Evaluation of the Stiffness of Thyroid Parenchyma With Shear Wave Elastography Using a Free–Region of Interest Technique in Graves Disease

2020 ◽  
Author(s):  
Abidin Kılınçer ◽  
Mehmet Sedat Durmaz ◽  
Süleyman Baldane ◽  
Cem Onur Kıraç ◽  
Hakan Cebeci ◽  
...  
Keyword(s):  
Shear Wave ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Graves Disease ◽  
Free Region ◽  
Thyroid Parenchyma

scholarly journals 2D-Shear Wave Elastography in the Evaluation of Parathyroid Lesions in Patients with Hyperparathyroidism

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ioana Golu ◽  
Ioan Sporea ◽  
Lavinia Moleriu ◽  
Anca Tudor ◽  
Marioara Cornianu ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Shear Wave ◽  
Thyroid Tissue ◽  
Shear Wave Elastography ◽  
Study Groups ◽  
Tertiary Hyperparathyroidism ◽  
A Value ◽  
Parathyroid Lesions ◽  
The Mean ◽  
Thyroid Parenchyma

Background and Aims. 2D-shear wave elastography (2D-SWE) is a relatively new elastographic technique. The aim of the present study is to determine the values of the elasticity indexes (EI) measured by 2D-SWE in parathyroid benign lesions (adenomas or hyperplasia) and to establish if this investigation is helpful for the preoperative identification of the parathyroid adenoma. Material and Methods. The study groups were represented by 22 patients with primary or tertiary hyperparathyroidism, diagnosed by specific tests, and 43 healthy controls, in whom the thyroid parenchyma was evaluated, in order to compare the EI of the thyroid tissue with those of the parathyroid lesions. Results. The mean EI measured by 2D-SWE in the parathyroid lesions was 10.2 ± 4.9 kPa, significantly lower than that of the normal thyroid parenchyma (19.5 ± 7.6 kPa; p=0.007), indicating soft tissue. For a cutoff value of 12.5 kPa, the EI assessed by 2D-SWE had a sensitivity of 93% and a specificity of 86% (AUC = 0.949; p<0.001) for predicting parathyroid lesions. Conclusion. A value lower than 12.5 kPa for the mean EI measured by 2D-SWE can be used to confirm that the lesion/nodule is a parathyroid adenoma.

scholarly journals Influencing Factors of 2D Shear Wave Elastography of the Muscle – An Ex Vivo Animal Study

2018 ◽  
Vol 04 (02) ◽  
pp. E54-E60 ◽  
Author(s):  
Marga Rominger ◽  
Pascal Kälin ◽  
Monika Mastalerz ◽  
Katharina Martini ◽  
Volker Klingmüller ◽  
...  
Keyword(s):  
Shear Wave ◽  
Ex Vivo ◽  
Operation Mode ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Longitudinal Direction ◽  
Test Configuration ◽  
Linear Probe ◽  
The Impact ◽  
Placement Depth

AbstractTo evaluate measurement confounders on 2D shear wave elastography (2D-SWE) elastography of muscle. Ex vivo, porcine muscle was examined with a GE LOGIQ E9 ultrasound machine with a 9 L linear (9 MHz) and C1-6 convex probe (operating at 2.5 or 6 MHz). The influence of different confounders on mean shear wave velocity (SWVmean) was analyzed: probes, pressure applied by probe, muscle orientation, together with the impact of different machine settings such as frequency, placement depth and size of region of interest (ROI). The mean of twelve repeated SWVmean measurements (m/s) and coefficient of variation (CV; standard deviation/mean in %) were assessed for each test configuration. Reproducibility (CV) and maximum possible tissue depth of the linear probe were inferior to the convex probe. With the linear probe, there was a linear decrease of SWVmean with placement depth from 4.56 m/s to 1.81 m/s. A significant increase of SWVmean (p<0.001) was observed for larger ROI widths (range 3.96 m/s to 6.8 m/s). A change in the machine operation mode ('penetration' instead of 'general') led to a significant increase of SWVmean (p=0.04). SWVmean in the longitudinal direction of muscle was significantly higher than in cross section (p<0.001) (e. g. 4.56 m/s versus 3.42 m/s). An increase of linear probe pressure significantly increased muscle SWVmean from 5.29 m/s to 7.21 m/s (p<0.001). 2D-SWE of muscle is influenced by a wealth of parameters. Therefore, standardization of measurement is advisable before application in clinical research studies and routine patient assessment.

scholarly journals Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 795
Author(s):  
Mauro Giuffrè ◽  
Michela Giuricin ◽  
Deborah Bonazza ◽  
Natalia Rosso ◽  
Pablo José Giraudi ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Shear Wave ◽  
Predictive Value ◽  
Liver Stiffness ◽  
Positive Likelihood Ratio ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Limiting Factor ◽  
Obese Patients ◽  
The Impact

Background: Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy. Materials and Methods: 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs: <5.7 kPa, F0–1; 5.7–7.99 kPa, F2; ≥8 kPa, F3–4. Results: We developed two logistic regression models using elastography–histology agreement (EHA) as the dependent variable and SLD as the independent variable. The model based on the second machine showed strongly more performant discriminative and calibration metrics (AIC 38.5, BIC 44.2, Nagelkerke Pseudo-R2 0.894, AUROC 0.90). The SLD cut-off value of 34.5 mm allowed a correct EHA with a sensitivity of 100%, a specificity of 93%, negative predictive value of 100%, positive predictive value of 87%, an accuracy of 96%, and positive likelihood ratio of 3.56. Conclusion: The impact of SLD is machine-dependent and should be taken into consideration when interpreting LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in obese patients.

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo(New Corresponding Author) ◽  
Hye Jeong Kim(Former Corresponding Author) ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it shows a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy remains unclear. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (E Mean , p<0.001; E Max , p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a valuable and standardized method in clinical practice. Moreover, our results showed that fibrosis in the histopathology increased EI on SWE and might lead to the discrepancy of the cut-off values in detecting thyroid cancer.

scholarly journals Shear Wave Elastography versus Strain Elastography in Diagnosing Parathyroid Adenomas

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Laura Cotoi ◽  
Daniela Amzar ◽  
Ioan Sporea ◽  
Andreea Borlea ◽  
Dan Navolan ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Shear Wave ◽  
Muscle Tissue ◽  
Thyroid Tissue ◽  
Shear Wave Elastography ◽  
Strain Ratio ◽  
Strain Elastography ◽  
Parathyroid Adenomas ◽  
The Mean ◽  
Thyroid Parenchyma

Objectives. The aim of the study was to compare elastographic means in parathyroid adenomas, using shear wave elastography and strain elastography. Methods. This prospective study examined 20 consecutive patients diagnosed with primary hyperparathyroidism and parathyroid adenoma, confirmed by biochemical assay, technetium-99 sestamibi scintigraphy, and pathology report, after parathyroid surgery. All patients were examined on conventional 2B ultrasound, 2D shear wave elastography, and strain elastography. We determined using 2D shear wave elastography (SWE) the elasticity index (EI) in parathyroid adenoma, thyroid parenchyma, and surrounding muscle and examined using strain elastography the parathyroid adenoma, and determined the strain ratio with the thyroid tissue and muscle tissue. Results. All patients had positive sestamibi scintigraphy and underwent surgery, with confirmation of parathyroid adenoma in all cases. The mean parathormone (PTH) value before surgery was 153.29 pg/ml (36.5, 464.8) and serum calcium concentration was 10.5 mg/dl (9, 11.5). We compared using 2D-SWE and strain elastography parathyroid adenoma with thyroid tissue and with surrounding muscle. The mean EI measured by SWE in parathyroid adenoma was 4.74 ± 2.74 kPa and in thyroid parenchyma was 11.718 ± 4.206 kPa (mean difference = 6.978 kPa, p<0.001), and the mean EI value in muscle tissue was 16.362 ± 3.829 kPa (mean difference = 11.622, p<0.001). Using ROC analysis, we found that an EI below 7 kPa correctly identifies parathyroid tissue. We evaluated parathyroid adenomas using strain elastography by color mapping and strain ratio as a semiquantitative measurement; however, we could not find any statistical correlation comparing the strain ratio obtained from the parathyroid adenoma with the thyroid tissue (p=0.485). Conclusion. Ultrasound elastography is a helpful tool in identifying parathyroid adenomas. A cutoff value below 7 kPa can be used in 2D-SWE. Color maps in strain elastography without adding strain ratio can be used, parathyroid adenoma being identified as score 1 in the Rago criteria.

Performance of shear-wave elastography for breast masses using different region-of-interest (ROI) settings

2017 ◽  
Vol 59 (7) ◽  
pp. 789-797 ◽  
Author(s):  
Ji Hyun Youk ◽  
Eun Ju Son ◽  
Kyunghwa Han ◽  
Hye Mi Gweon ◽  
Jeong-Ah Kim
Keyword(s):  
Standard Deviation ◽  
Receiver Operating Characteristic ◽  
Shear Wave ◽  
Roc Curve ◽  
Diagnostic Performance ◽  
Operating Characteristic ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Breast Masses ◽  
The Mean

Background Various size and shape of region of interest (ROI) can be applied for shear-wave elastography (SWE). Purpose To investigate the diagnostic performance of SWE according to ROI settings for breast masses. Material and Methods To measure elasticity for 142 lesions, ROIs were set as follows: circular ROIs 1 mm (ROI-1), 2 mm (ROI-2), and 3 mm (ROI-3) in diameter placed over the stiffest part of the mass; freehand ROIs drawn by tracing the border of mass (ROI-M) and the area of peritumoral increased stiffness (ROI-MR); and circular ROIs placed within the mass (ROI-C) and to encompass the area of peritumoral increased stiffness (ROI-CR). Mean (Emean), maximum (Emax), and standard deviation (ESD) of elasticity values and their areas under the receiver operating characteristic (ROC) curve (AUCs) for diagnostic performance were compared. Results Means of Emean and ESD significantly differed between ROI-1, ROI-2, and ROI-3 ( P < 0.0001), whereas means of Emax did not ( P = 0.50). For ESD, ROI-1 (0.874) showed a lower AUC than ROI-2 (0.964) and ROI-3 (0.975) ( P < 0.002). The mean ESD was significantly different between ROI-M and ROI-MR and between ROI-C and ROI-CR ( P < 0.0001). The AUCs of ESD in ROI-M and ROI-C were significantly lower than in ROI-MR ( P = 0.041 and 0.015) and ROI-CR ( P = 0.007 and 0.004). Conclusion Shear-wave elasticity values and their diagnostic performance vary based on ROI settings and elasticity indices. Emax is recommended for the ROIs over the stiffest part of mass and an ROI encompassing the peritumoral area of increased stiffness is recommended for elastic heterogeneity of mass.

scholarly journals Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma

2019 ◽  
Vol 8 (8) ◽  
pp. 1195-1205 ◽  
Author(s):  
Kristine Zøylner Swan ◽  
Steen Joop Bonnema ◽  
Marie Louise Jespersen ◽  
Viveque Egsgaard Nielsen
Keyword(s):  
Diagnostic Accuracy ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Thyroid Malignancy ◽  
Operating Characteristics ◽  
Factors Affecting ◽  
Benign Nodules

Thyroid nodular disease is common, but predicting the risk of malignancy can be difficult. In this prospective study, we aimed to assess the diagnostic accuracy of shear wave elastography (SWE) in predicting thyroid malignancy. Patients with thyroid nodules were enrolled from a surgical tertiary unit. Elasticity index (EI) measured by SWE was registered for seven EI outcomes assessing nodular stiffness and heterogeneity. The diagnosis was determined histologically. In total, 329 patients (mean age: 55 ± 13 years) with 413 thyroid nodules (mean size: 32 ± 13 mm, 88 malignant) were enrolled. Values of SWE region of interest (ROI) for malignant and benign nodules were highly overlapping (ranges for SWE-ROImean: malignant 3–100 kPa; benign 4–182 kPa), and no difference between malignant and benign nodules was found for any other EI outcome investigated (P = 0.13–0.96). There was no association between EI and the histological diagnosis by receiver operating characteristics analysis (area under the curve: 0.51–0.56). Consequently, defining a cut-off point of EI for the prediction of malignancy was not clinically meaningful. Testing our data on previously proposed cut-off points revealed a low accuracy of SWE (56–80%). By regression analysis, factors affecting EI included nodule size >30 mm, heterogeneous echogenicity, micro- or macrocalcifications and solitary nodule. In conclusion, EI, measured by SWE, showed huge overlap between malignant and benign nodules, and low diagnostic accuracy in the prediction of thyroid malignancy. Our study supports that firmness of thyroid nodules, as assessed by SWE, should not be a key feature in the evaluation of such lesions.

scholarly journals Evaluation of parenchymal vascularity of the thyroid gland with vascularization index by color superb microvascular imaging in patients with Graves’ disease

2021 ◽  
Vol 21 (84) ◽  
pp. e41-e47
Author(s):  
Abidin Kılınçer ◽  
◽  
Mehmet Sedat Durmaz ◽  
Cem Onur Kıraç ◽  
Süleyman Baldane ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Region Of Interest ◽  
Clinical Findings ◽  
Graves Disease ◽  
Asymptomatic Group ◽  
Free Region ◽  
Superb Microvascular Imaging ◽  
Index Value ◽  
Microvascular Imaging ◽  
Vascularization Index

Aim of the study: To determine the parenchymal vascularity of the thyroid gland with color superb microvascular imaging in patients with Graves’ disease, and compare the vascularization index values with healthy subjects. Materials and methods: The thyroid glands of 37 patients whose laboratory and clinical findings were consistent with Graves’ disease, and 40 asymptomatic subjects with normal laboratory values, were examined using color superb microvascular imaging. Measurements of the vascularization index were performed with a free region of interest which was drawn along the outer margin of the gland on the color superb microvascular imaging mode. The vascularization index values obtained in the Graves’ disease and control groups were compared. A correlation analysis was performed between the vascularization index values and laboratory and grayscale US parameters. Results: The median vascularization index value of the thyroid parenchyma in patients with Graves’ disease was significantly higher than in the asymptomatic group [median (min–max); 12 (2.3–32.1) vs 5.04 (1.1–10.8), p <0.001]. When the cutoff value of the vascularization index is determined as 6.3, Graves’ disease can be diagnosed with 83.8% sensitivity and 70% specificity. Conclusions: The vascularization index obtained with color superb microvascular imaging can be a quantitative indicator of parenchymal vascularity in the diagnosis of Graves’ disease, and serve as a supportive tool.

scholarly journals The role of shear wave elastography in the diagnosis of chronic autoimmune thyroiditis

2015 ◽  
Vol 17 (3) ◽  
pp. 322 ◽  
Author(s):  
Koray Hekimoglu ◽  
Fuldem Yildirim Donmez ◽  
Serdar Arslan ◽  
Adnan Ozdemir ◽  
Canan Demir ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Shear Wave ◽  
Predictive Value ◽  
Shear Wave Elastography ◽  
Treatment Monitoring ◽  
Study Group ◽  
Chronic Autoimmune Thyroiditis ◽  
Thyroid Parenchyma ◽  
Made In

Aims: The aim of this study is to assess the applicability of shear wave elastography (SWE) in the diagnosis of chronic autoimmun thyroiditis (CAT) patients. Material and methods: The study group consisted of 50 patients with first-diagnosed CAT and 40 control subjects (CS). In all patients with CAT and CS, sonoelastographic measurements were made in both thyroid lobes. Optimal cut-off values were chosen to maximize the sum of sensitivity and specificity. Positive predictive value (PPV), negative predictive value (NPV), and accuracy values were also calculated. Results: Quantitative elastographic analysis evaluated by SWE in CAT patients (2.56 ± 0.30 m/s) was significantly higher compared  with CS (1.63 ± 0.12 m/s) (p<0.001). The optimal cut-off value was 2.42 m/s. SWE had 77% sensitivity, 71% specificity, 92% PPV, 81% NPV, and 87% accuracy for the presence of CAT. Conclusions: Our data indicate that SWE correctly defines the elasticty of thyroid parenchyma, and this technique may assist in the diagnosis and treatment monitoring of CAT.

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