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Elastography is a non-invasive imaging modality that has been developed for the evaluation of the stiffness of various organs. It is categorized into two main types: strain elastography and shear wave elastography. While strain elastography offers valuable information on the mechanical properties of the organ being studied, it is limited by the qualitative nature of its measurements and its reliance on operator skills. On the other hand, shear wave elastography overcomes these limitations as it provides a quantitative assessment of tissue stiffness, offers more reproducibility, and is less operator-dependent. Endoscopic ultrasound-guided shear wave elastography (EUS-SWE) is an emerging technique that overcomes the limitations of transabdominal ultrasound in the evaluation of the pancreas. A growing body of literature has demonstrated its safety and feasibility in the evaluation of pancreatic parenchyma. This article provides a comprehensive review of the current state of the literature on EUS-SWE, including its technical aspects, clinical applications in the evaluation of various pancreatic conditions, technological limitations, and future directions. [ABSTRACT FROM AUTHOR]

Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). Methods: Sixty-five patients who underwent RSA over a 12-month follow-up period were included. Patient characteristics and clinical and radiologic measurements were recorded. Preoperatively and at 3, 6, 9, and 12 months after surgery, deltoid muscle stiffness and muscle strength for scapular-plane abduction were sequentially measured using SWE and a portable dynamometer. In each quarterly period (3–6, 6–9, and 9–12 months), patients were assessed for an improvement in muscle strength and separated into two groups: improved and non-improved. To assess the risk of lack of improvement in each quarterly period, the variables were compared between the groups. Results: Improvement in muscle strength was observed in 52 patients (80%) at 3–6 months, 46 patients (71%) at 6–9 months, and 39 patients (60%) at 9–12 months. Notably, SWE measurements at the beginning of each period showed significantly greater values in the non-improved group than in the improved group during the subsequent quarterly period. A receiver operating characteristic (ROC) curve analysis suggested that SWE values >45.1–50.0 kPa might be associated with a lack of muscle strength improvement over 3 months with 73–87% specificity and 73–85% sensitivity. Conclusions: Our study demonstrated that increased deltoid muscle stiffness negatively correlated with an improvement in muscle strength following RSA. According to our results, a postoperative assessment with SWE may be useful for not only improving muscle strength after RSA but also facilitating postoperative improvement by preventing excessive stiffness in the deltoid muscle. [ABSTRACT FROM AUTHOR]

Background: Ultrasound shear wave elastography (SWE) noninvasively measures the stiffness of tissue by producing and measuring tissue deformation. Scar formation, a crucial aspect of wound healing, can lead to functional and aesthetic complications when pathological. While SWE has shown promise in dermatological evaluations, its role in surgical scar assessment remains underestimated. Our study aims to investigate SWE in evaluating surgical scars at the donor site after forearm free flap surgery in transgender patients. Methods: After radial forearm free flap harvesting, the donor site was grafted with a split-thickness skin graft with or without interposition of Matriderm. Eleven patients were evaluated more than one year after surgery, using SWE alongside scar characteristics, sensory outcomes, and patient satisfaction surveys. Results: Our study revealed no significant difference in stiffness (p > 0.15), pigmentation (p = 0.32), or erythema (p = 0.06) between operated and non-operated sides. The interposition of Matriderm did not influence the stiffness. Patients significantly (p < 0.0001) reported a loss of discrimination. Patients' subjective scar evaluation appeared in line with our quantitative and objective results. Conclusions: This study contributes to the evolving understanding of SWE's role in scar assessment, highlighting its feasibility in evaluating surgical scars. However, continued research efforts are necessary to establish SWE as a reliable and objective method for surgical scar evaluation and management. [ABSTRACT FROM AUTHOR]

Background/Objectives: The utility of shear wave elastography (SWE) as an adjunct to ultrasound biometry and Doppler velocimetry for the examination of placental dysfunction and suboptimal fetal growth is unclear. To date, limited data exist correlating the mechanical properties of placentae with fetal growth. This study aimed to investigate the relationship between placental shear wave velocity (SWV) and ultrasound estimated fetal weight (EFW), and to ascertain if placental SWV is a suitable proxy measure of placental function in the surveillance of small-for-gestational-age (SGA) pregnancies. Methods: This prospective, observational cohort study compared the difference in placental SWV between SGA and appropriate-for-gestational-age (AGA) pregnancies. There were 221 women with singleton pregnancies in the study cohort—136 (61.5%) AGA and 85 (38.5%) SGA. Fetal biometry, Doppler velocimetry, the deepest vertical pocket of amniotic fluid, and mean SWV were measured at 2–4-weekly intervals from recruitment to birth. Results: There was no difference in mean placental SWV in SGA pregnancies compared to AGA pregnancies, nor was there any relationship to EFW. Conclusions: Although other studies have shown some correlation between increased placental stiffness and SGA pregnancies, our investigation did not support this. The mechanical properties of placental tissue in SGA pregnancies do not result in placental SWVs that are apparently different from those of AGA controls. As this study did not differentiate between constitutionally or pathologically small fetuses, further studies in growth-restricted cohorts would be of benefit. [ABSTRACT FROM AUTHOR]

Plantar fasciopathy is a very common musculoskeletal complaint that leads to reduced physical activity and undermines the quality of life of patients. It is associated with changes in plantar fascia structure and biomechanics which are most often observed between the tissue's middle portion and the calcaneal insertion. Sonographic measurements of thickness and shear wave (SW) elastography are useful tools for detecting such changes and guide clinical decision making. However, their accuracy can be compromised by variability in the tissue's loading history. This study investigates the effect of loading history on plantar fascia measurements to conclude whether mitigation measures are needed for more accurate diagnosis. The plantar fasciae of 29 healthy participants were imaged at baseline and after different clinically relevant loading scenarios. The average (±standard deviation) SW velocity was 6.5 m/s (±1.5 m/s) and it significantly increased with loading. Indicatively, five minutes walking increased SW velocity by 14% (95% CI: −1.192, −0.298, t(27), p = 0.005). Thickness between the calcaneal insertion and the middle of the plantar fascia did not change with the tissues' loading history. These findings suggest that preconditioning protocols are crucial for accurate SW elastography assessments of plantar fasciae and have wider implications for the diagnosis and management of plantar fasciopathy. [ABSTRACT FROM AUTHOR]

Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to clarify the relationship between fluctuations in uterine stiffness during the third stage of labor and blood loss upon placenta delivery using shear wave elastography. Methods: This prospective cohort study enrolled consecutive singleton pregnant women above 37 weeks of gestation who delivered infants transvaginally at a single perinatal center. Shear wave velocities (SWV) were continuously measured during the third stage of transvaginal labor using transabdominal ultrasound and these values were compared between groups with large (≥500 g) and small amounts of bleeding during this stage. Results: In total, 8 cases of large bleeding and 47 cases of small bleeding were compared. The large amount of bleeding group had a significantly lower median of minimum SWV values (0.97 [0.52–1.01] m/s than the small amount of bleeding group (1.25 [1.04–1.48] m/s p = 0.02). However, no significant differences were observed between the two groups in terms of median, mean, and maximum SWV values. The time from delivery of the infant to placental delivery was significantly longer in the large amount of bleeding group (median time: 370.5 s vs. 274 s, p < 0.05). Conclusion: Ultrasound quantification of uterine stiffness using shear wave elastography demonstrated that uterine contractions may influence the biological hemostasis of the uterus during the third stage of labor. Baseline uterine stiffness was weak and a longer duration of placental separation might be associated with cases of large amounts of bleeding during this stage. [ABSTRACT FROM AUTHOR]

Ultrasound shear wave elastography (SWE) is a non-invasive, low risk technology allowing the assessment of tissue stiffness. Used clinically for nearly two decades to diagnose and stage liver fibrosis and cirrhosis, it has recently been appreciated for its ability to differentiate between more subtle forms of liver dysfunction. In this review, we will discuss the principle of ultrasound shear wave elastography, its traditional utilization in grading liver cirrhosis, as well as its evolving role in identifying more subtle degrees of liver injury. Finally, we will show how this capacity to distinguish nuanced changes may provide an opportunity for its use in perioperative risk stratification. [ABSTRACT FROM AUTHOR]

We aimed to verify the feasibility of using shear wave elastography (SWE) to quantify knee scars and the elastic modulus of scar tissues. Overall, 16 participants underwent SWE assessments and range-of-motion measurement and completed the Knee Injury and Osteoarthritis Outcome Score. The inter-rater reliability for SWE in the suprapatellar bursa, below the patellar tendon, and in the medial and lateral trochlear groove remained within 0.861–0.907. The SWE values in the four regions increased with increasing knee angle, and significant differences were observed between the values for below the patellar tendon and the suprapatellar bursa at knee flexion angles of 60° and 90°. The SWE values of the medial and lateral trochlear groove at 30°, 60°, and 90° knee flexion were higher on the affected side. A negative correlation was observed between the SWE values for the lateral trochlear groove at 0°, 30°, and 60° and those for below the patellar tendon at 0° and the suprapatellar bursa at 30° with both active and passive knee extension. The suprapatellar bursa value at 60° exhibited a positive correlation with both knee flexion and passive knee flexion, whereas that of the suprapatellar bursa at 90° exhibited a positive correlation with both the range of motion and passive range of motion. SWE is a replicable and effective method for detecting scar strength in the knee joint. [ABSTRACT FROM AUTHOR]

Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.5 kPa would rule out a short hospital length of stay (LOS < 6 days) following isolated coronary artery bypass grafting (CABG) surgery. Methods: A prospective observational study of one hundred sixty-four adult patients undergoing non-emergent isolated CABG surgery at a single university hospital center. Preoperative liver stiffness measured by ultrasound elastography was obtained for each participant. Multivariate logistic regression models were used to assess the adjusted relationship between LSM and a short hospital stay. Results: We performed multivariate logistic regression models using short hospital LOS (<6 days) as the dependent variable. Independent variables included LSM (<9.5 kPa, ≥9.5 kPa), age, sex, STS predicted morbidity and mortality, and baseline hemoglobin. After adjusting for included variables, LSM ≥ 9.5 kPa was associated with lower odds of early discharge as compared to LSM < 9.5 kPa (OR: 0.22, 95% CI: 0.06–0.84, p = 0.03). The ROC curve and resulting AUC of 0.76 (95% CI: 0.68–0.83) suggest the final multivariate model provides good discriminatory performance when predicting early discharge. Conclusions: A preoperative LSM ≥ 9.5 kPa ruled out a short length of stay in nearly 80% of patients when compared to patients with a LSM < 9.5 kPa. Preoperative liver stiffness may be a useful metric to incorporate into preoperative risk stratification. [ABSTRACT FROM AUTHOR]

Ultrasound elastography is widely used to assess tissue stiffness for lesion characterization, including differentiation between benign and malignant lesions. This study focuses on the use of elastography in the male pelvis, including the prostate, testicles, and rectum, by comparing elastography types (shear wave and strain). This article provides a summary of the existing literature on the use of elastography in the male pelvic region and outlines the clinical perspective. Ultrasound elastography is a good technique for evaluating and monitoring lesions in the male pelvic region. [ABSTRACT FROM AUTHOR]

Instrument-assisted soft tissue mobilization (IASTM) stimulates soft subcutaneous tissues by applying pressure to the skin with a specialized bar or spurtle-like instrument. No studies have verified whether several weeks of continuous IASTM alone can alter joint flexibility and musculotendinous properties in healthy participants. We examined the effect of a 6-week IASTM program on joint flexibility and the musculotendinous properties of the lower limbs. Fourteen healthy men (aged 19–35 years) who participated in a 6-week IASTM program (3 days weekly) for the soft tissue of the posterior aspect of one lower leg were included. The other leg served as the control. Before and after the intervention, we measured the maximal ankle joint dorsiflexion angle (dorsiflexion range of motion: DFROM) and maximal passive torque (MPT), a measure of stretch tolerance. We measured muscle and tendon stiffness using shear wave elastography on the gastrocnemius and Achilles tendon. IASTM significantly increased the DFROM and MPT (p < 0.05 for both). However, no significant changes were observed in muscle and tendon stiffness. None of the parameters changed significantly in the control group. The 6-week IASTM program increased stretch tolerance and joint flexibility but did not change muscle and tendon stiffness. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE. [ABSTRACT FROM AUTHOR]

More than half of patients hospitalized with liver cirrhosis are dealing with an episode of acute kidney injury; the most severe pattern is hepatorenal syndrome due to its negative prognosis. The main physiopathology mechanisms involve renal vasoconstriction and systemic inflammation. During the last decade, the definition of hepatorenal syndrome changed, but the validated criteria of diagnosis are still based on the serum creatinine level, which is a biomarker with multiple limitations. This is the reason why novel serum and urinary biomarkers have been intensively studied in recent years. Meanwhile, the imaging studies that use shear wave elastography are using renal stiffness as a surrogate for an early diagnosis. In this article, we focus on the physiopathology definition and highlight the novel tools used in the diagnosis of hepatorenal syndrome. [ABSTRACT FROM AUTHOR]

Featured Application: Shear Wave Elastography can be used to quantify the stiffness of the short and long head of biceps brachii. The Shear Wave Elastography of muscles can provide real-time information on the stiffness of muscles; however, the difference in stiffness between biceps brachii muscle bellies requires more research. Understanding the variables that affect muscle stiffness will assist in the development of Shear Wave Elastography as a diagnostic tool for muscle stiffness pathologies. This study's aim is to determine the Shear Wave Velocity of the short and long head of biceps brachii and the change in stiffness with elbow flexion to create a reliable protocol for pathological muscle assessment. The muscle belly of the short and long heads of bilateral biceps brachii of 38 healthy participants were scanned supine with the arm at full extension and at 30° and 60° elbow flexion. A log transform of the SWV was used as the response variable in the regression analysis, and the intraclass correlation coefficient was determined for reliability. The Shear Wave Velocity of the short head was lower than the long head on average. By fitting Bayesian mixed effect regression models to the data, the estimated posterior predictive mean velocities for the short head at full extension, 30°, and 60° were 3.14 m/s, 2.65 m/s, and 2.62 m/s, respectively; and 3.91 m/s, 3.02 m/s, and 3.15 m/s, respectively, for the long head of the biceps brachii. The intraclass correlation coefficients (0.64–0.92) were good to excellent. Shear Wave Elastography can detect the consistent difference in the stiffness of the two muscle bellies of the biceps brachii at multiple elbow angles. The assessment of muscle stiffness with Shear Wave Elastography should consider the morphology of the muscles. [ABSTRACT FROM AUTHOR]

Objectives: The objective is to compare stiffness changes around the shoulder muscles between pitchers and position players after throwing overhead using shear wave elastography (SWE) in relation to throwing motion analysis and muscle strength. Methods: A total of 32 male college baseball players (12 pitchers and 20 position players) were observed throwing 20 times, and SWE was performed to evaluate 13 shoulder muscle items—tendons (supraspinatus, infraspinatus, subscapularis, and teres minor), muscles (supraspinatus, infraspinatus [transverse and oblique part], teres minor, lower trapezius, latissimus dorsi, and pectoralis minor), and capsules (posterior and posteroinferior). Motion analysis was used to assess elbow torque, forearm angle, forearm rotation speed, and maximum external rotation angle of the shoulder. Muscle strength was measured using a dynamometer for abduction, internal/external rotation of the shoulder at an abduction of 0°, internal/external rotation of the shoulder at an abduction of 90°, and internal/external rotation of shoulder at a flexion of 90°. Results: In the pitcher group, SWE values for the teres minor muscle and latissimus dorsi muscle increased significantly after throwing. In the position player group, SWE values for the teres minor muscle significantly increased, and SWE values of the pectoralis minor muscle decreased after throwing. In the pitcher group, positive correlations were found between the teres minor muscle and forearm rotation speed and between the latissimus dorsi muscle and forearm angle. No significant difference was found in muscle strength after throwing in any of the groups. Conclusions: Stiffness changes occurred after throwing and were related to the motion analysis, but the regions in which stiffness occurred varied between pitchers and position players. [ABSTRACT FROM AUTHOR]

Liver stiffness measurement (LSM) by Fibroscan is the most used non-invasive method to assess liver fibrosis. Recently, point-shear wave elastography (pSWE) has been introduced as a simple alternative non-invasive test. Therefore, we aimed to compare the results of these two techniques. One hundred and eighty-four consecutive patients attending our outpatient ultrasound clinic were recruited. LSM was performed by both Fibroscan and pSWE. Statistical analysis was conducted by Spearman's test for correlation and linear regression. Bland–Altman graphs and ROC curves were drawn with area under the curve (AUC). Overall, the correlation of LS between Fibroscan and pSWE was substantial (r = 0.68, p < 0.001). Linear regression showed a coefficient b= 0.94 ± 0.02. The Bland–Altman plot found a bias of −0.10, with only 11 values exceeding the 95% confidence interval. When only considering patients with a LSM of > 10 kPa (n = 31), we found an excellent r = 0.79 (0.60–0.90, p < 0.001). A cutoff of 12.15 kPa for pSWE had sensitivity = 74.2% and specificity = 99.3% to detect relevant fibrosis, with an AUC = 0.98. The highest correlation was observed for hepatitis C (r = 0.91) and alcoholic liver disease (ALD)(r = 0.99). In conclusion, pSWE shows LSM estimation in agreement with Fibroscan in most cases, and the best concordance was observed for hepatitis C and ALD, and for higher ranges of LS. [ABSTRACT FROM AUTHOR]

Shore hardness (SH) is a cost-effective and easy-to-use method to assess soft tissue biomechanics. Its use for the plantar soft tissue could enhance the clinical management of conditions such as diabetic foot complications, but its validity and reliability remain unclear. Twenty healthy adults were recruited for this study. Validity and reliability were assessed across six different plantar sites. The validity was assessed against shear wave (SW) elastography (the gold standard). SH was measured by two examiners to assess inter-rater reliability. Testing was repeated following a test/retest study design to assess intra-rater reliability. SH was significantly correlated with SW speed measured in the skin or in the microchamber layer of the first metatarsal head (MetHead), third MetHead and rearfoot. Intraclass correlation coefficients and Bland–Altman plots of limits of agreement indicated satisfactory levels of reliability for these sites. No significant correlation between SH and SW elastography was found for the hallux, 5th MetHead or midfoot. Reliability for these sites was also compromised. SH is a valid and reliable measurement for plantar soft tissue biomechanics in the first MetHead, the third MetHead and the rearfoot. Our results do not support the use of SH for the hallux, 5th MetHead or midfoot. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection can lead to hepatic fibrosis. The advent of direct-acting antivirals (DAAs) has substantially improved sustained virological response (SVR) rates. In this context, kidney transplant recipients (KTRs) are of particular interest due to their higher HCV infection rates and uncertain renal excretion and bioavailability of DAAs. We investigated liver stiffness after DAA treatment in 15 HCV-infected KTRs using ultrasound shear wave elastography (SWE) in comparison with magnetic resonance elastography (MRE). KTRs were treated with DAAs (daclatasvir and sofosbuvir) for three months and underwent SWE at baseline, end of therapy (EOT), and 3 (EOT+3) and 12 months (EOT+12) after EOT. Fourteen patients achieved SVR12. Shear wave speed (SWS)—as a surrogate parameter for tissue stiffness—was substantially lower at all three post-therapeutic timepoints compared with baseline (EOT: −0.42 m/s, p < 0.01; CI = −0.75–−0.09, EOT+3: −0.43 m/s, p < 0.01; CI = −0.75–−0.11, and EOT+12: −0.52 m/s, p < 0.001; CI = −0.84–−0.19), suggesting liver regeneration after viral eradication and end of inflammation. Baseline SWS correlated positively with histopathological fibrosis scores (r = 0.48; CI = −0.11–0.85). Longitudinal results correlated moderately with APRI (r = 0.41; CI = 0.12–0.64) but not with FIB-4 scores (r = 0.12; CI = −0.19–0.41). Although higher on average, SWE-derived measurements correlated strongly with MRE (r = 0.64). In conclusion, SWE is suitable for non-invasive therapy monitoring in KTRs with HCV infection. [ABSTRACT FROM AUTHOR]

Background: The standard method for assessing chronic renal damage is renal biopsy, which has limitations due to its invasiveness. Ultrasound elastography is a non-invasive technique that quantifies tissue elasticity and can be used to determine Young's modulus (YM). Although this breakthrough technology has been successfully employed to evaluate liver stiffness and the extent of fibrosis, its application in kidney-related conditions still needs improvement. Methods: Our study aimed to verify the correlation between renal elastography and the chronic histological score determined via renal biopsy, evaluate the correlation between elastography and response to treatment in the short-term follow-up (6 months), and compare elastography data between renal disease patients (AKD-P) and healthy controls (HP). Results: The analyzed population consisted of 82 patients (41 HP and 41 AKD-P). The AKD-P were divided into responders (R) or non-responders (NR) based on the criteria established by the guidelines. No association was found between renal stiffness and chronic histological score. Elastography data revealed median YM values of 6.15 kPa for AKD-P and 12.2 kPa for HP, with a statistically significant difference. The median YM values of the R and NR groups were 7.4 KPa and 5.6 KPa, respectively (p = 0.037). Conclusions: Patient responsiveness was associated with YM, with lower values observed in the NR group. We also found that the healthy controls exhibited significantly higher YM values than the renal disease population. [ABSTRACT FROM AUTHOR]

Relationship between stiffness of genioglossi (GG) and geniohyoidei (GH) muscles under electric hypoglossal nerve stimulation therapy (HNS) in relation to success of therapy was investigated with additional special focus on tongue movement. Patients and Methods: Clinical and sleep laboratory parameters of a cohort of 18 patients with known shear wave velocity (SWV) data of the ipsilateral and contralateral musculi GG and GH (sGG, sGH and nGG, nGH) before and under HNS therapy were analyzed. The SWV was already determined using the ultrasonic shear wave elastography (US-SWE) technique. Results: Median Epworth Sleepiness Scale (ESS) was 8 (IQR 12), median baseline Apnoe–Hypopnoe Index (AHI) 31.65 (IQR 25.1), median AHI under HNS therapy 16.3 (IQR 20.03). Therapy success: 9/18 patients (AHI during therapy < 15/h). There was no significant difference in SWV (sGG, sGH, nGG and nGH) between therapy responders and non-responders during therapy. Also, no difference could be seen with respect to the difference and increase in SWV values without and with stimulation. Examination of SWV values (sGG, sGH, nGG, nGH during stimulation, difference of SWV values stimulation − no stimulation, increase factor of SWV) revealed a significant negative correlation between the AHI under therapy and the measured SWV of the musculus GH of the contralateral side during stimulation (−0.622, p = 0.006). Patients with bilateral protrusion of the tongue differed regarding to therapy success in increase in SWV in sGG (p = 0.032). Tongue protrusion to contralateral: A significant difference between patients with AHI during therapy < 15/h in SWV values at sGG without stimulation (p = 0.021) was seen, with also a correlation to the current AHI under therapy (p = 0.047) and the change factor of the AHI (p = 0.015). Conclusion: Stiffness of the target muscle does not appear to be an isolated measure of the success of HNS therapy. This observation may have implications for future decision-making processes in the process of titrating electrical therapy parameters. But the technique of US-SWE may be useful for future research of the neurophysiology of the tongue and OSA phenotyping. [ABSTRACT FROM AUTHOR]

Simple Summary: In our pursuit for accurate thyroid nodule diagnosis, a common challenge, this study was conducted to investigate the role of shear wave elastography (SWE). Specifically, we examined the influence of the selection of different regions of interest (ROIs) on the diagnostic effectiveness of SWE. By employing three ROI sizes (1 mm, 2 mm, and Max), we found that although SWE is generally effective in distinguishing between malignant and benign nodules, the choice of ROI size can significantly influence the diagnostic accuracy of specific SWE elasticity metrics. Our study not only enhances the current understanding of SWE's utility in thyroid nodule assessment but also offers valuable insights for future research, potentially paving the way for more reliable diagnostic techniques. This study investigated the impact of different region-of-interest (ROI) sizes (Max, 1 mm, and 2 mm) on shear wave elastography (SWE) in differentiating between malignant and benign thyroid nodules. The study cohort comprised 129 thyroid nodules (50 malignant, 79 benign) and 78 normal subjects. Diagnostic efficacy was assessed through pairwise comparisons of area under the curve (AUC) values in receiver operating characteristic analysis by using DeLong's test. Our results indicated significant differences in all SWE elasticity metrics between the groups, with malignant nodules exhibiting higher values than benign nodules (p < 0.05). Smaller ROIs (1 and 2 mm) were found to outperform the max ROI in terms of diagnostic accuracy, particularly for the Emax and Emin elasticity metrics. Emax(1mm) had the highest diagnostic accuracy, with an AUC of 0.883, sensitivity of 74.0%, and specificity of 86.1%. This study underscores the significant influence of ROI size selection on the diagnostic performance of SWE, offering valuable insights for future research and clinical applications in thyroid nodule assessment. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the utility of shear wave elastography (SWE) in assessing changes in deltoid muscle properties following reverse shoulder arthroplasty (RSA). Methods: Our cohort consisted of 18 patients who underwent RSA due to various conditions, including osteoarthritis, cuff arthropathy, and irreducible proximal humeral fractures. Pre- and postoperative muscle elasticity and stiffness were measured using SWE and were compared with functional outcomes and radiological parameters. Results: Our results showed significant changes in deltoid muscle elasticity after RSA, particularly in the anterior and middle portions. However, these alterations were not correlated with postoperative functional outcomes or specific radiological parameters. The study also underscored the potential of SWE for future applications, including the preoperative assessment of deltoid function, postoperative monitoring, and intraoperative use for optimal component positioning during RSA. Conclusion: Further research, involving larger, more homogeneous patient cohorts is needed to confirm these findings and to explore the potential influence of these changes on the biomechanical design of implants and prosthesis positioning in RSA. [ABSTRACT FROM AUTHOR]

Shear Wave Elastography (SWE) is currently used to detect tissue pathologies, i.e., tendinopathy. For preventive medicine, it is important to examine the sensitivity of SWE and to investigate how stiffness measures are affected by methodological variables. The aim of this study is to examine shear wave elastography (SWE) measures in order to compare the pre- and post-running values and to determine the correlation between the shear wave speed values (m/s). SWE examinations of the Achilles tendon (AT), soleus muscle (MS) and gastrocnemius muscle (MG)) were performed in 24 healthy professional female athletes. Measurements of the shear wave speed (m/s) were taken before and after incremental treadmill running until exhaustion. Correlations were investigated using the Pearson correlation coefficient and were examined for significance using the Student's t-test. The pre- and post-exercise shear wave speed did not differ. The pre-exercise and post-exercise stiffness for MS (r = 0.613), MG (r = 0.609) and AT (r = 0.583) correlated strongly. The pre-exercise values and changes in stiffness showed a significant correlation (p < 0.001). In professional athletes, acute exercise induces different tissue stiffness changes in AT, MS and MG for each individual. Thus, exercise activity immediately prior to the SWE measurement needs to be factored in when evaluating tissue stiffness. [ABSTRACT FROM AUTHOR]

Purpose: To assess the possible influence of the presence of varicocele on the quantification of testicular stiffness. Methods: Ultrasound with shear wave elastography (SWE) was performed on 48 consecutive patients (96 testicles) referred following urology consultation for different reasons. A total of 94 testes were studied and distributed in three groups: testes with varicocele (group A, n = 19), contralateral normal testes (group B; n = 13) and control group (group C, n = 62). Age, testicular volume and testicular parenchymal tissue stiffness values of the three groups were compared using the Kruskal–Wallis test. Results: The mean age of the patients was 42.1 ± 11.1 years. The main reason for consultation was infertility (64.6%). The mean SWE value was 4 ± 0.4 kPa (kilopascal) in group A, 4 ± 0.5 kPa in group B and 4.2 ± 0.7 kPa in group C or control. The testicular volume was 15.8 ± 3.8 mL in group A, 16 ± 4.3 mL in group B and 16.4 ± 5.9 mL in group C. No statistically significant differences were found between the three groups in terms of age, testicular volume and tissue stiffness values. Conclusion: Tissue stiffness values were higher in our control group (healthy testicles) than in patients with varicocele. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer (PCa) is considered as one of main causes of death in men globally. More research is required on the diagnostic accuracy of mpUS and advanced modalities in prostate cancer detection, which may provide insightful information into the diagnostic accuracy and clinical utility of this technique. Therefore, we have conducted a systematic review and meta-analysis to assess the diagnostic test accuracy of different ultrasound scanning technologies (shear-wave elastography, contrast enhanced, micro-ultrasound) and grayscale ultrasound technology in the detection of prostate cancer. This will assist in determining whether this new method of detecting prostate cancer is effective. Our results showed that some studies proved that advanced ultrasound modalities are promising methods for the detection of prostate cancer. The present study aimed to assess the diagnostic test accuracy of different ultrasound scanning technologies in the detection of prostate cancer. A systematic search was conducted using the Cochrane Guidelines for Screening and Diagnostic Tests. We performed a systematic search in the international databases PubMed, Medline, Ovid, Embase and Cochrane Library. Searches were designed to find all studies that evaluated Micro-US, mpUS, SWE and CEUS as the main detection modalities for prostate cancer. This study was registered with Research Registry of systematic review and meta-analysis. The QUADAS-2 tool was utilized to perform quality assessment and bias analysis. The literature search generated 1376 studies. Of these, 320 studies were screened for eligibility, with 1056 studies being excluded. Overall, 26 studies with a total of 6370 patients met the inclusion criteria. The pooled sensitivity for grayscale, CEUS, SWE, Micro-US and mpUS modalities were 0.66 (95% CI 0.54–0.73) 0.73 (95% CI 0.58–0.88), 0.82 (95% CI 0.75–0.90), 0.85 (95% CI 0.76–0.94) and 0.87 (95% CI 0.71–1.03), respectively. Moreover, the pooled specificity for grayscale, CEUS, SWE, Micro-US and mpUS modalities were 0.56 (95% CI 0.21–0.90), 0.78 (95% CI 0.67–0.88), 0.76 (95% CI 0.65–0.88), 0.43 (95% CI 0.28–0.59) and 0.68 (95% CI 0.54–0.81), respectively. In terms of sensitivity, substantial heterogeneity between studies was detected (I2 = 72%, p = 0.000 < 0.05). In relation to specificity, extreme heterogeneity was detected (I2 = 93%, p = 0.000 < 0.05). Some studies proved that advanced ultrasound modalities such as mpUS, Micro-US, shear-wave elastography, contrast enhanced and micro-ultrasound are promising methods for the detection of prostate cancer. [ABSTRACT FROM AUTHOR]

Shear-wave elastography (SWE) is an imaging method that can be used to estimate shear wave speed and the Young's modulus based on the measured shear wave speed under certain conditions. Up to date, no research has analyzed whether body composition factors contribute to ultrasound attenuation, refraction, reflection, and, consequently, SWE measurement errors. Therefore, this study aimed to analyze the association between demographic and body composition features with SWE errors for assessing the anterior scalene stiffness (which is a key structure in patients with neck pain and nerve compressive syndromes). Demographic (sex, age, height, weight, and body mass index), body composition (water volume, fat mass, and lean mass), and anterior scalene muscle stiffness (Young's modulus and shear wave speed) data were collected from a sample of asymptomatic subjects. After calculating the absolute SWE differences between trials and the reliability estimates, a correlation matrix was generated to quantify the association among all the variables. A total of 34 asymptomatic subjects (24 males) were included in the analyses. Test–retest reliability was excellent for assessing the Young's modulus and shear wave velocity (ICC = 0.912 and 0.923, respectively). No significant associations were found between age, height, weight, body mass index, body fat, lean mass, or water volume with SWE errors (p > 0.05). However, the Young's modulus error was associated with the stiffness properties (p < 0.01), whereas shear wave speed was associated with none of them (all, p > 0.05). A detailed procedure can reliably assess the AS muscle stiffness. None of the sociodemographic or body composition features assessed were correlated with SWE errors. However, baseline stiffness seems to be associated with Young's modulus error. [ABSTRACT FROM AUTHOR]

Background: Injuries of the patellar tendon commonly occur as a result of mechanical loading of the tendon during physical activity. Shear wave elastography (SWE) is an established technique for assessing tendon stiffness, and has good interindividual reliability. The aim of this study was to investigate the impacts of physical parameters and different sports on patellar tendon stiffness in professional athletes using SWE. Methods: Standardized patellar tendon SWE was performed in a relaxed supine position with a small roll under the knee (20° flexion) in 60 healthy professional athletes (30 female, 30 male). Multiple linear regression was performed for patellar tendon stiffness including gender, age, body mass index (BMI), and type of sport. Results: Patellar tendon stiffness showed no significant difference between female (3.320 m/s) and male (3.416 m/s) professional athletes. Mean age (female: 20.53 years; male: 19.80 years) and BMI (female: 23.24 kg/m2; male: 23.52 kg/m2) were comparable. Female professional athletes with oral contraceptive (OC) intake showed higher patellar tendon stiffness than athletes without OC intake (3.723 versus 3.017; p = 0.053), but not significantly. Conclusion: In professional athletes, there are no significant differences in patellar tendon stiffness according to gender, age, BMI and type of sport (handball, volleyball, soccer, sprint, hammer throw). Oral contraceptives may not have an impact on patellar tendon stiffness in female athletes. Further studies are necessary. [ABSTRACT FROM AUTHOR]

Ultrasound imaging is the first-line investigation for patients with abdominal symptoms, as it effectively depicts the gastrointestinal tract and enables the diagnosis of multiple pathological conditions. Among different recent ultrasound technological advancements, elastography enables the evaluation of various tissue characteristics, such as neoplastic transformation or fibroinflammatory status. In recent years, ultrasound elastography has been utilized extensively for the study of liver diseases and in numerous other clinical settings, including gastrointestinal diseases. Current guidelines suggest the use of transabdominal ultrasound elastography to characterize bowel wall lesions, to assess gastrointestinal contractility, to diagnose and grade chronic pancreatitis; however, no specific indications are provided. In the present paper, we summarize the evidence concerning the application of different ultrasound elastography modalities in gastrointestinal non-liver diseases. [ABSTRACT FROM AUTHOR]

Rotator cuff myosteatosis following cuff tears is very common and one of the most important prognostic factors in clinical management. Quantitative ultrasound-based imaging techniques (QUBIT) are frequently used along with magnetic resonance imaging (MRI) to evaluate rotator cuff fatty degeneration. However, the examination of rotator cuff tissue integrity by QUBIT is lacking a standardized imaging protocol and procedural methodologies. In this scoping review, we synthesized the current state of QUBIT against the reference imaging modalities in patients with rotator cuff tears. The literature search was extracted from 963 studies, with 22 studies included in the final review in accordance with the preferred reporting items for systematic reviews and meta-analyses extensions for scoping reviews. The selected studies included human participants and focused on measuring at least one prognostic or diagnostic factor using ultrasonography-based imaging with reference to MRI. The findings suggest both conventional B-mode ultrasound and shear wave elastography imaging were comparable to MRI-based imaging techniques for the evaluation of fatty infiltration and rotator cuff tear characterization. This review establishes guidelines for reporting shoulder-specific QUBIT aimed at developing a standardized imaging protocol. The objective was to enhance the diagnostic and prognostic capabilities of QUBIT in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: Ultrasound plays a crucial role in early diagnosis of breast cancer. The aim of this research is to evaluate the diagnostic performance of BI-RADS classification in comparison with new semi-automatic software Resona R9, Mindray, "SmartBreast" and strain elastography (SE), point shear wave (pSWE), and 2D shear wave (2D SWE) Elastography for breast lesion differentiation. Methods: Ninety-two breast nodules classified according to BI-RADS lexicon by an expert radiologist were evaluated by a second investigator with B-mode ultrasound, color Doppler, "SmartBreast", and elastography. Histopathology was considered the gold standard. Results: The agreement between software and investigator was excellent in the identification of the posterior features of breast masses (Cohen's k = 0.94), good for shape and vascular signal (Cohen's k, respectively, of 0.6 and 0.65), poor for orientation, margins, and echo pattern (Cohen's k, respectively, of 0.28, 0.33 and 0.48), moderate for dimensions (Lin's correlation coefficient of 0.90, p = 0.07). SE showed a greater area under curve (AUC) than pSWE and 2D SWE (0.84, 0.64, and 0.61, respectively), with a greater specificity and a comparable sensitivity to pSWE (respectively, of 0.86 and 0.55, 0.81 and 0.84). Conclusions: SE improved the diagnostic performance of BI-RADS classification more than pSWE and 2D SWE; "SmartBreast" showed good agreement only for shape and vascularization but not for the other ultrasound features of breast lesions. [ABSTRACT FROM AUTHOR]

The prediction of induction of labor continues to be a paradigm nowadays. Bishop Score is the traditional widely spread method but with a low reliability. Ultrasound cervical assessment has been proposed as an instrument of measurement. Shear wave elastography (SWE) should be a promising tool in the prediction of the success of labor induction in nulliparous late-term pregnancies. Ninety-two women with nulliparous late-term pregnancies who were going to be induced were included in the study. A shear wave measurement of the cervix divided into six regions (inner, middle and outer in both cervical lips), cervical length and fetal biometry was performed by blinded investigators prior to routine hand cervical assessment (Bishop Score (BS)) and induction of labor. The primary outcome was success of induction. Sixty-three women achieved labor. Nine women did not, and they underwent a cesarean section due to failure to induce labor. SWE was significantly higher in the inner part of the posterior cervix (p < 0.0001). SWE showed an area under the curve (AUC): 0.809 (0.677–0.941) in the inner posterior part. For CL, AUC was 0.816 (0.692–0.984). BS AUC was 0.467 (0.283–0.651). The ICC of inter-observer reproducibility was ≥0.83 in each region of interest (ROI). The cervix elastic gradient seems to be confirmed. The inner part of the posterior cervical lip is the most reliable region to predict induction of labor results in SWE terms. In addition, cervical length seems to be one of the most important procedures in the prediction of induction. Both methods combined could replace the Bishop Score. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS) is an essential technique for the management of several diseases. Over the years, new technologies have been developed to improve and overcome certain limitations related to EUS-guided tissue acquisition. Among these new methods, EUS-guided elastography, which is a real-time method for the evaluation of tissue stiffness, has arisen as one of the most widely recognized and available. At present, there are available two different systems to perform an elastographic evaluation: strain elastography and shear wave elastography. Strain elastography is based on the knowledge that certain diseases lead to a change in tissue hardness while shear wave elastography monitored shear-wave propagation and measures its velocity. EUS-guided elastography has shown in several studies high accuracy in differentiating benign from malignant lesions from many different locations, mostly in the pancreas and lymph nodes. Therefore, nowadays, there are well-established indications for this technology, mainly for supporting the management of pancreatic diseases (diagnosis of chronic pancreatitis and differential diagnosis of solid pancreatic tumors) and characterization of different diseases. However, there are more data on new potential indications for the near future. In this review, we will present the theoretical bases of this technology and we will discuss the scientific evidence to support its use. [ABSTRACT FROM AUTHOR]

Background: Shear wave elastography (SWE) is currently used to detect tissue pathologies and, in the setting of preventive medicine, may have the potential to reveal structural changes before they lead to functional impairment. Hence, it would be desirable to determine the sensitivity of SWE and to investigate how Achilles tendon stiffness is affected by anthropometric variables and sport-specific locomotion. Methods: To investigate the influence of anthropometric parameters on Achilles tendon stiffness using SWE and examine different types of sports to develop approaches in preventive medicine for professional athletes, standardized SWE of Achilles tendon stiffness was performed in 65 healthy professional athletes (33 female, 32 male) in the longitudinal plane and relaxed tendon position. Descriptive analysis and linear regression were performed. Furthermore, subgroup analysis was performed for different sports (soccer, handball, sprint, volleyball, hammer throw). Results: In the total study population (n = 65), Achilles tendon stiffness was significantly higher in male professional athletes (p < 0.001) than in female professional athletes (10.98 m/s (10.15–11.65) vs. 12.19 m/s (11.25–14.74)). Multiple linear regression for AT stiffness did not reveal a significant impact of age or body mass index (BMI) (p > 0.05). Subgroup analysis for type of sport showed the highest AT stiffness values in sprinters (14.02 m/s (13.50–14.63)). Conclusion: There are significant gender differences in AT stiffness across different types of professional athletes. The highest AT stiffness values were found in sprinters, which needs to be considered when diagnosing tendon pathologies. Future studies are needed to investigate the benefit of pre- and post-season musculoskeletal SWE examinations of professional athletes and a possible benefit of rehabilitation or preventive medicine. [ABSTRACT FROM AUTHOR]

Tendon-related disorders are a common condition in both sports medicine and orthopedic clinical practice. Ultrasonography, power doppler, and magnetic resonance imaging (MRI) are the most widespread technologies, but the use of ultrasound elastography—including strain elastography and shear wave elastography—has been increasing in the last years. The aim of this paper is to evaluate the use of ultrasound elastography in tendon-related disorders. Research in PubMed, Scopus, and Web of Science databases is performed, and 364 papers are exported. After the study selection process, 38 papers are included in this systematic review. The risk of bias of each paper is evaluated using the RoBANS tool. Blinding, confounding variables, and measurement of exposure are the most affected items. From the included papers, tendinopathy is the most analyzed pathology, followed by tenosynovitis and rotator cuff disease. The Achilles tendon, patellar tendon, and common extensor tendon of the hand are the most analyzed tendons. Ultrasound elastography results in being the method providing good sensitivity and specificity (up to 100% and 100%, respectively, in tendinosis of the long head of the biceps tendon, in transverse plan examination) and accuracy (up to 97.8% in Achilles tendinopathy); furthermore, this technique is able to ensure real-time feedback on tissue elasticity and appears more sensitive than B-mode alone. [ABSTRACT FROM AUTHOR]

Shear wave elastography (SWE) is a non-invasive imaging technique used to quantify the elasticity/stiffness of any tissue. There are normative SWE studies on tonsils in healthy children in the literature. The purpose of this study is to analyze the palatine tonsils in children with acute tonsillitis using ultrasound and SWE. In this prospective study, pediatric patients aged 4–18 years diagnosed with acute tonsillitis and healthy children were included. Those with antibiotic use, chronic tonsillitis, adenoid hypertrophy, and having chronic disease, immunodeficiency, and autoimmune disease, or any rheumatological disease were excluded. The volume and elasticity of palatine tonsil were measured via ultrasound and SWE. The study included 81 (46 female, 35 male) acute tonsillitis patients, and 63 (38 female, 25 male) healthy children between the ages of 4 and 18. Elasticity (kPa) values of tonsils were found significantly higher in the tonsillitis group (SWE-R: 25.39 ± 4.64, SWE-L: 25.01 ± 4.17) compared to the normal group (SWE-R: 9.71 ± 2.37, SWE-L: 9.39 ± 2.19) (p < 0.001). In the tonsillitis group, a significant positive correlation was found between tonsil volume and elasticity (r: 0.774, p: 0.002). In conclusion, in pediatric patients with acute tonsillitis, higher kPa values were obtained with SWE in the palatine tonsils. [ABSTRACT FROM AUTHOR]

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease treated with local and systemic corticosteroids. This study aims to evaluate the efficacy of reducing corticosteroids doses in IGM cases based on shear wave elastography (SWE) tissue stiffness measurements. This prospective study included IGM patients who received systemic or local corticosteroids between January 2020 and September 2022. A 20% or more reduction in tissue elasticity values (kPa) was considered a positive response to treatment in the study group, and the corticosteroids dose was reduced. The control group was dosed routinely. All patients were followed for 2 years to compare treatment efficacy, duration, total corticosteroids dose, recurrence, and side effects. There were 12 patients (9 local/3 systemic corticosteroids) in the study group and 24 patients (17 local/7 systemic corticosteroids) in the control group. Ten (83.4%) out of 12 patients in the study group were successfully treated by reducing corticosteroid doses with follow-up, and 2 (16.6%) out of 12 patients were reverted to the initial treatment protocol due to an increase in elasticity values during the follow-up. Nevertheless, successful treatment results were obtained in these two patients without reducing the corticosteroid dose. When compared to the control group, the median corticosteroid dose in the study group was significantly lower in patients using both local (p < 0.01) and systemic (p < 0.01) corticosteroids. A significant negative correlation was found between the rate of decrease in elasticity values and the median dose of corticosteroids (r = −0.649, p < 0.05) and the median treatment time (r = −0.751, p < 0.01). Side effects due to corticosteroids were found to be significantly lower in the study group (p < 0.05). According to our first and preliminary results, the SWE-correlated dose-modifying technique may reduce corticosteroid doses and side effects without significantly compromising treatment efficacy. [ABSTRACT FROM AUTHOR]

Purpose: to evaluate and monitor the timely thermal ablation changes of rabbit liver by using two elastographic methods—real-time elastography (RTE) and shear wave elastography (SWE)—as compared to contrast-enhanced ultrasound (CEUS) and physical specimens. Materials and Methods: 20 ablation zones were created in the livers of 20 rabbits using radiofrequency ablation (RFA). After the ablation, RTE and SWE were used to measure the elastic properties of the twenty ablation zones. The consistency of efficacy evaluation for RTE and SWE measurements was analyzed using the Bland–Altman test. The areas of the thermal ablation zones were also measured and compared according to the images provided by RTE, SWE, CEUS, and gross physical specimen measurement. Results: RTE and SWE could clearly display the shape of RFA ablation zones within one hour after the ablation. The average elasticity ratio for the ablation zone measured by RTE was 3.41 ± 0.67 (2.23–4.76); the average elasticity value measured by SWE was 50.7 ± 11.3 kPa (33.2–70.4 kPa). The mean areas of the ablation zones measured with RTE, SWE, gross specimen, and CEUS were 1.089 ± 0.199 cm2, 1.059 ± 0.201 cm2, 1.081 ± 0.201 cm2, and 3.091 ± 0.591 cm2, respectively. The Bland–Altman test showed that RTE and SWE have great consistency. Area measurements by CEUS were significantly larger than those of the other three methods (p < 0.05). Conclusion: RTE and SWE are both able to accurately confirm the range of ablation zones shortly after the ablation for rabbit livers. [ABSTRACT FROM AUTHOR]

Myasthenia gravis (MG) is often accompanied with muscle weakness; however, little is known about mechanical adaptions of the affected muscles. As the latter can be assessed using ultrasound shear wave elastography (SWE), this study characterizes the biceps brachii muscle of 11 patients with MG and compares them with that of 14 healthy volunteers. Simultaneous SWE, elbow torque and surface electromyography measurements were performed during rest, maximal voluntary contraction (MVC) and submaximal isometric contractions (up to 25%, 50% and 75% MVC) at different elbow angles from flexion to extension. We found that, with increasing elbow angle, maximum elbow torque decreased (p < 0.001), whereas muscle stiffness increased during rest (p = 0.001), MVC (p = 0.004) and submaximal contractions (p < 0.001). Muscle stiffness increased with increasing contraction intensities during submaximal contractions (p < 0.001). In comparison to the healthy cohort, muscle stiffness of MG patients was 2.1 times higher at rest (p < 0.001) but 8.93% lower in active state (75% MVC, p = 0.044). We conclude that (i) increased muscle stiffness shown by SWE during rest might be an indicator of MG, (ii) SWE reflects muscle weakness and (iii) SWE can be used to characterize MG muscle. [ABSTRACT FROM AUTHOR]

Objectives: Measurement location and patient state can impact noninvasive liver assessment and change clinical staging in ultrasound examinations. Research into differences exists for Shear Wave Speed (SWS) and Attenuation Imaging (ATI), but not for Shear Wave Dispersion (SWD). The aim of this study is to assess the effect of breathing phase, liver lobe, and prandial state on SWS, SWD, and ATI ultrasound measurements. Methods: Two experienced examiners performed SWS, SWD, and ATI measurements in 20 healthy volunteers using a Canon Aplio i800 system. Measurements were taken in the recommended condition (right lobe, following expiration, fasting state), as well as (a) following inspiration, (b) in the left lobe, and (c) in a nonfasting state. Results: SWS and SWD measurements were strongly correlated (r = 0.805, p < 0.001). Mean SWS was 1.34 ± 0.13 m/s in the recommended measurement position and did not change significantly under any condition. Mean SWD was 10.81 ± 2.05 m/s/kHz in the standard condition and significantly increased to 12.18 ± 1.41 m/s/kHz in the left lobe. Individual SWD measurements in the left lobe also had the highest average coefficient of variation (19.68%). No significant differences were found for ATI. Conclusion: Breathing and prandial state did not significantly affect SWS, SWD, and ATI values. SWS and SWD measurements were strongly correlated. SWD measurements in the left lobe showed a higher individual measurement variability. Interobserver agreement was moderate to good. [ABSTRACT FROM AUTHOR]

Featured Application: Hamstring strain injuries occur particularly in the later stages of a football match, suggesting that fatigue may play an important role. Moreover, sprinting is the principal mechanism to sustain a hamstring strain injury since it demands the hamstrings muscle group. After the injury, sprint performance and strength might be reduced, and muscle tissue properties can be altered even after the player returns to competition. Therefore, the aim of the present study is to compare the effects of (i) a repeated sprint protocol on the sprint performance, hamstrings shear modulus pattern, and neuromuscular parameters between players with and without previous hamstring strain injury; and (ii) between limbs with hamstring strain injury and their healthy contralateral limbs on the hamstrings shear modulus pattern and neuromuscular parameters. It should be noted that the biceps femoris long head muscle is the most affected muscle, and it has been reported that a higher contribution of the biceps femoris long head could possibly explain the greater injury rate on this muscle. The aim of the present study is to compare the effects of a (i) repeated sprint protocol on the sprint performance, hamstrings shear modulus pattern, and neuromuscular parameters between players with and without previous hamstring strain injury (HSI); and (ii) between limbs with HSI and their healthy contralateral limbs on the hamstrings shear modulus pattern and neuromuscular parameters. One-hundred-and-five professional and semiprofessional football field players were invited to participate in this study during the pre-season 2021/2022 (June–July), resulting in a sample size of 210 limbs with 46 sustaining HSI in the previous 2 years. No differences were seen between previously injured and healthy control players regarding their sprint performance, hamstrings shear modulus pattern, and neuromuscular parameters, except for the early rate of torque development (0–50 ms) with previously injured limbs in the biceps femoris long head (BFlh) displaying higher rates than their contralateral muscle (injured: 496.93 ± 234.22 Nm/s; contralateral 422.72 ± 208.29 Nm/s; p = 0.005; η2p = 0.469). Overall, the present study provides evidence for no differences regarding sprint performance, hamstrings load sharing pattern, and major neuromuscular parameters between players with previous HSI in the last 2 years and healthy control players. Therefore, the results can possibly suggest that the duration between injury and screening could recover the differences between injured-control and injured-contralateral groups. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the stiffness of the sciatic nerve by shear wave elastography (SWE) and to determine whether SWE can be used to predict diabetic foot ulcer (DFU) in a patient with diabetic peripheral neuropathy (DPN). Methods: Sixteen patients (thirty-two lower limbs) with unilateral DFU were studied retrospectively. The ultrasonographic parameters including cross-sectional area (CSA) of sciatic nerve, intraneural blood flow, peak systolic velocity (Vmax) and resistive index (RI) in the intraneural artery of the sciatic nerve, and the SWE stiffness value of the sciatic nerve were measured. The examinations of arteries of the lower limbs were also performed by ultrasound. According to the presence or absence of DFU, the 32 lower limbs were divided into two groups: the DFU group and the non-DFU group. The ultrasonographic parameters were compared between these two groups. Results: There was no significant difference (p > 0.05) between the two groups for CSA, intraneural blood flow, Vmax and RI in the intraneural artery of the sciatic nerve, and numbers of severe artery stenosis or full occlusion of the artery in the lower limbs. However, SWE stiffness values in the sciatic nerve in the DFU group are higher than the non-DFU group (p < 0.05). When the SWE stiffness values were used for prediction of DFU in patients with DPN, the area under the ROC curve (AUC) was 0.727 (95% CI: 0.541–0.868). When the best SWE stiffness value of 24.48 kPa was taken as a cutoff for prediction of DFU, the sensitivity was 62.50% (95% CI: 35.4–84.8%), and the specificity was 75% (95% CI: 47.6–92.7%). Conclusions: Sciatic nerve stiffness is significantly higher in lower limbs with DFU. SWE is a noninvasive imaging method that may be used to evaluate sciatic nerve stiffness, then potentially predict DFU in patients with DPN. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated the difficulties in distinguishing malignant lesions of the breast from benign lesions owing to overlapping morphological features on ultrasound. Consequently, we aimed to develop a nomogram based on shear wave elastography (SWE), Angio Planewave Ultrasensitive imaging (Angio PLUS (AP)), and conventional ultrasound imaging biomarkers to predict malignancy in patients with breast lesions. This prospective study included 117 female patients with suspicious lesions of the breast. Features of lesions were extracted from SWE, AP, and conventional ultrasound images. The least absolute shrinkage and selection operator (Lasso) algorithms were used to select breast cancer-related imaging biomarkers, and a nomogram was developed based on six of the 16 imaging biomarkers. This model exhibited good discrimination (area under the receiver operating characteristic curve (AUC): 0.969; 95% confidence interval (CI): 0.928, 0.989) between malignant and benign breast lesions. Moreover, the nomogram also showed demonstrated good calibration and clinical usefulness. In conclusion, our nomogram can be a potentially useful tool for individually-tailored diagnosis of breast tumors in clinical practice. [ABSTRACT FROM AUTHOR]

Rigidity in Parkinson's disease (PD) is assessed by clinical scales, mostly the Unified Parkinson's Disease Rating Scale of the Movement Disorders Society (MDS-UPDRS). While the MDS-UPDRS-III ranges on an integer from 0 to 4, we investigated whether muscle ultrasound shear wave elastography (SWE) offers a refined assessment. Ten PD patients (five treated with deep brain stimulation (DBS) and levodopa, five with levodopa only) and ten healthy controls were included. Over a period of 80 min, both the SWE value and the item 22b-c of the MDS-UPDRS-III were measured at 5 min intervals. The measurements were performed bilaterally at the biceps brachii muscle (BB) and flexor digitorum profundus muscle in flexion and passive extension. Rigidity was modified and tracked under various therapeutic conditions (with and without medication/DBS). The feasibility of SWE for objective quantification was evaluated by correlation with the UPDRS-III: considering all positions and muscles, there was already a weak correlation (r = 0.01, p < 0.001)—in a targeted analysis, the BB in passive extension showed a markedly higher correlation (r = 0.494, p < 0.001). The application of dopaminergic medication and DBS resulted in statistically significant short-term changes in both clinical rigidity and SWE measurements in the BB (p < 0.001). We conclude that rigidity is reflected in the SWE measurements, indicating that SWE is a potential non-invasive quantitative assessment tool for PD. [ABSTRACT FROM AUTHOR]

Simple Summary: Grey scale ultrasound assessment is primarily used in the differential diagnosis of thyroid nodules. However, in recent years the assessment of tissue elasticity using shear wave elastography (SWE) has been suggested to have additional diagnostic value in thyroid cancer diagnosis. The aim of the present study was to evaluate the diagnostic efficiency of SWE in combination with grey scale ultrasound malignancy risk-stratification based on the European (EU) thyroid management guideline based on nodule size stratifications and indeterminate cytology status. We established that the combined approach had high diagnostic efficacy in differentiating malignant and benign nodules > 1 cm. However, in nodules with indeterminate cytology the approach highly discriminated benign nodules but resulted in low sensitivity which was indicative of an undesirable high false negative rate. The combination of SWE and the EU guideline is therefore most useful when evaluating non-micro-nodules based on size. Although multimodal ultrasound approaches have been suggested to potentially improve the diagnosis of thyroid cancer; the diagnostic utility of the combination of SWE and malignancy-risk stratification systems remains vague due to the lack of standardized criteria. The purpose of the study was to assess the diagnostic value of the combination of grey scale ultrasound assessment using EU TIRADS and shear wave elastography. 121 patients (126 nodules–81 benign; 45 malignant) underwent grey scale ultrasound and SWE imaging of nodules between 0.5 cm and 5 cm prior to biopsy and/or surgery. Nodules were analyzed based on size stratifications: <1 cm (n = 43); 1–2 cm (n = 52) and >2 cm (n = 31) and equivocal cytology status (n = 52), and diagnostic performance assessments were conducted. The combination of EU TIRADS with SWE using the SD parameter; maintained a high sensitivity and significantly improved the specificity of sole EU TIRADS for nodules 1–2 cm (SEN: 72.2% vs. 88.9%, p > 0.05; SPEC: 76.5% vs. 55.9%, p < 0.01) and >2 cm (SEN: 71.4% vs. 85.7%, p > 0.05; SPEC: 95.8% vs. 62.5%, p < 0.01). For cytologically-equivocal nodules; the combination with the SWE minimum parameter resulted in a significant reduction in sensitivity with increased specificity (SEN: 60% vs. 80%; SPEC: 83.4% vs. 37.8%; all p < 0.05). SWE in combination with EU TIRADS is diagnostically efficient in discriminating nodules > 1 cm but is not ideal for discriminating cytologically-equivocal nodules. [ABSTRACT FROM AUTHOR]

We aimed to validate the diagnostic accuracy of a novel sonographic scoring model and compare it with other methods in the evaluation of malignant major salivary gland tumors. We enrolled 138 patients who received neck ultrasound (US) with fine needle aspiration (FNA) and further operations or core needle biopsies for major salivary gland tumors from June 2015 to October 2021. The sonographic scoring model was presented as 2.08 × (vague boundary) + 1.75 × (regional lymphadenopathy) + 1.18 × (irregular or speculated shape) + 1.45 × (absence of posterior acoustic enhancement) + 2.4 × (calcification). We compared the diagnostic accuracy of the sonographic scoring model with shear wave elastography (SWE), real-time elastography (RTE), and US-FNA cytology for differentiating between benign and malignant lesions. The sensitivity, specificity, and accuracy were 58%, 89%, and 85% for the sonographic scoring model, 74%, 62%, and 64% for the SD of SWE with optimal cutoff value of 31.5 kPa, 69%, 70%, and 70% for the 4-point scoring system of RTE, and 74%, 93%, and 91% for US-FNA cytology, respectively. The sonographic scoring model is feasible as assistance in the evaluation of major salivary gland tumors. US-FNA cytology remains the tool of choice in diagnosing malignant salivary gland tumors. [ABSTRACT FROM AUTHOR]

Background: While adolescents have specific risk factors for acute and chronic injury, there is a lack of preventive medicine algorithms for this vulnerable group. Shear wave elastography (SWE) is currently mainly used for assessing muscle and tendon stiffness in adult athletes and can diagnose tissue pathologies such as tendinopathy. The aim was to investigate differences in quadriceps tendon and muscle stiffness between adolescent and adult professional soccer players using SWE and identify lateral imbalances in order to improve the knowledge of preventive medicine algorithms for professional adolescent athletes. Methods: Standardized SWE examinations of both lower limb tendons and muscles (the quadriceps tendon (QT) and the vastus medialis (VM) muscle) in the longitudinal plane and relaxed tendon position were performed in 13 healthy adolescent soccer athletes (13–17 years), and a control group of 19 healthy adult professional soccer athletes (18–29 years). Results: Adolescent soccer players had lower stiffness values for both the quadriceps tendon (3.11 m/s vs. 3.25 m/s) and the vastus medialis muscle (1.67 m/s vs. 1.71 m/s) than adult athletes. Moreover, QT stiffness in adolescent soccer players was significantly lower on the right side (QT: adult 3.50 m/s (2.73–4.56) vs. adolescent 2.90 m/s (2.61–3.12); p = 0.031). Analysis of the lateral differences revealed softer QT and VM tissue on the right side in over two-thirds of adolescent soccer athletes. Over two-thirds of adults had stiffer QT and VM tissue on the right side. Conclusion: In adolescent soccer players, the stiffness of the QT and VM muscle measured by SWE is lower in the right leg. SWE of the musculoskeletal system may thus become a relevant diagnostic tool to detect early lateral imbalances as a main risk factor for injury and may thus contribute to the prevention of acute and chronic injury prevention in adolescent athletes. [ABSTRACT FROM AUTHOR]

Viscosity and elasticity represent biomechanical properties of soft tissues that suffer changes during the pathophysiological alterations of the tissue in various conditions. This study aimed to determine average viscosity values for the thyroid gland and to evaluate the potential influences of age, gender and body mass index (BMI), using a recent technique Viscosity Plane-wave UltraSound (Vi PLUS). A total of 85 healthy Caucasian volunteers (56 women and 29 men, median age of 29 years, range 17–81 years) were included in this prospective monocentric study conducted between January 2022 and March 2022. Thyroid viscosity was measured using the SuperSonic MACH 30® Ultrasound system (Aixplorer, SuperSonic Imagine, Aix-en-Provence, France), equipped with a curvilinear C6-IX transducer that allows simultaneous quantification of the viscosity and stiffness. The mean thyroid viscosity measurement value was 2.63 ± 0.47 Pa.s. No statistically significant differences were detected between the left and the right lobes of the thyroid gland. A significant positive correlation was found between thyroid viscosity and elasticity (r = 0.685, p < 0.0001). There was no statistically significant correlation between body mass index (BMI) and thyroid gland viscosity and elasticity values (r = 0.215, p = 0.053; r = 0.106, p = 0.333). No correlation between viscosity and gender was established (p > 0.05). Vi PLUS represents a new and promising ultrasonographic technique that can provide helpful information for evaluating the thyroid parenchyma, similar to elastography. The effect of the potential confounding factors on thyroid viscosity was negligible, except for BMI. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the intra-rater reliability and agreement of diaphragm and intercostal muscle elasticity and thickness during tidal breathing. The diaphragm and intercostal muscle parameters were measured using shear wave elastography in adolescent athletes. To calculate intra-rater reliability, intraclass correlation coefficient (ICC) and Bland–Altman statistics were used. The reliability/agreement for one-day both muscle measurements (regardless of probe orientation) were at least moderate. During the seven-day interval between measurements, the reliability of a single measurement depended on the measured parameter, transducer orientation, respiratory phase, and muscle. Excellent reliability was found for diaphragm shear modulus at the peak of tidal expiration in transverse probe position (ICC3.1 = 0.91–0.96; ICC3.2 = 0.95), and from poor to excellent reliability for the intercostal muscle thickness at the peak of tidal inspiration with the longitudinal probe position (ICC3.1 = 0.26–0.95; ICC3.2 = 0.15). The overall reliability/agreement of the analysed data was higher for the diaphragm measurements (than the intercostal muscles) regardless of the respiratory phase and probe position. It is difficult to identify a more appropriate probe position to examine these muscles. The shear modulus/thickness of the diaphragm and intercostal muscles demonstrated good reliability/agreement so this appears to be a promising technique for their examination in athletes. [ABSTRACT FROM AUTHOR]

The mechanical status of the cervix is a key physiological element during pregnancy. By considering a successful induction when the active phase of labor is achieved, mapping the mechanical properties of the cervix could have predictive potential for the management of induction protocols. In this sense, we performed a preliminary assessment of the diagnostic value of using shear wave elastography before labor induction in 54 women, considering the pregnancy outcome and Cesarean indications. Three anatomical cervix regions and standard methods, such as cervical length and Bishop score, were compared. To study the discriminatory power of each diagnostic method, a receiver operating characteristic curve was generated. Differences were observed using the external os region and cervical length in the failure to enter the active phase group compared to the vaginal delivery group (p < 0.05). The area under the ROC curve resulted in 68.9%, 65.2% and 67.2% for external os, internal os and cervix box using elastography, respectively, compared to 69.5% for cervical length and 62.2% for Bishop score. External os elastography values have shown promise in predicting induction success. This a priori information could be used to prepare a study with a larger sample size, which would reduce the effect of any bias selection and increase the predictive power of elastography compared to other classical techniques. [ABSTRACT FROM AUTHOR]