Search Results (244)

Background: Greater trochanteric pain syndrome (GTPS) is associated with structural tendon alterations and functional impairment. Extracorporeal shockwave therapy (ESWT) is a common treatment, but objective monitoring of tendon remodeling and motor recovery remains limited. Objective: This study aimed to integrate shear-wave elastography (SWE) expressed in m/s and wearable inertial measurement unit (IMU) as biosensing tools for the quantitative assessment of tendon elasticity, morphology, and hip motion after ESWT in GTPS. Methods: In a prospective cohort of adults with chronic GTPS, shear wave elastography (SWE) quantified gluteus medius tendon (GMT) elasticity and thickness, while hip abduction range of motion (ROM) was measured using a triaxial inertial measurement unit. Clinical scores on the Visual Analogue Scale (VAS), Harris Hip Score (HHS), Low Extremity Functional Scale (LEFS), and Roles and Maudsley score (RM) were collected at baseline (T0) and at 6 months (T1). Results: Thirty-five patients completed follow-up. Pain and function improved significantly (VAS, HHS, LEFS, RM; all p < 0.05). SWE values of the affected GMT increased, while tendon thickness decreased yet remained greater than on the contralateral side. Hip abduction ROM increased significantly from T0 to T1 (p < 0.05). Correlation analysis showed a negative association between abduction and pain at T1 (r = −0.424; p = 0.011) and, at baseline, between abduction and VAS (r = −0.428; p = 0.010) and RM (r = −0.346; p = 0.042), and a positive association with LEFS (r = 0.366; p = 0.031). SWE correlated negatively with VAS at T1 (r = −0.600; p < 0.05) and positively with HHS at T1 (r = 0.400; p < 0.05). Conclusions: Integrating elastography with inertial sensor-based motion analysis provides complementary, quantitative insights into tendon remodeling and functional recovery after ESWT in GTPS. These findings support combined imaging and wearable motion measures to monitor treatment response over time. Full article

Tissue-mimicking phantoms that accurately replicate human tissue are crucial for validating and optimizing elastography systems and developing new treatment methods. The use of waste-based fibrous structures has the dual benefits of waste reduction and economic viability, mitigating the environmental consequences associated with the textile industry and, thus, posing a particularly interesting avenue of research in today’s ever-more environmentally conscious society. This work explores the development of elastography phantoms through the use of textile waste for sustainable valorization. Two cotton-short fiber-based and two polyester-nonwoven-based phantoms were produced by impregnating these textile structures with animal-origin gelatin. These materials were characterized by scanning electron microscopy (SEM), revealing that the diameter of the waste-based fibers (15.28 ± 6.18–22.40 ± 5.78 μm) falls within the typical size range of scatterers used in acoustic phantoms. It was observed that these fibers provided phantoms with intrinsic acoustic scattering properties, resulting in ultrasound images similar to those obtained in biological tissues. Shear wave elastography (SWE) was used to assess the stiffness of the phantoms, which produced realistic ultrasound images with shear wave speed (SWS) values ranging from 1.87 m s⁻¹ to 8.39 m s⁻¹, closely resembling those in different anatomical structures. This research presents an innovative methodology for producing low-cost and sustainable tissue-mimicking materials, underscoring the potential of textile industry waste for phantom production. Full article

Background: Accurate intraoperative assessment of sentinel lymph node (SLN) status is critical for staging and guiding surgical management in gynaecological malignancies. Frozen-section histopathology remains the gold standard, but it is time-consuming and resource-intensive. Shear-wave elastography (SWE) quantifies tissue stiffness in real time and may offer a rapid alternative. Methods: In this prospective single-centre study, 63 women (median age 62 years) undergoing primary surgery with sentinel lymph node biopsy (SLNB) for endometrial, cervical, vulvar, or early ovarian carcinoma were enrolled. A total of 172 SLNs were excised, submerged in coupling gel, and scanned ex vivo using a 9 MHz linear probe. Results: A total of 172 SLNs underwent SWE (mean 2.7 nodes/patient). Endometrial primaries accounted for 58% of nodes, mostly retrieved by robotic-assisted surgery (71.8%). Node dimensions were significantly larger in malignant lesions for sonographic (long-axis: 13.02 ± 3.31 mm vs. 10.80 ± 3.28 mm; p = 0.002) and pathological long-axis measurements (11.45 ± 2.83 mm vs. 9.75 ± 2.61 mm; p = 0.004). Mean SWE velocities were similar between groups (1.381 ± 0.307 vs. 1.343 ± 0.236 m/s; p = 0.541). Histopathology identified metastases in 18% of SLNs, comprising macrometastases (7%), micrometastases (5%), and isolated tumour cells (6%). Conclusions: Although ex vivo SWE is rapid, reproducible, and integrates seamlessly into the sterile field, stiffness measurements alone lack sufficient discriminatory power for SLN staging in gynaecological cancers. Future research should focus on three-dimensional SWE, advanced radiomic analyses, and machine-learning algorithms to improve the detection of low-volume metastatic disease. Full article

Hypertensive kidney disease (HKD) represents a significant contributor to chronic kidney disease and end-stage renal failure, yet its early detection remains challenging due to nonspecific clinical and imaging findings. The lack of a noninvasive diagnostic tool, preventing the use of biopsy and diagnosis by exclusion, suggests the underdiagnosis of patients and overestimation of HKD as the cause of renal replacement therapy. Ultrasonography, including Doppler assessment and renal resistive index measurements, provides a widely accessible, noninvasive approach to evaluate renal structure and hemodynamics, aiding in the identification of early renal impairment or renal artery stenosis. Shear-wave elastography (SWE) has emerged as a promising modality for noninvasive assessment of renal stiffness, potentially detecting structural changes prior to functional deterioration. Current evidence demonstrates SWE’s diagnostic potential in chronic kidney disease and early hypertensive renal disease; however, limitations such as inter-device variability, heterogeneous patient populations, and short follow-up periods constrain its clinical applicability. Neither ultrasonography nor SWE can yet serve as standalone diagnostic tools for HKD, emphasizing the need for standardization, further validation, and longitudinal studies to clarify their role in patient management and prediction. Full article

Background/Objectives: This study aimed to quantitatively and noninvasively evaluate the changes in the Genioglossus (GG) and Geniohyoid (GH) muscles in patients with Obstructive Sleep Apnea (OSA) using ultrasonography (US) and shear wave elastography (SWE). Methods: This prospective study included 94 adults (18–73 years) who underwent polysomnography (27 normal; 67 OSA). GG and GH muscle thickness was measured with US, and stiffness with SWE. Participants were grouped as non-OSA (Group 0) and OSA (Group 1). OSA patients were further divided by apnea–hypopnea index (AHI) into mild, moderate, and severe (Groups 1–3), forming four groups including controls. Results: No significant differences were observed in genioglossus or geniohyoid muscle thickness between groups. Shear wave elastography revealed significantly higher stiffness values for both the genioglossus and geniohyoid muscles bilaterally in OSA patients compared with non-OSA individuals (approximately 2.7 m/s vs. 2.4–2.5 m/s, p < 0.01). Geniohyoid muscle stiffness on both sides increased progressively with OSA severity, with significantly higher values in severe compared with mild OSA (p < 0.05). In contrast, genioglossus stiffness did not differ significantly across OSA severity subgroups. Conclusions: In patients with OSA, GH and GG muscle thickness remains unchanged, but their stiffness measured by SWE increases. GH stiffness also rises with increasing disease severity. These results indicate that GG and GH muscle stiffness may serve as useful noninvasive markers for OSA. Full article

Background: Objective, reproducible assessment of deep cervical muscle mechanics is clinically relevant, yet the reliability of shear-wave elastography (SWE) for the longus colli (LC) has not been established. Therefore, the aim of this study was to determine intra- and inter-examiner reliability of LC stiffness measured by SWE under a tightly standardized protocol in patients with mechanical neck pain. Methods: A longitudinal reliability study was conducted. Adults suffering from neck pain for ≥6 months were recruited. Two examiners (with different levels of experience) acquired bilateral LC images using fixed presets. The SWE region of interest covered the full muscle thickness (excluding fascia) to measure the LC shear-wave speed and Young’s modulus. Intraclass correlation coefficients (ICCs), standard error of measurement and minimal detectable changes were computed. Results: Nineteen participants with neck pain completed imaging (left and right sides analyzed). Inter-examiner agreement was good to excellent for single measurements (ICC_3,2 > 0.818) and improved when averaging two acquisitions (ICC_3,2 > 0.866). Intra-examiner repeatability was good to excellent for the novel examiner (ICC_3,1 > 0.891) and excellent for the experienced examiner (ICC_3,1 > 0.973). No meaningful stiffness differences by sex or side were observed in this sample (p > 0.05). Conclusions: A standardized SWE workflow yields reproducible LC stiffness measurements in mechanical neck pain. For longitudinal use, keep a single operator when feasible; in multi-examiner settings, average at least two acquisitions per side to enhance sensitivity to true change. Full article

Background/Objectives: Muscle thickness and stiffness near the arteriovenous fistula (AVF) site may influence vascular access function in hemodialysis patients. This exploratory study aimed primarily to describe differences in muscle thickness and stiffness between the AVF-bearing and contralateral limbs, and secondarily to examine whether these parameters were associated with AVF maturation. This study aimed to compare these muscle parameters between the AVF and contralateral sides and to evaluate their relationship with AVF maturation status. Methods: Thirty participants undergoing hemodialysis were included, comprising 22 with mature AVFs and 8 with non-mature AVFs. Ultrasound examinations measured muscle thickness and stiffness using Shear Wave Elastography (SWE) of the biceps brachii and brachioradialis muscles. Volume flow was recorded in the draining vein and feeding artery. Statistical analyses included paired comparisons, group comparisons, Pearson correlations, and multiple linear regression models. Results: Brachioradialis thickness was significantly reduced on the AVF side compared with the contralateral side (p = 0.013, Cohen’s d = –0.95), particularly in forearm (radiocephalic) fistulas (Wilcoxon p = 0.014, Cohen’s d = –0.95), indicating localized muscle atrophy. No significant side-to-side differences were found for biceps brachii thickness or for stiffness in either muscle (all p > 0.1). Comparisons between mature and non-mature AVF groups showed no significant differences in muscle parameters on the AVF side (all p > 0.4). Conclusions: AVF may lead to asymmetric muscle changes, especially a reduction in brachioradialis thickness, regardless of maturation status, which could affect forearm function. Nevertheless, muscle thickness and stiffness do not appear to predict AVF maturity or vascular access success directly. Full article

Objectives: Liver fibrosis staging and etiology diagnosis are critical for patient management, but non-invasive methods remain challenging. This study aims to evaluate the performance of radiomics models using 2D shear wave elastography (2D-SWE) of the liver and spleen for liver fibrosis staging and etiology differentiation, comparing them with serum biomarkers and conventional ultrasound. Methods: A retrospective analysis was conducted on 198 patients with liver fibrosis confirmed by biopsy. Radiomics features were extracted from the liver and spleen grayscale and 2D-SWE images. Machine learning (ML) and transfer learning (TL) models were established for fibrosis staging and etiology diagnosis. Model performance was evaluated according to receiver operating characteristic (ROC) curves. Results: For fibrosis staging, 2D-SWE-based models outperformed grayscale and serum biomarkers. The combined liver–spleen TL model achieved exceptional validation performance (AUCs 0.99 for S4, 0.98 for ≥S3, 1.00 for ≥S2). For etiology diagnosis, the liver 2D-SWE TL model and the combined liver–spleen TL model achieved AUCs of 0.97 and 0.94, respectively, significantly outperforming ML models in terms of AUC. Conclusions: Integrating liver and spleen 2D-SWE radiomics with TL significantly improves non-invasive liver fibrosis staging and etiology diagnosis, offering superior accuracy over conventional methods. This approach holds promise for clinical application, though further validation is needed. 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/Objectives: Medullary thyroid carcinoma (MTC) poses diagnostic challenges due to its sonographic similarity to benign nodules and the modest sensitivity of conventional ultrasound (US) and TIRADS-based risk stratification. Elastography, using strain (SE) and shear-wave (SWE) techniques, has demonstrated high accuracy in papillary thyroid carcinoma (PTC) but remains underexplored in MTC. This study investigates whether elastographic stiffness measurements can enhance diagnostic precision for MTC when combined with conventional US. Methods: We retrospectively analyzed 20 nodules confirmed as MTC by pathology after surgical resection (January 2013–June 2024) and evaluated via conventional US, SE, and SWE at a specialized endocrinology center. Elasticity scores (ES) and Emean/Emax values were compared with US features, TIRADS categories, calcitonin levels, nodule size, and lymph node status. Results: Qualitative SE showed a mean ES of 3.2 (55% ES 4, 20% ES 3), while 87.5% of nodules exceeded an SWE Emean cutoff of 30.5 kPa, indicating increased stiffness in most MTC nodules and outperforming TIRADS, where only 60% were high-risk. Moderate correlations were found between calcitonin and nodule size (r = 0.52, p = 0.018) and between ES and size (r = 0.48, p = 0.034), but calcitonin did not correlate with ES (r = 0.07, p = 0.768). Nodules with suspicious lymph nodes showed higher Emean and ES trends, though not significant. Conclusions: Elastography identifies increased stiffness in MTC, challenging its “soft” classification, and improves risk stratification beyond TIRADS. We suggest integrating elastography as a complementary tool alongside TIRADS to guide fine-needle aspiration, without replacing calcitonin or cytology. Prospective multicenter studies are needed to validate thresholds and optimize multimodal risk assessment in MTC. 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

Sarcopenia, a progressive age-related loss of skeletal muscle mass, strength, and function, is a major contributor to disability, reduced quality of life, and mortality in older adults. While current diagnostic approaches, such as dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), magnetic resonance imaging (MRI), and computed tomography (CT), are widely used to assess muscle mass, they have limitations in detecting early qualitative changes in muscle architecture and composition. Shear Wave Elastography (SWE), an ultrasound-based technique that quantifies tissue stiffness, has emerged as a promising tool to evaluate both muscle quantity and quality in a non-invasive, portable, and reproducible manner. Studies suggest that SWE can detect alterations in muscle mechanical properties associated with sarcopenia, providing complementary information to traditional morphometric assessments. Preliminary evidence indicates its good reproducibility, feasibility in various clinical settings, and potential for integration into routine evaluations. This narrative review summarizes current evidence on the use of SWE for the assessment of sarcopenia across diverse populations. Full article

Introduction. We hypothesized changes in the elasticity in quadriceps and patella tendon before and after total knee arthroplasty would be correlated with a post-operative range of motion after total knee arthroplasty. To prospectively assess the post-operative range of motion after total knee arthroplasty, logistic regression was adopted with elasticity in the quadriceps and patella tendons were measured using shear wave elastography (SWE). Materials and Methods. From March 2021 to June 2021, SWE was performed on 95 patients (86 women; aged 57–85, mean 70.62 ± 5.49 years) preoperatively and 2 days after total knee arthroplasty. Elasticity at quadriceps and patellar tendons were measured with full flexion and extension using SWE. Based on the range of motion after surgery at 56 days, we divided the patients into two groups (Group A > 120 degrees; group B < 120 degrees). Using a logistic regression algorithm, classification between groups was performed. For the input of algorithm, patient information, the elasticity of quadriceps and patella tendons preoperatively and two days after total knee arthroplasty were used. Results. The accuracy of predicting group using only patient information was 62%, whereas using only elasticity was 68%. Furthermore, combining information and elasticity before and after surgery at 2 days, accuracy, sensitivity, specificity was 79%, 92%, 56%. Conclusions. Combined with patient information, elasticity measured by SWE at pre-op and early post-op periods could be effective to predict the performance of postoperative ROM. This algorithm could provide direction for rehabilitation. Full article

Background/Objectives: A varicocele is a common, treatable cause of male infertility involving testicular alterations. Shear wave elastography (SWE) is a noninvasive imaging technique that may detect testicular changes. This study aimed to assess the testicular volume and stiffness (using SWE), compare them with healthy controls, and examine the associations with venous diameter and semen parameters. Methods: This prospective comparative study included 69 patients with a varicocele and 76 healthy controls. The testicular stiffness and volume were measured and compared among three groups: testes with a varicocele (Group A), contralateral healthy testes of the same patients (Group B), and testes of healthy individuals (Group C). In varicocele patients, the semen analysis results were compared with testicular stiffness and volume. The statistical analyses included an ANOVA, Kruskal–Wallis tests, a correlation analysis, and a receiver operating characteristic curve analysis. Results: Group A showed a significantly lower testicular volume compared to Group B (p = 0.004) and Group C (p < 0.001), and significantly higher SWE values compared to both groups (p < 0.001). No significant differences were observed between Group B and Group C (volume: p = 0.642; SWE: p = 0.094). In oligospermic varicocele patients, the testicular stiffness tended to be higher, though the difference was not significant (p = 0.051). The correlations between the testicular stiffness and volume (Group A: p = 0.488; Group B: p = 0.872; Group C: p = 0.222), between the venous diameter and stiffness (p = 0.067), and between the venous diameter and testicular volume (p = 0.245) were not statistically significant. The SWE cut-off value of 9.26 kPa provided a sensitivity of 73.1% (95% CI: 62.3–81.7%) and a specificity of 79.6% (95% CI: 72.5–85.2%) for identifying varicoceles. Conclusions: Varicoceles are associated with an increased testicular stiffness and a decreased volume, which may indicate possible structural parenchymal alterations. Shear wave elastography appeared to be capable of noninvasively detecting these changes and may have potential as a quantitative adjunct tool for evaluating testicular parenchymal changes in varicocele patients. However, further studies are required to validate these preliminary findings. Full article