Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems

Gilligan, Leah A; Trout, Andrew T.; Bennett, Paula S; Dillman, Jonathan R.

doi:10.1097/rli.0000000000000627

Cited by 33 publications

(27 citation statements)

References 34 publications

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“…Besides disease-specific features such as biochemical response (e.g., ALP/bilirubin normalization), liver fibrosis stage is an independent predictor of outcome in patients with PBC (22). All applied techniques of fibrosis and steatosis assessment have been widely investigated in healthy volunteers and various liver diseases and particularly TE and CAP are recommended by guidelines (9,23,24). As in NAFLD, TE is a well-established fibrosis assessment tool in PBC with disease-specific cutoffs (25), thereby serving as a reliable non-invasive reference method for 2D-SWE measurement.…”

Section: Discussionmentioning

confidence: 99%

Shear wave elastography and shear wave dispersion imaging in primary biliary cholangitis—a pilot study

Schulz¹,

Wilde²,

Demir³

et al. 2022

Quant Imaging Med Surg

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Background: Primary biliary cholangitis (PBC) is a chronic liver disease that can lead to liver fibrosis and cirrhosis. Two-dimensional shear wave elastography (2D-SWE) is a modern technique for fibrosis assessment. However, data regarding its performance in PBC is sparse. We aimed to characterize severity of liver disease in PBC patients using non-invasive 2D-SWE and the new methods of attenuation imaging (ATI) and shear wave dispersion imaging (SWD).Methods: Twenty two PBC patients were examined with 2D-SWE, SWD and ATI, alongside established non-invasive fibrosis and steatosis assessment methods as well as liver function tests.Results: Median 2D-SWE values were 1.48 m/S (range, 1.14-2.13 m/S) and 6.7 kPa (range, 3.8-14.7 kPa), respectively. Median SWD, ATI, transient elastography (TE) and controlled attenuation parameter (CAP) values were 13.9 m/S/kHz (range, 11.6-21 m/S/kHz), 0.57 dB/cm/MHz (range, 0.5-0.68 dB/cm/MHz), 7 kPa (range, 3.7-14.6 kPa), and 208 dB/m (range, 107-276 dB/m), respectively. 2D-SWE displayed a significant correlation with spleen length, platelet count, non-invasive fibrosis scores (FIB-4, APRI) and with TE. SWD correlated with alkaline phosphatase (ALP) levels, which is a prognostic marker in PBC.Conclusions: Our findings add further evidence that 2D-SWE is a reliable method for fibrosis assessment in PBC. Even though the cohort size was small, the correlation of SWD with the prognostic marker ALP suggests a potentially valuable role of this new non-invasive method in evaluating liver disease activity in PBC.

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Section: Discussionmentioning

confidence: 99%

Shear wave elastography and shear wave dispersion imaging in primary biliary cholangitis—a pilot study

Schulz¹,

Wilde²,

Demir³

et al. 2022

Quant Imaging Med Surg

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“…Portal hypertension manifests as venous congestion of the spleen and development of esophageal varices. For example, in the pediatric study by As stiffness measurements vary among manufacturers, each system must have its own reference values [17]. After using ARFI liver elastography with quantitative p-SWE over the last 10 years, we have found it is necessary to standardize spleen elastography techniques and to establish age-specific normal values for a large pediatric population, using more recent material, with the Siemens Acuson System with S3000 platform.…”

Section: Discussionmentioning

confidence: 99%

Acoustic radiation force impulse imaging: normal values of spleen stiffness in healthy children

et al. 2021

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Background Acoustic radiation force impulse (ARFI) imaging is a noninvasive ultrasound elastography technique for evaluating tissue stiffness. The association of liver and spleen stiffness provides additional information in the assessment of portal hypertension. The technique and normal values of spleen stiffness by point shear wave elastography (p-SWE) in pediatrics have not been well documented. Objective Our aim is to describe the feasibility and normal ARFI elastography values in the spleen for healthy children and to compare measurements in two different probe positions (the axial and sagittal planes). Materials and methods Spleen p-SWE using ARFI values were measured with a 6C1 probe in 102 healthy children (age range: 8 weeks to 17 years) divided into four age groups. An average of nine (standard deviation: two) spleen stiffness measurements were taken during free breathing in each plane (axial and sagittal). The impact of age and measurement plane in the spleen was analyzed using multivariate models. Results There was no significant difference in spleen stiffness values taken at different ages, with an average of the medians of 2.43±0.31 m/s. There was no significant difference based on probe orientation: sagittal plane (median: 2.46±0.29 m/s) and axial plane (median: 2.43±0.32 m/s) with Student’s t-test P=0.18. The mean depth of measurement varied between 2.3 cm and 3.7 cm, according to age. Conclusion Normal spleen stiffness values using ARFI imaging in children do not vary with age and correspond to a median of 2.43 m/s. No significant difference was found when using different probe positions.

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“…Yet, we did not test such possible variability as the distribution of patient population (liver diseases and degree of liver fibrosis) and the distribution of missing data were also variable according to centers. Finally, whether our result could be generalized to other US platforms should be explored in dedicated studies, nevertheless intersystem agreement is demonstrated to be good to excellent in both phantom and in-vivo acquisitions between different 2D-SWE systems [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

2D-shear wave elastography: number of acquisitions can be reduced according to clinical setting

et al. 2021

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Background The factors affecting intra-operator variability of two-dimensional shear wave elastography (2D-SWE) have not been clearly established. We evaluated 2D-SWE variability according to the number of measurements, clinical and laboratory features, and liver stiffness measurements (LSM). Methods At least three LSM were performed in 452 patients who underwent LSM by 2D-SWE (supersonic shear imaging) out of an initial database of 1650 patients. The mean value of the three LSM was our best measurement method. Bland–Altman plots were used to evaluate intra-operator variability when considering only one, or the first two measurements. Variability was assessed by taking the absolute value of the difference between the first LSM and the mean of the three LSM. Logistic regression was used to assess the factors associated with the highest tertile of variability. Results The limit of agreement was narrower with the mean of the first and second measurements than with each measurement taken separately (− 2.83 to 2.99 kPa vs. − 5.86 to 6.21 kPa and − 5.77 to 5.73 kPa for the first and second measurement, respectively). A BMI ≥ 25 kg/m2 and a first LSM by 2D-SWE ≥ 7.1 kPa increased the odds of higher variability by 3.4 and 3.9, respectively. Adding a second LSM didn’t change the variability in patients with BMI < 25 and a first LSM by 2D-SWE < 7.1 kPa. Conclusions Intra-operator variability of LSM by 2D-SWE increases with both a high BMI and high LSM value. In patients with BMI < 25 kg/m2 and a first LSM < 7.1 kPa we recommend performing only one LSM.

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Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems

Cited by 33 publications

References 34 publications

Shear wave elastography and shear wave dispersion imaging in primary biliary cholangitis—a pilot study

Shear wave elastography and shear wave dispersion imaging in primary biliary cholangitis—a pilot study

Acoustic radiation force impulse imaging: normal values of spleen stiffness in healthy children

2D-shear wave elastography: number of acquisitions can be reduced according to clinical setting

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