ObjectiveTo systematically review the clinical value of ultrasonographic elastography (UE) for the differential diagnosis of benign/malignant thyroid nodules. MethodsWe comprehensively searched the databases including The Cochrane Library (Issue2, 2013), PubMed, EMbase, CNKI, WanFang Data, Medalink, VIP and CBM from inception to the December of 2013, for including clinical research reports of determining thyroid nodules using ultrasonographic elastography. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Then Meta-DiSc software (version 1.4) was used for pooling analysis. ResultsA total of 35 studies including 4 127 patients were included. The results of metaanalysis showed that, specificity, sensitivity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio (DOR) were 0.89 (0.88 to 0.90), 0.88 (0.86 to 0.90), 6.37 (5.44 to7.47), 0.13 (0.11 to 0.16) and 58.72 (43.12 to 79.98), respectively; and the area under SROC curve (AUC) was 0.936 9. ConclusionCurrent evidence shows that ultrasonographic elastography has fairly high sensitivity (88%) and specificity (89%) in differential diagnosis of benign/malignant thyroid nodules. The positive rate in the malignant thyroid group is 58.72 times higher that in benign thyroid cancer with better efficacy in differential diagnosis, so ultrasonographic elastography is of effective and feasible diagnostic value for thyroid benign/malignant nodules.
Intravascular ultrasound (IVUS) is widely used in coronary artery examination. Ultrasonic elastography combined with IVUS is very conspicuous in identifying plaque component and in detecting plaque vulnerability degree. In this study, a simulation model of the blood vessel based on finite element analysis (FEA) was established. The vessel walls generally have radial changes caused by different intravascular pressure. The signals at lower pressures were used as the pre-deformation data and the signals at higher pressure were used as the post-deformation data. Displacement distribution was constructed using the time-domain cross-correlation method, and then strain images. By comparison of elastograms under different pressures, we obtained the optimal pressure step. Furthermore, on the basis of the obtained optimize pressure step, the simulation results showed that this method could effectively distinguish characteristics between different component plaques, and could guide the later experiments and clinical applications.
ObjectiveTo systematically review the diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer.MethodsWe electronically searched the databases including The Cochrane Library, PubMed, CNKI, WanFang Data, VIP, MedaLink and CBM for studies about diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then meta-analysis was performed using MetaDisc 1.4 software.ResultsA total of 9 studies involving 735 lymph nodes were included. The results of meta-analysis showed that, the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio and DOR were 0.82 (95%CI 0.78 to 0.86), 0.76 (95%CI 0.72 to 0.81), 3.32 (95%CI 2.57 to 4.27), 0.25 (95%CI 0.20 to 0.31), and 14.77 (95%CI 10.20 to 21.38), respectively. The AUC of the SROC curve was 0.8741.ConclusionUltrasonographic elastography has high sensitivity and specificity in the differential diagnosis of axillary lymph nodes in breast cancer, which indicates that it can be used to diagnosis axillary lymph nodes in breast cancer.
Objective To evaluate the diagnostic value of conventional ultrasound, ultrasound elastography and their combination in benign and malignant breast nodules using meta-analysis. Methods The English databases (EMBASE, PubMed, Cochrane Library) and Chinese databases (China Biomedical Literature Database, China HowNet, VIP, Wanfang Database) were searched to collect the Chinese and English literatures about the diagnostic value of conventional ultrasound and elastography in differentiating the benign and malignant breast lesions up to April 20, 2021, the reviewers strictly followed the inclusion and exclusion criteria to screen the literature, extract the data and conduct quality assessment. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and 95%CI were calculated by using meta-DiSc1.4 software for heterogeneity analysis and data combining analysis. The forest map and receiver operating characteristic (ROC) curve was drew, and the area under the ROC curve was calculated. StataSE14.0 software was used to draw deek funnel plot to evaluate publication bias, and Fagan’s nomogram was used to evaluate the clinical utility of each test method. Results A final selection of 42 articles involving 6 009 nodules in 5 118 patients was included. The sensitivity for conventional ultrasound, elastosonography and two techniques combination was 0.80 [95%CI (0.79, 0.82)], 0.87 [95%CI (0.86, 0.89)] and 0.93 [95%CI (0.91, 0.94)], respectively; with specificity of 0.75 [95%CI (0.73, 0.76)], 0.85 [95%CI (0.84, 0.86)] and 0.94 [95%CI (0.93, 0.95)]. The summery area under curve was 0.86, 0.94 and 0.98, respectively. There were significant differences in the diagnostic efficiency among the three groups（all P<0.05）. The Deek’s funnel plot showed no significant publication bias (all P>0.05). The pre-testprobability of conventional ultrasound, elastosonography and two techniques combination were both 20%, and the post-testprobability were 49%, 66%, and 82%, respectively. Conclusions The accuracy of elastography in distinguishing benign from malignant breast nodule is relatively high, while the accuracy of benign and malignant nodules in conventional ultrasound is generally acceptable. However, the accuracy of the combination of the two is higher, which is worthy of clinical application.
ObjectiveTo explore the significance of quantitative parameters of tissue diffusion included in the real-time ultrasound elastography (RTE), in diagnosing the degree of liver fibrosis. MethodFrom July 2012 to November 2014, liver biopsy being the gold standard for evaluating hepatic fibrosis stage, we performed RTE on 112 hepatitis patients and analyzed the elastogram we got. At the same time, we carried out quantitative analysis of tissue diffusion in these patients, and obtained the values of liver fibrosis index (LFI) of right liver parenchyma. Subsequently, we compared the biopsy pathological results with the values of LFI, and single-factor analysis of variance (ANOVA) was adopted to compare the LFI among patients with variant degrees of liver fibrosis. If there were any discrepancies, least significant difference method would be adopted in order to compare one with the other from different groups. Finally, critical value of LFI of different-stage liver fibrosis was obtained with the help of receiver operator characteristic (ROC)curve. ResultsChronological liver fibrosis was classified into stage 0, stage 1, stage 2, stage 3, and stage 4, and their LFI values were 2.36±0.46, 2.38±0.45, 2.84±0.54, 3.16±0.59, and 3.69±0.55, respectively. ANOVA showed that the LFI values of different-stage fibrosis had significant differences (F=29.959, P<0.001). However, there was no difference between stage 0 and stage 1 (P=0.920), or between stage 2 and stage 3 (P=0.076). The area under the ROC curve for stage 0-1 and stage 2-3, stage 2-3 and S4 was respectively 0.784 and 0.799, and their critical value was 2.83 and 3.69 respectively. ConclusionsThe real-time ultrasound elastography is a feasible and non-invasive method in diagnosing the degree of hepatitis fibrosis and LFI has advantage in distinguishing different stage of liver fibrosis.
ObjectiveTo investigate the influence of 6% hydroxyethyl starch (HES, 130/0.4)on blood coagulation of patients after off-pump coronary artery bypass grafting (opCAB)by thromboelastography (TEG). MethodsOne hundred patients undergoing elective opCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group (G1 group), there were 27 males and 23 females with their age of 64.9±4.4 years, who received intravenous 6% HES (130/0.4)20 ml/kg in 4 hours postoperatively. In the control group (G2 group), there were 31 males and 19 females with their age of 63.1±5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. ResultsThere was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups (591.7±171.7 ml vs. 542.4±174.0 ml, P > 0.05). None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index between the 2 groups (P > 0.05). TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups (P > 0.05). Maximum amplitude (MA)of G1 group was significantly decreased after intravenous fluid infusion (55.9±10.0 mm vs. 62.8±7.9 mm, P < 0.05), but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. ConclusionIntravenous infusion of 6% HES (130/0.4)20 ml/kg can reduce platelet function and clot strength, but does not significantly increase postoperative chest or mediastinal drainage, or the incidence of postoperative reexploration for bleeding. It's safe to administer 6% HES (130/0.4)for patients after OPCAB.
Objective To analyze the diagnostic value of shear wave elastography (SWE) combined with vascular endothelial growth factor B (VEGF-B) and hemoglobin A1c (HbA1c) in early diabetic peripheral neuropathy (DPN). Methods A total of 100 patients with type 2 diabetes mellitus (T2DM) admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group (n=31) and a T2DM without DPN group (n=69) based on the presence or absence of DPN. Additionally, 50 healthy individuals from the same hospital’s health examination center were included as a healthy control group. The basic clinical characteristics, mean elasticity (Emean) values of the left and right median and tibial nerves, serum VEGF-B, and HbA1c levels were compared among the three groups. The diagnostic efficacy of SWE, VEGF-B, and HbA1c for DPN was evaluated using receiver operating characteristic (ROC) curves, and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve Emean and VEGF-B/HbA1c. Results The Emean values of the left and right median nerves, Emean values of the left and right tibial nerves, serum VEGF-B, and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group (P<0.05). The Emean values of the left and right median and tibial nerves, Emean values of the left and right tibial nerves, and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group (P<0.05), while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group (P>0.05). The area under the ROC curve for the combined diagnosis of DPN using SWE, VEGF-B, and HbA1c was 0.859 [95% confidence interval (0.828, 0.955)]. The sensitivity of the combined diagnosis (93.72%) was significantly higher than that of individual diagnoses (78.82%, 75.39%, and 71.05%, respectively; P<0.05), while the specificity (88.64%) showed no significant difference compared to individual diagnoses (80.18%, 78.96%, and 82.88%, respectively; P>0.05). Positive correlations were observed between median/tibial nerve Emean and VEGF-B/HbA1c levels (r=0.428, 0.395, 0.416, and 0.416, respectively; P<0.05). Conclusions Elevated median/tibial nerve Emean, serum VEGF-B, and HbA1c levels are closely associated with DPN. The combination of SWE, VEGF-B, and HbA1c improves diagnostic sensitivity for DPN, demonstrating significant clinical value.
Objective To explore the clinical value of Wells score combined with thromboelastography (TEG) in rapid prediction of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 130 AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine of Guangxi University of Science and Technology from January 2022 to March 2023 were selected as the study subjects. According to results of digital subtraction angiography (DSA) of the pulmonary artery, the patients were divided into a PE group (n=37) and a non-PE group (n=93). Both groups underwent Wells score analysis combined with TEG. Thromboelastographic parameters were comparing between the two groups, including Wells score, reaction time (R time), reaction time (K time), coagulation index (CI), and maximum amplitude (MA). The diagnostic value of different prediction models to diagnose AECOPD with PE was compared, including Wells score, thromboelogram and Wells score combined with TEG. Results The Wells score of the patients in the PE group was significantly higher than that in the non-PE group, and R time of the patients in the PE group was significantly lower than that in the non-PE group. The K time, CI, MA and other parameter levels of the patients in the PE group were significantly higher than those in the non-PE group (all P<0.05). The sensitivity, specificity, and area under ROC curve of the combination of Wells score and TEG prediction model in diagnosing AECOPD complicated with PE were greater than those of the Wells score alone prediction model (P<0.05). Conclusion The combination of Wells score and TEG has significant clinical value in quickly predicting AECOPD complicated with PE, and is worthy of clinical application and promotion.
Objective To explore the application value of shear wave elastography (SWE) combined with diaphragmatic thickening fraction (DTF) and rapid shallow breathing index (RSBI) in predicting the results of weaning of patients with mechanical ventilation. Methods Fifty-two patients with severe illness who were hospitalized in this hospital from January 2022 to September 2022 were treated with mechanical ventilation. After meeting the conditions for weaning, they underwent spontaneous breathing test, and the diaphragm function of patients was evaluated by measuring DTF using ultrasound technology and shear modulus (SM) using SWE technology. According to the weaning results, they were divided into weaning success group and weaning failure group, The differences of mechanical ventilation time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, respiratory rate, RSBI, oxygenation index, DTF, SM and other parameters between the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the withdrawal results. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value of potential influencing factors on the withdrawal results. Results There were 39 cases of successful withdrawal and 13 cases of failure. There were significant differences in mechanical ventilation time, respiratory rate, RSBI, DTF and SM between the successful weaning group and the failure group (P<0.05). Through multivariate logistic regression analysis, RSBI [area under the ROC curve (AUC)=0.771, 95% confidence interval (CI) 0.589 - 0.953], DTF (AUC=0.806, 95%CI 0.661 - 0.951), SM (AUC=0.838, 95%CI 0.695 - 0.981) were independent factors that affected the results of withdrawal. The single parameter AUC was smaller than the combined index with RSBI≤70.48 times·min–1L–1, DTF≥30.0%, SM≥10.0 kPa as the cutoff value (AUC=0.937, 95%CI 0.714 - 1.0, diagnostic sensitivity, specificity and accuracy were 94.9%, 84.6% and 92.3% respectively). Conclusions SWE technology provides a new quantitative index for evaluating diaphragm function by evaluating diaphragm stiffness. Diaphragm stiffness combined with DTF and RSBI can better predict the successful withdrawal in patients with mechanical ventilation.
Objective To explore the clinical value of shear wave elastography in the evaluation of quadriceps femoris lesions in patients with chronic obstructive pulmonary disease (COPD). Methods Fifty-eight COPD patients who were admitted to Chengdu First People’s Hospital and 55 healthy controls were included in the study between August 2021 and February 2022. The thickness, circumference, cross-sectional area and Young's modulus of quadriceps femoris in all subjects were measured using shear wave elastography combined with conventional two-dimensional ultrasound. The differences in ultrasound parameters between the two groups were compared, and the correlation between each ultrasound parameter and clinical evaluation indicators (modified British Medical Research Council Scale, COPD Assessment Test, six-minute walk test, and five-time sit-to-stand test) was analyzed. Results Young’s modulus values of the quadriceps femoris muscle were smaller in the COPD group than those in the healthy control group [COPD Group: rectus femoris 6.72 (6.22, 7.36) kPa, vastus medialis 6.25 (5.82, 6.79) kPa, vastus lateralis 6.94 (6.17, 7.48) kPa; healthy control group: rectus femoris 11.40 (10.23, 12.11) kPa, vastus medialis 10.77 (9.62, 11.42) kPa, vastus lateralis 11.14 (10.42, 12.52) kPa]. The differences were statistically significant (all P<0.05). The Young's modulus value of the rectus femoris muscle correlates with the aforementioned clinical evaluation indicators, with positive correlation with six-minute walk distance and negative correlation with COPD Assessment Test, modified British Medical Research Council Scale, five-time sit-to-stand time (P<0.05). Quadriceps thickness, circumference, and cross-sectional area measured by conventional two-dimensional ultrasound were not significantly different between the two groups, nor were there significant correlations between each parameter and clinical parameters (P>0.05). In addition, shear wave elastography has good reproducibility in the measurement of Young's modulus in quadriceps. Conclusions Shear wave elastography can identify quadriceps lesions earlier than conventional two-dimensional ultrasound in COPD patients, and there is a significant correlation between its measurements and the clinical condition of COPD patients. Shear wave elastography may provide a simple and noninvasive method for clinical evaluation of quadriceps femoris lesions in COPD patients.