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Introducción: Las hepatopatías son un problema prevalente a nivel mundial. La biopsia hepática ha sido hasta la fecha el gold standard para valorar el grado de fibrosis, sin embargo, con el advenimiento de nuevos métodos no invasivos, costo-efectivos para el sistema sanitario, cada vez recurrimos menos a esta. En nuestro medio se introdujo recientemente la elastografía por onda cizallamiento con imagen biplanar, lo que implica una curva de aprendizaje por parte de los técnicos. Objetivo: Valorar la asociación de los grados de fibrosis hepática determinado por la elastografía por onda de cizallamiento con imagen biplanar (2D-SWE) y el score APRI en pacientes portadores de enfermedad hepática asistidos en el servicio de hepatología del Hospital Pasteur.Médica 2. Metodología: Se incluyeron los pacientes con enfermedad hepática de cualquier etiología, asistidos entre el 01/10/21 al 31/08/22, mayores de 15 años, de ambos sexos y que han sido valorados con elastografía por onda de cizallamiento con imagen biplanar (2D-SWE) y analítica sanguínea realizado por el equipo médico del servicio mencionado en los últimos 6 meses. Resultados: Se incluyeron 158 pacientes. Se encontró mayor prevalencia de enfermedad hepática en mujeres, con predominio de la etiología de enfermedad por hígado graso no alcohólico (EHGNA) e infección por virus de hepatitis C (VHC). Se evidenció asociación positiva entre la elastografía (2D-SWE) y el score APRI para el diagnóstico o exclusión de enfermedad hepática avanzada, sin diferencia estadísticamente significativa entre los dos médicos hepatólogos. Conclusiones: Existe asociación entre la elastografía por SWE y el score APRI para el diagnóstico de enfermedad hepática avanzada en la población general y por etiología.
Introduction: Liver diseases are a prevalent problem worldwide. To date, liver biopsy has been the gold standard for assessing the degree of fibrosis; however, with the advent of new non-invasive, cost-effective methods for the healthcare system, we are resorting to it less and less. Shear wave elastography with biplanar imaging was recently introduced in our setting, which implies a learning curve for technicians. Objective: To assess the association of the degrees of liver fibrosis determined by shear wave elastography with biplanar imaging (2D-SWE) and the APRI score in patients with liver disease treated in the hepatology service of the Pasteur Hospital. Methodology: Patients with liver disease of any etiology, attended between 01/10/21 and 08/31/22, over 15 years of age, of both sexes and who have been evaluated with shear wave elastography with biplanar image were included. (2D-SWE) and blood analysis performed by the medical team of the aforementioned service in the last 6 months. Results: 158 patients were included. A higher prevalence of liver disease was found in women, with a predominance of the etiology of nonalcoholic fatty liver disease (NAFLD) and hepatitis C virus (HCV) infection. A positive association was evident between elastography (2D-SWE) and the APRI score for the diagnosis or exclusion of advanced liver disease, with no statistically significant difference between the two hepatologists. Conclusions: There is an association between SWE elastography and the APRI score for the diagnosis of advanced liver disease in the general population and by etiology.
Introdução: As doenças hepáticas são um problema prevalente em todo o mundo. Até o momento, a biópsia hepática tem sido o padrão ouro para avaliar o grau de fibrose, porém, com o advento de novos métodos não invasivos e de baixo custo para o sistema de saúde, recorremos cada vez menos a ela. A elastografia por onda de cisalhamento com imagem biplanar foi introduzida recentemente em nosso meio, o que implica uma curva de aprendizado para os técnicos. Objetivo: Avaliar a associação dos graus de fibrose hepática determinados pela elastografia por ondas de cisalhamento com imagem biplanar (2D-SWE) e o escore APRI em pacientes com hepatopatia atendidos no serviço de hepatologia do Hospital Pasteur. Metodologia: Foram incluídos pacientes portadores de doença hepática de qualquer etiologia, atendidos entre 10/01/21 e 31/08/22, maiores de 15 anos, de ambos os sexos e que foram avaliados com elastografia por onda de cisalhamento com imagem biplanar. ( 2D-SWE) e análises sanguíneas realizadas pela equipa médica do referido serviço nos últimos 6 meses. Resultados: foram incluídos 158 pacientes. Foi encontrada maior prevalência de doença hepática em mulheres, com predomínio da etiologia da doença hepática gordurosa não alcoólica (DHGNA) e da infecção pelo vírus da hepatite C (HCV). Foi evidente uma associação positiva entre a elastografia (2D-SWE) e o escore APRI para o diagnóstico ou exclusão de doença hepática avançada, sem diferença estatisticamente significativa entre os dois hepatologistas. Conclusões: Existe associação entre a elastografia SWE e o escore APRI para o diagnóstico de doença hepática avançada na população geral e por etiologia.
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Early detection of renal allograft dysfunction plays a critical role in the management of immunosuppression and the survival of renal allograft. However, early detection of renal allograft dysfunction still has certain challenges because no significant changes could be observed in clinical manifestations and biochemical parameters during the early stage. As a novel ultrasound examination tool in recent years, shear wave elastography has been successfully applied in the detection of thyroid, breast, liver and alternative organs. In addition, it also has promising application prospect in the examination of renal allograft due to multiple advantages of real-time, dynamic, accuracy and repeatability. In this article, the classification, principle, advantages, influencing factors of shear wave elastography and its application in the field of kidney transplantation were reviewed, aiming to provide reference for clinicians to make accurate decisions in the prevention and monitoring of renal allograft diseases.
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Resumen Introducción: la elastografía en tiempo real, 2D-SWE (Supersonic), es una prueba no invasiva que se utiliza para determinar la elasticidad del hígado y, de esa forma, calcular el grado de fibrosis hepática. En Colombia, la prueba se introdujo en 2016 y no existen hasta el momento estudios del comportamiento de la prueba en todos los pacientes hepáticos, solo se han publicado en pacientes sanos y cirróticos. Objetivo: analizar la experiencia de la aplicación de la elastografía en tiempo real, en sujetos atendidos en el centro de enfermedades hepáticas y digestivas de Bogotá, Colombia. Materiales y métodos: estudio descriptivo retrospectivo de una cohorte de sujetos atendidos entre marzo de 2016 y julio de 2017. Se realizó una historia clínica completa y una prueba de elastografía en tiempo real (Supersonic). Resultados: se incluyeron 654 sujetos, con una mediana de edad de 55 años (rango intercuartílico [RIC]: 45-64). La mediana de valores de fibrosis expresada en kilopascales (kPs) fue de 8,3, con un promedio de 5 mediciones. Se observó una diferencia significativa en el grado de fibrosis entre los grupos de edad y en relación con el diagnóstico final, donde se evidenció una mayor fibrosis en el grupo de enfermedades colestásicas (autoinmune, colangitis biliar primaria [CBP] y superposición autoinmune-CBP). La tasa global de fracaso fue menor al 1%. Conclusiones: es la primera descripción del comportamiento de la prueba a nivel nacional. Los valores de rigidez hepática observados en los diferentes estadios demuestran la utilidad de la prueba para la determinación de la fibrosis hepática en pacientes con diferentes patologías.
Abstract Introduction: Real-time two-dimensional shear wave elastography (2D-SWE) (Supersonic Imagine SA), is a non-invasive test used to determine liver elasticity and calculate the degree of liver fibrosis. In Colombia, this test was introduced in 2016 and, to date, no study has tested its behavior in all liver patients, only in healthy and cirrhotic patients. Objective: To analyze the experience of real-time elastography implementation in subjects treated at the Centro de Enfermedades Hepáticas y Digestivas in Bogotá, Colombia. Materials and methods: This is a retrospective descriptive study of a cohort of subjects treated between March 2016 and July 2017. A complete medical report and a real-time elastography (Supersonic) test were performed. Results: 654 subjects were included, with a median age of 55 years (interquartile range [IQR]: 45-64). The median fibrosis values expressed in kilopascals (kPs) were 8.3, with an average of 5 measurements. There was a significant difference in the degree of fibrosis between the age groups and in relation to the final diagnosis, where there was a greater fibrosis in the cholestatic disease group (autoimmune, primary biliary cholangitis [PBC], and overlap). The overall failure rate was less than 1%. Conclusions: This is the first description of this test behavior in the country. Hepatic stiffness values observed in the different stages demonstrate the usefulness of the test to establish the degree of liver fibrosis in patients with multiple diseases.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Fibrosis , Elasticity Imaging Techniques , Liver , Medical Records , Elasticity , Research Report , MethodsABSTRACT
Objective:To evaluate the diagnostic value of ultrasound thyroid imaging-reporting and data system (TI-RADS) combined with three-dimensional shear wave elastography (3D-SWE) technique in thyroid microcarcinoma. Methods:From Jun. 2017 to Jan. 2018, 66 patients with 67 thyroid nodules in the Department of Ultrasound of Renji Hospital, Shanghai Jiao Tong University School of Medicine were recruited. All thyroid nodules were classified as TI-RADS 4-5, and the maximum diameter was 5.0-10.0 mm. After routine ultrasound examination, all thyroid nodules were evaluated by TI-RADS classification, 3D-SWE technique, fine-needle aspiration biopsy (FNAB) examination and an additional BRAFV600E gene mutation test. All the nodules were divided into benign group and malignant group according to the results of surgical pathology or fine-needle aspiration combined with BRAFV600E gene detection. The threshold value of the parameters in 3D-SWE for differentiating benign and malignant thyroid nodules was calculated, and the TI-RADS was further adjusted by Young's modulus parameters of the lesion to obtain combined TI-RADS (conventional ultrasound combined with 3D-SWE) for detecting the benign and malignant nodules. Results:Among the 67 thyroid nodules, 38 of them were malignant and 29 were benign. The optimal cut-off point of three-dimensional maximum Young's modulus in sagittal plane (3D-S-Emax) was 24.6 kPa. The area under the curve (AUC) value, sensitivity, specificity and accuracy of 3D-S-Emax were 0.683, 65.8%, 65.5% and 65.7%, respectively. The AUC value for combined TI-RADS was 0.801 and that for conventional TI-RADS was 0.794, without statistical difference. The sensitivity, specificity and accuracy of conventional TI-RADS and combined TI-RADS were 63.2%, 82.8%, 71.6%, and 86.8%, 69.0%, 79.1%, respectively. Only sensitivity of combined TI-RADS was significantly higher than that of conventional TI-RADS (P=0.004). Conclusion:Combined TI-RADS and conventional TI-RADS have similar diagnostic value in thyroid microcarcinoma, while combined TI-RADS has higher diagnostic sensitivity and lower missed diagnosis rate.
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Objective · To explore the value of the 2013 version of the ultrasound breast imaging reporting and data system (BI-RADS) classification diagnostic criteria combined with ultrasound shear wave elastography (SWE) to identify benign and malignant breast lesions. Methods · A total of 175 solid breast masses in 155 women were examined with ultrasound, and were judged to be benign or malignant by BI-RADS classification criteria. Then all the masses were examined with shear wave elastography (SWE), to obtain shear wave quantitative parameters of benign and malignant breast lesions, the pathological results were used as the gold standard to construct the receiver operating characteristic (ROC) curve of the subjects, which were used to compare the diagnostic value of the two methods alone and in combination. Results · The area under curve (AUC) of the BI-RADS classification diagnostic criteria, the Emax value, and the combination of the two methods to differential diagnosis of benign and malignant breast nodules were 0913, 0.884 and 0.957, respectively. Through pairwise comparison, there was significant difference in AUC between the two methods alone and their combination (BI-RADS classification vs. combination: Z=2.883, P=0.002; SWE vs. combination: Z=4.081, P=0.000). Conclusion · The combination of BI-RADS classification and SWE technology can improve the diagnostic accuracy of breast lesions.
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Objective • To explore the value of the 2013 version of the ultrasound breast imaging reporting and data system (BI-RADS) classification diagnostic criteria combined with ultrasound shear wave elastography (SWE) to identify benign and malignant breast lesions. Methods • A total of 175 solid breast masses in 155 women were examined with ultrasound, and were judged to be benign or malignant by BI-RADS classification criteria. Then all the masses were examined with shear wave elastography (SWE), to obtain shear wave quantitative parameters of benign and malignant breast lesions, the pathological results were used as the gold standard to construct the receiver operating characteristic (ROC) curve of the subjects, which were used to compare the diagnostic value of the two methods alone and in combination. Results • The area under curve (AUC) of the BI-RADS classification diagnostic criteria, the Emax value, and the combination of the two methods to differential diagnosis of benign and malignant breast nodules were 0913, 0.884 and 0.957, respectively. Through pairwise comparison, there was significant difference in AUC between the two methods alone and their combination (BI-RADS classification vs. combination: Z=2.883, P=0.002; SWE vs. combination: Z=4.081, P=0.000). Conclusion • The combination of BI-RADS classification and SWE technology can improve the diagnostic accuracy of breast lesions.
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Sonographic elastography is a new technique for measurement of the tissue stiffness, and is currently under investigation for tissue characterization in several anatomic sites. In recent years, real-time Ultrasonography elastography (USE) modes have appeared on commercially available clinical ultrasound machines, stimulating an explosion of research into potential oncologic and non-oncologic clinical applications of USE. Preliminary evidence suggests that USE can differentiate benign and malignant conditions accurately in several different tissues. The principles underlying elastography are that tissue compression produces strain (displacement) within the tissue – which is lower in harder tissues than in softer tissues and that malignant tissues are generally harder than normal surrounding tissue. Therefore, elastography might yield clinical information useful in diagnosing cervical metastasis and improving prognosis in oral cancer .The purpose of this review is to highlight a promising new ultrasound technique, known as elastography, which measures the characteristics of tissue compliance.
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@#BACKGROUND: Chronic viral hepatitis is the most important public health problems and main cause of liver fibrosis. Progressive hepatic fibrosis will gradually lead to liver cirrhosis, hepato-cellular carcinoma and liver failure and deaths. Study of liver fibrosis is becomes an essential issue of prevention, prognosis and radical treatment plan. The evaluation of liver fibrosis using ultrasound based-electrographic shear wave elastography (SWE) with elastography point quantification (ElastPQ) is a modern non-invasive method. This study is aimed to evaluate diagnostic value of SWE with ElastPQ feature of liver fibrosis. MATERIAL: A total of 110 patients with chronic viral (B, C and D) infection and 50 healthy controls were involved. Quantitative evaluation of LS was performed by Philips iU 22 ultrasound system with ElastPQ using convex transducer C5-1. RESULTS: In HBV patients: no fibrosis F0 score 7, mean liver stiffness was 3.1±0.28 kPa, mild liver fibrosis F1 score 26, mean LS was 4.9±0.90 kPa, F2 score 4, mean LS was 8.0±0.56 kPa, F3 score 3, mean LS was 11.0±0.83 kPa, and F4 score or liver cirrhosis 2, mean LS was 17±4.3 kPa, respectively. In patients HCV; F0 score -5, mean LS was 3.2±0,08 kPa, F1-36, mean LS was 5.0±0.94 kPa, F2 score-10, mean LS was 8.1±0.90 kPa, F3-10, mean LS was 10.9±1.03kPa, and F4 score 5, mean LS 15.9±2.8kPa, respectively. In patients with HBV, HDV; F0 score-1, liver stiffness was 3.2kPa, F1-13, mean LS was 4.9±0.72 kPa, F2 score 2, mean LS was 8.0±0.56kPa, F3 score, LS was 10.8kPa, F4 score 1, LS was 20.1kPa, respectively. CONCLUSIONS: Shear wave elastography with elastography point quantification technique is a reliable that can to detect of the earlier fibrosis stage in chronic viral hepatitis patients. ElastPQ SWE method is an optimal to monitor liver tissue stiffness in patients with chronic liver diseases.
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Objective To explore the application value of real-time shear wave elastography (SWE) technique in diagnosing and staging of chronic viral hepatitis B and hepatic fibrosis and to establish Young's modulus reference range for diagnosing and staging of hepatic fibrosis.Methods Forty-eight patients with chronic hepatitis B and fifty-eight healthy adults were enrolled and their Young's modulus values of S5 and S6 segments of liver were measured.Histopathologic examination was performed on 48 patients with chronic hepatitis B.Comparative analysis was conducted between the pathological findings and Young's modulus values,by means of which Young's modulus reference range for diagnosis and staging of hepatic fibrosis was obtained.Results There was significant difference in Young's modulus values of S5 and S6 segments of liver between chronic hepatitis B group and the normal control group (P＜0.05).Young's modulus values of S5 and S6 segments of liver in chronic hepatitis B group were (11.7 ± 2.9) kPa and (12.1 ± 3.2) kPa respectively,which were significantly higher than those in the normal control group,(5.7 ± 1.1) kPa and (5.8 ± 1.3) kPa respectively.Significant differences of Young's modulus values were detected in every staging of hepatic fibrosis (P＜0.05).S5 segment of liver Young's modulus values in S0-S4 stages were (5.8 ± 2.2) kPa,(7.3 ± 1.9) kPa,(10.3 ± 2.8) kPa,(10.3 ± 2.8) kPa,and (25.3 ± 3.6) kPa,respectively.S6 segment of liver Young's modulus values in S0-S4 stages were (5.7 ± 2.3) kPa,(9.2±2.1) kPa,(10.5±2.1) kPa,(14.7±4.5) kPa,and (26.1 ±2.1) kPa,respectively.Young's modulus value of the liver rose with the increase of S stage.Conclusion SWE technique can establish the Young's modulus reference range for hepatic fibrosis stage.Besides,it features high sensitivity,specificity and accuracy.