Comparison of Methods for Generating Thrombotic Models after the Endothelial Injury / 昆明医科大学学报

Objective Endothelial injury plays a crucial role in forming deep vein thrombosis.This study aims to compare the effectiveness of various methods for creating rabbit femoral vein thrombotic models after the endothelial injuryso as to provide a solid experimental foundation for further research on the endothelial injury and deep vein thrombosis.Methods Forty-five rabbits were randomly divided into three groups(A,B,C),with 15 cases in each group and subjected to the endothelial injury using the methods of simple clamping,combined complete ligation,and combined incomplete ligation,respectively.The intravascular ultrasonic manifestations and local endothelial pathological changes were compared at 1,3,and 7 days after modeling.Results Significant differences in vascular diameter and Young's modulus values were observed after 7 days of modeling(P<0.05).In pairwise comparisons between the groups,the Young's modulus values in group C were significantly higher than those in groups A and B after 7 days of modeling(P<0.05).Pathological examination confirmed the presence of fibr-inoid thrombus in the blood vessels of group C on the seventh day of modeling.Conclusion Combining simple clam-ping and incomplete ligation can produce a relatively stable endothelial injury and thrombus formation.This method provides a robust experimental model for further investigation into deep vein thrombosis after the endothelial injury.

Application value of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of ACR TI-RADS 4 thyroid nodules / 中国现代医生

@#Objective To explore the application value of ultrasound microvascular imaging combined with shear wave elastography in differentiating thyroid ultrasound image reporting and data system(TI-RADS)4 benign and malignant thyroid nodules.Methods Totally 114 thyroid nodules diagnosed as ACR TI-RADS 4 in Hangzhou traditional Chinese medicine hospital from November 2021 to December 2022 were retrospectively selected.All nodules were examined by ultrasound microvascular imaging and shear wave elastography,and compared with the surgical pathological results to evaluate the diagnostic efficacy of microvascular imaging,shear wave elastography and the combination of the two.Results Among 114 cases of thyroid TI-RADS type 4 nodules,35 cases were benign nodules,79 cases were malignant nodules.The microvascular pattern of malignant nodules was mainly concentrated and interrupted sign and perforator sign.The Emax value of shear wave elastography was statistically significant in differentiating benign from malignant nodules,and the SWE Emax value of malignant nodules was greater than 41.6kPa(P<0.05).The sensitivity,specificity and accuracy of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of thyroid TI-RADS 4 nodules were 96.20%,65.72%and 86.84%,respectively,and the area under curve(AUC)was 0.810.The sensitivity and accuracy were higher than those of single diagnosis mode,and the difference was statistically significant(P<0.05).Conclusion Ultrasound microvascular imaging combined with shear wave elastography can improve the diagnostic efficiency of benign and malignant thyroid TI-RADS 4 nodules with high diagnostic sensitivity and accuracy,which is helpful for the noninvasive differential diagnosis of such nodules and avoids some unnecessary needle biopsy.

Value of contrast-enhanced ultrasound combined with shear wave elastography in the diagnosis of benign and malignant liver tumors： A Meta-analysis / 临床肝胆病杂志

ObjectiveTo investigate the value of contrast-enhanced ultrasound （CEUS） combined with shear wave elastography （SWE） in the diagnosis of liver tumors. MethodsThis study was conducted according to the PRISMA guideline， with a PROSPERO registration number of CRD42023491288. PubMed， Embase， the Cochrane Library， CNKI， VIP， and Wanfang Data were searched for articles on CEUS combined with SWE in the diagnosis of liver tumors published from January 2000 to October 2023， and a total of 12 articles were included， with 1 328 patients in total. The QUADAS-2 tool was used to assess the quality of the articles included. Stata 15.0 software was used to calculate pooled sensitivity， specificity， positive likelihood ratio， negative likelihood ratio， diagnostic odds ratio， and heterogeneity. The summary receiver operating characteristic （SROC） curve was plotted， and the area under the SROC curve （AUC） was calculated. ResultsThere were 1 457 lesions for the patients included， among whom there were 764 malignant lesions and 693 benign lesions， with a positive rate of 52.44% and a negative rate of 47.56%. Calculations obtained a pooled sensitivity of 0.94 （95% confidence interval ［CI］： 0.91‍ ‍—‍ ‍0.96）， a specificity of 0.92 （95%CI： 0.87‍ ‍—‍ ‍0.95）， a positive likelihood ratio of 12.00 （95%CI： 7.40‍ ‍—‍ ‍19.40）， a negative likelihood ratio of 0.06 （95%CI： 0.04‍ — ‍0.10）， and a diagnostic odds ratio of 191 （95%CI： 87‍ ‍—‍ ‍417）. The tests for heterogeneity showed Q=54.78， df=11.00， P<0.001， and I2=79.92% （95%CI： 69.18%‍ ‍—‍ ‍90.66%）， with an AUC of 0.98. ConclusionCEUS combined with SWE has a relatively high diagnostic value for benign and malignant liver tumors and thus holds promise for clinical application.

Progress in diagnosis and treatment of hepatic alveolar echinococcosis / 器官移植

Hepatic echinococcosis is a chronic parasitic disease, which is caused by the larvae of Echinococcus multilocularis. It has a high risk of disability and mortality, which is also known as "parasite cancer". In clinical practice, hepatic echinococcosis can be divided into hepatic alveolar echinococcosis and hepatic cystic echinococcosis. Hepatic echinococcosis is widely prevalent worldwide. It mainly occurs in the populations residing agricultural and pastoral areas in western China, posing significant threats to the quality of life of local residents. At present, surgery is the main treatment for hepatic echinococcosis in clinical settings. With rapid development of surgical diagnosis and treatment technology and deepening understanding of hepatic echinococcosis, diagnosis and treatment regimens have also been constantly improved. In this article, research progresses on the diagnosis and treatment of hepatic alveolar echinococcosis were reviewed, aiming to provide reference for clinicians, deliver early diagnosis and treatment, mitigate adverse effects of this disease upon patients and improve clinical prognosis.

Evaluation of the relationship between neck and shoulder pain and scalene muscles based on shear wave elastography / 中国组织工程研究

BACKGROUND:In clinical work,the stiffness of neck soft tissue in patients with neck and shoulder pain is mainly detected through palpation,which is highly subjective and lacks an objective basis.Real-time shear wave elastography is a quantitative elastic ultrasound technique that can objectively assess muscle elasticity and muscle status. OBJECTIVE:To apply real-time shear wave elastography to assess the stiffness of scalene muscles in patients with neck and shoulder pain and to observe the characteristics of muscle stiffness changes in the bilateral anterior,middle and posterior scalene muscles in patients with neck and shoulder pain. METHODS:From December 2021 to June 2022,36 healthy subjects(control group)and 36 patients with neck and shoulder pain(test group)were recruited at the Shenzhen Hospital of Guangzhou University of Chinese Medicine.Real-time shear wave elastography was applied to measure the mean values of elastic modulus and cross-sectional area of the anterior and middle and posterior scalene muscles bilaterally in the neutral and lateral flexion positions of the neck in both groups. RESULTS AND CONCLUSION:In the same position,there were no significant differences between the mean Values of elastic modulus of the left and right anterior scalene muscles as well as between the mean Values of elastic modulus of the left and right middle scalene muscles in each group(P>0.05);there were no significant differences between the cross-sectional area of the left and right anterior scalene muscles as well as the cross-sectional area of the left and right posteromedial scalene muscles in each group(P>0.05);and the elastic modulus and cross-sectional area of the posteromedial scalene muscles were significantly higher than those of the anterior scalene muscles in both groups(P<0.01,P<0.001).The mean Values of elastic modulus of the anterior and posteromedial scalene muscles were higher in the test group than in the control group in the neutral and lateral neck flexion positions(P<0.001),while the cross-sectional areas of the anterior and posteromedial scalene muscles were lower than those in the control group(P<0.01,P<0.001).To conclude,real-time shear wave elastography can be used to visually evaluate the differences in the mean Values of elastic modulus of the anterior and posteromedial scalene muscles in different states of the neck muscles in patients with neck and shoulder pain,whose bilateral scalene muscles are in a state of strain and stiffness.

The diagnostic value of nomogram model established on the basis of C-TIRADS combined with SWE and clinically independent risk factors in category IV thyroid nodules / 安徽医科大学学报

Objective @#To investigate the diagnostic efficacy of the nomogram model based on Chinese thyroid ima ging reporting and data system (C TIRADS) combined with shear wave elastography ( SWE) and clinically inde pendent risk factors for category IV thyroid nodules .@*Methods @#2D-ultrasound images and SWE images of 256 pa tients (269 nodules ) with category IV thyroid nodules were analyzed . The sensitivity , specificity , and accuracy of the diagnosis by C-TIRADS and SWE were calculated using pathological findings as the gold standard . Receiver op erating characteristic (ROC) curves were plotted , and the area under the curve (AUC) was obtained . Independent risk factors for thyroid nodules were screened by univariate and multifactorial logistic regression analyses , a risk model was developed and a nomogram model was plotted , and a calibration curve analysis was used to assess the accuracy of prediction . ROC of the nomogram model was plotted , and the diagnostic efficacy of C-TIRADS , SWE and nomogram model based on independent risk factors was compared according to the AUC in category IV thyroid nodules . @*Results @#The sensitivity , specificity , and accuracy of C-TIRADS for differentiating malignant and benign nodules was 0.921 , 0.724 and 0.844 respectively , the AUC was equal to 0.822 with a 95% confidence interval (95% CI) of 0.775 - 0.870 . The sensitivity , specificity and accuracy of SWE were 0.701 , 0.981 , 0.814 respec tively , and the AUC was 0.833 (95% CI: 0.795 - 0.872) . Multifactorial logistic regression analysis suggested that C-TIRADS classification , mean value of elasticity (E-mean ) age and aspect ratio were independent risk factors for identifying benign and malignant thyroid nodules . The sensitivity , specificity and accuracy of the nomogram model established based on the above four factors were 0.957 , 0.943 and 0.959 , the AUC was 0.963 (95% CI: 0.943 - 0.984) , which showed a diagnostic efficacy superior to that of C-TIRADS or SWE alone .@*Conclusion@#The nomogram model , constructed based on C-TIRADS , SWE and clinically independent risk factors , can improve the efficacy in diagnosing category IV thyroid nodules , with a better clinical application value .

Asociación de fibrosis hepática mediante elastografía por shear wave 2D y score APRI

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.

Diagnostic value of real-time shear wave elastography for liver fibrosis in patients with autoimmune hepatitis / 临床肝胆病杂志

Objective To explore the diagnostic value of Young's modulus obtained by real-time shear wave elastography (SWE) for liver fibrosis in autoimmune hepatitis (AIH) patients. Methods A total of 75 AIH patients in the First Affiliated Hospital of Zhengzhou University from January 2013 to April 2022 were retrospectively enrolled. Scheuer scoring system was used to evaluate degrees of liver fibrosis (S0-S4). By using pathological examination of liver tissues as the golden standard, the receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was used to evaluate the diagnostic value of SWE for the significant fibrosis (≥S2), advanced liver fibrosis (≥S3), and liver cirrhosis (S4), respectively. Independent sample t test was used for comparison of continuous data with normal distribution between the two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and Bonferroni method was used for further comparison between two groups. The Spearman correlation coefficient was used for correlation analysis. The logistic regression analysis was used to predict the impact factors in diagnosis accuracy. Results The Young's modulus measured by SWE was statistically significant different among various fibrosis groups ( H =35.186, P 0.05). The Young's modulus measurement was positively correlated with liver fibrosis ( r =0.675, P < 0.05). The AUCs of SWE in the diagnosis of≥S2, ≥S3, and S4 were 0.839, 0.820 and 0.898, respectively and the corresponding optimum cut-off values were 9.2, 10.9, and 14.4 kPa, respectively. The overall concordance rate of the liver Young' s modulus measurements vs . fibrosis stages was 57.33%. Moreover, the alkaline phosphatase level was an independent predictor for diagnostic accuracy of SWE for stage 0-1 fibrosis ( OR =1.009, 95% CI : 1.001-1.018, P =0.029). Conclusion The SWE possessed a diagnosis value for the significant fibrosis (≥S2), advanced liver fibrosis (≥S3) and liver cirrhosis (S4), although there was a low overall concordance rate in the liver Young's modulus measurements obtained using SWE vs. fibrosis stages.

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy / 亚洲男科学杂志(英文版)

The purpose of this study was to analyze the value of transrectal shear-wave elastography (SWE) in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy (RP). Preoperative clinicopathological variables, multiparametric magnetic resonance imaging (mp-MRI) manifestations, and the maximum elastic value of the prostate (Emax) on SWE were retrospectively collected. The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology, and parameters with statistical significance were selected. The diagnostic performance of various models, including preoperative clinicopathological variables (model 1), preoperative clinicopathological variables + mp-MRI (model 2), and preoperative clinicopathological variables + mp-MRI + SWE (model 3), was evaluated with area under the receiver operator characteristic curve (AUC) analysis. Emax was significantly higher in prostate cancer with extracapsular extension (ECE) or seminal vesicle invasion (SVI) with both P < 0.001. The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa, respectively. Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE (model 2 vs model 1, P = 0.031; model 3 vs model 1, P = 0.002; model 3 vs model 2, P = 0.018) and SVI (model 2 vs model 1, P = 0.147; model 3 vs model 1, P = 0.037; model 3 vs model 2, P = 0.134). SWE is valuable for identifying patients at high risk of adverse pathology.

Clinical efficacy analysis of "Tongluo" technique on gastrocnemius muscle hardness and muscle tone in children with spastic cerebral palsy using shear wave elastography / 国际生物医学工程杂志

Objective:To investigate the clinical effect of the "Tongluo" technique on gastrocnemius muscle hardness and muscle tone in children with spastic cerebral palsy (SCP) using shear wave elastography (SWE).Methods:Forty children with SCP who were treated at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2020 to June 2021 were selected as the observation group and received the "Tongluo" technique intervention. At the same time, 20 normal children were selected as the control group, without any intervention. Compare the various indicators of the two groups at baseline and after 1.5 and 3 months of treatment, including Young’s modulus value of the medial gastrocnemius muscle at rest, the modified Ashworth scale (MAS) score, and the clinical spasm index (CSI) score. The changes in muscle tone and spasticity of SCP children before and after treatment were compared, and the differences in the Young’s modulus between MAS and CSI levels in SCP children as well as the correlation between MAS, CSI, and Young’s modulus were analyzed.Results:The difference in Young’s modulus values of the control group at baseline, after 1.5 and 3 months of treatment was not statistically significant (all P > 0.05). At baseline, after 1.5 and 3 months of treatment, Young’s modulus value, MAS score, and total CSI score gradually decreased in the observation group, and the differences obtained from pairwise comparisons were statistically significant (all P < 0.01). At the same intervention stage, Young’s modulus value of the observation group was higher than that of the control group, with a statistically significant difference ( P < 0.01). The MAS score results showed that Young’s modulus of the observation group increased with the increase in muscle tone, and there was a positive correlation between Young’s modulus and muscle tone ( P < 0.01), and the difference in Young’s modulus corresponding to different muscle tones was statistically significant ( P < 0.05). The CSI score results showed that the Young’s modulus of the observation group increased with the increase in spasticity degree, and there was a positive correlation between the Young’s modulus and muscle tone ( P < 0.01), and the difference in Young’s modulus corresponding to different spasticity degrees was statistically significant ( P < 0.05). Conclusions:The muscle hardness of children with SCP is higher than that of normal children. The "Tongluo" technique can effectively improve muscle hardness, reduce muscle tone, and effectively improve muscle spasticity in children with SCP. The principle may be related to adjusting the internal structure of muscles to reduce muscle hardness. The results of this study can guide clinical rehabilitation and evaluation.

Prediction of Ki-67 expression level in mass breast cancers using multi-modal ultrasound features / 中华超声影像学杂志

Objective:To predict the Ki-67 expression grading in patients with mass breast cancer based on multimodal ultrasound features to aid clinical diagnosis and treatment.Methods:Ninety-three female patients (93 masses in total) with breast cancers confirmed by pathological examination were retrospectively included in the Second Affiliated Hospital of Harbin Medical University from September 2017 to September 2020. According to the immunohistochemical results, the patients were divided into Ki-67 high expression group (55 cases) and Ki-67 low expression group (38 cases). The qualitative and quantitative features from two-dimensional gray-scale ultrasound, color Doppler flow imaging (CDFI), shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) images of all breast masses were retrospectively analyzed, differential features were analyzed based on logistic regression algorithm. ROC curves and Kappa test were used for the evaluation of diagnosis.Results:The univariate analysis revealed statistically significant differences between the two groups for conventional ultrasound features (size, shape, margins), SWE features (stiff rim sign, Eratio), and CEUS features (perfusion defect, IMAX) (all P<0.05). In the multiple logistic regression analysis, the margins, stiff rim sign, and perfusion defect were the independent factors for predicting the Ki-67 expression (all P<0.05). The performance of the predictive model was 0.882 (95%confidence interval of 0.798-0.940, P<0.05) with the sensitivity of 0.818 and specificity of 0.790. Conclusions:A preliminary analysis of the relationship between multi-modal ultrasound features and Ki-67 expression grading in mass breast cancers was performed based on logistic regression algorithm to provide more imaging information for clinical treatment and prognosis assessment.

Application of ultrasound shear wave elastography in the prediction of clinically relevant post-operative pancreatic fistula after pancreatectomy: a prospective study / 中华超声影像学杂志

Objective:To quantitatively evaluate the stiffness of pancreatic parenchyma and lesions by virtual touch tissue imaging and quantification (VTIQ) technique, and to investigate the potential usefulness of ultrasound shear wave elastography (SWE) in the prediction of clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreatectomy.Methods:Patients who scheduled to receive pancreatectomy were prospectively enrolled in Zhongshan Hospital, Fudan University from March 2021 to December 2021. VTIQ assessment was applied to patients within one week before the scheduled surgery to make quantitative SWE evaluation of target tissue. The SWV values of body part pancreatic parenchyma and lesions were measured and recorded. The palpation stiffness of pancreas was qualitatively evaluated during the operation by the surgeon.CR-POPF was diagnosed according to 2016 International Study Group of Pancreatic Fistula (ISGPF) standard.Grade B/C pancreatic fistula was defined as CR-POPF positive. Recognized peri-operative risk factors of CR-POPF were analyzed. ROC curve analysis was used to evaluate the diagnostic efficacy of SWV value in predicting CR-POPF.Results:A total of 72 patients were finally enrolled in this study, including 47 (65.3%, 47/72) patients who received pancreaticoduodenectomy (PD) and 25 (34.7%, 25/72) patients who underwent distal pancreatectomy. CR-POPF occurred in 22 (30.6%, 22/72) patients after pancreatectomy. The SWV value of body part pancreatic parenchyma was significant lower in CR-POPF positive group than in CR-POPF negative group ( P<0.001). There was no significant difference in lesion SWV value between CR-POPF positive and negative groups ( P=0.664). Besides, the palpation stiffness was no difference between the two groups ( P=0.689). Taking SWV value of pancreatic parenchyma >1.16 m/s as a cut-off value for predicting CR-POPF, the area under the ROC curve (AUROC) was 0.816 with 0.760 of sensitivity, 0.634 of specificity, 67.5% of positive predictive value and 72.5% of negative predictive value, respectively. Conclusions:The VTIQ method may improve the objectivity and accuracy of CR-POPF prediction via pre-operative, non-invasive and quantitative evaluation of pancreatic stiffness, which has potential value in clinical applications.

Application of ultrasonic shear wave elastography to the assessment of skin lesion in patients with systemic sclerosis / 中华风湿病学杂志

Objective:To evaluate the value of shear wave elastography (SWE) in skin assessment of Systemic sclerosis (SSc).Methods:A total of 58 SSc patients admitted to Peking University Third Hospital from May 2021 to October 2022 and 41 healthy volunteers were included in the study. Skin shear wave elastography (SWE) was performed at 17 sites defined in modified Rodnan skin score (mRSS) measurement, and shear wave velocity values were recorded to evaluate skin hardness. SPSS 22.0 software was used to analyze the skin hardness of SSc patients and healthy controls, and the correlation between skin hardness of SSc patients and clinical data was analyzed. A logistic regression model was constructed to evaluate the diagnostic efficacy of skin hardness at different sites of SSc patients, and to further select the most practical measurement site.Results:The SWE value of SSc patients was significantly higher than that of healthy control group ( P<0.05). There was a positive correlation between SWE and mRSS in the measurement of bilateral fingers, bilateral dorsal hands, bilateral forearms, fore-chest, abdomen, bilateral thighs, and bilateral dorsal feet. Skin stiffness measured by SWE was significantly correlated with SSc disease activity score (EScSG-DAI), ( r=0.71, P<0.001), disease injury score (SCTC-DI), (P=0.55, P=0.005) and functional score (HAQ-DI), ( r=0.46, P=0.003). Reducing the number of measurement sites to 12 (bilateral fingers, bilateral hands, bilateral forearms, bilateral upper arms, forehead, fore-chest, bilateral dorsum of feet) performs as well as all 17 measurement sites simultaneously in assessing disease activity. Conclusion:SWE is a good evaluation tool to reflect the skin lesions of SSc, which is of great value for the diagnosis and evaluation of the disease. We can further standardize the measurement sites and select the most appropriate evaluation strategy, so as to achieve better clinical application.

Assessing muscle stiffness using shear wave elastography / 中华物理医学与康复杂志

Objective:To measure the change in Young′s modulus of the biceps brachii during passive stretching and to assess the potential of shear wave elastography (SWE) as an auxiliary quantitative technique for assessing muscle tone.Methods:Forty-nine stroke survivors and 30 healthy subjects were evaluated using the modified Ashworth scale (MAS). According to their MAS scores they were divided into a healthy group, a healthy elbow group, an MAS class-0 group, an MAS class-1 group, an MAS class-1 + group and an MAS class-2 group. During passive extension of the subjects′ elbows, shear wave elastography was used to image the biceps brachii. Six points of the elbow were selected to record the instantaneous Young′s modulus ( EX) and calculate its change during the movement (Δ E). Those data were correlated with the MAS scores and compared among the groups. Results:Persons with higher MAS scores tended to have a higher Young′s modulus of the biceps brachii, and the modulus was likely to increase more with increases in the angle of elbow extension. From half of the range of motion to full extension there were significant differences in EX and Δ E between MAS class-0 and class-1 groups, as well as between the class-0 and class-1 + groups. There were, however, no significant differences between MAS class-1 and MAS class-1 + . Conclusions:MAS scores can usefully predict biceps brachii stiffness during passive elbow flexion. Shear wave elastography can quantify that stiffness and also muscle tone.

Application of Shear Wave Elastography in the Kidneys of Children with Henoch - Schonlein Purpura / 医学研究杂志

Objective To explore the value of shear wave elastography(SWE)in the kidneys of children with Henoch-Schonlein purpura(HSP).Methods A total of 59 cases with HSP admitted to the Second Affiliated Hospital of Wenzhou Medical University from November 2021 to August 2022 were selected and divided into simple HSP group(29 cases)and Henoch-Schonlein purpura nephritis(HSPN)group(30 cases).50 normal children during the same period were included as control group.The Young′s modulus(YM)of right renal cortex and medulla were compared among the three groups.receiver operating characteristic curve(ROC curve)was plotted to evaluate the diagnostic efficiency of SWE for simple HSP.Correlation analysis and multiple linear regression analysis were performed for the YM value of right renal cortex and medulla of all children with HSP and related indexes.Results There was statistical significance in YM values of right renal cortex and medulla among the three groups(P<0.05).The YM value of right renal cortex of the simple HSP group was higher than that in the control group and HSPN group(P<0.05).The YM value of right renal medulla of the simple HSP group were higher than that in the control group(P<0.05).The YM value of right renal cortex was better than the YM value of right renal medulla in the diagnostic efficiency of simple HSP.The YM value of right renal cortex and medulla both had a linear regression relation-ship with the right renal volume.Conclusion The YM value of right renal cortex and medulla were higher than those of healthy children,with the progression of the disease the YM values decreasing.It may become a new technology for routine screening and follow-up moni-toring of renal involvement in children with HSP.

Value of shear wave elastography combined with contrast-enhanced ultrasound in diagnosing the invasiveness of papillary thyroid microcarcinoma / 中国医师进修杂志

Objective:To study the value of shear wave elastography (SWE) combined with contrast-enhanced ultrasound (CEUS) in diagnosing the invasiveness of papillary thyroid microcarcinoma (PTMC), and analyze its risk factors.Methods:This study included 200 patients with pathologically confirmed PTMC who underwent surgery in Fenyang Hospital from January 2019 and June 2021. All were diagnosed with SWE and CEUS before surgery. The value of the two methods in diagnosing the invasiveness of PTMC was explored. The patients′ data were collected to screen the risk factors for the invasiveness of PTMC.Results:It was pathologically confirmed that among the 200 patients with PTMC, there were 112 cases with malignant nodules, 88 cases with benign nodules, 75 cases with cervical lymph node metastasis (including 71 cases with capsular invasion) and 125 cases without lymph node metastasis. CEUS parameters of malignant nodules were significantly higher than those of benign nodules ( P<0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SWE combined with CEUS to diagnose capsular invasion were 94.66%, 85.60%, 89.00%, 79.77% and 96.39%, with high consistency with the pathological results ( Kappa>0.75). Multivariate Logistic regression analysis showed that multiple foci, irregular shape, breakthrough capsule and small calcification were independent risk factors for the invasiveness of PTMC (VIF<3). The ROC curve results showed that the AUC of SWE combined with CEUS to diagnose capsular invasion was 0.772, and the diagnostic sensitivity and specificity were 73.91% and 80.56%. Conclusions:SWE combined with CEUS can significantly improve the diagnostic accuracy for the invasiveness of PTMC.

The value of real-time shear wave elastography in evaluating the severity of liver fibrosis in hepatitis B / 中国热带医学

@#Abstract: Objective　To explore the value of real-time shear wave elastography in evaluating the severity of liver fibrosis in hepatitis B, and to analyze the factors that affecting its accuracy. Methods　A total of 196 chronic hepatitis B patients, who admitted to the Third Affiliated Hospital of Chengdu Medical College from February 2018 to October 2020, were selected for retrospective analysis. Demographic indicators such as gender, age, body mass index(BMI), and laboratory indicators such as fasting blood glucose, liver function, and blood lipid composition were collected. The patients were detected by real-time shear wave elastography. Taking the pathological test results as the gold standard, the diagnostic value of real-time shear wave elastography in the severity of liver fibrosis in chronic hepatitis B was analyzed, and the comprehensive effect of various factors on the diagnostic accuracy of real-time shear wave elastography was evaluated by Logistic regression analysis. Results　The differences in real-time shear wave elastography of patients with different severity of liver fibrosis in hepatitis B were statistically significant, and F0 grade <F1 grade <F2 grade <F3 grade <F4 grade (all P<0.05). ROC analysis showed that the cut-off values of real-time shear wave elastography for patients with liver fibrosis in hepatitis B ≥ F1, ≥ F2, ≥ F3 and F4 were 6.15 kPa, 7.03 kPa, 8.15 kPa and 10.09 kPa respectively; the area under the curve (AUC) was 0.759, 0.806, 0.900 and 0.930 respectively (P<0.05). Results of multivariate Logistic regression analysis based on univariate analysis showed that glutamic alanine transaminase (ALT), glutamic oxalacetic transaminase (AST), fatty liver and inflammation levels were independent factors affecting the accuracy of real-time shear wave elastography in evaluating the severity of liver fibrosis in hepatitis B (P<0.05). Conclusions　Real-time shear wave elastography technology can be used to evaluate the severity of liver fibrosis in hepatitis B, and its accuracy is mainly affected by ALT, AST, inflammation levels and fatty liver.

The diagnostic value of Chinese-thyroid imaging reporting and data system classification combined with shear wave elastography in thyroid microcarcinoma / 中国医师进修杂志

Objective:To investigate the diagnostic value of Chinese-thyroid imaging reporting and data system (C-TIRADS) combined with shear wave elastography (SWE) in thyroid microcarcinoma.Methods:The clinical data of 270 patients (367 nodules) who underwent thyroid ultrasound examination and confirmed by pathology from January 2019 to June 2021 in the Affiliated Hospital of Jining Medical University were analyzed retrospectively. All patients were assisted by SWE in preoperative ultrasound examination to measure the maximum elastic modulus (E max), the average elastic modulus (E mean) and the minimum elastic modulus (E min). The receiver operating characteristic (ROC) curve was drawn to get the optimal threshold of SWE according to the pathological results. The diagnostic value of C-TIRADS, SWE and their combined in different diameters thyroid micronodules was analyzed. Results:Among 367 thyroid nodules, 119 nodules were benign and 248 nodules were malignant. The area under the curve (AUC) of E max in diagnosing TMC was significantly larger than that of E mean and E min (0.883 vs. 0.822 and 0.706), and there was statistical difference ( P<0.05); the best cut-off value of E max was 29.5 kPa. The ROC curve analysis results showed that the AUC of C-TIRADS combined with SWE in diagnosis of TMC was significantly larger than that of C-TIRADS and SWE alone (0.884 vs. 0.800 and 0.853), and there was statistical difference ( P<0.05); the sensitivity, accuracy and negative predictive value of C-TIRADS combined with SWE in diagnosis of TMC were significantly higher than those of C-TIRADS alone (90.32% vs. 80.24%, 89.10% vs. 80.11% and 81.10% vs. 65.97%), and there were statistical differences ( P<0.05). Thyroid nodules were divided into ≤0.5 cm nodules (56 nodules) and 0.5 to 1.0 cm nodules (311 nodules) according to the maximum diameter, the sensitivity and accuracy of C-TIRADS combined with SWE in diagnosing TMC in 0.5 to 1.0 cm nodules were significantly higher than those in ≤0.5 cm nodules: 91.82% (202/220) vs. 78.57% (22/28) and 90.68% (282/311) vs. 80.36% (45/56), and there were statistical differences ( χ2 = 4.99 and 5.20, P<0.05), but there was no statistical difference in specificity between 2 groups ( P<0.05). Conclusions:C-TIRADS combined with SWE can further improve the diagnostic value of TMC, which is worth popularizing and applying in clinic.

Value of real-time shear wave elastography in assessing splenic congestion in patients with chronic right heart failure / 中国医师杂志

Objective:To investigate the value of real-time shear wave elastography (SWE) in the assessment of splenic congestion in patients with chronic right heart failure.Methods:Sixty patients with chronic right heart failure with cardiac function grade Ⅱ-Ⅳ of New York Heart Association (NYHA) treated in Lianyungang First People′s Hospital from March 2020 to February 2021 were collected as the study group, and 20 healthy subjects in the same period were selected as the control group. Routine echocardiography was performed on all subjects; spleen stiffness measurement (SSM) was detected by SWE, and blood biochemical indicators related to patients with right heart failure were detected and recorded. SSM and other related parameters between the two groups were analyzed; the SSM in patients of different cardiac function classifications and course of disease were compared; 60 patients were divided into low SSM group (SSM≤15.0 kPa), middle SSM group (15.0 kPa<SSM<21.3 kPa) and high SSM group (SSM≥21.3 kPa) according to the measured SSM (9.1-34.5 kPa). The differences in clinical indicators between the three groups were analyzed and compared, and the adverse events of the three groups were analyzed by the kaplan-Meier (KM) method. Receiver operating characteristic (ROC) curve was used to evaluate the value of SSM for predicting right atrial pressure (RAP)≥10 mmHg in patients with chronic right heart failure. Multiple linear regression was used to analyze the independent risk factors of increased SSM in patients with chronic right heart failure.Results:Compared with the control group [(10.23±1.95)kPa], the SSM of the study group [(22.09±6.99)kPa] was significantly higher, and the difference between the two groups was statistically significant ( P<0.05); the SSM in patients with cardiac function grade Ⅳ [(25.24±4.53)kPa] was higher than those of grade Ⅲ [(16.71±3.12)kPa] and grade Ⅱ [(11.89±2.10)kPa] (all P<0.001); the SSM in patients with course of disease≥1 year [(24.71±4.61)kPa] was higher than those with a course of <1 year [(14.95±4.00)kPa] ( P<0.001); Compared with the low SSM group and the middle SSM group, the estimated RAP, N-terminal pro B-type natriuretic peptide (NT pro-BNP) and right atrial volume index (RAVI) of the high SSM group were higher (all P<0.05), and the inferior vena cava collapsible index (IVC-CI) was lower ( P<0.05). KM survival analysis showed that the incidence of adverse events in high SSM group was significantly higher compared with the middle SSM group and lower SSM group ( P<0.001). SSM in patients with right heart failure was positively correlated with NT pro-BNP, estimated RAP, and RAVI (all P<0.05), negatively correlated with IVC-CI ( P<0.05); When SSM≥26.1 kPa, the area under ROC curve was of predicting RAP≥10 mmHg 0.863 (95% CI: 0.771-0.955), and the sensitivity and specificity were 76.5% and 81.4%. Multiple linear stepwise regression analysis showed that NT pro-BNP, estimated RAP and IVC-CI were independent risk factors of SSM in patients with chronic right heart failure. Conclusions:The increase of SSM can reflect the increase of RAP, the severity of right heart failure and heart failure. The detection of SSM by SWE technology can conveniently and effectively monitor and evaluate the degree of splenic congestion and injury.

Diagnostic value of ultrasound shear wave elastography and portal vein hemodynamic parameters in chronic hepatitis liver fibrosis / 中国综合临床

Objective:To explore the diagnostic value of ultrasound shear wave elastography and portal vein hemodynamic parameters for chronic hepatitis and liver fibrosis.Methods:The clinical data of 48 hospitalized patients with chronic hepatitis diagnosed in Fuyang Second People's Hospital from May 2019 to July 2020 were collected and analyzed retrospectively. The patients voluntarily received portal vein hemodynamics and ultrasonic shear wave elastography. According to Scheuer's method, 48 patients were classified into 5 stages of liver fibrosis, including 10 patients in S0 stage, 13 patients in S1 stage, 10 patients in S2 stage, 10 patients in S3 stage and 5 patients in S4 stage. The average velocity of portal vein, peak portal vein velocity (PVVmax), portal vein diameter (PVD), liver stiffness measurement (LSM) and Young's modulus of liver were compared. Pathological and liver biopsy was the gold standard to analyze the sensitivity and specificity of various detection methods. The normally distributed measurement data were expressed as xˉ± s, the comparison between multiple groups was performed by one-way ANOVA, and the pairwise comparison was performed by LSD-t test. Spearman method was used to analyze the correlation between liver function classification and various parameters. ROC curve was used to analyze the diagnostic value of ultrasonic shear wave elastography, portal vein hemodynamics and combined detection in predicting liver fibrosis in chronic hepatitis. Results:In the staging of liver fibrosis, the LSM of the patients in the S0 stage was (5.29±0.19) kPa, and the Young's modulus of the liver was (21.65±2.35) kPa; the LSM of the patients in the S1 stage was (6.38±1.25) kPa, and the Young's modulus of the liver ( 22.89±3.19) kPa, LSM (9.76±1.33) kPa and hepatic Young's modulus (23.77±3.52) kPa in S2 group, LSM (15.44±2.44) kPa, hepatic Young's modulus (25.14±2.29) in S3 group, LSM (18.08±1.22) kPa and hepatic Young's modulus (27.94±2.58) kPa in patients with S4 stage, the differences between groups were statistically significant (F values ??were 115.47, 4.84, P values?were <0.001, 0.003), and the difference was statistically significant (all P<0.05). The average flow velocity of patients in S0 stage was (20.56±4.21) cm/s, PVVmax (22.19±4.33) cm/s, the average flow velocity of S1 stage was (18.39±3.79) cm/s, PVVmax (20.69±3.12) cm/s, and the average of S2 stage Flow velocity (13.46±2.21) cm/s, PVVmax (16.65±2.54) cm/s, average flow velocity in S3 stage (10.56±2.85) cm/s, PVVmax (13.42±2.46) cm/s, average flow velocity in S4 stage (8.15±1.65) cm/s, PVVmax (11.89±2.89) cm/s, the difference between the groups was statistically significant (F values were 21.35, 16.96, all P<0.001), and the difference between the two groups was statistically significant (all P<0.05). Correlation analysis by Spearman method showed that liver function grades were negatively correlated with average flow velocity and PVVmax (r values ?were -0.75 and -0.88, respectively; all P<0.001), and were positively correlated with liver Young's modulus and LSM. (r values ??were 0.54 and 0.86, respectively; all P<0.001). According to the ROC curve analysis, the AUC predicted by ultrasonic shear wave elastography was 0.75, AUC predicted by portal vein hemodynamics predicts was 0.68, and AUC predicted by combined detection predicts was 0.94. Conclusion:The combination of portal vein hemodynamics and ultrasonic shear wave elastography has a certain diagnostic power for the assessment of chronic hepatitis and liver fibrosis, with high specificity and sensitivity.