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Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 9400

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Dr. Murad Hossain

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Guest Editor

Biomedical Engineering Department, Columbia University, 630 West 168 Street, P&S 19-418, New York, NY 10032, USA
Interests: viscoelasticity imaging; anisotropy; ARFI; shear wave; breast cancer; kidney dysfunction

Special Issue Information

Dear Colleagues,

Over the last three decades, different ultrasound elastographic methods for interrogating the mechanical properties of tissue have been developed and applied in clinical diagnostic and therapeutic applications. Ultrasound elastography-based methods are favorable in many cases due to their low cost, ease of use, portability, real-time capability, ability to penetrate deeper into the body, and ability to characterize motion within the human body. These methods take advantage of changes in the elastic, viscous, and anisotropic properties of tissues due to disease-induced alterations in tissue structure and composition. All these elastographic methods are different in terms of the use of mechanical force to probe the tissue, tracking force-induced deformation and inferring mechanical properties from the estimated deformation. These methods can be broadly classified into strain or displacement and shear wave imaging that uses either internal, external, or acoustic radiation force (ARF) as a mechanical force to probe the tissue.

The purpose of this Special Issue is to gather comprehensive research on ultrasound elastography by collecting contributions covering technical developments and preclinical and clinical application of ultrasound elastography in diagnostics and therapeutics. Contributions may therefore be related, but not limited to displacement imaging, straining imaging, shear wave imaging, motion estimation, beam forming and novel pulse sequence for the elastography method, and viscoelastic and anisotropic properties estimation.

Dr. Murad Hossain
Guest Editor

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Keywords

elastography
ARF
shear wave
displacement
strain
particle velocity
phase velocity
viscoelasticity
anisotropy
motion estimation
inverse approach

Published Papers (7 papers)

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Research

18 pages, 2463 KiB

Open AccessArticle

Palm-Sized Wireless Transient Elastography System with Real-Time B-Mode Ultrasound Imaging Guidance: Toward Point-of-Care Liver Fibrosis Assessment

by Zi-Hao Huang, Li-Ke Wang, Shang-Yu Cai, Hao-Xin Chen, Yongjin Zhou, Lok-Kan Cheng, Yi-Wei Lin, Ming-Hua Zheng and Yong-Ping Zheng

Diagnostics 2024, 14(2), 189; https://doi.org/10.3390/diagnostics14020189 - 15 Jan 2024

Cited by 1 | Viewed by 1344

Abstract

Transient elastography (TE), recommended by the WHO, is an established method for characterizing liver fibrosis via liver stiffness measurement (LSM). However, technical barriers remain towards point-of-care application, as conventional TE requires wired connections, possesses a bulky size, and lacks adequate imaging guidance for precise liver localization. In this work, we report the design, phantom validation, and clinical evaluation of a palm-sized TE system that enables simultaneous B-mode imaging and LSM. The performance of this system was validated experimentally using tissue-equivalent reference phantoms (1.45–75 kPa). Comparative studies against other liver elastography techniques, including conventional TE and two-dimensional shear wave elastography (2D-SWE), were performed to evaluate its reliability and validity in adults with various chronic liver diseases. Intra- and inter-operator reliability of LSM were established by an elastography expert and a novice. A good agreement was observed between the Young’s modulus reported by the phantom manufacturer and this system (bias: 1.1–8.6%). Among 121 patients, liver stiffness measured by this system and conventional TE were highly correlated (r = 0.975) and strongly agreed with each other (mean difference: −0.77 kPa). Inter-correlation of this system with conventional TE and 2D-SWE was observed. Excellent-to-good operator reliability was demonstrated in 60 patients (ICCs: 0.824–0.913). We demonstrated the feasibility of employing a fully integrated phased array probe for reliable and valid LSM, guided by real-time B-mode imaging of liver anatomy. This system represents the first technical advancement toward point-of-care liver fibrosis assessment. Its small footprint, along with B-mode guidance capability, improves examination efficiency and scales up screening for liver fibrosis. Full article

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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13 pages, 9118 KiB

Open AccessArticle

Clinical Applicability of Ultrasound Shear Wave Elastography in Patients under Hypoglossal Nerve Stimulation Therapy

by Philipp Arens, Thomas Fischer, Ingo Fietze, Thomas Penzel, Steffen Dommerich, Heidi Olze and Markus Herbert Lerchbaumer

Diagnostics 2023, 13(23), 3493; https://doi.org/10.3390/diagnostics13233493 - 21 Nov 2023

Viewed by 716

Abstract

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

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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11 pages, 2072 KiB

Open AccessArticle

Combi-Elasto Evaluation of the Degree of Liver Fibrosis in Children with Cholestatic Liver Disease

by Rina Li, Caihui Hu, Fenglin Xu, Qi Zhang, Fazhi Zhou, Chenpeng Zheng, Yang Gao, Yi Tang and Jingyu Chen

Diagnostics 2023, 13(20), 3229; https://doi.org/10.3390/diagnostics13203229 - 17 Oct 2023

Viewed by 940

Abstract

Cholestatic liver disease is a common liver disease in infants and young children. Liver fibrosis is a key factor affecting the prognosis, and liver transplantation is the only treatment option for liver cirrhosis. This study aimed to explore the efficacy of Combi-elasto for diagnosing liver fibrosis in children affected by cholestatic liver disease. A total of 64 children with S1–S4-grade liver fibrosis were enrolled. The general data, routine ultrasound, Combi-elasto, aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) score were compared among children with different grades of liver fibrosis, and the efficacy of the above indexes for evaluating the degree of liver fibrosis was reported. There were remarkable differences in liver size, liver echogenicity, Young’s modulus (E), fibrosis index (FI), activity index (AI) and FIB-4 score among the groups (all p < 0.05). E and liver echogenicity were the independent impact factors of liver fibrosis. The areas under the curve of E, APRI, FIB-4 score and the combined model (E+ liver echogenicity) in the evaluation of liver fibrosis were 0.84, 0.61, 0.66 and 0.90, respectively. Ultimately, we concluded that CE is an effective method to evaluate liver fibrosis in children with cholestatic liver disease. Full article

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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17 pages, 5520 KiB

Open AccessArticle

Characterization of Muscle Weakness Due to Myasthenia Gravis Using Shear Wave Elastography

by Manuela Zimmer, Benedict Kleiser, Justus Marquetand and Filiz Ates

Diagnostics 2023, 13(6), 1108; https://doi.org/10.3390/diagnostics13061108 - 15 Mar 2023

Cited by 4 | Viewed by 1901

Abstract

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

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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11 pages, 2617 KiB

Open AccessArticle

Shear Wave Elastography in Bruxism—Not Yet Ready for Clinical Routine

by Cem Toker, Justus Marquetand, Judit Symmank, Ebru Wahl, Fabian Huettig, Alexander Grimm, Benedict Kleiser, Collin Jacobs and Christoph-Ludwig Hennig

Diagnostics 2023, 13(2), 276; https://doi.org/10.3390/diagnostics13020276 - 11 Jan 2023

Cited by 2 | Viewed by 1490

Abstract

Ultrasound shear wave elastography (SWE) is an emerging modality for the estimation of stiffness, but it has not been studied in relation to common disorders with altered stiffness, such as bruxism, which affects almost one-third of adults. Because this condition could lead to an increased stiffness of masticatory muscles, we investigated SWE in bruxism according to a proof-of-principle and feasibility study with 10 patients with known bruxism and an age- and gender-matched control group. SWE of the left and right masseter muscles was estimated under three conditions: relaxed jaw, 50% of the subjective maximal bite force, and maximal jaw opening. Rejecting the null hypothesis, SWE was significantly increased during relaxed jaw (bruxism 1.92 m/s ± 0.44; controls 1.66 m/s ± 0.24), whereas for maximal mouth opening, the result was vice versa increased with 2.89 m/s ± 0.93 for bruxism patients compared with 3.53 m/s ± 0.95 in the healthy control, which could be due to limited jaw movement in chronic bruxism patients (bruxism 4.46 m/s ± 1.17; controls 5.23 m/s ± 0.43). We show that SWE in bruxism is feasible and could be of potential use for diagnostics and monitoring, though we also highlight important limitations and necessary methodological considerations for future studies. Full article

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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10 pages, 1555 KiB

Open AccessArticle

Preoperative Transient Elastography in Patients with Esophageal Cancer

by Tzu-Yi Yang, Chia-Pang Shih, Pei-Ching Huang, Chun-Yi Tsai and Yin-Kai Chao

Diagnostics 2022, 12(12), 3194; https://doi.org/10.3390/diagnostics12123194 - 16 Dec 2022

Viewed by 1051

Abstract

Since excessive alcohol consumption is a shared risk factor for esophageal cancer and liver fibrosis, it is possible that patients with esophageal cancer may develop unknown liver fibrosis or cirrhosis. We applied preoperative transient elastography (TE) to patients without recorded cirrhosis undergoing esophagectomy to clarify the validity in predicting postesophagectomy hepatic failure. The cohort consisted of 107 patients who received TE before esophagectomy between June 2018 and December 2021. Patients were categorized into two groups based on the fibrosis score yielded by preoperative TE (mild group: 0~2, n = 92; severe group: 3~4, n = 15). There was no significant difference in demographic data nor surgical variables between the two groups. None of the cohort encountered hepatic failure, yet the severe fibrosis group had a significantly higher rate of pleural effusion (40.0% versus 15.2%, p = 0.03). The areas under the curve (AUCs) of TE in predicting postoperative complications and 180-day mortality were 0.60 (95% CI: 0.46–0.74) and 0.67 (95% CI: 0.51–0.83), respectively. In conclusion, stratification of patients with esophageal cancer who had liver fibrosis by preoperative TE demonstrates significant validity in predicting postoperative pleural effusions. Recruitment of noncirrhotic patients with higher TE scores is warranted to examine its power in other parameters. Full article

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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9 pages, 1106 KiB

Open AccessArticle

Dynamic Changes in Liver Stiffness in Patients with Chronic Hepatitis B Undergoing Antiviral Therapy

by Alin Lazar, Ioan Sporea, Alexandru Popa, Raluca Lupusoru, Diana Gherhardt, Ruxandra Mare, Alexandru Apostu, Madalina Hnatiuc and Roxana Șirli

Diagnostics 2022, 12(11), 2646; https://doi.org/10.3390/diagnostics12112646 - 31 Oct 2022

Cited by 3 | Viewed by 1263

Abstract

This is a retrospective single-center study that included 87 subjects. All subjects had chronic hepatitis B or HBV cirrhosis and underwent nucleos(t)ide analogs (NUC) treatment for more than one year. The study aimed to evaluate the dynamic changes in liver stiffness (LS) measured by transient elastography (TE) during a median interval of 64 months. Patients were assessed prior to starting therapy and followed up annually. Liver stiffness measurements (LSM) were performed annually, and ten valid LSMs were obtained in each session. Reliable LSMs were defined as the median value of 10 measurements with Interquartile range/median (IQR/M) ≤ 30%. A significant decrease in liver stiffness values (p < 0.001) was observed during follow-up. In patients with liver cirrhosis, the LSMs decreased significantly after only one year, 24.6 ± 4.3 kPa vs. 13.5 ± 4.2 kPa (p = 0.007), whereas the decrease in non-cirrhotic patients was not significant, 7.31 ± 3.62 vs. 6.80 ± 2.41 (p = 0.27). Liver stiffness decrease was more significant in patients with initially higher transaminases. Undetectable viral load was achieved in 73.5% of patients in year one, 82.7% in year two, and 90.8% in year three of treatment. In conclusion, our study reveals a decrease in liver stiffness by TE in patients with chronic hepatitis B when undergoing anti-HBV therapy in the first two years. It can be used as a method for follow-up in patients undergoing NUC therapy. Full article

(This article belongs to the Special Issue Recent Advances of Ultrasound Elastography in Diagnostics and Therapeutics)

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