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Elastography 2.0

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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 (30 June 2021) | Viewed by 23194

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Dr. Juan Melchor

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Guest Editor

1. Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain
2. Excellence Research Unit “ModelingNature” (MNat), University of Granada, 18071 Granada, Spain
3. Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
Interests: biostatistics; computational mathematics; mathematical modelling; mechanical engineering; public health; statistics; applied mathematics; mathematical statistics; cancer; epidemiology; finite element method; computational; simulation; wave propagation; numerics; surveillance; finite difference; acoustics; waves; transducers; ultrasonics; piezoelectricity; finite-difference schemes; scientific computation; numerical integration; tissue mechanics; elastography; biomechanics; biomathematicas; biomedical engineering; mechanical properties; fluid mechanics; modeling and simulation; computational fluid dynamics; numerical simulation; numerical modeling; numerical analysis; engineering; inverse problem
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Dr. Guillermo Rus

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Co-Guest Editor

Department of Structural Mechanics, University of Granada, 18071 Granada, Spain
Interests: mechanical properties; fluid mechanics; modeling and simulation; computational fluid dynamics; numerical simulation; numerical modeling; numerical analysis; engineering; applied and computational mathematics; mathematical modelling; mechanical engineering; public health; statistics; applied mathematics; composites; mathematical statistics; cancer; epidemiology; finite element method; computational; simulation; wave propagation; numerics; computational mathematics; surveillance; finite difference; acoustics; waves, transducers; ultrasonics; piezoelectricity; finite-difference schemes; scientific computation; numerical integration; tissue mechanics; elastography; biomechanics; biomathematicas; biomedical engineering
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The structural architecture of tissue has recently been receiving a great deal of great attention among the biomechanics and clinical community, as the elastic changes of tissue, which are associated with a broad spectrum of pathologies, promise a new class of diagnostic mechanical biomarkers that extend beyond linear stiffness to viscosity and nonlinear elastic parameters. The theory of ultrasonics physics and its relationship with elastography carries modeling approaches involving bulk and biomechanical properties of the medium, sources, responses, and ultrasonic scattered fields.

The recent and future developments in elastography techniques are allowing for the in vivo and noninvasive quantification of biomechancial markers. They are derived from ultrasound signal processing, which are direct measures and are intimately related to the pathological changes of the structural microarchitecture of tissue.

This Special Issue is focused on new trends of both compressional and shear waves in elastography, beyond the current standard of stiffness maps, from experimental assessment, which constitutes a set of biomarkers, to histology and biochemistry, which, combined with preliminary clinical evidence, suggest a powerful diagnostic potential, with a range of highly prevalent pathologies, from birth and labor disorders (prematurity, induction failures, etc.), solid tumors (e.g., prostate, cervix, breast, and melanoma) or liver fibrosis, just to name a few. Rheological models and hyperelasticity or viscoelasticity theoretical considerations are also taken into account in this Issue, especially when the wave propagation reconstructs the biomechanical parameters considered. The potential of shear wave elastography using correlation, acoustic radiation force impulse, single tracking location, anisotropic shear wave elastography, and ultrafast imaging for clinical applications are key for new research lines.

Dr. Juan Melchor
Guest Editor
Dr. Guillermo Rus
Co-Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Related Special Issue

Elastography in Diagnostics (10 articles)

Published Papers (9 papers)

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Research

13 pages, 1629 KiB

Open AccessArticle

Lung Ultrasound, Clinical and Analytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort

by Jaime Gil-Rodríguez, Michel Martos-Ruiz, José-Antonio Peregrina-Rivas, Pablo Aranda-Laserna, Alberto Benavente-Fernández, Juan Melchor and Emilio Guirao-Arrabal

Diagnostics 2021, 11(12), 2211; https://doi.org/10.3390/diagnostics11122211 - 26 Nov 2021

Cited by 5 | Viewed by 2420

Abstract

At the moment, several COVID-19 scoring systems have been developed. It is necessary to determine which one better predicts a poor outcome of the disease. We conducted a single-center prospective cohort study to validate four COVID-19 prognosis scores in adult patients with confirmed infection at ward. These are National Early Warning Score (NEWS) 2, Lung Ultrasound Score (LUS), COVID-19 Worsening Score (COWS), and Spanish Society of Infectious Diseases and Clinical Microbiology score (SEIMC Score). Our outcomes were the combined variable “poor outcome” (non-invasive mechanical ventilation, intubation, intensive care unit admission, and death at 28 days) and death at 28 days. Scores were analysed using univariate logistic regression models, receiver operating characteristic curves, and areas under the curve. Eighty-one patients were included, from which 21 had a poor outcome, and 9 died. We found a statistically significant correlation between poor outcome and NEWS2, LUS > 15, and COWS. Death at 28 days was statistically correlated with NEWS2 and SEIMC Score although COWS also performs well. NEWS2, LUS, and COWS accurately predict poor outcome; and NEWS2, SEIMC Score, and COWS are useful for anticipating death at 28 days. Lung ultrasound is a diagnostic tool that should be included in COVID-19 patients evaluation. Full article

(This article belongs to the Special Issue Elastography 2.0)

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8 pages, 1936 KiB

Open AccessArticle

Elastic Modulus and Elasticity Ratio of Malignant Breast Lesions with Shear Wave Ultrasound Elastography: Variations with Different Region of Interest and Lesion Size

by Antonio Bulum, Gordana Ivanac, Eugen Divjak, Iva Biondić Špoljar, Martina Džoić Dominković, Kristina Bojanić, Marko Lucijanić and Boris Brkljačić

Diagnostics 2021, 11(6), 1015; https://doi.org/10.3390/diagnostics11061015 - 01 Jun 2021

Cited by 4 | Viewed by 2755

Abstract

Shear wave elastography (SWE) is a type of ultrasound elastography with which the elastic properties of breast tissues can be quantitatively assessed. The purpose of this study was to determine the impact of different regions of interest (ROI) and lesion size on the performance of SWE in differentiating malignant breast lesions. The study included 150 female patients with histopathologically confirmed malignant breast lesions. Minimal (E_min), mean (E_mean), maximal (E_max) elastic modulus and elasticity ratio (e-ratio) values were measured using a circular ROI size of 2, 4 and 6 mm diameters and the lesions were divided into large (diameter ≥ 15 mm) and small (diameter < 15 mm). Highest E_min, E_mean and e-ratio values and lowest variability were observed when using the 2 mm ROI. E_max values did not differ between different ROI sizes. Larger lesions had significantly higher E_mean and E_max values, but there was no difference in e-ratio values between lesions of different sizes. In conclusion, when measuring the E_min, E_mean and e-ratio of malignant breast lesions using SWE the smallest possible ROI size should be used regardless of lesion size. ROI size has no impact on E_max values while lesion size has no impact on e-ratio values. Full article

(This article belongs to the Special Issue Elastography 2.0)

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10 pages, 3032 KiB

Open AccessArticle

Shear Wave Elastography in the Detection of Sinusoidal Obstruction Syndrome in Adult Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation

by Marten Schulz, Lam Giang Vuong, Hans Peter Müller, Martin Maibier, Frank Tacke, Igor Wolfgang Blau and Alexander Wree

Diagnostics 2021, 11(6), 928; https://doi.org/10.3390/diagnostics11060928 - 21 May 2021

Cited by 7 | Viewed by 2041

Abstract

Hepatic sinusoidal obstruction syndrome (SOS), also known as veno-occlusive disease (VOD) can be a life-threatening complication after hematopoietic stem cell transplantation (HSCT). Diagnosis is often difficult and traditionally based on clinical parameters. Shear wave elastography (SWE) is a modern non-invasive liver stiffness measurement technique using ultrasound. In this monocentric study, we evaluated the role of SWE in diagnosing SOS/VOD in 63 adult patients undergoing HSCT from February 2020 to August 2020 in real world settings. Three patients developed SOS/VOD. This was accompanied by an increase in shear wave velocity in all three patients, indicating that this method may contribute to establishing the diagnosis SOS/VOD after HSCT. Full article

(This article belongs to the Special Issue Elastography 2.0)

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11 pages, 5237 KiB

Open AccessArticle

Assessing Baveno VI Criteria Using Liver Stiffness Measured with a 2D-Shear Wave Elastography Technique

by Renata Fofiu, Felix Bende, Alina Popescu, Roxana Șirli, Bogdan Miuţescu and Ioan Sporea

Diagnostics 2021, 11(5), 737; https://doi.org/10.3390/diagnostics11050737 - 21 Apr 2021

Cited by 7 | Viewed by 2240

Abstract

The present study evaluates the performance of Baveno VI criteria, using liver stiffness (LS) assessed with a 2D-SWE elastography technique, for predicting high-risk varices (HRV) in patients with compensated advanced chronic liver disease (cACLD). A secondary aim was to determine whether the use of spleen stiffness measurements (SSMs), as additional criteria, increases the performance of the 2D-SWE Baveno VI criteria. Data were collected from 208 subjects with cACLD, who underwent abdominal ultrasound, liver and spleen stiffness measurements, and upper digestive endoscopy. HRV were defined as grade 1 esophageal varices (EV) with red wale marks, grade 2/3 EV, and gastric varices. A total of 35.6% (74/208) of the included subjects had HRV. The optimal LS cut-off value for predicting HRV was 12 kPa (AUROC-0.80). Using both LS cut-off value < 12 kPa and a platelet cut-off value > 150 × 109 cells/L as criteria to exclude HRV, 52/208 (25%) subjects were selected, 88.5% (46/52) were without EV, 9.6% (5/52) had grade 1 EV, and 1.9% (1/52) had HRV. Thus 98% of the subjects were correctly classified as having or not having HRV and 25% of the surveillance endoscopies could have been avoided. Using SS < 13.2 kPa and a platelet cut-off value > 150 × 109 cells/L as additional criteria for the patients that were outside the initial ones, 32.7% of the surveillance endoscopies could have been avoided. Full article

(This article belongs to the Special Issue Elastography 2.0)

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15 pages, 11810 KiB

Open AccessArticle

Experimental Evidence of Generation and Reception by a Transluminal Axisymmetric Shear Wave Elastography Prototype

by Antonio Gomez, Manuel Hurtado, Antonio Callejas, Jorge Torres, Nader Saffari and Guillermo Rus

Diagnostics 2021, 11(4), 645; https://doi.org/10.3390/diagnostics11040645 - 02 Apr 2021

Cited by 3 | Viewed by 2104

Abstract

Experimental evidence on testing a non-ultrasonic-based probe for a new approach in transluminal elastography was presented. The proposed modality generated shear waves by inducing oscillatory rotation on the lumen wall. Detection of the propagated waves was achieved at a set of receivers in mechanical contact with the lumen wall. The excitation element of the probe was an electromagnetic rotational actuator whilst the sensing element was comprised by a uniform anglewise arrangement of four piezoelectric receivers. The prototype was tested in two soft-tissue-mimicking phantoms that contained lumenlike conduits and stiffer inclusions. The shear wave speed of the different components of the phantoms was characterized using shear wave elastography. These values were used to estimate the time-of-flight of the expected reflections. Ultrafast ultrasound imaging, based on Loupas’ algorithm, was used to estimate the displacement field in transversal planes to the lumenlike conduit and to compare against the readouts from the transluminal transmission–reception tests. Experimental observations between ultrafast imaging and the transluminal probe were in good agreement, and reflections due to the stiffer inclusions were detected by the transluminal probe. The obtained experimental evidence provided proof-of-concept for the transluminal elastography probe and encouraged further exploration of clinical applications. Full article

(This article belongs to the Special Issue Elastography 2.0)

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9 pages, 4077 KiB

Open AccessArticle

The Measurement of Stiffness for Major Muscles with Shear Wave Elastography and Myoton: A Quantitative Analysis Study

by Youngjin Lee, Minkyoung Kim and Haneul Lee

Diagnostics 2021, 11(3), 524; https://doi.org/10.3390/diagnostics11030524 - 15 Mar 2021

Cited by 42 | Viewed by 4607

Abstract

The present study was performed to assess the relationship between hand-held myotonometer MyotonPRO and shear wave elastography (SWE) measurements of lower limb muscle stiffness during resting and active voluntary contraction. Forty healthy young adults, (20 males and 20 females) participated in the study. The stiffness of each subject’s rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (MG) was measured repeatedly by MyotonPRO and SWE. Moderate to strong correlations between the two methods’ measurements were found for both resting and active voluntary contraction. (r = 0.416–0.669, p < 0.05; r = 0.398–0.594, p < 0.05, respectively). Muscle stiffness at rest was significantly lower compared contraction in all four muscles measured by both methods (p < 0.05). Intra-rater reliabilities were generally lower when measurements were taken during contraction. Additionally, when compared by gender, muscle stiffness measured by MyotonPRO was significantly higher at rest in men compared to women, except for the TA. However, a significant difference was found in TA muscle stiffness by gender when measured with SWE. When muscles were contracted, all muscles showed significantly higher stiffness in men compared to women. There were moderate to good correlations in muscle stiffness between measurements of SWE and MyotonPRO at rest and during active voluntary contraction. Additionally, both instruments showed good intra-rater reliability. Full article

(This article belongs to the Special Issue Elastography 2.0)

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10 pages, 1954 KiB

Open AccessArticle

Shear-Wave Elastography—Diagnostic Value in Children with Chronic Autoimmune Thyroiditis

by Cristina Mihaela Cepeha, Corina Paul, Andreea Borlea, Renata Fofiu, Florin Borcan, Cristina Adriana Dehelean, Viviana Ivan and Dana Stoian

Diagnostics 2021, 11(2), 248; https://doi.org/10.3390/diagnostics11020248 - 05 Feb 2021

Cited by 11 | Viewed by 1895

Abstract

Chronic autoimmune thyroiditis (CAT) is the most common thyroid disorder in the pediatric population. Ultrasound evaluation may suggest the diagnosis. Additionally, shear-wave elastography (SWE) proved to be a valuable additional diagnosis tool in adults with CAT by assessing thyroid stiffness (TS). This study aims to assess its use also in detecting children with CAT. The study group consisted of 50 children with confirmed diagnosis of CAT, who were compared to the control group, consisting of 50 children with no thyroid pathology and with an adult group of 50 subjects with CAT. The evaluation included, besides bioimmunochemical evaluation, also thyroid ultrasound evaluation and elastography measurements in the same session (Aixplorer Mach 30, Supersonic imagine, France). The mean TS values were significantly lower for children in the CAT group compared to adults with CAT (15.51 ± 4.76 kPa vs. 20.96 ± 6.31 kPa; p < 0.0001) and higher compared to the healthy aged matched controls (15.51 ± 4.76 kPa vs. 10.41 ± 2.01 kPa; p < 0.0001). SWE elastography definitely seems a promising technique in the evaluation of children with autoimmune thyroid pathology. Full article

(This article belongs to the Special Issue Elastography 2.0)

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10 pages, 420 KiB

Open AccessArticle

A Preliminary Study on the Safety of Elastography during Pregnancy: Hypoacusia, Anthropometry, and Apgar Score in Newborns

by Paloma Massó, Juan Melchor, Guillermo Rus and Francisca Sonia Molina

Diagnostics 2020, 10(11), 967; https://doi.org/10.3390/diagnostics10110967 - 18 Nov 2020

Cited by 4 | Viewed by 1948

Abstract

Transient or acoustic radiation force elastography (ARFE) is becoming the most extended technology to assess cervical effacement, additionally to the Bishop test and conventional ultrasound. However, a debate on the fetal safety has been opened due to the high intensity focused beam emitted to produce shear waves. This work is aimed at providing preliminary data to assess clinical effects of fetal exposure. A follow-up study in newborns of 42 women exposed to ARFE during pregnancy was carried out to explore neonatal hypoacusia, Apgar test, and anthropometry. No hypoacusia cases attributable to ARFE were observed. The Apgar test at five minutes scored normally in all the newborns. Comparisons between anthropometric measurements showed no significant statistically differences. The results preclude to state the harmfulness nor the safety of ARFE. However, given the concern on the high level of energy and the potential risk of harmful bioeffects, larger studies are recommended. Full article

(This article belongs to the Special Issue Elastography 2.0)

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12 pages, 2878 KiB

Open AccessArticle

The Value of Strain Elastography in Predicting Autoimmune Thyroiditis

by Cristina Mihaela Cepeha, Corina Paul, Andreea Borlea, Florin Borcan, Renata Fofiu, Cristina Adriana Dehelean and Dana Stoian

Diagnostics 2020, 10(11), 874; https://doi.org/10.3390/diagnostics10110874 - 27 Oct 2020

Cited by 10 | Viewed by 2233

Abstract

Chronic autoimmune thyroiditis (CAT) defines a diffuse intrathyroidal lymphocytic infiltration associating a destructive process of the thyroid follicles, most commonly in evolution developing hypothyroidism. Typical ultrasound changes may suggest the presence of the disease. This study aims to evaluate the performance of strain elastography in detecting autoimmune thyroiditis as an additional tool to the conventional ultrasound examination. A total of 250 patients were enrolled in the study; 180 had biochemical confirmation of CAT, the other 70 healthy subjects represented the control group. All patients were examined clinically and by means of conventional thyroid ultrasound (US) and real-time elastography using a Hitachi Preirus machine (5–15 MHz linear probe). Five valid measurements for the parenchyma/muscle strain ratios (SR) were taken for each subject, considering the mean value for analysis. A mean SR value above 1.64 was found to predict the presence of CAT with sensitivity (Sen) 69%, specificity p92%, positive predictive value (PPV) 95.4%, negative predictive value (NPV) 54% and area under receiver operating characteristic (AUROC) 0.87. Moreover, when comparing the mean values for SR, significantly higher values were found in CAT patients compared with the controls (2.81 ± 2.11 vs. 1.03 ± 0.51; p < 0.0001). Of the 180 CAT subjects, 92 were on thyroid hormone replacement therapy; significantly higher values were detected for patients under therapy compared with asymptomatic cases (3.45 ± 2.53 vs. 2.15 ± 1.27, p < 0.0001). A cut-off value of 2.94 was established for identifying CAT patients who needed hormonal treatment (Sen 52.3%, Sp 83.7%, PPV 75.4%, NPV 64.7% and AUROC 0.66). No correlation was found between stiffness and antibody titers nor for functional status. Elastography does add valuable information to the US evaluation of cases with autoimmune thyroiditis. Full article

(This article belongs to the Special Issue Elastography 2.0)

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