The assessment of skin fibrosis is vital for the diagnosis and monitoring of treatment in the systemic sclerosis (SSc)-a severe autoimmune disease. The elastography is a technique of skin fibrosis assessment through the evaluation of skin strain. We compared the efficacy of the shear wave elastography (SWE) and commonly used modified Rodnan skin score (RSS) in skin fibrosis assessment in SSc. The study included 40 SSc patients and 28 healthy individuals, with the exclusion of individuals with other skin/autoimmune diseases. Skin thickness using RSS and skin strain using SWE were assessed in the same 20 body localizations. Subjects' informed consent and the bioethics committee approval were obtained. Elastographic skin strain correlated positively with both partial and overall RSS values, with strong positive correlation (r ≥ 0.75) for hands and fingers localizations in particular. In SSc patients with normal RSS values, the elastographic strain was significantly higher than in healthy controls. Elastographic strain of fingers' skin evaluated in SWE is highly accurate for distinguishing SSc patients (sensitivity 0.897-0.923, specificity 0.929-0.964, positive predictive value 0.946-0.973, negative predictive value 0.867-0.900). ESW results are substantially more reproducible than those of RSS examination (intraclass correlation coefficients: 0.987 vs. 0.941). The shear wave elastography is more reproducible and has higher sensitivity than RSS in the evaluation of skin condition in SSc, especially in case of changes non-detectable on physical evaluation, indicating it might become a useful tool in SSc diagnosis.
Peripheral neuropathy is associated with an increase in intraneural pressure, and hence ultrasound elastography seems to be an ideal method to detect early stages of this condition based on changes in the affected nerve stiffness. The aim of this systematic review was to analyse the applicability of strain elastography (SE) and shear wave elastography (SWE) in the evaluation of peripheral nerves in patients with neuropathy of various aetiologies. Published evidence shows clearly that ultrasound elastography can accurately diagnose many types of peripheral neuropathies (carpal tunnel syndrome and other entrapment neuropathies, diabetic peripheral neuropathy and peripheral neuropathy associated with other systemic diseases), sometimes at the stages at which the condition is still asymptomatic. However, it is still unclear whether elastographic changes within the nerves precede functional anomalies detectable on nerve conduction studies. Also, relatively little is known about the relationship between the stiffness of peripheral nerves and the severity of peripheral neuropathy and its underlying condition. Based on the reproducibility data, SWE seems to be superior to SE. Nevertheless, the sources of heterogeneity in the peripheral nerve stiffness in healthy persons need to be identified, and the sets of reference values for specific peripheral nerves need to be determined. Finally, the potential confounding effect of hardening artefacts, such as bones, on the stiffness of peripheral nerves needs to be verified. After addressing all these issues, elastographic evaluation of peripheral nerve stiffness might become a reliable, easily accessible, and convenient diagnostic test performed routinely in patients with various peripheral neuropathies.
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease that affects exocrine glands, especially salivary and lacrimal glands, leading to their progressive destruction. With highly differentiated clinical course the approach to the definition of pSS is constantly evolving and the pSS classification criteria have been modified over the past years. In the past sialography and scintigraphy were frequently used in pSS diagnostics. Recently no imaging method has been included in the pSS classification criteria. That raises the question about the benefits of using novel imaging techniques such as ultrasonography, elastography and magnetic resonance imaging to diagnose and monitor pSS patients. The purpose of this review is to evaluate the advantages and limitations of widely used imaging methods in pSS and their possible future development.
Entrapment neuropathies constitute a significant albeit still neglected problem in athletes. Currently available diagnostic options in patients with suspected neuropathies, nerve conduction studies, and magnetic resonance imaging have some drawbacks, mostly related to their invasive character, high cost, and limited availability. This paper reviews published articles documenting the use of ultrasound elastography, a novel technique to determine tissue strain, in the evaluation of nerve stiffness in entrapment neuropathy, and it discusses potential pros and cons of this method in the examination of elite athletes. Based on the review of literature, ultrasound elastography -especially shear wave elastography -seems suitable for the evaluation of entrapment neuropathies in elite athletes. Published evidence from the general population suggests that most common entrapment neuropathies (carpal tunnel syndrome, ulnar neuropathy of the elbow, ulnar tunnel syndrome) are associated with a significant increase in the stiffness of affected nerves, which can be accurately detected with ultrasound elastography. Before adding ultrasound elastography to the armamentarium of diagnostic tests used routinely in athletes, its accuracy in the detection of entrapment neuropathies needs to be verified in this specific group, and the reference values for peripheral nerve strain in sportspersons need to be determined.
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