ultrasound method for the differential diagnosis of breast lesions.

The diagnostic performance of shear wave velocity ratio for the differential diagnosis of benign and malignant breast lesions: Compared with VTQ, and mammography

PURPOSE

To evaluate the diagnostic value of shear wave velocity (SWV) ratio for the differential diagnosis of benign and malignant breast lesions.

MATERIAL AND METHODS

Our retrospective study included 151 breast lesions that were diagnosed by biopsy and surgical pathology. All of the breast lesions were detected by conventional ultrasound and Virtual Touch tissue quantification (VTQ) and mammography. The sonographic characteristics of the breast lesion, such as the internal echo, shape, margin, color flow, and calcification so on, were also observed. The SWV in lesions and surrounding parenchyma were measured and the SWV ratio between the lesion and surrounding parenchyma was calculated. Pathological results were used as a diagnosis standard to compare the value of SWV ratio, VTQ, and mammography in the diagnosis of benign and malignant breast lesions.

RESULTS

The 151 breast lesions included 96 benign lesions and 55 malignant lesions. The cutoff value of VTQ in the diagnosis of benign and malignant breast lesions was 5.01 m/s, of SWV ratio was 2.43, and mammography was BI-RADS 4B. The sensitivity, specificity, accuracy and the area under the ROC curve (AUC) of the SWV ratio were 78.2%, 86.5%, 83.4%, and 0.83 respectively. While of SWV ratio with mammography was 86.4%, 89.4%, 88.3% and 0.87, respectively. The sensitivity, specificity, accuracy, and AUC of SWV ratio and SWV ratio with mammography were statistically higher than those of mammography, no statistically higher than VTQ and VTQ with mammography.

CONCLUSION

The SWV ratio can improve the sensitivity without sacrificing diagnostic specificity in the process of breast cancer diagnostic, provide a better diagnostic performance, and avoid unnecessary biopsy or surgery.

USEFULNESS OF TRANSPERINEAL VIRTUAL TOUCH QUANTIFICATION IN THE CERVIX FOR PREDICTING OUTCOME OF LABOR INDUCTION

This study aimed to explore the feasibility of transperineal virtual touch tissue quantification (VTQ) for predicting the outcome of labor induction. A total of 80 nulliparous pregnant women were included. Before labor induction, cervical length was measured by B-mode sonography, cervical stiffness was measured by VTQ, and Bishop score was assessed by vaginal examination. Subsequently, labor was induced using standard oxytocin infusion in all patients. Delivery within 24 hours after labor induction was classified as spontaneous delivery; otherwise, cesarean delivery was performed. Out of 80 participants, 48 (60%) delivered vaginally and 32 (40%) underwent cesarean delivery. The cervical length was significantly longer and the shear wave velocity (SWV) was greater in the cesarean delivery group than in the vaginal delivery group (p = 0.004 and p < 0.000, respectively). Logistic regression analysis indicated that only the mean SWV had independent predictive value for the outcome of labor induction (p = 0.011). The best diagnostic cut-off point of the mean SWV was 1.23 m/s, with a sensitivity of 93.8% and a specificity of 89.6%. Transperineal VTQ technique could predict the outcome of labor induction using oxytocin.

Acoustic Radiation Force Impulse Imaging With Virtual Touch Tissue Quantification Enables Characterization of Mild Hypoxic-Ischemic Brain Damage in Neonatal Rats

OBJECTIVES

The aim of this study was to investigate whether the measurement of brain tissue stiffness using acoustic radiation force impulse (ARFI) elastography with virtual touch tissue quantification can improve the early detection of neonatal hypoxic-ischemic brain damage in rats.

METHODS

Seven-day-old Sprague-Dawley rats were randomly assigned to 3 groups: the mild asphyxia (n = 30), moderate asphyxia (n = 30), and sham control (n = 10) groups. Rats in the mild and moderate asphyxia groups were exposed to 8% oxygen (hypoxia) for 30 and 60 minutes, respectively, at 1 hour after ligation of the right common carotid artery. An ultrasound diagnostic instrument was used to obtain 2-dimensional ultrasound images, and ARFI with virtual touch tissue quantification was used to measure shear wave velocity preoperatively and at 12, 24, 48, and 72 hours postoperatively. Hematoxylin-eosin staining was used to evaluate brain damage.

RESULTS

Two-dimensional ultrasound imaging detected swelling and increased echogenicity at 48 to 72 hours in the mild asphyxia group and at 24 to 72 hours in the moderate asphyxia group. The shear wave velocity substantially increased from 0.65 ± 0.04 m/s preoperatively to 0.78 ± 0.07 m/s at 72 hours in the moderate asphyxia group and from 0.64 ± 0.04 m/s preoperatively to 0.70 ± 0.03 m/s at 72 hours in the mild asphyxia group. The changes in the shear wave velocity coincided with the histopathologic changes in the brain, which included neuronal demyelination, hyperplasia, and necrosis; edema around vascular structures; and hemorrhage in the ependymal and periventricular areas.

CONCLUSION

Shear wave velocity data obtained with the virtual touch tissue quantification technique may be used for early diagnosis of neonatal hypoxic-ischemic brain damage.

Diagnostic value of acoustic radiation force impulse imaging for assessing superficial lymph nodes: A diagnostic accuracy study

The aim of this study was to assess the diagnostic value of acoustic radiation force impulse (ARFI) imaging for differentiating superficial lymph nodes.Virtual touch tissue imaging (VTI) grade and shear wave velocity (SWV) were analyzed and compared in 97 patients (65 women, 32 men; mean age, 49 y; range, 23-72 y) with 97 lymph nodes [23 chronic nonspecific reactive lymph nodes (CLNs), 38 metastatic lymph nodes (MLNs), and 36 blood and lymphatic system diseases lymph nodes (BLLNs)]. The elastography characteristics in patients with CLNs, MLNs, and BLLNs were compared using the nonparametric Kruskal-Wallis test and Mann-Whitney U test for continuous variables and categorical variables. The diagnostic performance of VTI grade and SWV were evaluated using the area under the receiver operating characteristic curve (AUC).The median of SWV of MLNs was significantly higher (2.90 m/s) than those of CLNs (2.15 m/s) and BLLNs (2.52 m/s). The VTI grade of MLNs was significantly higher than those of CLNs (P < .001) and BLLNs (P < .001). The sensitivity, specificity, accuracy, and AUC were 81.58%, 95.65%, 86.89%, and 0.904, respectively, at a cutoff level of grade IV for VTI grade in differentiating MLNs from CLNs, whereas those of SWV were 57.89%, 86.96%, 68.85%, and 0.752, respectively, at a cutoff level of 2.76 m/s.The diagnostic performance of VTI grade was significantly higher than that of SWV in differentiating MLNs from CLNs. The diagnostic performance of VTI grade and SWV were lower intermediate in differentiating MLNs from BLLNs and in differentiating BLLNs from CLNs, and there was no significant difference between VTI grade and SWV. ARFI imaging may be a feasible method for differentiating MLNs from CLNs.

Different extent of hypoxic-ischemic brain damage in newborn rats: histopathology, hemodynamic, virtual touch tissue quantification and neurobehavioral observation

OBJECTIVE

To explore the correlation between pathological and ultrasound changes applying conventional ultrasound, Color Doppler ultrasound andVirtual Touch Tissue Quantification (VTQ) technique in newborn hypoxic-ischemic brain damage (HIBD) rat models. To provide theoretical basis for early diagnosis and treatment of HIBD neonatal.

METHODS

A total of 90 newborn Wistar rats were divided into ischemia, asphyxia and control group according to different HIBD molding methods. Conventional ultrasound, Color Doppler ultrasound and VTQ were applied on 3 h, 12 h, 24 h, 48 h and 72 h postoperative. After the observation of 72 h, 10 rats in each group were randomly selected for pathological specimens production. The rest rats were raised for 30 days for neuroethology detection.

RESULTS

In ischemia group and asphyxia group, there were 4 deaths and 6 deaths in the modeling process; the mortality rate was 13.33% (4/30) and 20.00% (6/30) respectively. For ischemia group, the systoli velocity (Vs), diastolic velocity (Vd) and resistance index (RI) of right middle cerebral artery (MCA) were significantly decreased after operation (P<0.05). For asphyxia group, the Vs and RI of right MCA were significantly decreased after operation (P<0.05), while the Vd of right MCA was significantly increased after operation (P<0.05), which lead to the postoperative RI value in each time point was all significantly lower than that in ischemia group (P<0.05). For ischemia group and asphyxia group, the VTQ results increased significantly postoperative (P<0.05), and compared with ischemia group and control group, the postoperative VTQ value in each time point was all significantly higher in asphyxia group (P<0.05). The neuroethology results were significantly lower in the ischemia group and asphyxia group (P<0.05), and the results in ischemia group were significantly higher than those of asphyxia group (P<0.05). And the results are consistent with the pathological findings.

CONCLUSION

There is a consistent correlation among histopathological changes, hemodynamic changes, VTQ values and neuroethology results in HIBD animal models. As noninvasive quantitative ultrasound elastography methods, Color Doppler ultrasound and VTQ can assess the extent of HIBD damages in newborn rats with specific values. This study provides basic research and theory to early diagnosis and early treatment of neonatal hypoxic-ischemic brain damage.

Bimodal peaks of liver stiffness in a case of drug-induced liver injury

A 69-year-old male complained of general fatigue and presented with elevation of liver enzymes without any cause of liver injury. We diagnosed him with hepatocellular drug-induced liver injury (DILI). Liver stiffness, which was evaluated according to the shear wave velocity (SWV) using virtual touch tissue quantification, was serially observed during hospitalization. A fast SWV was noted on the date of admission, indicating a "hard" degree of liver stiffness. The SWV gradually decreased until the 20th hospital day. However, the patient's liver enzymes again became elevated on the 20th hospital day, and the SWV simultaneously increased in association with a rise in the total bilirubin level. The laboratory data for the second peak of the SWV indicated mixed-type DILI; therefore, the patient's pathological state transitioned from the hepatocellular type to the mixed type. A liver biopsy performed before discharge revealed a state of recovery from acute inflammation without fibrotic changes. We conclude that the second peak of the SWV may be affected by the presence of intrahepatic cholestasis. We herein report the occurrence of bimodal peaks of liver stiffness in a patient with DILI. In such cases, each peak of liver stiffness may be the result of a different pathological mechanism, namely acute inflammation versus acute intrahepatic cholestasis. Although the detailed mechanisms underlying the development of liver stiffness due to intrahepatic cholestasis remain unclear, this case presented a limitation of virtual touch tissue quantification for evaluation of liver stiffness as fibrosis marker in the liver with intrahepatic cholestasis.

Non-invasive liver fibrosis score calculated by combination of virtual touch tissue quantification and serum liver functional tests in chronic hepatitis C patients

AIM

Acoustic radiation force impulse (ARFI) technology, involving the shear wave velocity (SWV) with virtual touch tissue quantification (VTTQ), are currently available for the assessment of liver fibrosis, while there is no index derived from the combination of SWV and blood tests. The aim of this study was to develop a new index for assessment of liver fibrosis.

METHODS

The subjects were 176 consecutive patients with hepatitis C (training set [n = 120] and validation set [n = 56]) who underwent liver biopsy in our institution.

RESULTS

In the training set, SWV, international normalized ratio (INR) and alanine aminotransferase (ALT) correlated independently and significantly with fibrosis. According to this, we developed the VIA index = -1.282 + 0.965 × SWV + 1.785 INR + 0.00185 ALT. The areas under the receiver-operator curve (AUROC) of the VIA index were 0.838 for the diagnosis of significant fibrosis (≥F2), 0.904 for the severe fibrosis (≥F3) and 0.958 for the cirrhosis (F4) in the training set. While in the validation set, AUROC of the VIA index were 0.917 for F2 or higher, 0.906 for F3 or higher and 1.000 for F4, respectively. AUROC of the VIA index was improved compared to SWV alone, equivalent for VIA for the diagnosis of F2 or higher, and superior to that of FIB-4 index and aspartate aminotransferase-to-platelet ratio index for the diagnosis of F3 or higher and F4.

CONCLUSION

The VIA index is potentially more useful for assessment of liver fibrosis than SWV alone, and easily and accurately measures liver fibrosis stage.

Evaluation of penile erection rigidity in healthy men using virtual touch tissue quantification

Background

The aim of the study was to describe the shear wave velocity (SWV) values of the penis by virtual touch tissue quantification (VTTQ) and to examine the clinical usefulness of this procedure in evaluation of the rigidity changes in penile erection.

Patients and methods.

VTTQ was performed in 37 healthy volunteers. In the course of erection, SWV values of glans penis, corpus penis and radix penis were quantified and grades of erection were documented. The SWV values at different grades of erection were compared.

Results

The axial and radial SWV values of glans penis, corpus penis and radix penis all significantly decreased from Grade 0 to Grade 4 of erection. At Grade 4, they were less than one-third of that at Grade 0 (axial direction: 0.79 ± 0.13 vs. 2.79 ± 0.32 for glans penis, P<0.001; 0.77 ± 0.19 vs. 2.84 ± 0.30 for corpus penis, P<0.001 and 0.76 ± 0.15 vs. 2.81 ± 0.34 for radix penis, P<0.001; radial direction: 0.82 ± 0.15 vs. 2.83 ± 0.31 for glans penis, P<0.001; 0.79 ± 0.18 vs. 2.81 ± 0.27 for corpus penis, P<0.001 and 0.81 ± 0.16 vs. 2.82 ± 0.33 for radix penis, P<0.001).

Conclusions

VTTQ can provide numerical measurements of penile rigidity and can effectively and sensitively indicate the axial and radial rigidity changes in penile erection, which provide a new approach to assessing the erectile function.

A comparison of virtual touch tissue quantification and digital rectal examination for discrimination between prostate cancer and benign prostatic hyperplasia

BACKGROUND

Virtual touch tissue quantification (VTTQ) is a new, promising technique for detecting the stiffness of tissues. The aim of this study is to compare the performance of VTTQ and digital rectal examination (DRE) in discrimination between prostate cancer and benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

VTTQ was performed in 209 prostate nodular lesions of 107 patients with BPH and suspected prostate cancer before the prostate histopathologic examination. The shear wave velocity (SWV) at each nodular lesion was quantified by implementing an acoustic radiation force impulse (ARFI). The performance of VTTQ and DRE in discrimination between prostate cancer and BPH was compared. The diagnostic value of VTTQ and DRE for prostate cancer was evaluated in terms of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy.

RESULTS

Prostate cancer was detected in 57 prostate nodular lesions by histopathologic examination. The SWV values (m/s) were significantly greater in prostate cancer and BPH than in normal prostate (2.37 ± 0.94, 1.98 ± 0.82 vs. 1.34 ± 0.47). The area under the receiver operating characteristic curve (AUC) for VTTQ (SWV>2.5m/s) to differentiate prostate nodules as benign hyperplasia or malignancy was 0.86, while it was 0.67 for DRE. The diagnostic sensitivity, specificity, PPV, NPV and accuracy were 71.93 %, 87.5 %, 68.33 %, 89.26 %, 83.25 %, respectively for VTTQ (SWV>2.5m/s), whereas they were 33.33 %, 81.57 %, 40.43 %, 76.54 %, 68.42 % respectively for DRE.

CONCLUSIONS

VTTQ can effectively detect the stiffness of prostate nodular lesions, which has a significantly higher performance than DRE in discrimination between prostate cancer and BPH.