Point shear wave ultrasound elastography with Esaote compared to real-time 2D shear wave elastography with supersonic imagine for the quantification of liver stiffness

Abstract Background To explore the value of liver stiffness assessed by two-dimensional real-time shear wave elastography (2D-SWE）in predicting the occurrence of hypersplenism in patients diagnosed with Wilson’s disease (WD). Methods A total of 90 WD patients were enrolled in this prospective study between May 2018 and December 2018. Clinical data and ultrasound imaging including 2D-SWE liver stiffness of WD patients as baseline data were collected. Patients were followed up for 24 months, or patients developed hypersplenism after enrollment. Risk factors for hypersplenism were determined using cox regression and receiver operating characteristic curve. Results Twenty-night (32.2%) patients were found developed hypersplenism. The age, the diameter of portal vein, and the liver stiffness were independent risk factors associated with hypersplenism in WD. The cutoff value of liver stiffness for predicting hypersplenism was 10.45 kPa, with sensitivity and specificity of 75.9% and 73.8%, respectively. When patients were divided into two groups according to liver stiffness ≥10.45 kPa or <10.45 kPa, the incidence of hypersplenism were 57.9% vs. 13.5% (P<0.001), and the median time between the enrollment and the development of hypersplenism was 15 months vs. 22 months (P<0.001) for the two groups, respectively. Conclusion The liver stiffness measured by 2D-SWE was a reliable predictor of hypersplenism in WD patients. Dynamic monitoring WD patients using 2D-SWE is crucial for the early diagnosis of hypersplenism.

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Evaluation Of The Diagnostic Effectiveness Of Real Time Shear-Wave Elastography Technique In Determination Of Liver Stiffness And Fibrosis In Chronic Viral Hepatitis And Autoimmune Hepatitis

Eurasian Journal of Medical Investigation ◽

10.14744/ejmi.2020.14743 ◽

2020 ◽

Author(s):

Emrah Karatay

Keyword(s):

Autoimmune Hepatitis ◽

Viral Hepatitis ◽

Real Time ◽

Shear Wave ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Chronic Viral Hepatitis

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Reliability Criteria for Liver Stiffness Measurements with Real-Time 2D Shear Wave Elastography in Different Clinical Scenarios of Chronic Liver Disease

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0042-108431 ◽

2016 ◽

Vol 38 (06) ◽

pp. 648-654 ◽

Cited By ~ 21

Author(s):

Maja Thiele ◽

Bjørn Madsen ◽

Bogdan Procopet ◽

Janne Hansen ◽

Linda Møller ◽

...

Keyword(s):

Portal Hypertension ◽

Standard Deviation ◽

Real Time ◽

Shear Wave ◽

High Reliability ◽

Intraclass Correlation ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Diagnostic Study ◽

Clinical Scenarios

Abstract Purpose Liver stiffness measurement by real-time 2-dimensional shear wave elastography (2D-SWE) lacks universal reliability criteria. We sought to assess whether previously published 2D-SWE reliability criteria for portal hypertension were applicable for the evaluation of liver fibrosis and cirrhosis, and to look for criteria that minimize the risk of misclassification in this setting. Materials and Methods In a biopsy-controlled diagnostic study, we obtained five 2D-SWE measurements of optimal image quality. Correctly classified cases of fibrosis and cirrhosis were compared to misclassified cases. We compared reliability predictors (standard deviation (SD), SD/mean, size of region of interest (ROI) and difference between a single measurement and the patient’s median) with those obtained in a prior study on clinically significant portal hypertension. Results We obtained 678 2D-SWE measurements from 142 patients. Overall, the variability in liver stiffness within single 2D-SWE measurements was low (SD = 1.1 ± 1.5kPa; SD/mean = 12 ± 9 %). Intra-observer analysis showed almost perfect concordance (intraclass correlation coefficient = 0.95; 95 % CI 0.94 – 0.96; average difference from median = 0.4 ± 0.9kPa). For the diagnosis of cirrhosis, a smaller SD (optimally ≤ 1.75 kPa) and larger ROI size (optimally ≥ 18 mm) were associated with higher accuracy. Similarly, within the published cohort of patients assessed for portal hypertension, a low variability of measurements was associated with high reliability. Conclusion A high quality 2D-SWE elastogram ensures low variability and high reliability, regardless of indication. We recommend aiming for a combination of low standard deviation and large ROI.

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Ultrasound Elastography for Rapid, Real-time Detection of Localized Muscular Reaction in Malignant Hyperthermia–susceptible Pigs

Anesthesiology ◽

10.1097/aln.0000000000002424 ◽

2018 ◽

Vol 129 (5) ◽

pp. 989-999

Author(s):

Stephan Johannsen ◽

Ismail Türkmeneli ◽

Susanne Isbary ◽

Norbert Roewer ◽

Frank Schuster

Keyword(s):

Malignant Hyperthermia ◽

Real Time ◽

Shear Wave ◽

Intramuscular Injection ◽

Shear Wave Elastography ◽

Ultrasound Elastography ◽

Temporary Increase ◽

Maximum Effect ◽

Tissue Elasticity ◽

Real Time Detection

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Halothane and caffeine induce excessive sarcoplasmic calcium liberation and skeletal muscle contracture in patients susceptible to malignant hyperthermia (MH) and are utilized for diagnosis in the in vitro contracture test. Intramuscular injection previously caused a marked local lactate increase in MH-susceptible but not in MH-nonsusceptible individuals in vivo. Using shear-wave elastography, this study evaluated localized changes in muscle stiffness after intramuscular injection of halothane and caffeine. Methods Microdialysis probes were placed into the gracilis muscle of 16 pigs (9 MH-susceptible and 7 MH-nonsusceptible). After local injection of either halothane or caffeine in different concentrations, changes of tissue elasticity surrounding the probe were examined by quantitative shear-wave elastography. Local lactate concentrations were analyzed spectrophotometrically. Results Ultrasound elastography detected a temporary increase in local muscle rigidity in MH-susceptible but not in MH-nonsusceptible pigs after 2.5 and 5 vol% halothane and after 10, 40, and 80 mM caffeine, whereas there were no differences in the control groups (median [interquartile range] for maximum effect after 5 vol% halothane: MH-susceptible: 97 [31 to 148] vs. MH-nonsusceptible: 5 [−6 to 18] kPa; P = 0.0006; maximum effect after 80 mM caffeine: 112 [64 to 174] vs. −3 [−6 to 35] kPa; P = 0.0002). These effects were seen rapidly within 5 min. Local lactate concentrations were higher in MH-susceptible versus nonsusceptible pigs after 1 and 2.5 vol% halothane and 10, 40, and 80 mM caffeine (2.5 vol% halothane: MH-susceptible: 2.8 [1.9 to 4.4] vs. MH-nonsusceptible: 0.6 [0.6 to 0.7] mmol/l; P < 0.0001; 80 mM caffeine: 5.2 [4.1 to 6.3] vs. 1.6 [1.2 to 2.4] mmol/l; P < 0.0001). After 10 vol% halothane, rigidity and lactate levels were increased in both MH-susceptible and MH-nonsusceptible animals. Conclusions This pilot study revealed shear-wave elastography as a suitable technique for real-time detection of altered tissue elasticity in response to pharmacologic stimulation. By considering the variability of these results, further test protocol optimization is required before elastography could serve as a minimally invasive MH diagnostic test.

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