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Objectives: To investigate whether shear wave elastography (SWE) can accurately identify interstitial fibrosis and tubular atrophy (IFTA) in chronic renal allograft injury (CRAI) and whether it can differentiate between different grades of IFTA. Materials and Methods: Prospective observational study on renal transplant recipients who presented with CRAI. Patient selection was done on the basis of clinical presentation, serum creatinine, and eGFR levels. Biopsy and SWE were performed and SWE values were correlated with histopathological findings according to Banff schema. Receiver operating characteristic (ROC) was also analyzed to assess the diagnostic efficacy of SWE. Results: Sxity‐one patients were evaluated. Ten patients had no IFTA, 33 patients had mild IFTA, 16 patients had moderate IFTA, and 2 patients had severe IFTA. Mean parenchymal stiffness values in no IFTA, mild IFTA, moderate IFTA and severe IFTA were 39.86 ± 2.17 kPa (3.64 ± 0.09 m/s), 41.59 ± 3.36 kPa (3.71 ± 0.15 m/s), 47.59 ± 3.34 kPa (3.98 ± 0.14 m/s), and 53.83 ± 1.41 kPa (4.25 ± 0.03 m/s), respectively. SWE values of parenchymal stiffness reached statistical significance to differentiate between mild, moderate, and severe IFTA. ROC analysis revealed cut‐off values of 45.09 kPa (3.89 m/s) to differentiate between mild IFTA and moderate IFTA, 52.06 kPa (4.18 m/s) to differentiate between moderate IFTA and severe IFTA with acceptable sensitivity and specificity. Conclusion: SWE is a non‐invasive and cost‐effective imaging tool to evaluate the disease status of renal allografts affected by CRAI. Thus, it can be of paramount importance if added to the regular follow‐up imaging protocol of renal allograft along with grayscale and Doppler imaging. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate normal supraspinatus (SS) muscle elasticity using shear wave elastography (SWE) in an asymptomatic group, analyze its correlation with demographic factors and ultrasound (US) grayscale grade, and compare the elasticity between normal SS muscles and symptomatic SS muscles with tendon tears. Methods: A prospective study was conducted with 101 adult patients with normal SS muscle scheduled for surgery due to a contralateral shoulder with SS tendon tear. Both shoulders underwent US examinations, including SWE. The SWE values, including mean and median elasticity, as well as the elasticity ratio, were analyzed for their correlation with demographic characteristics and grayscale grades. A comparison of SWE values was performed between the normal and symptomatic SS muscle groups. Results: The mean SWE modulus of the normal SS muscle was 27.87 kPa (±49.04), with an elasticity ratio of approximately 1.52 (±0.03). Males exhibited slightly higher elasticity ratios compared with females (1.61 vs 1.45, P =.016). The interobserver agreement for all SWE measurements was excellent (>0.8). Grayscale grade increased with age, showing a similar pattern in females (P <.001). However, no significant correlation was observed between SWE values and grayscale grade in the normal SS muscle group. SWE values in normal SS muscles were significantly lower than those with tendon tears (P <.001). Conclusions: SWE provides objective measurements of normal SS muscle elasticity. Gender‐based variations were observed, with males exhibiting slightly higher elastography ratios. SWE values were significantly lower in asymptomatic SS muscles compared with those with tendon tears. [ABSTRACT FROM AUTHOR]

Objective: To describe the morphologic sonographic appearances and frequency of the "halo sign" in the setting of fat necrosis on shear wave elastography (SWE). Methods: Patients with clinically suspected fat necrosis were prospectively scanned using SWE in addition to standard gray‐scale and Doppler images. Cases were qualitatively grouped into one of three sonographic appearances: focal hypoechoic lesion with increased internal tissue stiffness ("focal stiffness"), focal hypoechoic lesion with isoechoic or hyperechoic periphery demonstrating increased tissue stiffness relative to the central hypoechoic lesion ("halo stiffness"), heterogeneously echogenic lesion with diffusely increased stiffness ("heterogeneous stiffness"). Results: Exactly 19 patients met inclusion criteria (female n = 14; male n = 5). Shear wave velocities were recorded and retrospectively evaluated. The mean clinical follow‐up was 11.4 months (range 3.0–25.5). Lesions demonstrated higher average tissue stiffness than background tissue (overall mass shear wave velocity 3.26 m/s, background 1.42 m/s, P <.001; lesion Young's modulus 40.85 kPa vs background 7.22 kPa, P <.001). The halo sign was identified in 10/19 (55%) patients. Conclusion: The halo sign is a potentially useful sign in the setting of fat necrosis seen in the majority of clinically suspected cases. [ABSTRACT FROM AUTHOR]

Objectives: Although magnetically induced hyperthermia has shown great efficiency in the treatment of solid tumors, it is still a challenge to avoid incomplete ablation or overtreatment. In this study, we applied magnetomotive ultrasound shear wave elastography (MMUS‐SWE) as a tool for real‐time image guidance and feedback in the magnetic hyperthermia (MH) process. We called this new method as magneto‐acoustic theranostic approach (MATA). Methods: In MATA, a ferromagnetic particle (fMP) was simultaneously used as a thermoseed for MH and a shear wave source for MMUS‐SWE. The fMP was excited by a high‐frequency magnetic field to induce the heating effect for MH. Meanwhile, the fMP was stimulated by a pulsed magnetic field to generate shear wave propagation for MMUS‐SWE. Thus, the changes in elastic modulus surrounding fMP can be used to estimate the therapy effect of MH. Results: The phantom and in vitro experiments were conducted to verify the feasibility of MATA, which has good performance in magnetothermal conversion and treatment efficacy feedback. The shear wave speed of the isolated pork liver changed significantly after the MH process, which varied from about 1.36 to 4.85 m/s. Conclusions: Preliminary results proved that changes in elastic modulus could be useful to estimate the therapy effect of MH. We expect that MATA, which is the integration of MMUS‐SWE and MH, will be a novel theranostic method for clinical translation. [ABSTRACT FROM AUTHOR]

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes that can result in severe lower limb pain and amputation. Early detection and treatment of DPN are vital, but this condition is often missed due to a lack of symptoms and the insensitivity of testing methods. This article reviews various ultrasound imaging modalities in the direct and indirect evaluation of peripheral neuropathy. Moreover, how ultrasound‐related therapeutic strategies are playing a role in clinical treatment is discussed. Finally, the application of innovative methodologies in the diagnosis of DPN, including ultrasound attenuation, photoacoustic imaging, and artificial intelligence, is described. [ABSTRACT FROM AUTHOR]

Objectives: This study examines the associations between the median nerve (MN) shear wave elastography (SWE), the MN cross‐sectional area (CSA), patient's symptoms, and the neurophysiological severity of carpal tunnel syndrome (CTS). The most appropriate site to perform SWE was also tested. Methods: This prospective study comprised 86 wrists of 47 consecutive patients who volunteered for MN ultrasound after an electrodiagnostic study. The neurophysiological severity of CTS was assessed according to the results of a nerve conduction study (NCS). The MN CSA was measured at the carpal tunnel inlet (wCSA) and the forearm (fCSA). SWE was performed on the MN in a longitudinal orientation at the wrist crease (wSWE), at the forearm (fSWE), and within the carpal tunnel (tSWE). Results: The wCSA and wSWE correlated positively with the neurophysiological severity of CTS (r =.619, P <.001; r =.582, P <.001, respectively). The optimal cut‐off values to discriminate the groups with normal NCS and with findings indicating CTS were 10.5 mm2 for the wCSA and 4.12 m/s for the wSWE. With these cut‐off values, wCSA had a sensitivity of 80% and specificity of 87% and wSWE a sensitivity of 88% and specificity of 76%. Neither tSWE nor fSWE correlated with the neurophysiological severity of CTS or differed between NCS negative and positive groups (P =.429, P =.736, respectively). Conclusion: Shear wave velocity in the MN at the carpal tunnel inlet increases in CTS and correlates to the neurophysiological CTS severity equivalently to CSA measured at the same site. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objective: Improve the characterization of mechanical properties of blood clots. Parameters derived from shear wave (SW) velocity and SW amplitude spectra were determined for gel phantoms and in vitro blood clots. Methods: Homogeneous phantoms and phantoms with gel or blood clot inclusions of different diameters and mechanical properties were analyzed. SW amplitude spectra were used to observe resonant peaks. Parameters derived from those resonant peaks were related to mimicked blood clot properties. Three regions of interest were tested to analyze where resonances occurred the most. For blood experiments, 20 samples from different pigs were analyzed over time during a 110‐minute coagulation period using the Young modulus, SW frequency dispersion, and SW attenuation. Results: The mechanical resonance was manifested by an increase in the number of SW spectral peaks as the inclusion diameter was reduced (P <.001). In blood clot inclusions, the Young modulus increased over time during coagulation (P <.001). Descriptive spectral parameters (frequency peak, bandwidth, and distance between resonant peaks) were linearly correlated with clot elasticity values (P <.001) with R2 =.77 for the frequency peak,.60 for the bandwidth, and.48 for the distance between peaks. The SW dispersion and SW attenuation reflecting the viscous behavior of blood clots decreased over time (P <.001), mainly in the early stage of coagulation (first minutes). Conclusion: The confined soft inclusion configuration favored SW mechanical resonances potentially challenging the computation of spectral‐based parameters, such as the SW attenuation. The impact of resonances can be reduced by properly selecting the region of interest for data analysis. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to explore the application value of two‐dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of diastasis recti abdominis (DRA) during different gestational periods. Methods: A cohort of 202 gravidas that were examined in our hospital between June 2021 and September 2022 were selected for the purpose of the study, which included 26 cases with <14 weeks of pregnancy, 36 cases in the 14th–27th week of pregnancy, 36 cases in the 28th–34th week of pregnancy, 32 cases in the 35th–38th week of pregnancy, 45 cases at 42 days postpartum, and 27 cases at 3 months postpartum. The inter‐rectus distance (IRD) and the thickness in each gestational period were measured, and Young's modulus of the rectus abdominis at different gestational periods was measured using SWE by two sonographers. The differences in IRD, thickness, and elasticity characteristics during different periods, and the correlation between rectus abdominis elasticity and IRD, thickness, body mass index (BMI), neonatal weight, and delivery mode were analyzed and compared. The consistency of SWE parameters obtained by different sonographers was also compared. Results: There were significant differences in IRD, thickness, and Young's modulus during different gestational periods (P =.000, P <.001, P <.001). Early postpartum IRD and Young's modulus did not restore to the level of early pregnancy (P <.001, P <.001), while the thickness of rectus abdominis was not significantly different from that of early pregnancy (P =.211). The Young's modulus of rectus abdominis was negatively correlated with the IRD (r =.515), positively correlated with the thickness of rectus abdominis (r =.408), and weakly negatively correlated with maternal BMI (r = −.296). There was no significant correlation with neonatal weight or delivery mode (P =.147,.648). The Bland–Altman plot showed that the two sonographers had good consistency in evaluating the elasticity of rectus abdominis by SWE. Conclusion: The multidimensional evaluation of DRA by ultrasound is feasible and IRD and Young's modulus can be used to evaluate the postpartum recovery of DRA. The combination of the two can objectively reflect the severity of DRA morphology and function. [ABSTRACT FROM AUTHOR]

Objectives: The present study aims to explore the role of shear wave elastography (SWE) in the diagnosis of Peyronie disease (PD). Methods: A total of 59 PD patients and 59 age‐matched healthy adult men were included in this study. The B‐mode ultrasound (US) and SWE were performed for all subjects, and the Young modulus (YM) values of the corresponding regions of the penis in the PD and control groups were recorded and compared. Results: The mean age of the included PD patients and age‐matched controls was 53.81 years (SD 9.52, range 32–73). On B‐mode US evaluation, 41 (69.5%) of 59 included PD patients were found to have penile plaques, and the remaining 18 (30.5%) patients had no evidence of penile plaque. After evaluation using SWE, the YM values in the penile plaque region of these 41 patients with penile dysplasia were found to be significantly higher (60.29 kPa ± 19.95) than those outside the plaque (in the same patient) (21.05 kPa ± 4.58) and in the same penile region of the control group (20.59 kPa ± 4.65) (P <.001). In the remaining 18 PD patients, the results showed that the YM value of the abnormal penile region in the PD patients (56.67 kPa ± 13.52) was significantly higher than the YM value outside the abnormal penile region in the same patients (22.79 kPa ± 4.31) and in the same penile region in the control group (19.87 kPa ± 3.48) (P <.001; P <.001). Conclusions: In conclusion, this study showed that SWE as a non‐invasive technique is useful in identifying and differentiating penile plaques in PD patients and is a simple, rapid and complementary method to B‐mode US. [ABSTRACT FROM AUTHOR]

Objectives: Shear wave elastography (SWE) is increasingly used in breast cancer diagnostics. However, large, prospective, multicenter data evaluating the reliability of SWE is missing. We evaluated the intra‐ and interobserver reliability of SWE in patients with breast lesions categorized as BIRADS 3 or 4. Methods: We used data of 1288 women at 12 institutions in 7 countries with breast lesions categorized as BIRADS 3 to 4 who underwent conventional B‐mode ultrasound and SWE. 1243 (96.5%) women had three repetitive conventional B‐mode ultrasounds as well as SWE measurements performed by a board‐certified senior physician. 375 of 1288 (29.1%) women received an additional ultrasound examination with B‐mode and SWE by a second physician. Intraclass correlation coefficients (ICC) were calculated to examine intra‐ and interobserver reliability. Results: ICC for intraobserver reliability showed an excellent correlation with ICC >0.9, while interobserver reliability was moderate with ICC of 0.7. There were no clinically significant differences in intraobserver reliability when SWE was performed in lesions categorized as BI‐RADS 3 or 4 as well as in histopathologically benign or malignant lesions. Conclusion: Reliability of additional SWE was evaluated on a study cohort consisting of 1288 breast lesions categorized as BI‐RADS 3 and 4. SWE shows an excellent intraobserver reliability and a moderate interobserver reliability in the evaluation of solid breast masses. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the application value of shear wave elastography in healthy adults with knee meniscus. Methods: One hundred adult subjects who underwent health checkups at our hospital from December 2022 to February 2023 were selected as research participants. Shear wave elastography was used to evaluate the periphery of the lateral and medial meniscus in both knees. To assess the mean differences in Young's modulus values between male and female groups, a one‐way analysis of variance (ANOVA) and independent samples t‐test were conducted. In addition, a Pearson correlation coefficient test was used to analyze the correlation between the elastic values of the meniscus and age, height, weight, and body mass index (BMI). Results: There were no significant differences in elastic values between the lateral meniscus of the left and right sides or between the medial meniscus of the left and right sides within the same gender group (P >.05). Stiffness values of the medial meniscus were higher in each gender group than those of the lateral meniscus (P <.01). Additionally, males demonstrated higher stiffness values than females (P <.01). As age increased, the Young's modulus of the meniscus increased significantly (r >.75, P <.01). Conclusion: Shear wave elastography can serve as an adjunctive tool to aid in the assessment of knee meniscal elasticity. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). Material and Methods: Sixty‐seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non‐mass lesion were included. They were evaluated by B‐mode US, SMI, and SWE before US‐guided core‐needle biopsy. B‐mode US, SMI (vascular index (SMIvi)), and SWE (E‐mean, E‐ratio) findings were compared with histopathologic features. Results: Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P =.015), distortion (P =.028), cystic component (P <.001), E‐mean (P <.001), E‐ratio (P <.001), and SMIvi (P =.006). For differentiation of invasiveness E‐mean (P =.002), E‐ratio (P =.002), and SMIvi (P =.030) were statistically significant. According to ROC analysis E‐mean (cut‐off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E‐mean, and E‐ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut‐off point at 3.4) and the most specific (72%) method was E‐mean (cut‐off point at 91.5 kPa). Conclusion: Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US‐guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy. [ABSTRACT FROM AUTHOR]

Objectives: How the material properties of the human supraspinatus tendon change following arthroscopic rotator cuff repair is undetermined. Shear wave elastography ultrasound is a relatively new, noninvasive measure of tissue stiffness. We aimed to evaluate any temporal changes in stiffness and/or thickness of supraspinatus tendons in humans following primary arthroscopic rotator cuff repair. Methods: Shear wave elastography was performed at three predetermined regions by a single sonographer at 1‐, 6‐, 12‐, 24‐, and 52 weeks postoperatively in 50 consecutive single‐row inverted mattress primary arthroscopic rotator cuff repairs. One‐way ANOVA with Tukey's correction and Spearman's correlation tests was performed. Results: Of 50 patients, two retore by 1‐week and were excluded. Two patients retore at 6 weeks, two at 12 weeks, and one at 24 weeks. The mean tendon stiffness in 48 patients at the tendon footprint increased by 21% (1.32 m/s) at 6 months (P <.001), with the lateral tendon stiffening before the medial tendon. Tendon thickness decreased by 11% (0.6 mm) at 6 weeks (P =.008), then stabilized to 24 weeks. Tendons that were less elastographically stiff at 1 week were more likely to be thinner at 6‐weeks (r =.38, P =.010). Conclusions: The data supports the hypothesis that rotator cuff tendons repaired using the single‐row inverted‐mattress technique take 6 weeks to heal to bone. Unlike in other tendons, there was no hypertrophic healing response. Prior to 6 weeks, the tendon may stretch/thin‐out, particularly if its material properties, as assessed by shear wave elastography, are inferior. The material properties of the tendon improved at the tendon insertion site first, then medially out to 12 months post‐repair. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated whether lesion‐to‐fat ratio measured by shear wave elastography in patients with Breast Imaging Reporting and Data System (BI‐RADS) 3 or 4 lesions has the potential to further refine the assessment of B‐mode ultrasound alone in breast cancer diagnostics. Methods: This was a secondary analysis of an international diagnostic multicenter trial (NCT02638935). Data from 1288 women with breast lesions categorized as BI‐RADS 3 and 4a–c by conventional B‐mode ultrasound were analyzed, whereby the focus was placed on differentiating lesions categorized as BI‐RADS 3 and BI‐RADS 4a. All women underwent shear wave elastography and histopathologic evaluation functioning as reference standard. Reduction of benign biopsies as well as the number of missed malignancies after reclassification using lesion‐to‐fat ratio measured by shear wave elastography were evaluated. Results: Breast cancer was diagnosed in 368 (28.6%) of 1288 lesions. The assessment with conventional B‐mode ultrasound resulted in 53.8% (495 of 1288) pathologically benign lesions categorized as BI‐RADS 4 and therefore false positives as well as in 1.39% (6 of 431) undetected malignancies categorized as BI‐RADS 3. Additional lesion‐to‐fat ratio in BI‐RADS 4a lesions with a cutoff value of 1.85 resulted in 30.11% biopsies of benign lesions which correspond to a reduction of 44.04% of false positives. Conclusions: Adding lesion‐to‐fat ratio measured by shear wave elastography to conventional B‐mode ultrasound in BI‐RADS 4a breast lesions could help reduce the number of benign biopsies by 44.04%. At the same time, however, 1.98% of malignancies were missed, which would still be in line with American College of Radiology BI‐RADS 3 definition of <2% of undetected malignancies. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we used the recently developed ultrasound elastography techniques sound touch elastography (STE) and sound touch quantification (STQ) to quantify portal hypertension (PHT) severity in a rat model of carbon tetrachloride (CCl4)‐induced cirrhotic PHT. Methods: In total, 60 rats were used. Various degrees of PHT were established. Liver and spleen stiffness were measured by STE (L‐STE and S‐STE, respectively) and STQ (L‐STQ and S‐STQ, respectively). We measured portal pressure (PP) after ultrasonographic examination. The performance of the STE and STQ parameters in the identification of PHT was evaluated using receiver operating characteristic (ROC) analyses. Results: Liver and spleen stiffness measurements obtained with STE and STQ correlated positively with the PP (r = 0.566–0.882, all P <.001). The areas under ROC curves for L‐STE, S‐STE, L‐STQ, and S‐STQ values were 0.931 (95% confidence interval [CI], 0.847–1.000), 0.982 (95% CI, 0.956–1.000), 0.796 (95% CI, 0.680–0.912), and 0.925 (95% CI, 0.858–0.993), respectively, for PP ≥5 mmHg; 0.937 (95% CI, 0.865–1.000), 0.938 (95% CI, 0.864–1.000), 0.967 (95% CI, 0.923–1.000), and 0.960 (95% CI, 0.897–1.000), respectively, for PP ≥10 mmHg; and 0.954 (95% CI, 0.897–1.000), 0.790 (95% CI, 0.652–0.928), 0.808 (95% CI, 0.680–0.935), and 0.740 (95% CI, 0.595–0.885), respectively, for PP ≥12 mmHg. Conclusions: STE and STQ are reliable noninvasive tools for the assessment of PHT severity, especially for PP ≥10 mmHg, in a rat model of CCl4‐induced cirrhotic PHT. [ABSTRACT FROM AUTHOR]

Objective: We herein compared the diagnostic accuracy of the BI‐RADS, ABVS, SWE, and combined techniques for the classification of breast lesions. Methods: Breast lesions were appraised using the BI‐RADS classification system as well as the combinations of BI‐RADS plus ABVS (BI‐RADS + ABVS) and BI‐RADS plus SWE (BI‐RADS + SWE), and both methods (BI‐RADS + ABVS + SWE) by two specialties Medical Ultrasound physician. The Fisher's exact and χ2 tests were performed to compare the degree of malignancy for the various methods with a pathology ground truth. Receiver operating characteristic curves (ROC) were generated and the corresponding area under the curve (AUC) values were determined to test the diagnostic efficacy of the various methods and identify the optimal SWE cut‐off indicative of malignancy. Results: The incidence of the retraction phenomenon on ABVS images of the malignant group was significantly higher (P <.001) than that of the benign group. The specificity, sensitivity, and positive and negative predictive values of the BI‐RADS classification were 88.72, 79.38, 83.70, and 85.50%, respectively. BI‐RADS plus SWE‐Max exhibited enhanced specificity, sensitivity, and positive and negative predictive values of 88.72, 92.78, 85.70, and 94.40%, respectively. Similarly, when BI‐RADS + ABVS was utilized, the sensitivity and negative predictive value increased to 95.88 and 96.40%, respectively. BI‐RADS + ABVS + SWE possessed the highest overall sensitivity (96.91%), specificity (94.74%), and positive (93.10%) and negative (97.70%) predictive values from all four indices. Conclusion: ABVS and SWE can reduce the subjectivity of BI‐RADS. As a result, BI‐RADS + ABVS + SWE resulted in the best diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate the value of shear wave elastography (SWE) in determining tumor extent of basal cell carcinomas (BCC), and thereby determine the optimal surgical margins (OSM). Methods: 10 patients (40 surgical margins) with BCC were collected, the visual observation boundaries (VOB) were marked, and the SWE parameters of soft tissues were measured 1 mm intervals in "3, 6, 9, 12" clock directions, starting from VOB. Then tumors were resected with a 5 mm surgical margin outward expansion of VOB. All specimens were examined pathologically 1 mm intervals from VOB in four clock directions. With the positive margins furthest from the tumor as the real tumor boundaries (RTB) and the negative margins closest to the tumor as the optimal surgical margins (OSM). The SWE parameters were compared between these two groups. Results: The elasticity ratio (Eratio) of average young's modulus between region of interest and adjacent normal soft tissue had statistically significant differences between groups (P =.000), while other parameters show no difference. The Eratio of RTB and OSM were 1.22 ± 0.14 and 0.99 ± 0.07. The area under the ROC curve was.947. Taking 1.075 as the threshold of Eratio for the diagnosis of tumor extent, the sensitivity, specificity and accuracy were 87.5%, 90.0% and 90.0%. The surgical margins designed according to OSM were better than those designed according to VOB + 5 mm (P =.000). Conclusions: The Eratio of SWE is helpful in determining tumor extent of BCC. This is beneficial for surgical margin designing. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic parenchyma in patients with liver tumors before resection. Methods: A total of 174 patients with liver tumors were prospectively enrolled. SWE and SWD examinations were performed. Fibrosis stage and necroinflammatory activity were determined histopathologically according to the Scheuer standard. We compared the diagnostic accuracy of SWE and SWD. Results: Both SWE and SWD values of the liver were highly correlated with liver fibrosis stage (P <.05, respectively). Both SWE and SWD values of the liver were moderately correlated with necroinflammatory activity (P <.05, respectively). Both SWE and SWD values of the liver were not correlated with steatosis (P >.05, respectively). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (P <.001, respectively). The area under the receiver operating characteristic (ROC) curve of SWE value was 0.982, 0.977, 0.969, and 0.984 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWE values were 6.9, 7.9, 8.7, and 10.6 kPa for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The area under the ROC curve of SWD value was 0.967, 0.960, 0.925, and 0.954 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWD values were 11.2, 12.0, 13.2, and 16.0 m/s/kHz for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. Conclusions: SWE and SWD could be noninvasive and accurate for predicting the stage of liver fibrosis in patients with liver tumors before surgery. SWE was more accurate than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4). [ABSTRACT FROM AUTHOR]

Purpose: To investigate the feasibility of ultrasound elastography for assessing the symmetry in stiffness values and movements of both false vocal folds (FVFs). Methods: After Institutional Review Board's approval and written informed consent obtained, we measured ultrasound strain and shear wave velocity (SWV) of the bilateral FVF in vocal fold abduction and adduction in 30 participants using a linear array transducer (4–10 MHz). Twenty‐eight participants met inclusion criteria as healthy subjects for analysis. Mean strain of FVF produced by FVF movement from abduction to adduction was analyzed using 2D speckle‐tracking software offline. A SWV ratio ([SWVadduction – SWabduction]/SWabduction) was developed to test the contractibility of FVF. Statistical analysis included one‐way ANOVA to test the difference in mean strain, SWV (adduction and abduction), and SWV ratio among the three age groups; linear regression to analyze correlations of stiffness and movement between the right and left FVF; and intraclass correlation coefficient (ICC) to examine intra‐ and interobserver reliability in performing shear wave elastography (SWE) of FVF. Results: The 28 healthy participants were divided into 3 age groups (10 of young 20–44 years; 9 of mid‐age 45–64 years; and 9 of senior ≥65 years). The SWV in FVF abduction was higher and the SWV ratio was lower in seniors compared to young participants (P <.05). Good to excellent correlation of mean strain and SWV between both FVFs (R2 > 0.89). The reliability of performing SWE of FVF was moderate to excellent. Conclusion: Ultrasound elastography is feasible to assess the stiffness, dynamic movement, and symmetry of adult FVF, and healthy seniors may exhibit increased FVF stiffness. [ABSTRACT FROM AUTHOR]

Objective: Shear wave elastography (SWE) allows assessment of muscle and tendon stiffness and can be used to diagnose soft tissue pathologies such as tendinopathies. In sports medicine, SWE may have the potential to uncover structural changes early on before they lead to functional impairment. To systematically analyze possible differences in tendon and muscle stiffness of the lower limb between professional (PG) and semiprofessional female athletes (SG) using SWE and to compile reference values for developing preventive medicine approaches for professional athletes. Methods: Standardized SWE of both lower limb tendons and muscles (Achilles tendon [AT], soleus muscle insertion [SM], patellar tendon [PT], quadriceps tendon [QT], vastus medialis muscle [VM]) in the longitudinal plane was performed with the tendons in relaxed position in 24 healthy professional female athletes (PG) in comparison with 24 healthy semiprofessional female athletes (SG). Results: Median tendon and muscle stiffness was significantly higher in professional athletes (AT:PG, 11.12 m/s vs SG, 7.33 m/s, P <.001; SM: 1.77 m/s vs 1.14 m/s, P <.001; VM: 1.63 m/s vs 0.87 m/s, P <.001; QT: 3.31 m/s vs 2.61 m/s, P <.05). There was no significant difference in patellar tendon stiffness between PG and SG (PT: 2.57 m/s vs 3.21, P =.25). Conclusion: Professional female athletes have higher stiffness values than semiprofessional female athletes in lower limb muscles and tendons, except for the patellar tendon. Knowledge of such differences is necessary for diagnosing tendinopathy and injuries. Musculoskeletal SWE could offer great benefits in sports medicine as well as in rehabilitation and preventive medicine. [ABSTRACT FROM AUTHOR]

Objectives: To study the shear wave elastography (SWE) of the coracohumeral ligament (CHL) in different stages of frozen shoulder and to analyze its correlation with the visual analogue scale (VAS) score and shoulder range of motion (ROM). Methods: Sixty‐four patients with frozen shoulder were divided into three stages: stage I (freezing phase), stage II (frozen phase), and stage III (thawing phase). The SWE of the CHL of the affected and healthy sides was measured and compared in the different stages. The VAS score and ROM of the affected side were evaluated, and their correlation with the SWE of the CHL was analyzed in the different stages. Results: In stage I frozen shoulder, the SWE of the CHL on the affected side was lower than that on the healthy side, while in stages II and III, the SWE on the affected side was higher (P =.001 for all). The SWE of the CHL of the affected side was different across the three stages; the SWE in stages II and III higher than that in stage I (P <.01), while the difference between stages II and III was not significant (P >.05). The SWE of the CHL of the affected side was negatively correlated with the VAS score but not with forward flexion (Ff), external rotation (Er) or internal rotation (Ir) in stage I; in stages II and III, it was positively correlated with the VAS score and negatively correlated with Ff, Er, and Ir. Conclusions: The CHL stiffness of the affected side and its correlation with the shoulder VAS score and ROM are different for different stages of frozen shoulder. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to explore, which muscle stiffness changes may be related to medial tibial stress syndrome (MTSS) and the correlation between the medial tibial periosteal thickness and lower leg muscle stiffness. Methods: This study included 63 subjects distributed into 3 groups: the symptomless group, the MTSS group, and the control group. The lower leg muscle stiffness of the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus (PL), soleus (SOL), lateral gastrocnemius (LG), medial gastrocnemius (MG), tibialis posterior (TP), and flexor digitorum longus (FDL) in the 3 groups was obtained by two‐dimensional shear wave elastography. Differences in the muscle stiffness and medial tibial periosteal thickness in the 3 groups were determined by one‐way analysis of variance (ANOVA) and least significant difference tests. The relationships between the periosteal thickness and the muscle stiffness were assessed using Pearson correlations. Results: The shear wave velocity (SWV) of all lower leg muscles except the EDL was higher in the symptomless and MTSS groups than in the control group (TA, P =.001; PL, P =.006; SOL, P <.001; LG, P <.001; MG, P <.001; TP, P <.001; FDL, P =.013; and ANOVA). A significant difference was found in the SWV of the SOL, TP, and FDL between the control and symptomless groups (P =.041, P <.001, and P =.013, respectively). Moreover, the medial tibial periosteum was thickened after running training, and its thickness was positively correlated with muscle stiffness. Conclusion: The medial tibia periosteal thickness is positively correlated with the lower leg muscles stiffness. Changes in SOL, TP, and FDL stiffness may be related to the occurrence of MTSS. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate the value of high‐frequency ultrasound and shear wave elastography (SWE) in quantitative differential diagnosis of high‐risk and low‐risk basal cell carcinomas (BCCs). Methods: A total of 52 BCCs confirmed by surgical pathology were studied. Taking pathologic subtypes as reference, all the cases were classified as high‐risk BCCs or low‐risk BCCs. High‐frequency ultrasound parameters and SWE parameters recorded preoperatively were retrospectively analyzed. The differences of two groups were compared. Results: There were 12 high‐risk BCCs and 40 low‐risk BCCs. The maximum infiltration depth (MID) and average Young's modulus (Eave) of high‐risk BCCs were 5.76 ± 2.56 mm and 31.61 ± 12.36 kPa, whereas of low‐risk BCCs were 4.29 ± 1.77 mm and 20.04 ± 4.74 kPa, respectively, P <.05. The area under the receiver operator characteristic curve of MID and Eave were 0.714 and 0.811, P >.05. Taking 5.5 mm of MID and 24.45 kPa of Eave as the threshold for the diagnosis of high‐risk BCCs, the sensitivity, specificity, and accuracy were 58.3%, 82.5%, 76.9% and 75.0%, 82.5%, 80.8%, P >.05. Conclusions: The MID and Eave of the lesion can be used to determine the recurrence risk of BCCs and provide a reference for the development of individualized treatment plans. [ABSTRACT FROM AUTHOR]

Objectives: Intersystem variability in liver stiffness (LS) quantification with ultrasound shear wave elastography (SWE) precludes direct comparison of results obtained with different equipment. The aim of this study was to investigate the agreement between point‐SWE and 2‐dimensional‐SWE with Esaote‐MyLab 9 (p‐QElaXto and 2D‐QElaXto, respectively) and 2D‐SWE with SuperSonic Imagine (SSI) in order to assess specific LS thresholds for fibrosis staging with QElaXto techniques, using SSI as a reference standard. Methods: A total of 235 compensated chronic liver disease (CLD) patients without comorbidities potentially affecting LS were enrolled in the study. Among them, 101 patients underwent also liver biopsy. Agreement between the equipment was assessed with Pearson coefficient and Bland–Altman analysis, while cut‐off values were calculated with receiver operating characteristics analysis. Results: Correlation between 2D‐QElaXto and p‐QElaXto with SSI resulted very good (r = 0.898 and r = 0.866), especially in precirrhotic stages, with a mean difference between LS values of −1.3 kPa for 2D‐QElaXto and −0.6 kPa for p‐QElaXto compared with SSI. Cut‐off thresholds for diagnosing fibrosis ≥F2, ≥F3, and F4 in non‐HBV‐related CLD were, respectively, 5.5, 8.0, and 10.6 kPa for 2D‐QElaXto and 6.1, 8.1, and 11.7 kPa for p‐QElaXto. All three SWE techniques were effective in differentiating significant fibrosis ≥F2 from mild or absent fibrosis in the subgroup of patients submitted to biopsy and showed good feasibility. Conclusions: Correlation between QElaXto techniques and SSI in LS measurements is very good. Our study identifies for the first time cut‐off thresholds for fibrosis staging in non‐HBV‐related CLD using two QElaXto techniques. [ABSTRACT FROM AUTHOR]

Objectives: Testicular complications after inguinal hernia (IH) operations can be overlooked because they are difficult to diagnose, but usually have a long‐term effect. This study evaluates the effects of IH on preoperative and postoperative testicular elasticity and vascularity in children with unilateral hernias, examined using the superb microvascular imaging (SMI) and shear wave elastography (SWE) modalities. Methods: Forty‐four male children with unilateral indirect IHs were included. Quantitative SMI and SWE examinations of the testicles were performed on the herniated and intact sides, both preoperatively and at 1, 3, and 6 months postoperatively. The SMI and SWE values of the testicles were compared between the herniated and intact sides, as well as with the opposite testicle. Results: Preoperative vascular index (VI) values were lower on the herniated side than on the intact side. Furthermore, preoperative kPa and m/s values were higher on the herniated side than on the intact side. In follow‐up examinations performed at 6 months postoperatively, there was no equalization of kPa or m/s values, although VI values were equalized on both sides. Conclusions: Testicular vascularization secondary to mechanical compression in testicles on the herniated side increased significantly in the postoperative period, and reached a level similar to that of the contralateral side. Mean SWE values decreased in testicles on the herniated side, but were not equal with those of contralateral testicles. Preoperative and postoperative evaluation of testicles using SMI and SWE is important for detecting possible advanced testicular complications in children with IH. [ABSTRACT FROM AUTHOR]

Objectives: Skeletal muscle dysfunction is one of the most common comorbidities in chronic obstructive pulmonary disease (COPD). The occurrence of respiratory failure in COPD is common and leads to the patient's death. The diaphragm is the most important muscle in the respiratory system and plays a key role in the onset of respiratory failure. This study explores the feasibility of ultrasound shear wave elastography (SWE) to measure diaphragmatic stiffness and evaluates its changes in COPD patients. Methods: In total, 77 participants (43 patients with stable COPD and 34 healthy controls) were enrolled. All subjects underwent complete diaphragmatic ultrasound SWE measurements and pulmonary function tests. The diaphragmatic stiffness was indicated via diaphragmatic shear wave velocity (SWV) at functional residual capacity (FRC). A trained operator performed the ultrasound SWE examinations of the first 15 healthy controls thrice to assess the reliability of diaphragmatic SWE. Results: A good to excellent reliability was found in diaphragmatic SWV at FRC (ICC = 0.93, 95%CI 0.82–0.98). As compared to the control group, the diaphragmatic SWV at FRC was considerably high in the COPD group (median 2.5 m/s versus 2.1 m/s, P =.008). Diaphragmatic SWV at FRC was linked to forced expiratory volume in one second (r = −0.30, P =.009), forced vital capacity (r = −0.33, P =.003), modified Medical Research Council score (r = 0.30, P =.001), and COPD assessment test score (r = 0.48, P <.001). Conclusions: Ultrasound SWE may be employed as an effective tool for quantitative evaluation of diaphragm stiffness and can help in personalized management of COPD, such as treatment guidance and follow‐up monitoring. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the stiffness of 2‐dimensional (2D) shear wave elastography (SWE) in preoperatively predicting the prognostic stage groups of invasive ductal carcinoma (IDC). Methods: Eighty‐six newly diagnosed lesions on 83 patients with IDCs were analyzed. All parameters from conventional ultrasound and stiffness to virtual touch tissue imaging and quantification were collected, and mean shear wave velocity (SWVmean) was calculated. Data on maximum diameter, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), histologic grading system and Tumor Node Metastasis (TNM) stages were collected. The levels of maximum shear wave velocity (SWVmax), minimum shear wave velocity (SWVmin) and SWVmean were compared. In receiver operating characteristic (ROC) curves analysis, the diagnostic efficacy was found in area under the curve (AUC). Parallel mode was used to improve the predictive value of sensitivity. Results: The median stiffness of SWVmax and SWVmean for IDCs were 9.38 and 6.32 m/s for late stage (stages II, III, IV) and 6.39 m/s and 4.72 m/s for early stage (stage I) of the prognostic stage groups, respectively. The median stiffness values in the late stage were significantly higher than those in the early stage (P =.003, P =.005). The optimal cutoff stiffness of SWVmax and SWVmean were 8.62 and 6.13 m/s, respectively. In ROC curves analysis, the AUC for SWVmax was 0.742, and it showed a better diagnostic value than SWVmean (0.725). In predictive diagnosis, the sensitivity for SWVmax and SWVmean were both 62.50%. The parallel mode improved the prediction power of sensitivity to 68.75%. Conclusions: Preoperative SWV level may serve as a promising prognostic imaging indicator for breast IDCs. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate shear wave elastography (SWE) technology diagnosis value of endometrial cancer (EC) and atypical endometrial hyperplasia (AEH), and to establish predictive logistic regression models for the diagnosis of EC and AEH. Methods: Clinical information collection, transvaginal conventional ultrasonography, and SWE check were performed on 122 patients, who were perimenopausal or postmenopausal vaginal bleeding with ≥4.5 mm thick endometrium. The maximal (Emax) and mean (Emean) of Young's modulus for the endometrium were obtained. Using pathology as the gold standard, ROC curves were plotted to evaluate Young's modulus on the diagnostic effectiveness of EC and AEH. Single‐factor analysis and bivariate logistic regression methods were applied to assess the clinical variables, transuaginal conventional ultrasonography variables, and Young's modulus on the identification of EC and AEH. Results: Out of 122 cases of endometrial lesions, 85 cases were benign lesions, and the remaining 37 cases were EC and AEH. The Emax and Emean for the benign group were 29.80 ± 11.40 and 17.96 ± 8.05 kPa, respectively. The Emax and Emean values for EC and AEH group were 59.49 ± 16.95 and 38.46 ± 17.10 kPa, respectively. Emax and Emean for both groups were statistically significant, with p <.001. In the logistical regression analysis, endometrial thickness, Color score, and Young's modulus were identified as independent risk factors for EC and AEH. Conclusions: SWE technology plays an important role in the diagnosis of EC and AEH, and the diagnostic effectiveness would be higher when combined with conventional ultrasonography. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: Successful antiviral treatment in patients with hepatitis C can lead to reduced liver stiffness. In this study, we attempted to compare 2‐dimensional (2D) shear wave elastography (SWE), shear wave dispersion (SWD), and attenuation imaging (ATI) with transient elastography (TE) and the controlled attenuation parameter (CAP) in patients under direct‐acting antiviral (DAA) therapy. Methods: Patients with chronic hepatitis C infection undergoing DAA therapy from January 2017 to June 2020 were retrospectively examined. The results of 2D SWE, SWD, ATI, TE, and CAP were recorded before and 12 weeks after the completion of DAA therapy. Results: A total of 122 patients with a median age of 61 years were investigated; among them, 121 (99.2%) achieved a sustained virologic response at 12 weeks after DAA therapy. Fibrosis 4, the aspartate aminotransferase–to–platelet ratio index, 2D SWE, and TE were reduced after DAA therapy. The CAP was increased; however, SWD and ATI showed no statistically significant changes after DAA therapy. Two‐dimensional SWE and TE were strongly correlated (r = 0.885–0.897; P <.001). Albumin and the baseline liver stiffness measurement were independent factors of liver stiffness measurement changes after DAA therapy. Conclusions: Direct‐acting antiviral therapy can significantly decrease liver stiffness (using both 2D SWE and TE) but not SWD and ATI values in patients with hepatitis C. An increased CAP is also observed after DAA therapy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate intraoperative contrast‐enhanced ultrasound (IoCEUS) and intraoperative shear wave elastography (IoSWE) for characterization of focal pancreatic lesions (FPLs) in correlation with postoperative histologic results. Thereby, the impact of intraoperative ultrasound (US) on pancreas surgery was evaluated. Methods: Intraoperative CEUS and SWE data from 54 patients, who underwent pancreas surgery between 2017 and 2019, were analyzed retrospectively. Ultrasound examinations were performed with multifrequency linear/T‐shaped transducers (3–9 MHz) on a high‐end US device (LOGIQ E9; GE Healthcare, Chicago, IL). To analyze FPL stiffness by SWE, regions of interest were placed to measure the shear wave speed (meters per second) and stiffness (kilopascals). After intravenous bolus injections of 2.4 to 10 mL of sulfur hexafluoride microbubbles, a dynamic analysis of FPL microvascularization from arterial to late phases was performed using IoCEUS considering hypoenhancement/irregular vascularization of macrocystic/small solid FPL malignancy criteria. Ultrasound findings were correlated with postoperative histologic results. The impact of intraoperative US on surgery was documented in each case. Results: Of 54 FPLs, IoCEUS could correctly characterize 39 of 39 malignant and 6 of 15 benign FPLs; IoSWE 29 of 39 as malignant and 7 of 15 as benign. Intraoperative CEUS's sensitivity was 100%; specificity, 40%; accuracy, 83.3%; positive predictive value, 81.3%; and negative predictive value, 100% (P <.05). Applying cutoff values of 3 m/s and 28.7 kPa, SWE's sensitivity was 74.4%; specificity, 46.7%; accuracy, 66.7%; positive predictive value; 78.4%; and negative predictive value, 41.2% for cancer detection (P <.05). The combined use of both techniques showed an accuracy rate of 76%, sensitivity of 74.4%, and specificity of 33.3%. In 29.6%, US results had an immediate impact on surgery. Conclusions: Intraoperative SWE and CEUS are highly valuable techniques for intraoperative characterization of FPLs. Although IoCEUS proved to be superior to IoSWE, the combined use can be helpful in particular cases. [ABSTRACT FROM AUTHOR]

Fibroadenoma is the most common benign tumor of the breast, and complex fibroadenoma (CFA) is one of its variants. Of the fibroadenomas, 22% are CFAs, and in women with CFAs, the malignancy development is found to be higher than in women with noncomplex fibroadenomas. Although there is an increased risk of malignancy with CFAs, the imaging findings of CFAs are fundamentally similar to those of other variants of fibroadenomas. In the literature, B‐mode ultrasound features of CFAs were reported in detail. To our knowledge, there is no study that has specifically described the elastographic findings of CFAs. This article aims to illustrate the elastographic features of CFAs and to correlate radiologic and histopathologic findings of different cases. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of our study was to evaluate the potential of cervical lymph node shear wave elastography (SWE) to quantify the lymph node stiffness (kilopascals) noninvasively among patients with lymph node–first presentation of Kawasaki disease (NFKD), patients with bacterial cervical lymphadenitis (BCL), and healthy children (HC). We further aimed to investigate the correlation of laboratory data and lymph node stiffness to provide a reference basis for the early diagnosis of NFKD. Methods: Lymph node stiffness measurements were prospectively performed in 47 patients with NFKD, 56 patients with BCL, and 56 HC using SWE. Cervical SWE was compared in the groups. Factors associated with increased cervical lymph node stiffness were studied. Results: The mean elasticity of the largest cervical lymph nodes was significantly higher in the BCL group than the NFKD and HC groups (mean elasticity ± SD, 16.37 ± 2.45, 12.22 ± 2.64, and 7.81 ± 1.67 kPa, respectively; P <.01), with a cutoff of 14.55 kPa (area under the curve, 0.885; sensitivity, 89%; and specificity, 76%). In patients with NFKD, interleukin 6 (standardized β = 0.363; P =.01), alanine aminotransferase (standardized β = 0.253; P =.03), aspartate aminotransaminase (standardized β = 0.536; P =.047), and total bilirubin (standardized β = 0.486; P <.01) values were correlated with increased largest cervical lymph node stiffness. Conclusions: Cervical lymph node stiffness was different between NFKD and BCL. Shear wave elastography is a potential method to identify clinically distinguishable early NFKD. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: To explore the feasibility of shear wave elastography (SWE) in the evaluation of arterial erectile dysfunction (ED). Methods: From November 2018 to November 2019, 26 patients with arterial ED and 30 patients with non‐vascular ED were prospectively included. SWE values of corpus cavernosum penis (CCP) and the flow velocity of cavernous artery for all patients in both before intracavernous injection (ICI) (flaccid state) and after ICI (erectile state) were measured. Performance of SWE value in assessing arterial ED was studied. Correlation between SWE value of CCP and the age of patients was also investigated. Results: ICI significantly reduced SWE values in both arterial and non‐vascular group (from 19.57 ± 6.33 KPa to 12.17 ± 3.64 KPa in the first, and from 19.91 ± 6.69 KPa to 8.04 ± 3.13 KPa in the former, both P <.001). SWE values of CCP after ICI in arterial ED were significantly larger than that in non‐vascular ED (P <.001). SWE values of CCP before ICI negatively correlated with age of patients in arterial ED (r = − 0.601, P <.001). With a cutoff value of 7.75 KPa, the area under curve, specificity, sensitivity, PPV, and NPV of SWE values of CCP after ICI in distinguishing arterial ED from non‐vascular ED were 0.810, 63.3%, 96.2%, 96.2%, and 70%, respectively. Conclusions: SWE was expected to be a potential technique for the noninvasive, simply operated, repeatable and quantitative evaluation of arterial ED. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the efficacy of 2‐dimensional (2D) shear wave elastography (SWE) in the diagnosis of acute cystitis (AC) in children. Methods: Between June 2019 and March 2020, 126 children with AC and 126 healthy participants were prospectively investigated by 2D SWE and B‐mode ultrasound. Elastographic measurements were performed by drawing the contours of the posterior wall of the bladder between the ureter orifices using a free region of interest. The quantitative 2D SWE values of the patients and the healthy group were compared. Results: The mean 2D SWE values of the bladder wall were significantly higher in patients with AC compared to the healthy group (P =.001). On B‐mode ultrasound imaging, the bladder wall thickness of patients with AC was higher than that in the healthy group (P =.001). On 2D SWE, when the cutoff value used was 9.25 kPa, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.1%, 88.1%, 89.3%, and 92.6%, respectively, whereas when the cutoff value used was 1.72 m/s, the sensitivity, specificity, positive predictive value, and negative predictive value were 90.5%, 88.9%, 89.1%, and 90.7%. There was a statistically significant positive correlation between the 2D SWE values and wall thickness measurements (P <.001). Conclusions: Two‐dimensional SWE is a noninvasive, fast, and effective imaging method to evaluate the bladder wall in children with AC. [ABSTRACT FROM AUTHOR]

In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic performance between strain elastography and shear wave elastography (SWE) for the diagnosis of carpal tunnel syndrome (CTS). Methods: Between July 2018 and June 2019, 66 consecutive patients with 95 imaged wrists underwent wrist ultrasound, including grayscale ultrasound, strain elastography, and SWE, because of the suspicion of CTS. During wrist ultrasound, the cross‐sectional area (CSA), strain ratio, elasticity, and shear wave velocity of each median nerve were measured at the proximal carpal bone level (scaphoid to pisiform). The variables were compared between the normal and CTS groups by using the independent t test, and subgroup analyses were performed using one‐way analysis of variance. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of each variable. Results: CSA, elasticity, and shear wave velocity showed significant intergroup differences (P < 0.001, P < 0.001, and P = 0.002, respectively). However, the strain ratio showed no statistically significant intergroup difference (P = 0.639). In the subgroup analyses, elasticity showed significantly higher values in the severe group than in the mild and moderate groups (P < 0.001 and P = 0.001, respectively). Other parameters showed no significant differences among the different subgroups. The areas under the ROC curve were 0.823 for CSA, 0.772 for elasticity, and 0.779 for shear wave velocity. The differences in the areas under the ROC curve among CSA, elasticity, and shear wave velocity were not statistically significant (all P > 0.05). Conclusions: SWE has a good diagnostic value in CTS. In particular, elasticity can discriminate the severe group from the other groups. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: The first aim was to evaluate the stiffness of thyroid parenchyma with shear wave elastography (SWE) in patients with Graves disease (GD) and compare the elastographic values with those of asymptomatic volunteers. The second aim was to evaluate whether there was a correlation between SWE values and grayscale ultrasound (US) and laboratory parameters. Methods: In this prospective study, the thyroid gland parenchyma of 50 patients whose clinical and laboratory findings were indicative for GD and 54 asymptomatic participants with normal laboratory values was examined by SWE. Grayscale US images of the thyroid and submandibular gland were recorded. The volume of the thyroid gland was measured. Elastographic measurements were performed with a free region of interest. The quantitative SWE values (meters per second and kilopascals) of the patient and control groups were compared. A correlation analysis between the SWE values and grayscale US and laboratory parameters was performed. Results: The median (range) SWE values of the thyroid gland in patients with GD were significantly higher than those of the control group [17.34 (12.58–56.15) versus 12.05 (7.72–23.67) kPa and 2.28 (1.83–4.12) versus 1.92 (1.55–2.61) m/s; P <.001 for both comparisons]. When 14.5 kPa or 2.115 m/s was designated as the cutoff value, GD could be diagnosed with a high sensitivity and specificity. We showed a negative weak correlation between the SWE values and parenchymal echogenicity in the GD group. Conclusions: Shear wave elastography can be used as an effective imaging method with high sensitivity and specificity rates in the diagnosis of GD. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective of this study was to assess the effect of fasting versus ingestion of food and water on hepatic measurements by shear wave elastography (SWE) in healthy participants. The secondary objective was to assess inter‐ and intra‐reader reliability of hepatic elastography in healthy participants. Methods: Twenty healthy participants were enrolled in this prospective study and underwent quantitative SWE under fasting conditions and after the ingestion of water and food and water. Two blinded sonographers each independently performed a total of 6 sessions of hepatic SWE in each participant. Sessions 1 to 3 were performed on day 0 and sessions 4 to 6 on day 7. Statistical tests used included the Wilcoxon signed ranks test, the intraclass correlation coefficient, and Bland–Altman plots. Results: There were no significant differences in hepatic SWE measurements after the ingestion of water versus the fasting state. Statistical significance was assessed as P < 0.05. The postprandial status had a statistically significant effect on hepatic SWE measurements at 1 hour (P =.04) but not at 3 hours (P =.08). By the intraclass correlation coefficient, there was poor‐to‐moderate inter‐reader agreement and minimal‐to‐moderate intra‐reader agreement. The median inter‐reader difference in SWE measurements ranged from 0.66 to 0.96 kPa. The median intra‐reader difference ranged from 0.43 to 0.55 kPa. Conclusions: Our study shows that the ingestion of water has no effect on hepatic SWE measurements in healthy participants. The postprandial state had a significant effect on SWE measurements at 1 hour after ingestion but not at 3 hours. The inter‐reader and intra‐reader agreements were variable and moderate at best. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the application value of shear wave elastography in the evaluation of tumor downstaging for locally advanced rectal cancer after neoadjuvant chemoradiotherapy. Methods: A retrospective analysis was conducted using data from patients with locally advanced rectal cancer treated in our hospital who received endorectal ultrasound (ERUS) and shear wave elastographic examinations before and after chemoradiotherapy. The cases were grouped according to the postoperative pathologic tumor‐staging scores. The lesions were divided into 2 groups: 1 showing and the other not showing tumor downstaging. The efficacy of ERUS in diagnosis of tumor downstaging was calculated. The differences in the mean and maximum values of the Young modulus of the lesions before and after chemoradiotherapy between the groups were calculated and compared. Receiver operating characteristic curves were constructed by using the differences in the 2 kinds of values of the Young modulus. Results: The mean and maximum values of the Young modulus before and after chemoradiotherapy were significantly different (P <.05). The differences in the mean and maximum values of the Young modulus of rectal lesions between groups were statistically significant (P <.05). The results of the receiver operating characteristic curve showed that a difference in the mean value at 34.7 kPa was the optimal diagnostic threshold. Compared with ERUS, this standard showed a significant difference in diagnosis of tumor downstaging (P <.05). Conclusions: Shear wave elastography is an effective ultrasound elastographic technique to assist ERUS in evaluating lesions after chemoradiotherapy in rectal cancer. It can improve the diagnostic efficacy of tumor downstaging and provide effective imaging conclusions for clinical decision making. [ABSTRACT FROM AUTHOR]

Objectives: The myotendinous junction (MTJ) represents a specialized anatomic region through which the contractile strength is transmitted from the muscle to the tendon. The integrity of this region is essential to permit force transmission and to optimize energy expenditure during walking, running, and globally for human movement. We evaluated the MTJ with shear wave elastography to assess its elasticity variation during a functional test. Methods: Forty professional soccer players were enrolled in the study. Shear wave elastography was performed at the level of the medial gastrocnemius MTJ both in a resting position and during a standing calf rise position to assess functional contraction. Results: All 40 participants were male, aged between 18 and 38 years (mean age, 25 years). The results of the elastographic study showed mean stiffness values ± SD of 4.19 ± 0.86 m/s for the right medial gastrocnemius and 4.20 ± 0.87 m/s for the left medial gastrocnemius with the muscle relaxed. During contraction, the stiffness values were 8.33 ± 0.5 m/s for the right medial gastrocnemius and 8.30 ± 0.48 m/s for the left medial gastrocnemius. Conclusions: Our study showed an increase of stiffness at the level of the MTJ during muscle contraction. This result is in line with the physiologic stiffening of the MTJ to resist the high level of force applied during muscle contraction. Shear wave elastography could be a useful method to assess the characteristics of the MTJ under both physiologic and pathologic conditions. [ABSTRACT FROM AUTHOR]

Ultrasound (US) can be used to evaluate the brain structure and nervous system damage. Patients with neurologic symptoms need rapid, noninvasive imaging with high spatial resolution and tissue contrast. Magnetic resonance imaging is currently the most sensitive and specific imaging method for evaluating neuropathologic conditions. This approach does present some challenges, such as the need to transport patients who may be seriously ill to the magnetic resonance imaging suite and the need for patients to remain for a considerable time. Cranial US provides a very valuable imaging method for clinicians, which can make a rapid diagnosis and evaluation without ionizing radiation. The main disadvantage of cranial US is its low sensitivity and specificity for subtle/early lesions. In recent years, with the rapid development of anatomic and functional US technology, the practicability of US diagnosis and intervention has been greatly improved. Ultrasound elastography may have the potential to improve the sensitivity and specificity of various cranial nerve conditions. Ultrasound elastography has received considerable critical attention, and an increasing number of studies have recognized its critical role in evaluating brain diseases. At present, US elastography has been applied to the evaluation of traumatic brain injury, ischemic stroke, intraoperative brain tumors, and hypoxic ischemic encephalopathy. The latest animal experiments and human clinical trial developments in the applications of US elastography for brain diseases are summarized in this review. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the correlation between fibrosis and elastic values in papillary thyroid carcinoma (PTC) by shear wave elastography and to evaluate the effect of platelet‐derived growth factor (PDGF) on the fibrosis process. Methods: Small interfering RNA (siRNA)‐PDGF and normal BCPAP cell lines were injected subcutaneously into the backs of nude mice. The elastic values of all tumors were measured by shear wave elastography. The content of collagen fibers and the expression of PDGF and type IV collagen (COL4) were evaluated by Masson staining and western blotting. Results: There were 32 tumors in the control group and 30 tumors in the siRNA‐PDGF group. The tumors were divided into 4 subgroups based on maximum diameters of the tumors. The mean elastic values ± SD (Emean, 29.79 ± 11.04 kPa; Emin, 16.98 ± 7.51 kPa, Emax, 39.99 ± 15.30 kPa; and SD, 5.92 ± 2.00 kPa) in the siRNA‐PDGF group were lower than in the control group (Emean, 35.73 ± 18.49 kPa; Emin, 23.65 ± 14.92 kPa, Emax, 45.73 ± 22.88 kPa; and SD, 6.02 ± 3.38 kPa). The content of collagen fibers and the expression of platelet‐derived growth factor B (PDGFB) and COL4 proteins in the siRNA‐PDGF group were lower than in the control group (11.43% ± 6.99% and 19.80% ± 11.70%; P =.010; 0.14 ± 0.06 and 0.27 ± 0.10; P =.002; and 0.11 ± 0.06 and 0.15 ± 0.07; P =.101). The elastic values, collagen fiber content, and PDGFB and COL4 in the 4 subgroups gradually increased with the maximum diameter of tumors. Conclusions: There was a positive correlation among PDGF, tumor stiffness, and fibrosis in the growth of PTC. Thus, PDGF might play an important role in the development of PTC. [ABSTRACT FROM AUTHOR]

Objectives: The primary purpose of this study was to determine whether elasticity quantification of the levator ani muscle (LAM) using shear wave elastography (SWE) is different between women with and without pelvic organ prolapse (POP) and to determine whether LAM elasticity is associated with the prolapse stage or the dimensions of the levator hiatus. The secondary aim was to evaluate the intraobserver and interobserver reliability of LAM elasticity measurements using SWE. Methods: The study participants included 20 women with normal pelvic support and 38 women with prolapse (stages I–III). The levator hiatus was imaged by transperineal 3‐dimensional ultrasound, and LAM elasticity and the elastic modulus were measured by SWE at rest and while performing the Valsalva maneuver. Results: The elastic modulus increased significantly from rest to during to maximal Valsalva maneuver (29.2 versus 54.1 kPa; P <.05) in all women. Levator ani muscle elasticity was significantly higher under prolapse conditions than under normal conditions at rest (27.9 versus 31 kPa; P <.001) but was lower during the maximal Valsalva maneuver than under normal conditions (57.3 versus 53.1 kPa; P <.05). Levator ani muscle elasticity at rest was associated with the hiatus area during the Valsalva maneuver (Spearman r = 0.608; P <.001) and distensibility of the levator hiatus (r = 0.594; P <.001), and the hiatus area decreased as the LAM elastic modulus increased during the maximal Valsalva maneuver (r = –0.414; P <.05). Moreover, LAM elasticity was associated with the severity of prolapse (P <.001). Conclusions: As a noninvasive quantitative method, SWE, may be used to assess the biomechanical properties of the pelvic floor muscle, providing some research basis for a thorough understanding of POP and its treatment and prevention. [ABSTRACT FROM AUTHOR]

Objectives: There are conflicting results in the literature on the use of shear wave elastography of the kidney parenchyma to determine whether renal stiffness values are related to a disease process. This study was conducted to evaluate the raw data from 3 ultrasound systems and determine whether adequate displacement curves are obtained to accurately estimate shear wave speeds. Methods: Shear wave elastography was performed on 5 healthy volunteers with 3 ultrasound systems. The raw data were collected and evaluated for the shear wave propagation quality to determine whether accurate estimates of renal shear wave speeds could be determined. Results: Results from the 3 machines demonstrate that accurate shear wave displacement curves are not obtained with renal elastography on existing systems (as of June 2018). One vendor has recently released software that appears to acquire accurate shear wave displacements. Conclusions: Elastographic studies performed on the kidney to date are likely to be inaccurate. A new algorithm that appears to acquire accurate shear wave displacements in the kidney has been developed. Additional studies are needed to confirm that the new algorithm provides accurate clinical results. This study demonstrates that although the system provides a shear wave speed, it is important to confirm the accuracy of that number by evaluating the raw data. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the diagnostic performance of two‐dimensional (2D) shear wave elastography (SWE) in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS). Methods: Fifty‐three patients with pSS and 30 healthy volunteers were included. The echogenicity of all submandibular and parotid glands was evaluated with B‐mode ultrasound, and their elasticity was assessed with 2D SWE. The mean and standard deviation of the shear wave speed and elasticity modes on 2D SWE were calculated. Results: The mean shear wave speed and elasticity mode values for the submandibular and parotid glands were significantly higher in the patients with pSS (P <.05). The mean elasticity of the shear wave speed mode was best able to differentiate the parotid glands of patients with pSS from those of healthy volunteers at a cutoff value of 2.48 m/s, whereas the mean elasticity of the elasticity mode was best able to differentiate the submandibular glands of patients with pSS from those of healthy volunteers at a cutoff value of 21 kPa. Conclusions: Two‐dimensional SWE is an effective technique for assessment of the parenchyma of the salivary glands in patients with pSS and predicts interstitial fibrosis and the severity of histologic damage. [ABSTRACT FROM AUTHOR]

Objectives: Arterial stiffness has been proposed as a marker of arteriovenous fistula failure and can be measured locally by using ultrasound shear wave elastography (SWE). This preliminary study aimed to assess whether SWE measurements of the brachial artery were associated with arteriovenous fistula failure. Methods: Data were collected on patients who were indicated for fistula creation. Preoperative and postoperative vessel diameters from B‐mode ultrasound, brachial artery SWE maps, and demographic data were collected. Logistic and linear regression analyses were used to determine whether any of these variables were related to the outcome of the fistula 3 months after creation. Results: Data were acquired for 33 patients. Shear wave velocity values decreased after fistula creation (mean ± SD, –1.2 ± 1 m/s; P <.05). No parameters were associated with failure of the fistula in the logistic regression analysis. Conclusions: No markers were related to fistula failure, but a decrease in the shear wave velocity was observed in the brachial arteries after fistula creation, indicating increased compliance. [ABSTRACT FROM AUTHOR]

Objectives: To compare the feasibility and clinical applicability of ElastQ imaging (Philips Healthcare, Best, the Netherlands) with that of SuperSonic shear imaging (SSI; SuperSonic Imagine, Aix‐en‐Provence, France) using an elastographic phantom and a pilot study of patients. Methods: Two‐dimensional shear wave elastography measurement was performed by ElastQ imaging and SSI by 2 radiologists. An elastographic phantom with 5 target elasticities at 2 acquisition depths was used. The coefficients of variation and intraclass correlation coefficients (ICCs) were evaluated for repeatability and interobserver agreement, respectively. The mean elasticities of the systems at each target were compared. The proportions of measurements that were out of the range of expected values and measurement errors were calculated to determine accuracy. Liver stiffness (LS) was measured by both systems in 27 children and young adult patients with various liver diseases. Results: Both systems provided high repeatability in elasticity measurements of phantom targets (coefficients of variation, 0.69%–15.82%), and there was excellent interobserver agreement (ICC, 0.992). Most (90%) mean elasticities of targets were significantly different between the techniques (P ≤.002) and acquisition depths (P ≤.004). ElastQ imaging had significantly lower proportions of out‐of‐range measurements and measurement errors (P ≤.003) than SSI. In patients with liver disease, LS measurements of the systems were strongly correlated (ρ = 0.955; P <.001) and had excellent agreement (ICC, 0.951; P <.001). Conclusions: ElastQ imaging had comparably good results in terms of repeatability, interobserver agreement, and accuracy in the phantom model compared with SSI. The pilot patient study showed strong correlations in LS values between the systems. [ABSTRACT FROM AUTHOR]

Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively steep learning curve, and variability in methods between vendors. This article describes our protocol for performing breast elastography using both strain elastography and shear wave elastography, which produces high sensitivity and specificity. Additionally, we will describe the most commonly known false‐positive and false‐negative lesions as well as how to detect them. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the feasibility of ultrasound shear wave elastography (SWE) in assessing iliocostalis lumborum muscle changes after osteopathic manipulative treatment (OMT). Methods: Using a linear array ultrasound transducer (4–9 MHz), we prospectively measured the shear wave velocity (SWV) of bilateral iliocostalis lumborum muscles in 20 patients with low back somatic dysfunction and in 9 age‐matched healthy volunteers. The SWV was measured in muscle relaxation and contraction in all participants and immediately before and after OMT in patients. We developed a muscle SWV rate [SWVcontraction – SWVrelaxation)/SWVrelaxation] and an SWV improvement index [(SWVpre‐OMT – SWVpost‐OMT)/SWVpre‐OMT] for quantifying muscle contractibility and changes in muscle stiffness after OMT. Statistical analyses included an unpaired t test to analyze the difference in the muscle SWV between muscle relaxation and contraction and between somatic dysfunction and nonsomatic dysfunction in patients and healthy volunteers, a paired t test to examine the difference in the SWV and SWV rate before and after OMT, the intraclass correlation coefficient to test intraobserver and interobserver reliability, and Spearman rank correlation to analyze the correlation of changes in the SWV with manual osteopathic assessments. Results: The mean ages of the patients with low back somatic dysfunction and the healthy volunteers were 28 and 26 years, respectively. The muscle SWV significantly differed between somatic dysfunction and nonsomatic dysfunction in patients and healthy volunteers, between muscle relaxation and contraction, and before and after OMT (P <.001). The SWV improvement index moderately correlated with manual osteopathic assessments (r = 0.68). The interobserver and intraobserver reliability for performing SWE was good (intraclass correlation coefficient, >0.8). Conclusions: Our results suggest that SWE is feasible for quantifying the change in muscle stiffness and contractibility after OMT. [ABSTRACT FROM AUTHOR]