BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigat...BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.AIM To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.METHODS This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023.All tumors underwent conventional ultrasound examination,strain elastography(SE),and shearwave elastography(SWE)before surgical resection.The study evaluated elastographic parameters such as strain ratio,elastographic patterns,mean elastic modulus,and heterogeneity index.Diagnostic performance was evaluated using receiver operating characteristic curve analysis,with histopathological diagnosis as the reference standard.RESULTS Of the 103 GISTs,45(43.7%)were benign and 58(56.3%)were malignant based on modified National Institutes of Health criteria.Malignant GISTs exhibited significantly higher strain ratios(4.82±1.73 vs 2.31±0.89;P<0.001)and mean elastic modulus values(45.6±15.8 kPa vs 21.3±8.4 kPa;P<0.001)than benign tumors.The optimal cutoff values were 3.45 for the strain ratio(sensitivity:84.5%,specificity:86.7%)and 32.5 kPa for the mean elastic modulus(sensitivity:87.9%,specificity:88.9%).The areas under the curve were 0.892 and 0.918,respectively.Interobserver agreement was excellent for both SE[intraclass correlation coefficient(ICC)=0.88]and SWE(ICC range:0.85-0.93)measurements.CONCLUSION Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs.Combining SE and SWE provides complementary parameters for preoperative risk stratification.展开更多
BACKGROUND Shear wave elastography(SWE)is a non-invasive ultrasound-based technique used to assess tissue stiffness,which reflects underlying pathological changes.While SWE has been widely applied for liver fibrosis e...BACKGROUND Shear wave elastography(SWE)is a non-invasive ultrasound-based technique used to assess tissue stiffness,which reflects underlying pathological changes.While SWE has been widely applied for liver fibrosis evaluation,its application to other abdominal organs,such as the spleen and pancreas,is gaining interest.However,normal stiffness values and inter-system agreement remain poorly defined.AIM To assess the feasibility and agreement of liver,spleen,and pancreas stiffness using three SWE methods.METHODS This single-center observational study enrolled 50 healthy adult volunteers.Liver,spleen,and pancreas stiffness were assessed using three SWE methods:Point-SWE(p-QElaXto)and 2-Dimensional-SWE(2D-QElaXto)with Esaote MyLab 9,and 2D-SWE with SuperSonic Imagine.Feasibility,inter-operator reproducibility,and concordance among systems were evaluated.Stiffness was expressed as median kPa values,and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds.RESULTS Liver and spleen stiffness assessment was feasible in>98%of patients,while pancreas stiffness was measurable in 84%-88%depending on the SWE technique.Mean liver stiffness ranged between 3.9-4.7 kPa across techniques,spleen stiffness ranged from 19.4-23.0 kPa,and pancreas stiffness from 5.2-7.6 kPa.Inter-operator agreement was excellent for liver(intraclass correlation coefficient>0.90)and good to moderate for spleen and pancreas(intraclass correlation coefficient from 0.43 to 0.90).Bland-Altman analysis confirmed good correlation but also systematic differences among devices,especially in pancreas measurements.CONCLUSION This is the first study to establish normal liver,spleen,and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine,with acceptable inter-technique agreement.Liver and spleen values matched existing guidelines;pancreas SWE showed more variability and reduced reproducibility.展开更多
BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performanc...BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performance of three fibrosis noninvasive tests[FibroTest,vibration-controlled transient elastography(VCTE),and the fibrosis-4 index(FIB-4)and two activity biomarkers(alanine aminotransferase(ALT)and ActiTest].METHODS This study enrolled 103 patients for whom liver biopsy,hepatic elastography results,and laboratory markers were available.Diagnostic performance was assessed with receiver operating characteristic(ROC)curves,the Obuchowski measure(OM),and the Bayesian latent class model.RESULTS FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis(≥F2),with areas under the ROC curve of 0.83[95%confidence interval(CI):0.73-0.90],0.86(95%CI:0.77-0.92),and 0.71(95%CI:0.60-0.80),respectively.The mean(standard error)OM values were 0.92(0.01),0.93(0.01),and 0.88(0.02)for FibroTest,VCTE,and FIB-4,respectively;FibroTest and VCTE performed comparably,and both were superior to FIB-4(P=0.03 and P=0.005).The areas under the ROC curve values for activity biomarkers were 0.86(95%CI:0.76-0.92)for ActiTest and 0.84(95%CI:0.73-0.90)for ALT(P=0.06).The OM values for ActiTest and ALT were 0.92(0.02)and 0.90(0.02),respectively(P=0.005).CONCLUSION FibroTest and VCTE outperformed FIB-4 according to the OM.FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.展开更多
Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,name...Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,namely,hepatic venous pressure gradient measurement,is invasive and not widely available.Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness(LS),and recent studies have highlighted the potential role of splenic stiffness(SS)in evaluating PH severity.This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH.We evaluated its diagnostic accuracy,technical challenges,and clinical applications,particularly in distinguishing between cirrhotic PH(CPH)and noncirrhotic PH(NCPH).A comprehensive literature search was conducted using the PubMed database,focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH.This review compares splenic elastography with other non-invasive imaging modalities,including MR elastography and shearwave elastography.Additionally,we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening.Studies have demonstrated that splenic elastography correlates well with PH severity,with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection.Splenic elastography,when combined with platelet count and LS measurements,improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding.Despite its clinical promise,technical challenges such as patient positioning,body habitus,and probe selection remain key limitations.Notably,splenic elastography may be particularly useful in diagnosing NCPH,where LS remains normal but PH is present.Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH.Its ability to predict varices,differentiate between CPH and NCPH,and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice.Future research should focus on refining SS cut-offs,evaluating its cost-effectiveness,and integrating splenic elastography into clinical guidelines for PH management.展开更多
BACKGROUND There is insufficient evidence on the evaluation of liver fibrosis in Asian indivi-duals with primary biliary cholangitis(PBC)using vibration-controlled transient elastography(VCTE).AIM To assess advanced f...BACKGROUND There is insufficient evidence on the evaluation of liver fibrosis in Asian indivi-duals with primary biliary cholangitis(PBC)using vibration-controlled transient elastography(VCTE).AIM To assess advanced fibrosis(AF)using liver stiffness measurement(LSM)in Chinese patients with PBC.METHODS In total,277 Chinese patients diagnosed with PBC who underwent liver biopsy and VCTE were retrospectively included and categorized into the derivation and validation cohorts.The areas under the receiver operating characteristic curves(AUROCs)with 95%confidence intervals(CIs)were used to estimate the dia-gnostic accuracy of LSM for AF(Ludwig stage≥III).Multivariable analysis was performed using logistic regression.RESULTS In the derivation cohort,VCTE accurately detected patients with AF,achieving an AUROC of 0.93(95%CI:0.88-0.96).AF was independently predicted by LSM according to multivariable analysis.AF can be excluded and confirmed using LSM cutoffs of≤10.0 and>14.5 kPa,respectively,with a sensitivity of 0.91,negative predictive value of 0.93,specificity of 0.96,positive predictive value of 0.92,and an error rate of 7.5%.The accuracy of these values was validated in an independent cohort,achieving an AUROC of 0.97(95%CI:0.90-0.99)for AF with a sensitivity of 0.89,negative predictive value of 0.88,specificity of 0.95,positive predictive value of 0.94,and error rate of 9.0%.Compared with serum fibrosis markers,the AUROC of LSM was significantly higher in both the derivation and validation cohorts.CONCLUSION VCTE has a high accuracy for assessing AF in Chinese patients with PBC in a real-world setting.展开更多
BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastas...BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastases and differentiate between benign and malignant tumors.AIM To investigate SWE usefulness in measuring lymph node hardness to predict metastasis presence or absence in surgically removed lymph nodes.METHODS This observational study obtained data from patients who underwent surgery for esophageal or gastric cancer at Nippon Medical School Hospital.The hardness of the surgically removed lymph nodes was measured using SWE.The lymph nodes with hardness values≥2.2 m/s were considered clinically positive for metastasis,whereas those with lower hardness values were considered clinically negative.The lymph nodes subsequently underwent pathological examination to determine the presence of metastasis,and the SWE results and pathological assessments were compared.RESULTS A total of 1077 lymph nodes were evaluated;18 and 15 cases of esophageal and gastric cancer were identified,respectively.The optimal cutoff value for lymph node size was calculated to be 5.1 mm,and the area under the curve value was 0.74(95%confidence interval:0.69-0.84).When limited to a lymph node larger than the cut off value,the SWE sensitivity and specificity for metastasis identification were 0.76 and 0.82,respectively.CONCLUSION SWE was useful in detecting lymph node metastases in the upper gastrointestinal tract.展开更多
Endoscopic ultrasound-guided shear wave elastography(EUS-SWE)represents a significant advancement in non-invasive tissue characterization,enabling objective assessment of quantitative tissue stiffness in real-time wit...Endoscopic ultrasound-guided shear wave elastography(EUS-SWE)represents a significant advancement in non-invasive tissue characterization,enabling objective assessment of quantitative tissue stiffness in real-time with potential clinical relevance across a variety of gastrointestinal disorders.Recent developments in EUS-SWE have expanded its application beyond hepatic fibrosis to include pancreatic diseases and the evaluation of solid tumors.EUS-SWE has demonstrated diagnostic accuracy comparable to vibration-controlled transient elastography in assessing fibrosis stages,positioning it as a potential alternative to liver biopsy.Moreover,EUS-SWE has shown promise in evaluating pancreatic tissue stiffness,aiding in the diagnosis and monitoring of chronic pancreatitis and pancreatic cancer.This technique offers a distinct advantage by allowing tissue stiffness measurements during the same procedure,thereby reducing the need for additional imaging studies and biopsies.Despite its clinical potential,challenges remain,including the need for standardized protocols,optimal cutoff values,and validation across diverse patient populations.This minireview provides a comprehensive analysis of the current literature on EUS-SWE,examining its diagnostic performance,reproducibility,and limitations.Furthermore,we discuss the future directions of EUS-SWE,including its integration into routine clinical practice and its evolving role in precision medicine,emphasizing the necessity of large-scale studies to solidify its clinical utility and establish standardized guidelines for its use.展开更多
BACKGROUND Fontan-associated liver disease(FALD)often occurs in patients with single-ventricle physiology following Fontan surgery,and ranges from liver congestion to cirrhosis.The assessment of the severity of FALD u...BACKGROUND Fontan-associated liver disease(FALD)often occurs in patients with single-ventricle physiology following Fontan surgery,and ranges from liver congestion to cirrhosis.The assessment of the severity of FALD using noninvasive methods is challenging.However,transient elastography(TE)may be useful for the non-invasive evaluation of FALD and prediction of clinical outcomes.AIM To evaluate the role of TE in the diagnosis of FALD and its association with clinically relevant events.METHODS This retrospective single-center study(Hospital Universitario La Paz,Madrid),including 91 post-Fontan patients aged>18 years old.Laboratory and ultrasound findings,and liver stiffness measurements(LSM)by TE(FibroScan®)were assessed.FALD was defined using ultrasound criteria hepatomegaly,liver surface nodularity,parenchymal heterogeneity,hyperechoic lesions,spleno-RESULTS Patient characteristics were:60.4%male;Mean age,33.3±8.2 years;Mean elapsed time since surgery,24.3±7.7 years;89%with FALD;73%with advanced FALD.LSM by TE was associated with FALD[odds ratio(OR)=1.34;95%confidence interval(95%CI):1.10-1.64;P=0.003]and advanced FALD(OR=1.10;95%CI:1.01-1.19;P=0.023).Areas under the curve(AUC)were 0.905 and 0.764 for FALD and advanced FALD,respectively.FALD cut-off values comprised:Optimal,20 kPa(sensitivity:92.3%;specificity:80.0%);Rule-out,15 kPa(sensitivity:96.9%);Rule-in,25 kPa(specificity:100%).A FALD algorithm was proposed based on LSM by TE and elapsed time since surgery(AUC:0.877;sensitivity,95.4%;specificity,80.0%;positive predictive value,96.9%;negative predictive value,72.7%).LSM by TE was associated with clinically relevant events(OR=1.07;95%CI:1.01-1.13;P=0.021)and all-cause mortality(OR=1.23;95%CI:1.02-1.47;P=0.026).CONCLUSION In adult patients post-Fontan surgery,TE is a useful noninvasive method for FALD diagnosis.The association between LSM by TE and clinically relevant events suggests a role in prognosis.展开更多
In this article,we comment on the article by Cheng et al published in recently.Posthepatectomy liver failure(PHLF)remains a leading cause of hepatectomyrelated mortality and can be evaluated according to liver reserve...In this article,we comment on the article by Cheng et al published in recently.Posthepatectomy liver failure(PHLF)remains a leading cause of hepatectomyrelated mortality and can be evaluated according to liver reserve function.Liver stiffness(LS)measured by ultrasonic elastography and spleen area demonstrate a strong correlation with hepatic proliferation,fibrosis,and portal vein congestion,thus indirectly reflecting liver reserve function.This article highlights a meticulous study aimed at investigating the potential of two-dimensional shear wave elastography in assessing LS,as well as its integration with spleen area,surgical factors,and laboratory indicators,for predicting the risk of PHLF in hepatocellular carcinoma patients.In this article,we discussed the non-invasive elastography modality by ultrasound and magnetic resonance imaging to assess LS.Based on literature data,we subsequently suggested that several risk factors may contribute to PHLF,including excessive intrahepatic neutrophil accumulation,the formation of neutrophil extracellular traps,end-stage liver disease scores,and albumin-bilirubin scores.Therefore,a more comprehensive study incor-porating detailed information requires further investigation.展开更多
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxi...BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.展开更多
BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imagi...BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.AIM To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.METHODS We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019.We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging.Liver imaging findings(hepatic steatosis,increased echogenicity,cirrhosis,and chronic liver disease)were further evaluated for their diagnostic performance in detecting fibrosis(≥F2,≥F3,≥F4)and steatosis(≥S1,≥S2,≥S3).RESULTS Of 959 HCV patients who underwent TE,651 had liver imaging.Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings(P=0.0050),hepatic steatosis(P<0.0001),and increased echogenicity(P<0.0001).Higher liver stiffness measurement values were also noted in those with abnormal liver(P<0.0001)and increased echogenicity(P=0.0026).Steatosis severity correlated with hepatic steatosis(r=0.195,P<0.001)and increased echogenicity(r=0.209,P<0.001).For fibrosis detection,abnormal liver imaging had moderate sensitivity(81.7%)and specificity(70.4%)for cirrhosis(≥F4),while cirrhosis on imaging had high specificity(99.2%)but low sensitivity(18.3%).Increased echogenicity showed high specificity(92.8%)but low sensitivity(20.9%)for steatosis detection.CONCLUSION Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity.Integrating TE with imaging may improve evaluation in patients with HCV.展开更多
BACKGROUND Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children.Two-dimensional(2D)shear wave elastography(SWE)is the newest ultrasonic elastography technology and ...BACKGROUND Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children.Two-dimensional(2D)shear wave elastography(SWE)is the newest ultrasonic elastography technology and its value in differentiating benign and malignant thyroid nodules has been widely recognized.However,the value of 2D SWE in evaluating and predicting thyroid function is unclear.AIM To explore prospectively the value of 2D SWE quantitative analysis for the evaluation of thyroid function in the first trimester.METHODS We included outpatients of reproductive age in the Department of Gynecology in Shanghai Changning Maternity and Infant Health Hospital between March 2023 and March 2024 who had conventional ultrasound examination and 2D SWE of the thyroid.They also underwent transvaginal ultrasound examination to confirm early intrauterine pregnancy and serum thyroid stimulating hormone(TSH)level was measured.The patients were divided into pregnant with normal TSH,pregnant with abnormal TSH,and nonpregnant with normal TSH.Conventional ultrasound and 2D SWE results were compared among the three groups.RESULTS A total of 108 patients were included in the study;57 in the pregnant with normal TSH group,18 in the pregnant with abnormal TSH group and 33 were in the nonpregnant with normal TSH group.Thyroid size,thyroid echotexture,2D SWE quantitative parameters including mean elasticity in the region of interest and maximal elasticity in the region of interest showed no significant differences among the three groups(P>0.05).CONCLUSION Conventional ultrasound and 2D SWE features could not reflect the level of serum TSH.展开更多
In this article,we discuss the study by Cheng et al,published in the World Journal of Gastroenterology,focusing on predictive methods for post-hepatectomy liver failure(PHLF).PHLF is a common and serious complication,...In this article,we discuss the study by Cheng et al,published in the World Journal of Gastroenterology,focusing on predictive methods for post-hepatectomy liver failure(PHLF).PHLF is a common and serious complication,and accurate prediction is critical for clinical management.The study examines the potential of ultrasound elastography and splenic size in predicting PHLF.Ultrasound elastography reflects liver functional reserve,while splenic size provides additional predictive value.By integrating these factors with serological markers,we developed a comprehensive prediction model that effectively stratifies patient risk and supports personalized clinical decisions.This approach offers new insights into predicting PHLF.These methods not only assist clinicians in identifying high-risk patients earlier but also provide scientific support for personalized treatment strategies.Future research will aim to validate the model's accuracy with larger sample sizes,further enhancing the clinical application of these non-invasive indicators.展开更多
This study explores the significance of using two-dimensional shear wave elastography(2D-SWE)to assess liver stiffness(LS)and spleen area(SPA)for predicting post-hepatectomy liver failure(PHLF).By providing a non-inva...This study explores the significance of using two-dimensional shear wave elastography(2D-SWE)to assess liver stiffness(LS)and spleen area(SPA)for predicting post-hepatectomy liver failure(PHLF).By providing a non-invasive method to measure LS,which correlates with the degree of liver fibrosis,and SPA,an indicator of portal hypertension,2D-SWE offers a comprehensive evaluation of a patient’s hepatic status.These advancements are particularly crucial in hepatic surgery,where accurate preoperative assessments are essential for optimizing surgical outcomes and minimizing complications.This letter highlights the prac-tical implications of integrating 2D-SWE into clinical practice,emphasizing its potential to improve patient safety and surgical precision by enhancing the ability to predict PHLF and tailor surgical approaches accordingly.展开更多
BACKGROUND The association between diabetes mellitus(DM)and metabolic dysfunctionassociated steatotic liver disease(MASLD)is well documented,with DM increasing the risk of developing MASLD and liver fibrosis.AIM To ev...BACKGROUND The association between diabetes mellitus(DM)and metabolic dysfunctionassociated steatotic liver disease(MASLD)is well documented,with DM increasing the risk of developing MASLD and liver fibrosis.AIM To evaluate the cost-effectiveness and budget impact of transient elastography(TE)for detecting significant fibrosis in Thai patients with DM.METHODS We conducted a lifetime cost-utility analysis from a societal perspective,combining a decision tree with a Markov model.Four alternatives were compared:Fibrosis-4(FIB-4)index triage followed by TE,steatosis-associated fibrosis estimator(SAFE)score triage followed by TE,standalone TE,and no screening.Clinical probabilities,utilities,and costs came from previous studies and Siriraj Hospital data.Costs and quality-adjusted life-years(QALYs)were discounted 3%annually,and incremental cost-effectiveness ratios(ICERs)were judged against the 160000-Thai baht(THB;4619 United States dollars[USD])/QALY threshold.A 5-year budget impact was evaluated from the payer perspective.RESULTS Among the screening methods evaluated,TE alone yielded the highest total lifetime costs of 200403 THB(5785 USD)and the highest QALYs of 12.81.Compared to no screening,all strategies demonstrated cost-effectiveness with ICERs of 75961,80385,and 98965 THB(2193,2321,and 2857 USD)/QALY gained for FIB-4+TE,SAFE+TE,and TE alone,respectively.Extended dominance favored SAFE+TE,yet probabilistic analysis showed FIB-4+TE had the highest cost-effectiveness probability and the smallest budget impact.Estimated annual budget impacts amounted to 470.7-755.8 million THB(13.6-21.8 million USD).CONCLUSION Implementing screening for significant fibrosis in patients with DM is cost-effective.In resource-limited settings,prioritizing the FIB-4 index as a triage tool before TE is recommended.展开更多
Background:Patients with Fontan physiology are predisposed to congestive hepatopathy,progressive liver fib rosis,and end-stage liver disease.Ulrasound-based shear wave elastography(SWE)is a non-invasive tool to diagno...Background:Patients with Fontan physiology are predisposed to congestive hepatopathy,progressive liver fib rosis,and end-stage liver disease.Ulrasound-based shear wave elastography(SWE)is a non-invasive tool to diagnose and mnonitor liver fibrosis,We sought to deternine whether the degreeof hemodynanic derangement priorto and after the Fontan operation is associated with irncreased liverstiffness measured by SWE.Methods:A single-center retrospectivestudy of patients with Pontan circulationwho underwert ultrasound elastography between 2008 and 2024 was conducted,Liver stiffness wasmeasuued by SWE and teported as vlocity in n/s.Henodynanic assessmert with catrdiac cathetaizationand echocardiograms were collected before and after the Fontan operation,Data was analyzed as acontinuous(lineat regression model)and a dichotomous variable(t-test).Results:78 pcst-Fortan ultrasoundelactography studies pt fotmedin 56 patients wee analyzed.Pre-Fontan hemnodyrnarrics ircluded medianeffective pulmonary flow of 2.45 L/min/m^(2)[2.21,3.16](p=0.46)ventricular end-diastolic pressure of10 mmHg[8,10.5](p=0.77),and median Glenn ptessue of 12 mmHg[13,15](p=0.83).Post-Fontan mediansystemnic cardiac index was 2.80 L/min/m^(2)[2.4,3.34](p=0.93),median ventricular end-diastolic pressureof 12 mmHg[13.5,14](p=0.99),median systenic saturation of 93%[87,96](p=0.77),median indexedpulmonary vasculat resistance of 1.80 WU·m^(2)[1.49,2.37](p=0.93),and median Fontan ptessue of 18 mmHg[16,21](p=0.86).No corelation was found between SWE and hemodynamics.On echoc ardiography,no correlation was found between SWE and systenic vantricular systolic function(p=0.35)or degree ofsystenic atriovertricula valve regurgitation (p=0.35).Conclusions:The degree of liver stffness by SWEinthis cohort did not correlate withpre and post-Fontan hermodynarnics on cat diac catheterization,degr ee ofverntriculat dysfuntiony or severity of atrioventriculat valve regurgitation by echocardiography.展开更多
Distinguishing the severity of burned skin from structural optical coherence tomography(OCT)intensity maps remains a challenging task,and functional imaging from an elastic perspective can improve the accuracy of burn...Distinguishing the severity of burned skin from structural optical coherence tomography(OCT)intensity maps remains a challenging task,and functional imaging from an elastic perspective can improve the accuracy of burned skin examination.As a functional extension of OCT,optical coherence elastography(OCE)can reveal the mechanical properties of samples while inheriting the imaging advantages of OCT.In this study,we used OCE to reveal the shear modulus and anisotropy parameters of burned skin before and after burning.A porcine skin burn model was constructed at a series of burned time durations and tested by elastic anisotropy imaging.Normal skin after hydration maintains good consistency in shear modulus.Interestingly,the shear modulus and longitudinal modulus of the burned skin show a tendency to stepwise increase with increasing burned times.A dataset was constructed by sampling the modulus parameters of burned skin maps through a scratch window,and its category was automatically identi¯ed by Kmeans and density peak clustering(DPC)algorithms with good agreement.The elastic anisotropy-based skin burn assessment method shows a prospect to be supplemented into the nondestructive means of burned skin examination.展开更多
Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultra...Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.展开更多
Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered...Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks(inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis(serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasoundbased elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography(TE) and acoustic radiation force impulse(ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shearwave elastography, the Elast PQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.展开更多
BACKGROUND Few systematic comparative studies of the different methods of physical elastography of the spleen are currently available.AIM To compare point shear wave and two-dimensional elastography of the spleen cons...BACKGROUND Few systematic comparative studies of the different methods of physical elastography of the spleen are currently available.AIM To compare point shear wave and two-dimensional elastography of the spleen considering the anatomical location(upper,hilar,and lower pole).METHODS As part of a prospective clinical study,healthy volunteers were examined for splenic elasticity using four different ultrasound devices between May 2015 and April 2017.The devices used for point shear wave elastography were from Siemens(S 3000)and Philips(Epiq 7),and those used for two-dimensional shear wave elastography were from GE(Logiq E9)and Toshiba(Aplio 500).In addition,two different software versions(5.0 and 6.0)were evaluated for the Toshiba ultrasound device(Aplio 500).The study consisted of three arms:A,B,and C.RESULTS In study arm A,200 subjects were evaluated(78 males and 122 females,mean age 27.9±8.1 years).In study arm B,113 subjects were evaluated(38 men and 75 women,mean age 26.0±6.3 years).In study arm C,44 subjects were enrolled.A significant correlation of the shear wave velocities at the upper third of the spleen(r=0.33088,P<0.0001)was demonstrated only for the Philips Epiq 7 device compared to the Siemens Acuson S 3000.In comparisons of the other ultrasound devices(GE,Siemens,Toshiba),no comparable results could be obtained for any anatomical position of the spleen.The influencing factors age,gender,and body mass index did not show a clear correlation with the measured shear wave velocities.CONCLUSION The absolute values of the shear wave elastography measurements of the spleen and the two different elastography methods are not comparable between different manufacturers or models.展开更多
文摘BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.AIM To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.METHODS This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023.All tumors underwent conventional ultrasound examination,strain elastography(SE),and shearwave elastography(SWE)before surgical resection.The study evaluated elastographic parameters such as strain ratio,elastographic patterns,mean elastic modulus,and heterogeneity index.Diagnostic performance was evaluated using receiver operating characteristic curve analysis,with histopathological diagnosis as the reference standard.RESULTS Of the 103 GISTs,45(43.7%)were benign and 58(56.3%)were malignant based on modified National Institutes of Health criteria.Malignant GISTs exhibited significantly higher strain ratios(4.82±1.73 vs 2.31±0.89;P<0.001)and mean elastic modulus values(45.6±15.8 kPa vs 21.3±8.4 kPa;P<0.001)than benign tumors.The optimal cutoff values were 3.45 for the strain ratio(sensitivity:84.5%,specificity:86.7%)and 32.5 kPa for the mean elastic modulus(sensitivity:87.9%,specificity:88.9%).The areas under the curve were 0.892 and 0.918,respectively.Interobserver agreement was excellent for both SE[intraclass correlation coefficient(ICC)=0.88]and SWE(ICC range:0.85-0.93)measurements.CONCLUSION Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs.Combining SE and SWE provides complementary parameters for preoperative risk stratification.
文摘BACKGROUND Shear wave elastography(SWE)is a non-invasive ultrasound-based technique used to assess tissue stiffness,which reflects underlying pathological changes.While SWE has been widely applied for liver fibrosis evaluation,its application to other abdominal organs,such as the spleen and pancreas,is gaining interest.However,normal stiffness values and inter-system agreement remain poorly defined.AIM To assess the feasibility and agreement of liver,spleen,and pancreas stiffness using three SWE methods.METHODS This single-center observational study enrolled 50 healthy adult volunteers.Liver,spleen,and pancreas stiffness were assessed using three SWE methods:Point-SWE(p-QElaXto)and 2-Dimensional-SWE(2D-QElaXto)with Esaote MyLab 9,and 2D-SWE with SuperSonic Imagine.Feasibility,inter-operator reproducibility,and concordance among systems were evaluated.Stiffness was expressed as median kPa values,and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds.RESULTS Liver and spleen stiffness assessment was feasible in>98%of patients,while pancreas stiffness was measurable in 84%-88%depending on the SWE technique.Mean liver stiffness ranged between 3.9-4.7 kPa across techniques,spleen stiffness ranged from 19.4-23.0 kPa,and pancreas stiffness from 5.2-7.6 kPa.Inter-operator agreement was excellent for liver(intraclass correlation coefficient>0.90)and good to moderate for spleen and pancreas(intraclass correlation coefficient from 0.43 to 0.90).Bland-Altman analysis confirmed good correlation but also systematic differences among devices,especially in pancreas measurements.CONCLUSION This is the first study to establish normal liver,spleen,and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine,with acceptable inter-technique agreement.Liver and spleen values matched existing guidelines;pancreas SWE showed more variability and reduced reproducibility.
文摘BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performance of three fibrosis noninvasive tests[FibroTest,vibration-controlled transient elastography(VCTE),and the fibrosis-4 index(FIB-4)and two activity biomarkers(alanine aminotransferase(ALT)and ActiTest].METHODS This study enrolled 103 patients for whom liver biopsy,hepatic elastography results,and laboratory markers were available.Diagnostic performance was assessed with receiver operating characteristic(ROC)curves,the Obuchowski measure(OM),and the Bayesian latent class model.RESULTS FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis(≥F2),with areas under the ROC curve of 0.83[95%confidence interval(CI):0.73-0.90],0.86(95%CI:0.77-0.92),and 0.71(95%CI:0.60-0.80),respectively.The mean(standard error)OM values were 0.92(0.01),0.93(0.01),and 0.88(0.02)for FibroTest,VCTE,and FIB-4,respectively;FibroTest and VCTE performed comparably,and both were superior to FIB-4(P=0.03 and P=0.005).The areas under the ROC curve values for activity biomarkers were 0.86(95%CI:0.76-0.92)for ActiTest and 0.84(95%CI:0.73-0.90)for ALT(P=0.06).The OM values for ActiTest and ALT were 0.92(0.02)and 0.90(0.02),respectively(P=0.005).CONCLUSION FibroTest and VCTE outperformed FIB-4 according to the OM.FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.
文摘Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,namely,hepatic venous pressure gradient measurement,is invasive and not widely available.Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness(LS),and recent studies have highlighted the potential role of splenic stiffness(SS)in evaluating PH severity.This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH.We evaluated its diagnostic accuracy,technical challenges,and clinical applications,particularly in distinguishing between cirrhotic PH(CPH)and noncirrhotic PH(NCPH).A comprehensive literature search was conducted using the PubMed database,focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH.This review compares splenic elastography with other non-invasive imaging modalities,including MR elastography and shearwave elastography.Additionally,we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening.Studies have demonstrated that splenic elastography correlates well with PH severity,with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection.Splenic elastography,when combined with platelet count and LS measurements,improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding.Despite its clinical promise,technical challenges such as patient positioning,body habitus,and probe selection remain key limitations.Notably,splenic elastography may be particularly useful in diagnosing NCPH,where LS remains normal but PH is present.Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH.Its ability to predict varices,differentiate between CPH and NCPH,and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice.Future research should focus on refining SS cut-offs,evaluating its cost-effectiveness,and integrating splenic elastography into clinical guidelines for PH management.
基金Supported by the Capital’s Funds for Health Improvement and Research,No.CFH2024-1-2173State Administration of Traditional Chinese Medicine High-Level Key Disciplines Construction Project,No.zyyzdxk-2023005the Scientific Research Fund Project of Beijing Ditan Hospital,No.DTDR202403.
文摘BACKGROUND There is insufficient evidence on the evaluation of liver fibrosis in Asian indivi-duals with primary biliary cholangitis(PBC)using vibration-controlled transient elastography(VCTE).AIM To assess advanced fibrosis(AF)using liver stiffness measurement(LSM)in Chinese patients with PBC.METHODS In total,277 Chinese patients diagnosed with PBC who underwent liver biopsy and VCTE were retrospectively included and categorized into the derivation and validation cohorts.The areas under the receiver operating characteristic curves(AUROCs)with 95%confidence intervals(CIs)were used to estimate the dia-gnostic accuracy of LSM for AF(Ludwig stage≥III).Multivariable analysis was performed using logistic regression.RESULTS In the derivation cohort,VCTE accurately detected patients with AF,achieving an AUROC of 0.93(95%CI:0.88-0.96).AF was independently predicted by LSM according to multivariable analysis.AF can be excluded and confirmed using LSM cutoffs of≤10.0 and>14.5 kPa,respectively,with a sensitivity of 0.91,negative predictive value of 0.93,specificity of 0.96,positive predictive value of 0.92,and an error rate of 7.5%.The accuracy of these values was validated in an independent cohort,achieving an AUROC of 0.97(95%CI:0.90-0.99)for AF with a sensitivity of 0.89,negative predictive value of 0.88,specificity of 0.95,positive predictive value of 0.94,and error rate of 9.0%.Compared with serum fibrosis markers,the AUROC of LSM was significantly higher in both the derivation and validation cohorts.CONCLUSION VCTE has a high accuracy for assessing AF in Chinese patients with PBC in a real-world setting.
基金This study was approved by the Ethics Committee of Nippon Medical School Hospital(No.B-2022-582).
文摘BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastases and differentiate between benign and malignant tumors.AIM To investigate SWE usefulness in measuring lymph node hardness to predict metastasis presence or absence in surgically removed lymph nodes.METHODS This observational study obtained data from patients who underwent surgery for esophageal or gastric cancer at Nippon Medical School Hospital.The hardness of the surgically removed lymph nodes was measured using SWE.The lymph nodes with hardness values≥2.2 m/s were considered clinically positive for metastasis,whereas those with lower hardness values were considered clinically negative.The lymph nodes subsequently underwent pathological examination to determine the presence of metastasis,and the SWE results and pathological assessments were compared.RESULTS A total of 1077 lymph nodes were evaluated;18 and 15 cases of esophageal and gastric cancer were identified,respectively.The optimal cutoff value for lymph node size was calculated to be 5.1 mm,and the area under the curve value was 0.74(95%confidence interval:0.69-0.84).When limited to a lymph node larger than the cut off value,the SWE sensitivity and specificity for metastasis identification were 0.76 and 0.82,respectively.CONCLUSION SWE was useful in detecting lymph node metastases in the upper gastrointestinal tract.
文摘Endoscopic ultrasound-guided shear wave elastography(EUS-SWE)represents a significant advancement in non-invasive tissue characterization,enabling objective assessment of quantitative tissue stiffness in real-time with potential clinical relevance across a variety of gastrointestinal disorders.Recent developments in EUS-SWE have expanded its application beyond hepatic fibrosis to include pancreatic diseases and the evaluation of solid tumors.EUS-SWE has demonstrated diagnostic accuracy comparable to vibration-controlled transient elastography in assessing fibrosis stages,positioning it as a potential alternative to liver biopsy.Moreover,EUS-SWE has shown promise in evaluating pancreatic tissue stiffness,aiding in the diagnosis and monitoring of chronic pancreatitis and pancreatic cancer.This technique offers a distinct advantage by allowing tissue stiffness measurements during the same procedure,thereby reducing the need for additional imaging studies and biopsies.Despite its clinical potential,challenges remain,including the need for standardized protocols,optimal cutoff values,and validation across diverse patient populations.This minireview provides a comprehensive analysis of the current literature on EUS-SWE,examining its diagnostic performance,reproducibility,and limitations.Furthermore,we discuss the future directions of EUS-SWE,including its integration into routine clinical practice and its evolving role in precision medicine,emphasizing the necessity of large-scale studies to solidify its clinical utility and establish standardized guidelines for its use.
文摘BACKGROUND Fontan-associated liver disease(FALD)often occurs in patients with single-ventricle physiology following Fontan surgery,and ranges from liver congestion to cirrhosis.The assessment of the severity of FALD using noninvasive methods is challenging.However,transient elastography(TE)may be useful for the non-invasive evaluation of FALD and prediction of clinical outcomes.AIM To evaluate the role of TE in the diagnosis of FALD and its association with clinically relevant events.METHODS This retrospective single-center study(Hospital Universitario La Paz,Madrid),including 91 post-Fontan patients aged>18 years old.Laboratory and ultrasound findings,and liver stiffness measurements(LSM)by TE(FibroScan®)were assessed.FALD was defined using ultrasound criteria hepatomegaly,liver surface nodularity,parenchymal heterogeneity,hyperechoic lesions,spleno-RESULTS Patient characteristics were:60.4%male;Mean age,33.3±8.2 years;Mean elapsed time since surgery,24.3±7.7 years;89%with FALD;73%with advanced FALD.LSM by TE was associated with FALD[odds ratio(OR)=1.34;95%confidence interval(95%CI):1.10-1.64;P=0.003]and advanced FALD(OR=1.10;95%CI:1.01-1.19;P=0.023).Areas under the curve(AUC)were 0.905 and 0.764 for FALD and advanced FALD,respectively.FALD cut-off values comprised:Optimal,20 kPa(sensitivity:92.3%;specificity:80.0%);Rule-out,15 kPa(sensitivity:96.9%);Rule-in,25 kPa(specificity:100%).A FALD algorithm was proposed based on LSM by TE and elapsed time since surgery(AUC:0.877;sensitivity,95.4%;specificity,80.0%;positive predictive value,96.9%;negative predictive value,72.7%).LSM by TE was associated with clinically relevant events(OR=1.07;95%CI:1.01-1.13;P=0.021)and all-cause mortality(OR=1.23;95%CI:1.02-1.47;P=0.026).CONCLUSION In adult patients post-Fontan surgery,TE is a useful noninvasive method for FALD diagnosis.The association between LSM by TE and clinically relevant events suggests a role in prognosis.
基金Medical and Health Research Projects of Health Commission of Zhejiang Province,No.2022KY040 and No.2023KY472Zhejiang Provincial Natural Science Foundation of China,No.LTGY24H180017.
文摘In this article,we comment on the article by Cheng et al published in recently.Posthepatectomy liver failure(PHLF)remains a leading cause of hepatectomyrelated mortality and can be evaluated according to liver reserve function.Liver stiffness(LS)measured by ultrasonic elastography and spleen area demonstrate a strong correlation with hepatic proliferation,fibrosis,and portal vein congestion,thus indirectly reflecting liver reserve function.This article highlights a meticulous study aimed at investigating the potential of two-dimensional shear wave elastography in assessing LS,as well as its integration with spleen area,surgical factors,and laboratory indicators,for predicting the risk of PHLF in hepatocellular carcinoma patients.In this article,we discussed the non-invasive elastography modality by ultrasound and magnetic resonance imaging to assess LS.Based on literature data,we subsequently suggested that several risk factors may contribute to PHLF,including excessive intrahepatic neutrophil accumulation,the formation of neutrophil extracellular traps,end-stage liver disease scores,and albumin-bilirubin scores.Therefore,a more comprehensive study incor-porating detailed information requires further investigation.
文摘BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.
文摘BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.AIM To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.METHODS We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019.We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging.Liver imaging findings(hepatic steatosis,increased echogenicity,cirrhosis,and chronic liver disease)were further evaluated for their diagnostic performance in detecting fibrosis(≥F2,≥F3,≥F4)and steatosis(≥S1,≥S2,≥S3).RESULTS Of 959 HCV patients who underwent TE,651 had liver imaging.Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings(P=0.0050),hepatic steatosis(P<0.0001),and increased echogenicity(P<0.0001).Higher liver stiffness measurement values were also noted in those with abnormal liver(P<0.0001)and increased echogenicity(P=0.0026).Steatosis severity correlated with hepatic steatosis(r=0.195,P<0.001)and increased echogenicity(r=0.209,P<0.001).For fibrosis detection,abnormal liver imaging had moderate sensitivity(81.7%)and specificity(70.4%)for cirrhosis(≥F4),while cirrhosis on imaging had high specificity(99.2%)but low sensitivity(18.3%).Increased echogenicity showed high specificity(92.8%)but low sensitivity(20.9%)for steatosis detection.CONCLUSION Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity.Integrating TE with imaging may improve evaluation in patients with HCV.
基金Supported by the Natural Science Foundation of Shanghai,No.22ZR1458200Medical Ph.D Innovative Talent Base Project of Changning District,No.RCJD2021B09+1 种基金Key Specialty of Changning District,No.20231004Shanghai Changning Maternity and Infant Health Hospital Start-Up Project,No.2020Y-14.
文摘BACKGROUND Thyroid dysfunction during pregnancy is an important disease affecting the health of mothers and children.Two-dimensional(2D)shear wave elastography(SWE)is the newest ultrasonic elastography technology and its value in differentiating benign and malignant thyroid nodules has been widely recognized.However,the value of 2D SWE in evaluating and predicting thyroid function is unclear.AIM To explore prospectively the value of 2D SWE quantitative analysis for the evaluation of thyroid function in the first trimester.METHODS We included outpatients of reproductive age in the Department of Gynecology in Shanghai Changning Maternity and Infant Health Hospital between March 2023 and March 2024 who had conventional ultrasound examination and 2D SWE of the thyroid.They also underwent transvaginal ultrasound examination to confirm early intrauterine pregnancy and serum thyroid stimulating hormone(TSH)level was measured.The patients were divided into pregnant with normal TSH,pregnant with abnormal TSH,and nonpregnant with normal TSH.Conventional ultrasound and 2D SWE results were compared among the three groups.RESULTS A total of 108 patients were included in the study;57 in the pregnant with normal TSH group,18 in the pregnant with abnormal TSH group and 33 were in the nonpregnant with normal TSH group.Thyroid size,thyroid echotexture,2D SWE quantitative parameters including mean elasticity in the region of interest and maximal elasticity in the region of interest showed no significant differences among the three groups(P>0.05).CONCLUSION Conventional ultrasound and 2D SWE features could not reflect the level of serum TSH.
基金Sichuan Province Science and Technology Department Key Research and Development Project,No.2023YFS0473.
文摘In this article,we discuss the study by Cheng et al,published in the World Journal of Gastroenterology,focusing on predictive methods for post-hepatectomy liver failure(PHLF).PHLF is a common and serious complication,and accurate prediction is critical for clinical management.The study examines the potential of ultrasound elastography and splenic size in predicting PHLF.Ultrasound elastography reflects liver functional reserve,while splenic size provides additional predictive value.By integrating these factors with serological markers,we developed a comprehensive prediction model that effectively stratifies patient risk and supports personalized clinical decisions.This approach offers new insights into predicting PHLF.These methods not only assist clinicians in identifying high-risk patients earlier but also provide scientific support for personalized treatment strategies.Future research will aim to validate the model's accuracy with larger sample sizes,further enhancing the clinical application of these non-invasive indicators.
基金Supported by Guangdong Medical Science and Technology Research Fund Project,No.A2024475.
文摘This study explores the significance of using two-dimensional shear wave elastography(2D-SWE)to assess liver stiffness(LS)and spleen area(SPA)for predicting post-hepatectomy liver failure(PHLF).By providing a non-invasive method to measure LS,which correlates with the degree of liver fibrosis,and SPA,an indicator of portal hypertension,2D-SWE offers a comprehensive evaluation of a patient’s hepatic status.These advancements are particularly crucial in hepatic surgery,where accurate preoperative assessments are essential for optimizing surgical outcomes and minimizing complications.This letter highlights the prac-tical implications of integrating 2D-SWE into clinical practice,emphasizing its potential to improve patient safety and surgical precision by enhancing the ability to predict PHLF and tailor surgical approaches accordingly.
基金Supported by Faculty of Medicine Siriraj Hospital,Mahidol UniversityFaculty of Medicine,Thammasat Universityand University of Phayao and Thailand Science Research and Innovation Fund,No.5017/2567.
文摘BACKGROUND The association between diabetes mellitus(DM)and metabolic dysfunctionassociated steatotic liver disease(MASLD)is well documented,with DM increasing the risk of developing MASLD and liver fibrosis.AIM To evaluate the cost-effectiveness and budget impact of transient elastography(TE)for detecting significant fibrosis in Thai patients with DM.METHODS We conducted a lifetime cost-utility analysis from a societal perspective,combining a decision tree with a Markov model.Four alternatives were compared:Fibrosis-4(FIB-4)index triage followed by TE,steatosis-associated fibrosis estimator(SAFE)score triage followed by TE,standalone TE,and no screening.Clinical probabilities,utilities,and costs came from previous studies and Siriraj Hospital data.Costs and quality-adjusted life-years(QALYs)were discounted 3%annually,and incremental cost-effectiveness ratios(ICERs)were judged against the 160000-Thai baht(THB;4619 United States dollars[USD])/QALY threshold.A 5-year budget impact was evaluated from the payer perspective.RESULTS Among the screening methods evaluated,TE alone yielded the highest total lifetime costs of 200403 THB(5785 USD)and the highest QALYs of 12.81.Compared to no screening,all strategies demonstrated cost-effectiveness with ICERs of 75961,80385,and 98965 THB(2193,2321,and 2857 USD)/QALY gained for FIB-4+TE,SAFE+TE,and TE alone,respectively.Extended dominance favored SAFE+TE,yet probabilistic analysis showed FIB-4+TE had the highest cost-effectiveness probability and the smallest budget impact.Estimated annual budget impacts amounted to 470.7-755.8 million THB(13.6-21.8 million USD).CONCLUSION Implementing screening for significant fibrosis in patients with DM is cost-effective.In resource-limited settings,prioritizing the FIB-4 index as a triage tool before TE is recommended.
基金Our study used RedCap(Grant UL1TR001427.Together:Transforming and TranslatingDiscovery to Improve Health.David Nelson).
文摘Background:Patients with Fontan physiology are predisposed to congestive hepatopathy,progressive liver fib rosis,and end-stage liver disease.Ulrasound-based shear wave elastography(SWE)is a non-invasive tool to diagnose and mnonitor liver fibrosis,We sought to deternine whether the degreeof hemodynanic derangement priorto and after the Fontan operation is associated with irncreased liverstiffness measured by SWE.Methods:A single-center retrospectivestudy of patients with Pontan circulationwho underwert ultrasound elastography between 2008 and 2024 was conducted,Liver stiffness wasmeasuued by SWE and teported as vlocity in n/s.Henodynanic assessmert with catrdiac cathetaizationand echocardiograms were collected before and after the Fontan operation,Data was analyzed as acontinuous(lineat regression model)and a dichotomous variable(t-test).Results:78 pcst-Fortan ultrasoundelactography studies pt fotmedin 56 patients wee analyzed.Pre-Fontan hemnodyrnarrics ircluded medianeffective pulmonary flow of 2.45 L/min/m^(2)[2.21,3.16](p=0.46)ventricular end-diastolic pressure of10 mmHg[8,10.5](p=0.77),and median Glenn ptessue of 12 mmHg[13,15](p=0.83).Post-Fontan mediansystemnic cardiac index was 2.80 L/min/m^(2)[2.4,3.34](p=0.93),median ventricular end-diastolic pressureof 12 mmHg[13.5,14](p=0.99),median systenic saturation of 93%[87,96](p=0.77),median indexedpulmonary vasculat resistance of 1.80 WU·m^(2)[1.49,2.37](p=0.93),and median Fontan ptessue of 18 mmHg[16,21](p=0.86).No corelation was found between SWE and hemodynamics.On echoc ardiography,no correlation was found between SWE and systenic vantricular systolic function(p=0.35)or degree ofsystenic atriovertricula valve regurgitation (p=0.35).Conclusions:The degree of liver stffness by SWEinthis cohort did not correlate withpre and post-Fontan hermodynarnics on cat diac catheterization,degr ee ofverntriculat dysfuntiony or severity of atrioventriculat valve regurgitation by echocardiography.
基金supported by the National Natural Science Foundation of China(Nos.62375144 and 12404345)the Tianjin Foundation of Natural Science(No.22JCZDJC00160)+1 种基金the China Postdoctoral Science Foundation(No.2023M731787)the Fundamental Research Funds for the Central Universities,Nankai University(No.63241331).
文摘Distinguishing the severity of burned skin from structural optical coherence tomography(OCT)intensity maps remains a challenging task,and functional imaging from an elastic perspective can improve the accuracy of burned skin examination.As a functional extension of OCT,optical coherence elastography(OCE)can reveal the mechanical properties of samples while inheriting the imaging advantages of OCT.In this study,we used OCE to reveal the shear modulus and anisotropy parameters of burned skin before and after burning.A porcine skin burn model was constructed at a series of burned time durations and tested by elastic anisotropy imaging.Normal skin after hydration maintains good consistency in shear modulus.Interestingly,the shear modulus and longitudinal modulus of the burned skin show a tendency to stepwise increase with increasing burned times.A dataset was constructed by sampling the modulus parameters of burned skin maps through a scratch window,and its category was automatically identi¯ed by Kmeans and density peak clustering(DPC)algorithms with good agreement.The elastic anisotropy-based skin burn assessment method shows a prospect to be supplemented into the nondestructive means of burned skin examination.
文摘Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.
文摘Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks(inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis(serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasoundbased elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography(TE) and acoustic radiation force impulse(ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shearwave elastography, the Elast PQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.
文摘BACKGROUND Few systematic comparative studies of the different methods of physical elastography of the spleen are currently available.AIM To compare point shear wave and two-dimensional elastography of the spleen considering the anatomical location(upper,hilar,and lower pole).METHODS As part of a prospective clinical study,healthy volunteers were examined for splenic elasticity using four different ultrasound devices between May 2015 and April 2017.The devices used for point shear wave elastography were from Siemens(S 3000)and Philips(Epiq 7),and those used for two-dimensional shear wave elastography were from GE(Logiq E9)and Toshiba(Aplio 500).In addition,two different software versions(5.0 and 6.0)were evaluated for the Toshiba ultrasound device(Aplio 500).The study consisted of three arms:A,B,and C.RESULTS In study arm A,200 subjects were evaluated(78 males and 122 females,mean age 27.9±8.1 years).In study arm B,113 subjects were evaluated(38 men and 75 women,mean age 26.0±6.3 years).In study arm C,44 subjects were enrolled.A significant correlation of the shear wave velocities at the upper third of the spleen(r=0.33088,P<0.0001)was demonstrated only for the Philips Epiq 7 device compared to the Siemens Acuson S 3000.In comparisons of the other ultrasound devices(GE,Siemens,Toshiba),no comparable results could be obtained for any anatomical position of the spleen.The influencing factors age,gender,and body mass index did not show a clear correlation with the measured shear wave velocities.CONCLUSION The absolute values of the shear wave elastography measurements of the spleen and the two different elastography methods are not comparable between different manufacturers or models.
