Search Results (304)

Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). Methods: Sixty-five patients who underwent RSA over a 12-month follow-up period were included. Patient characteristics and clinical and radiologic measurements were recorded. Preoperatively and at 3, 6, 9, and 12 months after surgery, deltoid muscle stiffness and muscle strength for scapular-plane abduction were sequentially measured using SWE and a portable dynamometer. In each quarterly period (3–6, 6–9, and 9–12 months), patients were assessed for an improvement in muscle strength and separated into two groups: improved and non-improved. To assess the risk of lack of improvement in each quarterly period, the variables were compared between the groups. Results: Improvement in muscle strength was observed in 52 patients (80%) at 3–6 months, 46 patients (71%) at 6–9 months, and 39 patients (60%) at 9–12 months. Notably, SWE measurements at the beginning of each period showed significantly greater values in the non-improved group than in the improved group during the subsequent quarterly period. A receiver operating characteristic (ROC) curve analysis suggested that SWE values >45.1–50.0 kPa might be associated with a lack of muscle strength improvement over 3 months with 73–87% specificity and 73–85% sensitivity. Conclusions: Our study demonstrated that increased deltoid muscle stiffness negatively correlated with an improvement in muscle strength following RSA. According to our results, a postoperative assessment with SWE may be useful for not only improving muscle strength after RSA but also facilitating postoperative improvement by preventing excessive stiffness in the deltoid muscle. Full article

Objectives: The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects. Methods: A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young’s modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study (n = 174 cases with neck pain and n = 142 asymptomatic controls). Results: No significant differences (p > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases (p < 0.001). Gender differences were significant across all US and SWE metrics (all, p < 0.001 except p = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area (p = 0.038). No significant interactions between group, gender and side (all metrics, p > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition. Conclusions: Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain. Full article

This study included 468 patients and aimed to use multimodal ultrasound radiomic technology to predict the malignancy of TI-RADS 4-5 thyroid nodules. First, radiomic features are extracted from conventional two-dimensional ultrasound (transverse ultrasound and longitudinal ultrasound), strain elastography (SE), and shear-wave-imaging (SWE) images. Next, the least absolute shrinkage and selection operator (LASSO) is used to screen out features related to malignant tumors. Finally, a support vector machine (SVM) is used to predict the malignancy of thyroid nodules. The Shapley additive explanation (SHAP) method was used to intuitively analyze the specific contributions of radiomic features to the model’s prediction. Our proposed model has AUCs of 0.971 and 0.856 in the training and testing sets, respectively. Our proposed model has a higher prediction accuracy compared to those of models with other modal combinations. In the external validation set, the AUC of the model is 0.779, which proves that the model has good generalization ability. Moreover, SHAP analysis was used to examine the overall impacts of various radiomic features on model predictions and local explanations for individual patient evaluations. Our proposed multimodal ultrasound radiomic model can effectively integrate different data collected using multiple ultrasound sensors and has good diagnostic performance for TI-RADS 4-5 thyroid nodules. Full article

There is no general consensus on evaluating disease progression in facioscapulohumeral muscular dystrophy (FSHD). Recently, shear wave elastography (SWE) has been proposed as a noninvasive diagnostic tool to assess muscle stiffness in vivo. Therefore, this study aimed to characterize biceps brachii (BB) muscle mechanics in mild-FSHD patients using SWE. Eight patients with mild FSHD, the BB were assessed using SWE, surface electromyography (sEMG), elbow moment measurements during rest, maximum voluntary contraction (MVC), and isometric ramp contractions at 25%, 50%, and 75% MVC across five elbow positions (60°, 90°, 120°, 150°, and 180° flexion). The mean absolute percentage deviation (MAPD) was analyzed as a measure of force control during ramp contractions. The shear elastic modulus of the BB in FSHD patients increased from flexed to extended elbow positions (e.g., p < 0.001 at 25% MVC) and with increasing contraction intensity (e.g., p < 0.001 at 60°). MAPD was highly variable, indicating significant deviation from target values during ramp contractions. SWE in mild FSHD is influenced by contraction level and joint angle, similar to findings of previous studies in healthy subjects. Moreover, altered force control could relate to the subjective muscle weakness reported by patients with dystrophies. Full article

Objective: This study aimed to evaluate the distribution and trends of masseter muscle tension in patients with temporomandibular joint (TMJ) pain, examining gender-specific differences and the impact of various TMJ disorders. Methods: From January 2020 to June 2024, a total of 734 patients presenting with facial pain radiating to the head and neck, localized around and extending from the TMJ, were referred for ultrasonographic examination. After applying exclusion criteria, 535 patients (72.9%) were included in the study. The patient cohort consisted of 343 females (64.1%) and 192 males (35.9%), with muscle tension measured using the Aixplorer ultrasound system equipped with a shear wave device. Data were collected and analyzed across different age groups and TMJ conditions, including “no changes”, “exudate”, “arthrosis”, and “disc displacement”. Results: The study found that males exhibited higher muscle tension across all conditions, particularly in the “no changes” (40.4 kPa vs. 32.1 kPa, 25.9% higher) and “exudate” (38.5 kPa vs. 29.7 kPa, 29.6% higher) categories, indicating increased muscle strain and inflammation during middle age. In females, a trend of decreasing muscle tension with age was observed, with a significant reduction from 36.2 kPa in the 20–30 age group to 24.3 kPa in the 60–70 age group (32.9% reduction), suggesting a reduction in muscle mass or strength due to aging. Both genders showed high muscle tension in the presence of exudate, with females peaking in the 40–50 age group at 37.1 kPa and males peaking earlier in the 20–30 age group at 41.2 kPa (10.9% higher in males), highlighting potential gender differences in inflammatory response. In the arthrosis group, males displayed a consistent increase in muscle tension with age, peaking at 37.5 kPa in the 50–60 age group (50.7% increase from the 20–30 age group), while females showed high tension, particularly in the 40–50 age group at 31.0 kPa (82.4% higher compared to the 20–30 age group), indicating the need for targeted joint health interventions in middle-aged women. Conclusions: This study reveals significant gender-specific differences in masseter muscle tension among patients with TMJ pain. Males were found to be more affected by muscle strain and inflammation during middle age, whereas females showed a significant decrease in muscle tension with age. The presence of exudate significantly impacted muscle tension across all age groups for both genders. These findings underscore the importance of tailored clinical interventions and preventive strategies to manage TMJ disorders effectively. Full article

Hepatic fibrosis with various origins can be estimated non-invasively by using certain biomarkers and imaging-based measurements. The aim of our study was to examine redox homeostasis biomarkers and liver stiffness measurements for the assessment of significant liver fibrosis in different etiologies of chronic liver diseases. A cohort study consisting of 88 chronic liver disease patients of both sexes (age 49.1 ± 14.7 years) was performed. Cytokine profiles as well as redox homeostasis characteristics were determined. Liver fibrosis stages were assessed with shear wave elastography. The plasma levels of four cytokines showed no significant alteration between the four fibrotic stages; however, higher values were measured in the F2–4 stages. Free sulfhydryl group concentration, the marker of redox homeostasis, was lower in significant fibrosis (F0–F1: 0.36 ± 0.06 vs. F2–4: 0.29 ± 0.08 mmol/L, p < 0.05). Higher chemiluminescence values, as free radical–antioxidant parameters, were detected in advanced fibrosis stages in erythrocytes (F0–F1: 36.00 ± 37.13 vs. F2–4: 51.47 ± 44.34 RLU%). These data suggest that oxidative stress markers can predict significant fibrosis, with the aim of reducing the number of protocol liver biopsies in patients unlikely to have significant disease; however, their role in distinguishing between the certain fibrosis groups needs further studies. Full article

Breast cancer is the most prevalent cancer among women worldwide. B-mode ultrasound (US) is essential for early detection, offering high sensitivity and specificity without radiation exposure. This study introduces a semi-automatic method to streamline breast US report generation, aiming to reduce the burden on radiologists. Our method synthesizes comprehensive breast US reports by combining the extracted information from radiologists’ annotations during routine screenings with the analysis results from deep learning algorithms on multimodal US images. Key modules in our method include image classification using visual features (ICVF), type classification via deep learning (TCDL), and automatic report structuring and compilation (ARSC). Experiments showed that the proposed method reduced the average report generation time to 3.8 min compared to manual processes, even when using relatively low-spec hardware. Generated reports perfectly matched ground truth reports for suspicious masses without a single failure on our evaluation datasets. Additionally, the deep-learning-based algorithm, utilizing DenseNet-121 as its core model, achieved an overall accuracy of 0.865, precision of 0.868, recall of 0.847, F1-score of 0.856, and area under the receiver operating characteristics of 0.92 in classifying tissue stiffness in breast US shear-wave elastography (SWE-mode) images. These improvements not only streamline the report generation process but also allow radiologists to dedicate more time and focus on patient care, ultimately enhancing clinical outcomes and patient satisfaction. Full article

An incidental focal liver lesion (IFLL) is defined as a hepatic lesion identified in a patient imaged for an unrelated reason. They are frequently encountered in daily practice, sometimes leading to unnecessary, invasive and potentially harmful follow-up investigations. The clinical presentation and the imaging aspects play an important role in deciding if, and what further evaluation, is needed. In low-risk patients (i.e., without a history of malignant or chronic liver disease or related symptoms), especially in those younger than 40 years old, more than 95% of IFLLs are likely benign. Shear Wave liver Elastography (SWE) of the surrounding liver parenchyma should be considered to exclude liver cirrhosis and for further risk stratification. If an IFLL in a low-risk patient has a typical appearance on B-mode ultrasound of a benign lesion (e.g., simple cyst, calcification, focal fatty change, typical hemangioma), no further imaging is needed. Contrast-Enhanced Ultrasound (CEUS) should be considered as the first-line contrast imaging modality to differentiate benign from malignant IFLLs, since it has a similar accuracy to contrast-enhanced (CE)-MRI. On CEUS, hypoenhancement of a lesion in the late vascular phase is characteristic for malignancy. CE-CT should be avoided for characterizing probable benign FLL and reserved for staging once a lesion is proven malignant. In high-risk patients (i.e., with chronic liver disease or an oncological history), each IFLL should initially be considered as potentially malignant, and every effort should be made to confirm or exclude malignancy. US-guided biopsy should be considered in those with unresectable malignant lesions, particularly if the diagnosis remains unclear, or when a specific tissue diagnosis is needed. Full article

Background: Ultrasound shear wave elastography (SWE) noninvasively measures the stiffness of tissue by producing and measuring tissue deformation. Scar formation, a crucial aspect of wound healing, can lead to functional and aesthetic complications when pathological. While SWE has shown promise in dermatological evaluations, its role in surgical scar assessment remains underestimated. Our study aims to investigate SWE in evaluating surgical scars at the donor site after forearm free flap surgery in transgender patients. Methods: After radial forearm free flap harvesting, the donor site was grafted with a split-thickness skin graft with or without interposition of Matriderm. Eleven patients were evaluated more than one year after surgery, using SWE alongside scar characteristics, sensory outcomes, and patient satisfaction surveys. Results: Our study revealed no significant difference in stiffness (p > 0.15), pigmentation (p = 0.32), or erythema (p = 0.06) between operated and non-operated sides. The interposition of Matriderm did not influence the stiffness. Patients significantly (p < 0.0001) reported a loss of discrimination. Patients’ subjective scar evaluation appeared in line with our quantitative and objective results. Conclusions: This study contributes to the evolving understanding of SWE’s role in scar assessment, highlighting its feasibility in evaluating surgical scars. However, continued research efforts are necessary to establish SWE as a reliable and objective method for surgical scar evaluation and management. Full article

Background: A better understanding of the peritumoral stroma changes due to tumour invasion using non-invasive diagnostic methods may improve the differentiation between benign and malignant breast lesions. This study aimed to assess the correlation between breast lesion differentiation and intra- and peritumoral shear-wave elastography (SWE) gradients. Methods: A total of 135 patients with newly diagnosed breast lesions were included. Intratumoral, subsurface, and three consecutive peritumoral SWE value measurements (with three repetitions) were performed. Intratumoral, interface, and peritumoral gradients (Gradient 1 and Gradient 2) were calculated using averaged SWE values. Statistical analysis included descriptive statistics and an ordinary one-way ANOVA to compare overall and individual gradients among Breast Imaging-Reporting and Data System (BI-RADS) 2, 3, and 5 groups. Results: Malignant tumours showed higher average SWE velocity values at the tumour centre (BI-RADS 2/3: 4.1 ± 1.8 m/s vs. BI-RADS 5: 4.9 ± 2.0 m/s, p = 0.04) and the first peritumoral area (BI-RADS 2/3: 3.4 ± 1.8 m/s vs. BI-RADS 5: 4.3 ± 1.8 m/s, p = 0.003). No significant difference was found between intratumoral gradients (0.03 ± 0.32 m/s vs. 0.0 ± 0.28 m/s; p > 0.999) or gradients across the tumour–tissue interface (−0.17 ± 0.18 m/s vs. −0.13 ± 0.35 m/s; p = 0.202). However, the first peritumoral gradient (−0.16 ± 0.24 m/s vs. −0.35 ± 0.31 m/s; p < 0.0001) and the second peritumoral gradient (−0.11 ± 0.18 m/s vs. −0.22 ± 0.28 m/s; p = 0.037) were significantly steeper in malignant tumours. The AUC was best for PTG1 (0.7358) and PTG2 (0.7039). A threshold value for peritumoral SWI PT1 above 3.76 m/s and for PTG1 below −0.238 m/s·mm⁻¹ indicated malignancy in 90.6% of cases. Conclusions: Evaluating the peritumoral SWE gradient may improve the diagnostic pre-test probability, as malignant tumours showed a significantly steeper curve of the elasticity values in the peritumoral stroma compared to the linear regression with a relatively flat curve of benign lesions. Full article

Supersonic shear image (SSI) ultrasound elastography provides a quantitative assessment of tissue stiffness using the velocity of shear waves. SSI’s great potential has allowed researchers in fields like biomechanics and muscle physiology to study the function of complex muscle groups in different conditions. The aim of this study is to use SSI to investigate changes in the stiffness of the vastus lateralis (VL) muscle as a consequence of passive elongation, isometric contraction, and repeated muscle activity. In a single session, 15 volunteers performed a series of isometric, concentric, and eccentric contractions. SSI images were collected from the VL to assess its stiffness before and after the contractions and at various knee angles. Two-way within-subjects ANOVA was used to test the effects of muscle contraction type and knee angle on VL stiffness. Linear regression analysis was employed to assess the relationship between muscle stiffness and the intensity of isometric contractions. After maximal contractions, VL stiffness increased by approximately 10% compared to baseline values, and following maximal isometric (p < 0.01) and eccentric contractions (p < 0.05). Yet, there was no change in VL shear modulus at the end of concentric contractions. The relaxed VL shear modulus increased with knee flexion both before and after the knee extensor contractions (p < 0.001). A linear relationship between the shear modulus and the degree of isometric contraction was observed, although with notable individual variation (R² = 0.125). Maximal contractile activity produces modest increases in relaxed muscle stiffness. The SSI-measured shear modulus increases linearly with the degree of isometric contraction. Full article

Ultrasound elastography has been available on most modern systems; however, the implementation of quality processes tends to be ad hoc. It is essential for a medical physicist to benchmark elastography measurements on each system and track them over time, especially after major software upgrades or repairs. This study aims to establish baseline data using phantoms and monitor them for quality assurance in elastography. In this paper, we utilized two phantoms: a set of cylinders, each with a composite material with varying Young’s moduli, and an anthropomorphic abdominal phantom containing a liver modeled to represent early-stage fibrosis. These phantoms were imaged using three ultrasound manufacturers’ elastography functions with either point or 2D elastography. The abdominal phantom was also imaged using magnetic resonance elastography (MRE) as it is recognized as the non-invasive gold standard for staging liver fibrosis. The scaling factor was determined based on the data acquired using MR and US elastography from the same vendor. The ultrasound elastography measurements showed inconsistency between different manufacturers, but within the same manufacturer, the measurements showed high repeatability. In conclusion, we have established baseline data for quality assurance procedures and specified the criteria for the acceptable range in liver fibrosis phantoms during routine testing. Full article

Background/Objectives: The utility of shear wave elastography (SWE) as an adjunct to ultrasound biometry and Doppler velocimetry for the examination of placental dysfunction and suboptimal fetal growth is unclear. To date, limited data exist correlating the mechanical properties of placentae with fetal growth. This study aimed to investigate the relationship between placental shear wave velocity (SWV) and ultrasound estimated fetal weight (EFW), and to ascertain if placental SWV is a suitable proxy measure of placental function in the surveillance of small-for-gestational-age (SGA) pregnancies. Methods: This prospective, observational cohort study compared the difference in placental SWV between SGA and appropriate-for-gestational-age (AGA) pregnancies. There were 221 women with singleton pregnancies in the study cohort—136 (61.5%) AGA and 85 (38.5%) SGA. Fetal biometry, Doppler velocimetry, the deepest vertical pocket of amniotic fluid, and mean SWV were measured at 2–4-weekly intervals from recruitment to birth. Results: There was no difference in mean placental SWV in SGA pregnancies compared to AGA pregnancies, nor was there any relationship to EFW. Conclusions: Although other studies have shown some correlation between increased placental stiffness and SGA pregnancies, our investigation did not support this. The mechanical properties of placental tissue in SGA pregnancies do not result in placental SWVs that are apparently different from those of AGA controls. As this study did not differentiate between constitutionally or pathologically small fetuses, further studies in growth-restricted cohorts would be of benefit. Full article

Introduction: Sports requiring sprinting, jumping, and kicking tasks frequently lead to hamstring strain injuries (HSI). One of the structural risk factors of HSI is the increased passive stiffness of the hamstrings. Anterior cruciate ligament (ACL) injury history is associated with a 70% increase in the incidence of HSI, according to a recent meta-analysis. The same report recommended that future research should concentrate on the relationships between the HSI risk factors. Hence, the present study aimed to retrospectively compare changes in the passive stiffness of the hamstrings in athletes with and without ACL reconstruction history. Methods: Using ultrasound-based shear-wave elastography, the mid-belly passive muscle stiffness values of the biceps femoris long head, semimembranosus, and semitendinosus muscles were assessed and compared amongst athletes with and without a history of ACL reconstruction. Results: There were no significant differences in the biceps femoris long head (injured leg (IL): 26.19 ± 5.28 KPa, uninjured contralateral (UL): 26.16 ± 7.41 KPa, control legs (CL): 27.64 ± 5.58 KPa; IL vs. UL: p = 1; IL vs. CL: p = 1; UL vs. CL: p = 1), semimembranosus (IL: 24.35 ± 5.58 KPa, UL: 24.65 ± 8.35 KPa, CL: 22.83 ± 5.67 KPa; IL vs. UL: p = 1; IL vs. CL: p = 1; UL vs. CL, p = 1), or semitendinosus (IL: 22.45 ± 7 KPa, UL: 25.52 ± 7 KPa, CL: 22.54 ± 4.4 KPa; IL vs. UL: p = 0.487; IL vs. CL: p = 1; UL vs. CL, p = 0.291) muscle stiffness values between groups. Conclusions: The passive mid-muscle belly stiffness values of the biceps femoris long head, semitendinosus, and semimembranosus muscles did not significantly differ between previously injured and uninjured athletes; therefore, further assessment for other muscle regions of hamstrings may be necessary. To collect more comprehensive data related to the structural changes that may occur following ACL reconstructions in athletes, a future study should examine the passive stiffness of wider muscle regions from origin to insertion. Full article

Soccer teams integrate specific exercises into their typical workout programs for injury prevention. This study examined the effects of hamstring exercise on paraspinal and hamstring stiffness. These findings can inform training and rehabilitation programs to improve muscle health and prevent injuries. Fifteen young, healthy males performed passive and active (submaximal) knee flexion efforts from 0°, 45°, to 90° angle of knee flexion from the prone position. Using shear-wave elastography (SWE) and surface electromyography, we measured the elastic modulus and root mean square (RMS) signal of the erector spinae (ES), multifidus (MF), semitendinosus (ST), and semimembranosus (SM) during different knee flexion angles. Passive SWE modulus at 0° was 12.44 ± 4.45 kPa (ES), 13.35 ± 6.12 kPa (MF), 22.01 ± 4.68 kPa (ST), and 21.57 ± 5.22 kPa (SM) and it was greater (p < 0.05) compared to 45° and 90°. The corresponding values during knee flexion contractions at 0° increased to 18.99 ± 6.11 kPa (ES), 20.65 ± 11.31 kPa (MF), 71.21 ± 13.88 kPa (ST), and 70.20 ± 14.29 kPa (SM) and did not differ between angles (p > 0.05). Compared to rest, the relative increase in the SWE modulus during active contraction had a median value (interquartile range) ranging from 68.11 (86.29) to 101.69 (54.33)% for the paraspinal muscles and it was moderately to strongly correlated (r > 0.672) with the corresponding increase of the hamstring muscles [ranging from 225.94 (114.72) to 463.16 (185.16)%]. The RMS signal was greater during active compared to passive conditions, and it was lower at 90° compared to 45° (for SM/ST) and 0° (for all muscles). The association between paraspinal and hamstring passive muscle stiffness indicates a potential transmission of forces through myofascial connections between the lumbar spine and the lower limbs. In this laboratory setting, hamstring exercises affected the stiffness of the paraspinal muscles. Full article