Objective To understand and analyze technique development of magnetic resonance elastography (MRE) and its application in chronic liver disease. Method The relevant literatures about the application of MRE in the field of chronic liver disease were reviewed. Results The liver fibrosis was a common pathway of chronic liver disease, which would progress to cirrhosis of the liver if untreated. The diagnosis and assessment of fibrosis was important in the treatment of patients with chronic liver disease. The liver biopsy was considered to be the reference standard for clinical assessment of liver fibrosis. However, this technique was invasive and still had inevitable drawbacks in the clinical practice. With the update of the imaging technology and equipment, the MRE had been developed as a safe and noninvasive examination method for the evaluation of liver fibrosis in the chronic liver disease, early diagnosis of nonalcoholic fatty liver disease, evaluation of focal liver lesions, and other clinical applications. Conclusion MRE is currently regarded as an attractive noninvasive technique in management of chronic liver disease.
Objective To evaluate the diagnostic value of conventional ultrasound, ultrasound elastography and their combination in benign and malignant breast nodules using meta-analysis. Methods The English databases (EMBASE, PubMed, Cochrane Library) and Chinese databases (China Biomedical Literature Database, China HowNet, VIP, Wanfang Database) were searched to collect the Chinese and English literatures about the diagnostic value of conventional ultrasound and elastography in differentiating the benign and malignant breast lesions up to April 20, 2021, the reviewers strictly followed the inclusion and exclusion criteria to screen the literature, extract the data and conduct quality assessment. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and 95%CI were calculated by using meta-DiSc1.4 software for heterogeneity analysis and data combining analysis. The forest map and receiver operating characteristic (ROC) curve was drew, and the area under the ROC curve was calculated. StataSE14.0 software was used to draw deek funnel plot to evaluate publication bias, and Fagan’s nomogram was used to evaluate the clinical utility of each test method. Results A final selection of 42 articles involving 6 009 nodules in 5 118 patients was included. The sensitivity for conventional ultrasound, elastosonography and two techniques combination was 0.80 [95%CI (0.79, 0.82)], 0.87 [95%CI (0.86, 0.89)] and 0.93 [95%CI (0.91, 0.94)], respectively; with specificity of 0.75 [95%CI (0.73, 0.76)], 0.85 [95%CI (0.84, 0.86)] and 0.94 [95%CI (0.93, 0.95)]. The summery area under curve was 0.86, 0.94 and 0.98, respectively. There were significant differences in the diagnostic efficiency among the three groups（all P<0.05）. The Deek’s funnel plot showed no significant publication bias (all P>0.05). The pre-testprobability of conventional ultrasound, elastosonography and two techniques combination were both 20%, and the post-testprobability were 49%, 66%, and 82%, respectively. Conclusions The accuracy of elastography in distinguishing benign from malignant breast nodule is relatively high, while the accuracy of benign and malignant nodules in conventional ultrasound is generally acceptable. However, the accuracy of the combination of the two is higher, which is worthy of clinical application.
Objective To analyze the diagnostic value of shear wave elastography (SWE) combined with vascular endothelial growth factor B (VEGF-B) and hemoglobin A1c (HbA1c) in early diabetic peripheral neuropathy (DPN). Methods A total of 100 patients with type 2 diabetes mellitus (T2DM) admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group (n=31) and a T2DM without DPN group (n=69) based on the presence or absence of DPN. Additionally, 50 healthy individuals from the same hospital’s health examination center were included as a healthy control group. The basic clinical characteristics, mean elasticity (Emean) values of the left and right median and tibial nerves, serum VEGF-B, and HbA1c levels were compared among the three groups. The diagnostic efficacy of SWE, VEGF-B, and HbA1c for DPN was evaluated using receiver operating characteristic (ROC) curves, and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve Emean and VEGF-B/HbA1c. Results The Emean values of the left and right median nerves, Emean values of the left and right tibial nerves, serum VEGF-B, and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group (P<0.05). The Emean values of the left and right median and tibial nerves, Emean values of the left and right tibial nerves, and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group (P<0.05), while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group (P>0.05). The area under the ROC curve for the combined diagnosis of DPN using SWE, VEGF-B, and HbA1c was 0.859 [95% confidence interval (0.828, 0.955)]. The sensitivity of the combined diagnosis (93.72%) was significantly higher than that of individual diagnoses (78.82%, 75.39%, and 71.05%, respectively; P<0.05), while the specificity (88.64%) showed no significant difference compared to individual diagnoses (80.18%, 78.96%, and 82.88%, respectively; P>0.05). Positive correlations were observed between median/tibial nerve Emean and VEGF-B/HbA1c levels (r=0.428, 0.395, 0.416, and 0.416, respectively; P<0.05). Conclusions Elevated median/tibial nerve Emean, serum VEGF-B, and HbA1c levels are closely associated with DPN. The combination of SWE, VEGF-B, and HbA1c improves diagnostic sensitivity for DPN, demonstrating significant clinical value.
ObjectiveTo systematically review the diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer.MethodsWe electronically searched the databases including The Cochrane Library, PubMed, CNKI, WanFang Data, VIP, MedaLink and CBM for studies about diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then meta-analysis was performed using MetaDisc 1.4 software.ResultsA total of 9 studies involving 735 lymph nodes were included. The results of meta-analysis showed that, the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio and DOR were 0.82 (95%CI 0.78 to 0.86), 0.76 (95%CI 0.72 to 0.81), 3.32 (95%CI 2.57 to 4.27), 0.25 (95%CI 0.20 to 0.31), and 14.77 (95%CI 10.20 to 21.38), respectively. The AUC of the SROC curve was 0.8741.ConclusionUltrasonographic elastography has high sensitivity and specificity in the differential diagnosis of axillary lymph nodes in breast cancer, which indicates that it can be used to diagnosis axillary lymph nodes in breast cancer.
ObjectiveTo explore the diagnostic value of ultrasound elastography (USE) combined with long non-coding RNA actin filament associated protein 1 anti-sense RNA 1 (AFAP1-AS1) mRNA in thyroid fine-needle aspiration (FNA) wash-out fluid for distinguishing benign from malignant thyroid nodules. MethodsThe patients with thyroid nodules who were treated in the Shenzhen Futian District Second People’s Hospital from January 2020 to June 2022 were collected. Before operation, the patients’ thyroid nodules were evaluated by the USE score and the AFAP1-AS1 mRNA in the thyroid FNA wash-out fluid was detected. The pathological result of the thyroid nodule after operation was as a gold standard for diagnosis of malignant thyroid nodules. The clinical diagnostic value of USE score combined with AFAP1-AS1 mRNA in the FNA wash-out fluid of the benign and malignant thyroid nodules were analyzed. ResultsA total of 174 thyroid nodules (124 patients) were detected in this study, of which 62 (45 patients) were histologically diagnosed as malignant. There was a statistical difference in the comparison of the composition ratio of USE score grading between the benign and malignant thyroid nodules (Z=8.82, P<0.001). The point of USE of the benign thyroid nodules was statistically lower than that of the malignant thyroid nodules [2.28±1.16 vs. 4.26±1.01, mean difference (MD) and 95% confidence interval (95%CI)=2.98 (2.76, 3.20), t=30.85, P<0.001]. The AFAP1-AS1 mRNA in the FNA wash-out fluid of the malignant thyroid nodules was statistically higher than that of the benign thyroid nodules [1.45±0.27 vs. 1.13±0.16, MD (95%CI)=1.45(1.39, 1.50), t=10.69, P<0.001]. Pearson correlation analysis showed that there was a positive correlation between the USE score of thyroid nodules and the expression of AFAP1-AS1 mRNA in the FNA wash-out fluid (r=0.58, P<0.001). The sensitivity and specificity of USE score in combination with expression of AFAP1-AS1 mRNA in the FNA wash-out fluid for diagnosing the malignant thyroid nodules by receiver operating characteristic (ROC) curve was 93.5% and 88.4% respectively. The area under the ROC curve (95%CI) was 0.91 (0.86, 0.96). Conclusion According to preliminary results of this study, USE score combined with AFAP1-AS1 mRNA in the thyroid FNA wash-out fluid is more sensitive and shows a potential diagnostic performance than USE score or AFAP1-AS1 mRNA detection alone for distinguishing benign from malignant thyroid nodules.
ObjectiveTo explore the value of ultrasound real-time tissue elastography in the differential diagnosis between benign and malignant breast lesions.Methods A total of 131 cases of patients with breast lesions who underwent ultrasound examination in the People’s Hospital of Guangan City between December 2010 and December 2015 were enrolled as the research object. The patients took conventional color Doppler ultrasound diagnosis firstly, and then took ultrasound real-time tissue elastography diagnosis. The lesions were scored with improved 5-scoring system respectively. By the strain ratio measure method equipped with the ultrasonic machine, strain ratio of the lesion was calculated, with 3.08 as the cut-off pont. The results were campared with the pathologic diagnosis.ResultsThere were 182 breast lumps in the 131 patients. The conventional ultrasound examination detected 128 benign lesions and 54 malignant lesions. By ultrasound real-time tissue elastography examination, there were 121 benign tumors and 61 malignant tumors. For the benign tumors, the elasticity imaging score was 1.74±0.81, and the elastic strain rate ratio was 1.83±1.22; for the malignant tumors, the elasticity imaging score was 4.45±0.59, and the elastic strain rate ratio was 8.68±5.58. The 182 breast lumps were all removed by surgical resection, and the pathologic examination showed there were 121 benign lesions and 61 malignant lesions. The accuracy, sensitivity and specificity of conventional ultrasonic diagnosis of breast malignant lesions was 76.4%, 59.0% and 85.1%, respectively; while the indexes of ultrasound real-time tissue elastography diagnosis of breast malignant lesions was 96.7%, 95.1% and 97.5%, respectively, and the differences were statistically significant (P<0.05).ConclusionReal-time tissue elastography is helpful in the differential diagnosis between malignant and benign breast lesions.
Objective To compare differences of characteristics of ultrasonic elasticity imaging for benign and malignant small thyroid nodules with or without Hashimoto thyroiditis (HT). Methods The thyroid nodules with ≤1 cm size and the category 4A, 4B, 4C, and 5 of Thyroid Imaging Reporting and Data System (TI-RADS) were included into this study, and a further examination of real-time elastography was performed. The final diagnosis was relied on the pathological diagnosis. The elasticity score and strain ratio (SR) were recorded and compared between these two groups, respectively. Results Of the 424 nodules, 103 nodules were accompanied with HT (thyroid nodule with HT group), 321 nodules were not accompanied with HT (thyroid nodule without HT group). In the thyroid nodule with HT group, the area under the receiver operator characteristic (ROC) curve (AUCs) of the elasticity score and the SR was 0.685 and 0.676, respectively; the optimal cut offs of the elasticity score and the SR was 3 points and 2.45 respectively, their corresponding sensitivity, specificity, and accuracy was 75.7%, 57.6%, 68.0% and 75.7%, 60.6%, 67.6%, respectively. In the thyroid nodule without HT group, the AUCs of the elasticity score and the SR was 0.692 and 0.692, respectively; the optimal cut offs of the elasticity score and the SR was 4 points and 2.84, respectively; their corresponding sensitivity, specificity, and accuracy was 57.5%, 74.2%, 69.2% and 76.1%, 59.7%, 67.7%, respectively. Conclusions Elastography is helpful in differential diagnosis of benign and malignant small thyroid nodules. While, standards of elasticity score and SR value in differential diagnosis are different between benign and malignant small thyroid nodules with HT and without HT, elasticity score and SR ratio decrease in benign and malignant small thyroid nodules with HT.
Objective To evaluate the security and validity of the acute extreme hypervolemic hemodilution (AEHH) in spine surgery. Methods Thirteen patients(8 males, 5 females; age, 16-65 years; weight, 50-75 kg) who had undergone major spine operations were enrolled in this study. Eleven of them had undergone anterior decompression, who were given the grafting and the internal fixation for their thoracolumber spinal burst fractures; the other 2 patients were given the correction operation for their scoliosis. The baselines of the haematocrit (Hct）were 0.363-0.481 before operation. The patients had no cardiac, pulmonary, hepatic or renal dysfunction or coagulation abnormality. The hemodynamic status and the haematocrit were observed during operation. The parameters of thromboelastography (TEG)，arterial blood gas, and electrolytes were measured and observed at the following time points: before AEHH, after AEHH, 60 minutes after AEHH, 120 minutes after AEHH, and the end of the operation. The total fluid volume was recorded. Results The autologous blood volume was1 050-1 575 ml (average,1 419±198 ml), plasma substitute 2 100-3 150 ml (average,2 838±397 ml), blood loss1 000-3 130 ml (average, 1 747±743 ml), urine 450-1 270 ml (average, 871±374 ml), and the net blood transfusion 1 206-2 661 ml(1 863±598 ml). The homogenous blood of 400 ml was transfused in 1 patient for making upthe blood loss of 3 130 ml. There were no statistically significant differencesin the hemodynamic measurements, arterial blood gas, and electrolyte variables when compared with the baseline values before the hemodilution (Pgt;0.05). The reaction time of TEG was longer 60 minutes after AEHH than before AEHH (Plt;0.05); the other parameters of TEG had no differences when compared with the baseline values (Pgt;0.05). Conclusion The AEHH is safe and efficient in reduction of the perioperative homogenous blood transfusion in spine surgery.
ObjectiveTo explore value of ultrasound real-time elastography (RTE) technology for identification of benign and malignant solid thyroid nodules.MethodsA retrospective analysis was performed on 125 patients with thyroid nodules who underwent ultrasound RTE in this hospital from February 2018 to August 2019. All patients underwent RTE on the basis of conventional ultrasound. The ultrasound elasticity contrast index (ECI) was used as the evaluation index and the pathological examination result was used as the gold standard. The receiver operating characteristic (ROC) curve analysis was used to evaluate the value of ECI in the identification of benign and malignant solid thyroid nodules. Logistic regression analysis was used to analyze the influencing factors of ECI.ResultsAmong the 125 patients with solid thyroid nodules, 51 were malignant nodules, 74 were benign nodules. The ECI value of patients with benign thyroid nodules was lower than that of patients with malignant nodules (2.71±0.83 versus 3.42±1.14, t=–4.030, P<0.001). The result of ROC analysis showed that the cutoff value of ECI to distinguish benign and malignant solid thyroid nodules was 3.07, area under curve of ROC was 0.806 [95%CI (0.717, 0.894), P<0.001], sensitivity was 80.3%, specificity was 70.4%. The multivariate logistic regression analysis showed that the thyroid nodules with diffuse lesions, calcification, and maximum nodule diameter ≥1 cm were the risk factors for elevated ECI values (P<0.05). For the solid thyroid nodules without diffuse lesions, without calcification, and maximum nodule diameter <1 cm, ECI had the higher sensitivity, specificity, accuracy, and positive predictive value for the differential diagnosis of benign and malignant thyroid nodules (all exceed 80%), but these indexes were lower (under 60%) for the differential diagnosis of solid thyroid nodules with diffuse diseases, with calcification, and maximum nodule diameter ≥1 cm.ConclusionsECI obtained by ultrasound RTE can be used to differentiate solid thyroid nodules from benign ones. The presence or absence of diffuse lesions, calcification, and maximum nodule diameter are the influencing factors for ECI to differentiate solid thyroid nodules. In clinical diagnosis, it should be paid attention to the comprehensive analysis of the above factors.
ObjectiveTo study the Young's modulus obtained by the real-time shear wave elastography (SWE) in healthy adults' parotid gland and submaxillary gland and to explore the probable factors affecting the Young's modulus, such as bilateral parotid and submaxillary gland, sex, age, height and weight. MethodsThere were 35 healthy volunteers who underwent SWE in parotid gland and submaxillary gland between December 3 and 18, 2013. The difference of Young's modulus in bilateral parotid and submaxillary gland, and the modulus values of different sex, age, height and weight groups were also compared. ResultsThe Young's modulus of parotid gland was (8.14±1.78) kPa, and the Young's modulus of submaxillary gland was (11.52±2.34) kPa. The differences of Young's modulus between the two sides of parotid gland and submaxillary gland were not statistically significant (P>0.05); the differences of Young's modulus of parotid and submaxillary gland between different sex, age, height and weight groups had no statistical significance, either (P>0.05). ConclusionThe real-time shear wave elastography can be applied to evaluate the elasticity of parotid and submaxillary gland and to lay the foundation for further diagnosis of salivary lesions.