Search Results (67)

Background: Pancreatic cancer (PC) is expected to be the second leading cause of cancer-related death by 2030. Surgical resection with R0 margins remains the only available treatment capable of improving the overall survival of the patients; thus, appropriate characterization of pancreatic tumors is mandatory for the correct assessment of PC resectability. Despite advances in pancreatic surgery, POPF remains a frequent and dreaded complication that impacts the morbidity and mortality of PC patients, entailing both clinical and economic consequences. Soft pancreatic texture is known as an independent risk factor for POPF occurrence in pancreatic surgery. Intraoperative exploration of the pancreas is most frequently assessed subjectively, through the surgeon’s palpation. Intraoperative elastography is a modern ultrasound technique suitable to replace the surgeon’s intraoperative palpation to better evaluate pancreatic lesions, pancreatic texture, and improve surgical management. Thus, intraoperative elastography could provide quantifiable and reproducible information in pancreatic parenchyma characterization. Real-time intraoperative assessment of pancreatic texture through an objective method could improve surgical decisions. This systematic review analyzes the role of intraoperative elastography in differentiating benign from malignant pancreatic tumors and the efficacy of this technique in the assessment of pancreatic texture as a predictor of postoperative pancreatic fistula (POPF). Methods: We conducted a comprehensive systematic literature research on PubMed, Google Scholar, Scopus, Web of Science, Embase and Cochrane Library Database using PRISMA framework guided by the words “intraoperative elastography” or “intraoperative elasticity imaging” or “intraoperative shear wave elastography” or “intraoperative strain elastography” and “pancreatic cancer” or “pancreatic neoplasm” or “pancreatic adenocarcinoma” or “pancreatic tumor” or “pancreatic fistula” or “postoperative pancreatic fistula” or “pancreatic leak”. Articles that were listed between 2000 and 2025 and written in the English language were screened for potentially relevant articles. The primary outcome was to evaluate the use of intraoperative elastography in differentiating between benign and malignant lesions of the pancreas. The second outcome was to assess the role of intraoperative elastography in the evaluation of pancreatic texture as a predictive factor for the occurrence of postoperative pancreatic fistula. Results: From a total of 17 publications, 2 scientific articles were considered relevant for the role of intraoperative elastography in differentiating benign from malignant pancreatic lesions, while 4 articles analyzed the role of intraoperative pancreatic elastography as a predictor of postoperative pancreatic fistula (POPF). Based on the results, detection of pancreatic cancer through intraoperative SWE is possible at cut-off values of 3 m/s and 28.7 kPa, and values of 2.2 m/s or less obtained after intraoperative elastography of the pancreas are considered an independent risk factor for POPF in pancreatic surgery. Reported cut-off values should, however, be interpreted as exploratory and should represent a starting point for further studies aimed at validating their clinical implementation. Conclusions: Intraoperative elastography can be a promising tool in pancreatic tumor characterization and could differentiate between benign and malignant pancreatic tumors and predict the risk of POPF, but further prospective studies are required before cut-off values can be routinely applied in clinical practice. Full article

Background and Objectives: What led to the development of elastography was the emerging need for a method that could objectively and accurately assess the stiffness of internal structures. As a result, a distinction between normal from pathological tissues becomes possible. Objective: To evaluate non-invasive elastographic techniques, point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE), as methods for differentiating simple liver cysts from liver hemangiomas. Materials and Methods—a total of 63 patients—32 with simple liver cysts and 31 with liver hemangiomas were analyzed. The purpose was to determine the values of the average trend (arithmetic mean or median according to the data distribution) as well as the reference intervals of SWV for both methods in the above-mentioned patients. Final diagnoses were confirmed by contrast-enhanced computed tomography (CECT). Results: The pSWE SWV values (median) for simple hepatic cysts showed an average trend of 1.14 m/s, with an upper limit of 3.33 m/s and a lower limit of 0.35 m/s. For 2D-SWE, the average trend for simple hepatic cysts was 1.00 m/s, with an upper limit of 1.54 m/s and a lower limit of 0.65 m/s. For liver hemangiomas, the average trend in pSWE was 1.36 m/s, with an upper limit of 3.22 m/s and a lower limit of 0.57 m/s. For 2D-SWE, the average trend was 1.34 m/s, with an upper limit of 2.27 m/s and a lower limit of 0.80 m/s. Findings in our work mainly serve as reference values. Conclusions: The accurate diagnosis of liver diseases is of paramount importance when it comes to the approach and treatment of individual benign liver lesions. Early diagnosis of focal liver lesions remains a challenging task. Full article

Background: Latent myofascial trigger points (MTrPs) are clinically relevant because they lower local pressure pain thresholds (PPTs), can perturb motor control, and may sustain shoulder symptoms even when overt pain is absent. However, even if previous studies assessed stiffness and mechanosensitivity differences between MTrPs and asymptomatic regions, objective patient-level cut-offs and diagnostic-accuracy metrics to distinguish latent MTrPs from adjacent asymptomatic tissue are lacking. Objective: To quantify the diagnostic accuracy of pressure algometry (PPT) and shear-wave elastography (SWE) for distinguishing latent MTrPs from adjacent asymptomatic tissue. Methods: A single-center cross-sectional study was conducted including 76 volunteers with ≥1 latent infraspinatus MTrP (assessed by following the current Delphi consensus criteria). The most sensitive latent MTrP and a control site 2 cm cranial was measured on the dominant side infraspinatus muscle in each participant. PPT and SWE were acquired with a standardized protocol (long-axis imaging, anisotropy control, minimal probe pressure; three captures per site; 1 cm rectangular ROI; operator blinded to site type). ROC analyses estimated areas under the curve (AUCs), Youden-optimal cut-offs, sensitivity, specificity, and likelihood ratios (LR+/−). Results: Latent MTrPs showed lower PPTs than controls (p < 0.001) and higher stiffness (shear modulus: p = 0.009; shear-wave speed: p = 0.022). PPT yielded AUC = 0.704 with an optimal cut-off of 47.5 N (sensitivity 0.75; specificity 0.592; LR+ 1.84; LR− 0.42), outperforming SWE metrics (shear modulus AUC 0.611; cut-off 23.6 kPa; sensitivity 0.632; specificity 0.605; LR+ 1.60; LR− 0.61; shear-wave speed AUC 0.601; cut-off 2.55 m/s; sensitivity 0.592; specificity 0.632; LR+ 1.61; LR− 0.65). Conclusions: In the infraspinatus, PPT provides moderate discrimination between latent MTrPs and adjacent asymptomatic tissue, whereas resting SWE—despite small mean differences—exhibited lower accuracy. These findings support mechanosensitivity as a primary measurable signal and position SWE as an adjunct. External validation across devices and operators, and multivariable models integrating sensory, imaging, and clinical features, are warranted. Full article

Background: Shear-wave elastography (SWE) performed during endoscopic ultrasound (EUS) is a promising tool for quantifying pancreatic stiffness, but its intra-session reproducibility remains incompletely defined. Methods: In this prospective single-center study, 86 consecutive patients (median age 66 years; 59.3% women) referred for diagnostic EUS underwent EUS-guided point SWE. Ten measurements were acquired from a 10 × 15 mm region of interest in the pancreatic body or tail when the breath was held by a single expert operator. Reproducibility was assessed by comparing the first and last five acquisitions; intra-individual variability was expressed as the coefficient of variation (CV). Results: Mean stiffness was 18.5 ± 8.9 kPa (2.31 ± 0.58 m/s). Agreement between early and late measurements was excellent in kPa (ICC = 0.99; r = 0.997; mean bias −0.06 kPa) and moderate in m/s (ICC = 0.61; r = 0.61). The mean CVs were 0.640 for kPa and 0.328 for m/s. Sex, age, and BMI had no significant influence on stiffness or reproducibility. The technical success rate was 97%, with no adverse events. Conclusions: EUS-guided point SWE provides highly reproducible pancreatic stiffness measurements within a single session, particularly when expressed in kPa. Demographic factors do not affect stability, supporting its integration into routine EUS practice. Further multicenter studies are needed to establish pathology-specific cut-offs and confirm clinical relevance. Full article

Background/Objectives: Fatigue is the most common systemic manifestation of chronic liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD). Fatigue not only adversely affects quality of life in MASLD patients but also complicates the attainment of therapeutic goals and contributes to a worse prognosis. This study aimed to analyze the relationship between clinically significant fatigue and laboratory parameters reflecting systemic inflammation, liver function, body composition, muscle strength, and blood pressure in patients with MASLD. Methods: A total of 154 patients with a confirmed diagnosis of MASLD were enrolled in this study. All participants underwent anthropometric assessment, laboratory testing, abdominal ultrasonography, and point shear-wave elastography. Muscle strength was evaluated using handgrip strength (GS) measurement and the Five Times Sit-to-Stand Test (5TSTS). Skeletal muscle mass (SMM) was quantified using dual-energy X-ray absorptiometry (DXA). Fatigue was evaluated using the Fatigue Assessment Scale (FAS), with scores ≥ 22 indicating clinically significant fatigue. Results: Patients with FAS scores ≥ 22 exhibited significantly lower hemoglobin levels (p = 0.004) and erythrocyte counts (p = 0.011), along with a significantly elevated erythrocyte sedimentation rate (ESR; p = 0.002) and C-reactive protein level (CRP; p = 0.007). Furthermore, MASLD patients with FAS scores ≥ 22 demonstrated significantly reduced relative grip strength (p = 0.012) and took longer to complete the 5TSTS (p = 0.011). Additionally, these patients had higher maximum systolic and diastolic blood pressure values compared to those with FAS scores < 22 (p = 0.028 and p = 0.019, respectively). Conclusions: These findings underscore the multifactorial nature of fatigue in MASLD and highlight the need for a comprehensive management strategy. Such a strategy should include dietary modification, increased physical activity, targeted treatment of systemic manifestations of MASLD, and appropriate management of comorbidities. Full article

Background: Transient elastography (TE), using Fibroscan^® and point shear wave elastography (pSWE), are two techniques used to estimate liver fibrosis. The aim of our study was to compare, for the first time, these two techniques in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), stratifying the analysis on the basis of the grades of steatosis. Methods: We recruited 85 consecutive MAFLD patients who underwent liver stiffness (LS) measurement performed by Fibroscan^® and pSWE on the same day. Severity of steatosis was estimated by Fibroscan^® and expressed as controlled attenuation parameter (CAP), ranging from S0 to S3. Spearman’s “r” coefficient was used to calculate the correlation and Bland–Altman graphs was used to evaluate the agreement. Results: In general, the correlation and agreement between Fibroscan^® and pSWE were substantial (r = 0.66, p < 0.001 and bias= −0.64 ± 2.48, respectively). When data were analyzed according to the grade of steatosis, an increasing significant correlation was observed going from S0 to S2 (r = 0.79, r = 0.81, and r = 0.85, respectively), whereas a low correlation and agreement were observed for S3 patients (r = 0.48, p = 0.003, bias= −0.95 ± 2.51). Conclusions: Fibroscan^® and pSWE are equivalent techniques to estimate liver fibrosis in patients with mild to moderate steatosis, while in presence of severe steatosis their agreement is low. Full article

Objective: To determine reference values of liver stiffness during the first week of extrauterine life in healthy newborns, according to gestational age, sex, and birth weight, using three elastography techniques: point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) with convex and linear probes. Materials and Methods: This was a cross-sectional observational study conducted at a single center on a hospital-based cohort of 287 newborns between 24 and 42 weeks of gestation, admitted between January 2023 and May 2024. Cases with liver disease, significant neonatal morbidity, or technically invalid studies were excluded. Hepatic elastography was performed during the first week of life using pSWE and 2D-SWE with both convex and linear probes. Clinical and technical neonatal variables were recorded. Liver stiffness values were analyzed in relation to gestational age, birth weight, and sex. Linear regression models were applied to assess associations, considering p-values < 0.05 as statistically significant. Results: After applying exclusion criteria, valid liver stiffness measurements were obtained in 208 cases with pSWE, 224 with 2D-SWE (convex probe), and 222 with 2D-SWE (linear probe). A statistically significant inverse association between liver stiffness and gestational age (p < 0.03) was observed across all techniques except for 2D-SWE with the linear probe. Only 2D-SWE with the convex probe showed a significant association with birth weight. No significant differences were observed based on neonatal sex. The 2D-SWE technique with the convex probe demonstrated significantly shorter examination times compared to pSWE (p < 0.001). Conclusions: Neonatal liver stiffness measured by pSWE and 2D-SWE with a convex probe shows an inverse correlation with gestational age, potentially reflecting the structural and functional maturation of the liver. These techniques are safe, reliable, and provide useful information for distinguishing normal findings in preterm neonates from early hepatic pathology. The values obtained represent a valuable reference for clinical hepatic assessment in the neonatal period. Full article

Background: The relationship between spleen and bone marrow stiffness, and other features of abnormal myeloproliferation has long been described. However, the scientific knowledge in this area remains very superficial. This review evaluated the diagnostic effectiveness of various ultrasound (US) methods in the assessment of neoplastic myeloproliferation using spleen stiffness measurement (SSM). Aim: To explore the diagnostic accuracy of US techniques in assessing spleen stiffness, determining which of them may be suitable for the diagnosis of myeloproliferative diseases in adults. Methods: The review included original retrospective or prospective studies published in the last five years (2019–2024) in peer-reviewed medical journals that reported receiver operating characteristics (ROCs) for SSM and the articles concerning the relation between SSM values and neoplastic myeloproliferation. The studies were identified through PubMed searches on 1 July and 1 December 2024. Quality was assessed using the QUADAS-2 tool. Results were tabulated according to the diagnostic method separately for myeloproliferative neoplasms (MNs) and for other clinical findings. Results: The review included 52 studies providing ROCs for SSM or compatibility between operators, and five studies covering the relation between SSM values and MNs. Conclusions: Acoustic radiation force impulse (ARFI), two-dimensional shear wave elastography (2D-SWE), transient elastography (TE), and point shear wave elastography (p-SWE) are promising methods for measuring SSM that can be incorporated into the diagnosis, screening, and monitoring system in MNs. Full article

Background and Aims: Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease frequently associated with fatigue and mild cognitive impairment. Brain-derived neurotrophic factor (BDNF) plays key roles in neuroplasticity, immune regulation, and metabolism. This study aimed to evaluate plasma BDNF levels in early-stage PBC and examine their clinical and biochemical associations. Methods: In this observational study, plasma BDNF, IL-6, and IL-18 concentrations were measured by ELISA in 45 patients with early-stage PBC and 31 age- and sex-matched healthy controls (mean age 60.5 years; 96% women). All participants underwent liver elastography using point shear wave elastography (ElastPQ), Doppler ultrasound, laboratory testing, and assessment of cognitive function (PHES) and fatigue severity (MFIS). Non-invasive fibrosis scores (APRI, FIB-4) were calculated. Results: Median plasma BDNF concentrations were significantly higher in PBC patients than in controls [median: 21.04 ng/mL (IQR: 10.68–38.07) vs. 5.80 ng/mL (IQR: 4.58–7.54); p < 0.0001]. In PBC patients, higher BDNF levels correlated inversely with liver stiffness measured by ElastPQ (R = −0.39, p = 0.0258), spleen dimensions, splenic vein flow volume (R = −0.49, p = 0.0018), suggesting an association with milder liver fibrosis and early hemodynamic alterations. A trend toward association between BDNF and IL-6 levels was observed in multivariate analysis. No significant associations were found between BDNF concentrations and markers of hepatocellular injury, cognitive performance, or fatigue severity. Conclusions: Plasma BDNF concentrations are elevated in early-stage PBC and inversely correlate with liver fibrosis severity. No significant associations were found with hepatocellular injury, cognitive function, or fatigue. These findings suggest that BDNF may play a protective role against hepatic fibrogenesis, or alternatively, that BDNF concentrations may decline with advancing liver disease. Further studies are needed to clarify its significance in PBC. Full article

Background/Objectives: The application of shear wave elastography (SWE) for the assessment of placental disease is still unproven and there is limited data correlating placental biomechanical properties with aberrations in fetal growth. This study investigated changes in placental shear wave velocity (SWV) in early and late fetal growth restriction (FGR). Methods: We analyzed three study cohorts: Pregnancies with appropriate growth for gestational age (AGA) and those with early (<32 weeks’) and late (>32 weeks’) FGR. Mean SWV at two time points was compared in the following cohorts: all FGR vs. AGA, early FGR vs. late FGR, early FGR vs. AGA, and late FGR vs. AGA. Results: The study comprised 222 women—79 (35.6%) FGR and 143 (64.4%) AGA. Of the FGR pregnancies, 37 (46.8%) were early and 42 (53.2%) were late. On multivariate analysis mean, SWV was not increased in FGR compared to AGA placentae (β 0.21, 95% CI −0.17–0.60, p 0.28). It was also not increased in early FGR compared to late FGR or AGA placentae (β 0.36, 95% CI −0.06–0.77, p 0.09). We observed an effect measure modification by pre-eclampsia, increasing mean SWV to a greater extent in AGA compared to FGR cases. Conclusions: Although previous studies have shown an association between placental SWV and FGR, our study showed no difference between cases and controls. The interaction of pre-eclampsia indicated that SWE may have a greater role in pre-eclampsia than in FGR alone. Further investigation of the influence of increased maternal vascular pressure on placental stiffness would be beneficial. Full article

Background/Objectives: Increasing evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN), a well-established cardiometabolic risk factor, both negatively impact bone metabolism. This study aimed to investigate the associations between bone turnover markers (BTMs)—namely, osteopontin (OPN) and procollagen type 1 N-terminal propeptide (P1NP)—and metabolic health indicators, non-invasive measures of liver disease severity, as well as skeletal muscle mass (SMM), muscle strength, and bone mineral density (BMD) in patients with MASLD and HTN. Methods: We enrolled 117 patients diagnosed with MASLD and HTN and conducted anthropometric measurements, laboratory analyses, abdominal ultrasound, and point shear-wave elastography. Muscle strength was evaluated using grip strength measurements and the Five Times Sit-to-Stand Test (FTSST). SMM and BMD were quantified using dual-energy X-ray absorptiometry (DEXA). Serum OPN and P1NP concentrations were quantified using enzyme-linked immunosorbent assays (ELISAs). Results: Serum OPN concentrations below 2.89 ng/mL were associated with significantly elevated levels of AST (p = 0.001), ALT (p = 0.006), and GGT (p = 0.025), while serum P1NP concentrations above 47.5 pg/mL were associated only with significantly elevated GGT levels (p = 0.024). In addition, patients with MASLD and HTN with lower serum OPN levels had higher liver stiffness values (p = 0.003). Serum OPN concentrations were inversely associated with the following metabolic health indicators: waist circumference (WC, p < 0.001) and epicardial fat thickness (EFT, p = 0.001). In addition, they were significantly elevated in patients with MASLD and HTN who had decreased spinal BMD (p = 0.017). In turn, serum P1NP levels were reduced in patients with decreased SMM (p = 0.023). Conclusions: These findings in patients with MASLD and HTN suggest an association between serum P1NP levels and SMM, and between OPN levels and spinal BMD, indicating a potential interplay among liver function, muscle mass, and bone health. Furthermore, OPN appeared to be strongly associated with overall metabolic health indicators, such as WC and EFT, whereas P1NP exhibited a stronger association with muscle mass. Full article

Objectives: To compare thresholds and accuracies of FIB-4, vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2D shear wave elastography (2D-SWE), and MR elastography (MRE) for detecting hepatic fibrosis in patients with MASLD. Materials and Methods: Systematic searching of MEDLINE, EMBASE, Cochrane Library, Scopus, and the gray literature from inception to March 2024 was performed. Studies evaluating accuracies of FIB-4, VCTE, 2D-SWE, pSWE, and/or MRE for detecting significant (≥F2) and/or advanced (≥F3) hepatic fibrosis in MASLD patients compared to histology were identified. Full-text review and data extraction were performed independently by two reviewers. Multivariate meta-analysis and subgroup analyses were performed using index test and fibrosis grading. Risk of bias was assessed using QUADAS-2. Results: 207 studies with over 80,000 patient investigations were included. FIB-4 1.3 threshold sensitivity was 71% (95% CI 66–75%) for detecting advanced hepatic fibrosis, which improved to 88% (85–91%) using a <0.75 threshold. FIB-4 specificity using a 2.67 threshold was 96% (94–97%). Sensitivities of 88–91% were achieved using thresholds of 3.2 kPa for pSWE, 4.92 kPa for 2D-SWE, 7.18 kPa for VCTE, and 2.32 kPa for MRE. No significant differences were identified for sensitivities in subgroup analysis with thresholds between 7 and 9 kPa. Most imaging-based studies were high risk of bias for the index test. Conclusions: A FIB-4 threshold of <0.75 and modality-dependent thresholds (VCTE < 7 kPa; pSWE <3 kPa; 2D-SWE <5 kPa; and MRE <2.5 kPa) would achieve sensitivities of around 90% when defining low-risk MASLD in population screening. A modified two-tier algorithm aligning with existing Society of Radiologists in Ultrasound guidelines would improve risk stratification accuracies compared to existing guidelines by European and American liver societies. Full article

Background: Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by bile duct destruction, cholestasis, and fibrosis. Acylcarnitines are esters of carnitine responsible for the transport of long-chain fatty acids into mitochondria for β-oxidation, playing a crucial role in energy metabolism and lipid homeostasis. This study aimed to assess acylcarnitine and free fatty acid (FFA) profiles in PBC patients and their associations with fibrosis severity and inflammation. Methods: This cross-sectional study included 46 PBC patients and 32 healthy controls. Acylcarnitines and FFAs were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and enzymatic assays, respectively. Liver stiffness was measured by point shear wave elastography (ElastPQ), and fibrosis was assessed using APRI and FIB-4 scores. Inflammatory markers (IL-6, IL-1β) were also analyzed. Results: PBC patients had significantly higher levels of C18:1-acylcarnitine (median: 165.1 ng/mL) compared with the controls (152.4 ng/mL, p = 0.0036). Similarly, the FFA levels were markedly elevated in the PBC patients (median: 0.46 mM/L) compared with the controls (0.26 mM/L, p < 0.0001). Patients with higher liver stiffness (ElastPQ > 5.56 kPa) had significantly elevated C18:1-acylcarnitine (p = 0.0008) and FFA levels (p = 0.00098). Additionally, FFAs were significantly increased in patients with higher APRI and FIB-4 scores and were associated with elevated inflammatory markers (IL-6, IL-1β) and liver injury markers. Multivariate regression analysis confirmed C18:1-acylcarnitine (OR = 1.031, 95% CI: 1.007–1.057, p = 0.013) and FFAs (OR = 2.25 per 0.1 mM/L increase, 95% CI: 1.20–4.22, p = 0.012) as independent predictors of fibrosis severity in PBC. Conclusions: C18:1-acylcarnitine and FFAs are significantly elevated in PBC and are strongly associated with fibrosis severity and inflammation. These findings suggest a link between lipid metabolism disturbances and PBC. Both metabolites may potentially serve as non-invasive biomarkers of fibrosis progression in PBC, warranting further investigation. Full article

Background/Objectives: The quadratus lumborum (QL) muscle is a key structure involved in patients with low back pain (LBP). Since the discriminative capability of morphological descriptors is uncertain and considering the high prevalence of myofascial trigger points and the poor reliability of manual palpation in this condition, developing a reliable procedure for assessing the QL’s tenderness is needed for facilitating the diagnosis and monitoring changes over time. We aimed to analyze the intra- and inter-examiner reliability of SWE for calculating the QL tenderness in patients with LBP. Methods: Using a convex transducer, longitudinal shear wave elastography (SWE) images of the QL muscle were acquired bilaterally twice in 52 volunteers with moderate LBP and disability by one experienced examiner and one novel examiner to measure shear wave speed and Young’s modulus as stiffness metrics. Results: Intra-examiner reliability estimates demonstrated high consistency independently of the examiner’s experience (intraclass correlation coefficients (ICCs) > 0.930) for both metrics. However, experienced examiners showed smaller minimal detectable changes. Additionally, inter-examiner reliability was lower, with ICCs ranging from 0.57 to 0.68, and significant differences in mean values between examiners (p < 0.01) were found. Conclusions: This procedure exhibited excellent intra-examiner reliability for assessing QL muscle stiffness in patients suffering LBP, indicating high repeatability of measurements when performed by the same examiner. In addition, experienced examiners demonstrated greater sensitivity in detecting real changes not attributed to measurement errors. However, inter-examiner reliability was moderate, highlighting the need for consistent examiner use to avoid measurement variability and averaging multiple measurements to enhance the accuracy. Full article

Background/Objectives: Liver elastography is increasingly used in neonatal intensive care units (NICUs) as a non-invasive, radiation-free, reproducible technique for assessing liver stiffness. This technique demonstrates substantial advantages over conventional ultrasound in diagnosing diffuse liver diseases by providing quantitative measures of tissue elasticity. This article aims to describe the most critical milestones for performing liver elastography ultrasound point-of-care, a tool increasingly used to complement traditional ultrasound in the study of the liver in intensive care units where the population is very susceptible to manipulation. Methods: Techniques such as point-shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have become key in evaluating conditions such as hypoxic-ischemic liver disease, cholestatic diseases, storage and metabolic disorders, or infectious liver conditions. However, despite its usefulness, performing elastography in neonates, particularly in those weighing less than 1000 g or in high-frequency oscillatory ventilation, presents notable challenges, including the extreme sensitivity of neonates to touch, noise, and temperature changes and the difficulty in obtaining accurate measurements due to limited hepatic depth. Results: Key factors for the success of sonoelastography in this population include minimizing contact time, adjusting mechanical and thermal indices to meet biosecurity guidelines, and ensuring patient comfort and stability during the procedure. Despite these challenges, elastography has proven helpful in routine clinical practice. Conclusions: The growing evidence on elastography has provided standardized reference values, further enhancing its clinical applicability in NICU settings. Full article