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.
ObjectiveTo study the Young's modulus obtained by the real-time shear wave elastography (SWE) in healthy adults' parotid gland and submaxillary gland and to explore the probable factors affecting the Young's modulus, such as bilateral parotid and submaxillary gland, sex, age, height and weight.
MethodsThere were 35 healthy volunteers who underwent SWE in parotid gland and submaxillary gland between December 3 and 18, 2013. The difference of Young's modulus in bilateral parotid and submaxillary gland, and the modulus values of different sex, age, height and weight groups were also compared.
ResultsThe Young's modulus of parotid gland was (8.14±1.78) kPa, and the Young's modulus of submaxillary gland was (11.52±2.34) kPa. The differences of Young's modulus between the two sides of parotid gland and submaxillary gland were not statistically significant (P>0.05); the differences of Young's modulus of parotid and submaxillary gland between different sex, age, height and weight groups had no statistical significance, either (P>0.05).
ConclusionThe real-time shear wave elastography can be applied to evaluate the elasticity of parotid and submaxillary gland and to lay the foundation for further diagnosis of salivary lesions.
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.
ObjectiveTo summarize the progress of transient elastography in predicting the prognosis of hepatic surgery.
MethodsThe related literatures were reviewed.
ResultsLiver stiffness can be measured by using transient elastography.In patients with hepatocarcinoma, the liver stiffness measurements are higher, the more likely they are to have surgical complications and hepatocarcinoma recurrence.Liver transplant recipients with higher liver stiffness measurements tend to have higher acute rejection and hepatitis C recurrence rates.
ConclusionTransient elastography can evaluate hepatic functional reserve to help improve the outcome of hepatic surgery.
ObjectiveTo explore value of ultrasound real-time elastography (RTE) technology for identification of benign and malignant solid thyroid nodules.MethodsA retrospective analysis was performed on 125 patients with thyroid nodules who underwent ultrasound RTE in this hospital from February 2018 to August 2019. All patients underwent RTE on the basis of conventional ultrasound. The ultrasound elasticity contrast index (ECI) was used as the evaluation index and the pathological examination result was used as the gold standard. The receiver operating characteristic (ROC) curve analysis was used to evaluate the value of ECI in the identification of benign and malignant solid thyroid nodules. Logistic regression analysis was used to analyze the influencing factors of ECI.ResultsAmong the 125 patients with solid thyroid nodules, 51 were malignant nodules, 74 were benign nodules. The ECI value of patients with benign thyroid nodules was lower than that of patients with malignant nodules (2.71±0.83 versus 3.42±1.14, t=–4.030, P<0.001). The result of ROC analysis showed that the cutoff value of ECI to distinguish benign and malignant solid thyroid nodules was 3.07, area under curve of ROC was 0.806 [95%CI (0.717, 0.894), P<0.001], sensitivity was 80.3%, specificity was 70.4%. The multivariate logistic regression analysis showed that the thyroid nodules with diffuse lesions, calcification, and maximum nodule diameter ≥1 cm were the risk factors for elevated ECI values (P<0.05). For the solid thyroid nodules without diffuse lesions, without calcification, and maximum nodule diameter <1 cm, ECI had the higher sensitivity, specificity, accuracy, and positive predictive value for the differential diagnosis of benign and malignant thyroid nodules (all exceed 80%), but these indexes were lower (under 60%) for the differential diagnosis of solid thyroid nodules with diffuse diseases, with calcification, and maximum nodule diameter ≥1 cm.ConclusionsECI obtained by ultrasound RTE can be used to differentiate solid thyroid nodules from benign ones. The presence or absence of diffuse lesions, calcification, and maximum nodule diameter are the influencing factors for ECI to differentiate solid thyroid nodules. In clinical diagnosis, it should be paid attention to the comprehensive analysis of the above factors.
Objective To investigate the diagnostic value of strain elastography (SE) and virtual touch tissue image quantification (VTIQ) technique in determining the nature of cervical lymph nodes in patients with lung cancer. Methods A total of 124 patients with lung cancer combined with cervical lymph node enlargement were selected for this study. All patients underwent routine ultrasound examination, using SE to detect lymph nodes and scored them, and using VTIQ technique fro measurement of lymph node shear wave velocity (SWV). Pathological results were taken as gold standards. Non-metastatic lymph nodes were included in the benign group, while metastatic lymph nodes were included in the malignant group. Receiver operating characteristic (ROC) curve was generated. The optimal cutoff value of SWV was determined for predicting metastatic lymph nodes, the area under curve (AUC) of SE and VTIQ technique was compared, and the diagnostic efficacy of SE and VTIQ technique for benign and malignant lymph nodes was analyzed. Results Among the 124 patients, 28 cases of benign lymph nodes had an SE score of 2 - 3, and 59 cases of malignant lymph nodes had an SE score of 4 - 5. The accuracy, sensitivity, and specificity of SE were 70.2%, 75.6%, and 60.9%, respectively. The maximum, minimum, median, and mean values of SWV in the malignant lymph nodes were significantly higher than those in the benign lymph nodes in VTIQ technique testing (P<0.05). Based on the ROC curve analysis, the mean value of SWV had the highest diagnostic efficiency, and its cutoff value of 3.18 m/s was used as the diagnostic criterion for predicting malignant lymph nodes. The accuracy, sensitivity, and specificity of the VTIQ technique in diagnosing malignant lymph nodes were 85.5%, 92.3%, and 73.9%, respectively. The AUC of SE and VTIQ technique were 0.713 and 0.896, respectively, indicating higher diagnostic value of VTIQ technique. Conclusions Both SE and VTIQ technique have high accuracy in determining the nature of cervical lymph nodes in lung cancer patients. Compared with SE, VTIQ technique showed superior diagnostic performance, and SWVmean has the best diagnostic performance. It can provide a new non-invasive examination method for evaluating the nature of cervical lymph nodes in lung cancer patients in clinical practice.
ObjectiveTo explore the value of ultrasound real-time tissue elastography in the differential diagnosis between benign and malignant breast lesions.Methods A total of 131 cases of patients with breast lesions who underwent ultrasound examination in the People’s Hospital of Guangan City between December 2010 and December 2015 were enrolled as the research object. The patients took conventional color Doppler ultrasound diagnosis firstly, and then took ultrasound real-time tissue elastography diagnosis. The lesions were scored with improved 5-scoring system respectively. By the strain ratio measure method equipped with the ultrasonic machine, strain ratio of the lesion was calculated, with 3.08 as the cut-off pont. The results were campared with the pathologic diagnosis.ResultsThere were 182 breast lumps in the 131 patients. The conventional ultrasound examination detected 128 benign lesions and 54 malignant lesions. By ultrasound real-time tissue elastography examination, there were 121 benign tumors and 61 malignant tumors. For the benign tumors, the elasticity imaging score was 1.74±0.81, and the elastic strain rate ratio was 1.83±1.22; for the malignant tumors, the elasticity imaging score was 4.45±0.59, and the elastic strain rate ratio was 8.68±5.58. The 182 breast lumps were all removed by surgical resection, and the pathologic examination showed there were 121 benign lesions and 61 malignant lesions. The accuracy, sensitivity and specificity of conventional ultrasonic diagnosis of breast malignant lesions was 76.4%, 59.0% and 85.1%, respectively; while the indexes of ultrasound real-time tissue elastography diagnosis of breast malignant lesions was 96.7%, 95.1% and 97.5%, respectively, and the differences were statistically significant (P<0.05).ConclusionReal-time tissue elastography is helpful in the differential diagnosis between malignant and benign breast lesions.
Objective
To evaluate the significance of the ultrasound elastography (UE) strain ratio (SR) in the diagnosis of breast nodule by meta-analysis.
Methods
A computer-based online search was conducted in PubMed, The Cochrane Library (Issue 6, 2017), EMbase, CNKI, VIP, CBM, WanFang data databases, and so on (establishment time to June 2017), to collect the relevant diagnostic trials of the SR for breast nodules. Two reviewers independently screened literatures, extracted data, and evaluated the methodological quality of included studies. The meta-analysis was performed by using Stata 12.0 and Meta-Disc 1.4 software, and the combined indexes included sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic odds ratio (DOR).
Results
A total of 26 studies were finally included. The results of meta-analysis showed that, the pooled Sen, Spe, LR+, LR–, and DOR was 0.88 (95% CI was 0.87 to 0.90), 0.85 (95% CI was 0.84 to 0.86), 6.66 (95% CI was 5.26 to 8.43), 0.14 (95% CI was 0.11 to 0.17), and 53.37 (95% CI was 34.96 to 81.49), respectively, P<0.000 1.
Conclusion
SR has high diagnostic accuracy in the differential diagnosis of benign and malignant breast nodules, it is worthy of widely utilized in the clinic.
ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. ResultsIn cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.
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.
