POS1270 USEFULNESS OF ULTRASOUND SHEAR WAVE ELASTOGRAPHY FOR IgG4-RELATED SIALADENITIS
Keisuke NishimuraA. SaharaYo KobayashiOsamu IriN. NishimuraKaoru MizukawaKeiichiro KadobaHiroki MukoyamaRintaro SaitoTomohiro YoshidaT. NagamotoDaisuke WakiHiroyuki MurabeJ. Saegusa
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Abstract:
Background:
IgG4-related disease (IgG4RD) is a chronic and systemic disease that is characterised by multiple organ inflammation, elevated serum IgG4, and storiform fibrosis. IgG4RD often presents with organ enlargement and can affect the submandibular glands, lacrimal glands, orbits, pancreas, bile ducts, retroperitoneum, lungs, kidneys, aorta and pachymeninges [1]. One of the most commonly involved organs is the submandibular glands. However, methods for evaluating the severity and treatment response of IgG4-related sialadenitis have not been established. Ultrasound shear wave elastography (SWE) is a technique to quantify tissue elasticity using shear wave velocity (SWV), and is considered to be a useful noninvasive method for diagnosing fibrosis. Recently, SWE has been reported as a valid diagnostic method for primary Sjogren's syndrome (pSS) [2].Objectives:
The purpose of this study was to investigate whether ultrasound SWE evaluate disease activity of IgG4-related sialadenitis.Methods:
We retrospectively investigated the submandibular gland sonographic features of IgG4RD patients who fulfilled the 2020 revised comprehensive diagnostic criteria for IgG4RD [3]. Submandibular gland ultrasonography was performed in Kurashiki Central Hospital from April 2016 to December 2022. We assessed sex, age, affected organs, disease duration, use of glucocorticoid and immunosuppressive agents, serum IgG/IgG4, and ultrasonographic findings. We choose patients with pSS as controls for ultrasound image. The volume of the submandibular gland was calculated using the following formula: Volume = (long diameter) x (transverse diameter) x (cranial-caudal diameter) x 0.52 [4]. Submandibular gland SWV was compared between IgG4RD and pSS patients. In addition, it was compared in IgG4RD patients with and without submandibular gland lesions. Submandibular gland SWV was compared before and after treatment among patients with IgG4-related sialadenitis.Results:
Twenty-nine patients (18 males, 11 females) with IgG4RD and 35 patients (4 males, 31 females) with pSS underwent submandibular gland SWE. The median age [interquartile range (IQR)] of IgG4RD and pSS was 69 (64-77) and 67 (52.5-78), respectively. The median time (IQR) since IgG4RD diagnosis was 4 days (0-547). Of the IgG4RD patients, 4 were treated with glucocorticoid (maximum 10 mg/day of prednisolone equivalent) and 2 with immunosuppressive agents (azathioprine and methotrexate). PSS patients were all untreated. The submandibular gland was the most common organ affected in 19 patients with IgG4RD, followed by the lacrimal gland (n=8), aorta (n=7), retroperitoneum (n=7), pancreas (n=6), parotid gland (n=3), lungs (n=3), pituitary gland (n=1), bile duct (n=1), pachymeninges (n=1) and vertebra (n=1). Nineteen patients with IgG4RD showed multiple hypoechoic areas in the submandibular gland. The median SWV (IQR) of the submandibular gland was 1.88 (1.59-2.40) in the IgG4RD group and 1.59 (1.43-1.72) in the pSS group, which was significantly higher in the IgG4RD group (p <0.001). The median SWV (IQR) of IgG4RD was 1.59 (1.50-1.70) in the group without sialadenitis and 2.06 (1.79-2.65) in the group with sialadenitis (p < 0.05) (Figure 1A). Among patients treated with immunosuppressive therapy for IgG4RD, 7 patients were followed up for submandibular gland ultrasonography. The median observation period (IQR) was 408.5 days (81.25-630.25). Ultrasound-estimated submandibular gland volume was reduced from 2.4 cm3 to 1.7 cm3 and submandibular gland SWV was significantly decreased from 1.98 to 1.55 (p < 0.05), respectively (Figure 1B).Conclusion:
Submandibular gland SWV was significantly higher in IgG4RD than in pSS. Submandibular gland SWV was elevated in IgG4-related sialadenitis, and SWV was decreased by immunosuppressive treatment. Ultrasound SWE is a useful tool for evaluating the disease activity of IgG4-related sialadenitis.REFERENCES:
[1] Perugino CA, et al. Nat Rev Rheumatol 2020;16(12):702-714. [2] Ma H, et al. Int J Rheum Dis. 2023;26(7):1314-1320. [3] Umehara H, Mod Rheumatol 2021;31(3):529-533. [4] Badea AF, et al. Med Ultrason 2013;15(3):173-9.Acknowledgements:
NIL.Disclosure of Interests:
None declared.Keywords:
Sialadenitis
Ultrasound Elastography
Ultrasonography (renamed from the Journal of Korean Society of Ultrasound in Medicine in January 2014), the official English-language journal of the Korean Society of Ultrasound in Medicine (KSUM), is an international peer-reviewed academic journal dedicated to practice, research, technology, and education dealing with medical ultrasound, Aims and Scope:Ultrasonography (renamed from the Journal of Korean Society of Ultrasound in Medicine in January 2014), the official English-language journal of the Korean Society of Ultrasound in Medicine (KSUM), is an international peer-reviewed academic journal dedicated to practice, research, technology, and education dealing with medical ultrasound.It is published four times per year: January 1, April 1, July 1, and October 1. Original articles, topical reviews, pictorial essays, and notable case reports are published in Ultrasonography covering state-of-the-art content. Ultrasonography also serves as a medium for cooperation among physicians and specialists from around the world who are focusing on various ultrasound technology and disease problems.
Ultrasound Elastography
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Objective: The aim of this study was to investigate the application value of score by ultrasound elastography in grading fatty liver. Methods: Seventy-seven patients with fatty liver were enrolled, and 30 patients with proven healthy livers were used as control group. After all patients with conventional ultrasound scanning, and following ultrasound elastography scan, we scored patients with fatty liver in accordance with ultrasound elastography score criteria. Results: There was a high consistency between ultrasound elastography score and traditional ultrasound score (Kappa value=0.833). The sensitivity, specificity of fatty liver evaluated by ultrasound elastography were 96.1%, 93.3% respectively. Conclusion: Ultrasound elasticity imaging technique can be used as a more objective auxiliary examination method in grading fatty liver.
Ultrasound Elastography
Grading (engineering)
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Ultrasound elastography is to extract the elastic characteristics of the organization and a new imaging technology,It make up for the shortcomings that traditional medical imaging modality can not provide direct tissue elasticity.and it is widely used in clinical,especially in the superficial organs application has been carried out in full swing,And further used in the diagnosis of diseases of other organs,become a hot research topic in medical elastography.This article describes the basic principles of elastography,and focuses on the UE in the breast,thyroid and prospects for development in clinical applications.
Ultrasound Elastography
Modality (human–computer interaction)
Ultrasound imaging
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Identifying the HER2 status of breast cancer patients is important for treatment options. Previous studies have shown that ultrasound features are closely related to the subtype of breast cancer.
Ultrasound Elastography
Interpretability
Breast ultrasound
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Ultrasound elastography is an emerging ultrasound technology based on different elastic characteristics inside organizations.By providing elastic characteristics inside organizations,it can reflect the softness and hardness of the pathological tissues,thus determining whether the neoplasm is benign or malignant.Elastography compensates for the tissue biomechanics in conventional imaging examinations and plays an increasingly important role in ultrasound testing,so it is gradually applied in clinic.This paper summarizes the application of ultrasound elastography in the differential diagnosis of breast neoplasm in recent years.
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Objective
To evaluate the effects of the range and the frequency of the compression load on the accuracy for discerning target stiffness differences in ultrasound elastography.
Methods
Quantitative ultrasound elastography was achieved by integrating two compression force sensors, a laptop computer and a clinical ultrasound elastographic system. The force sensors and the ultrasound probe were assembled in a 3D printed mounting bracket for continuous monitoring of compression loads during ultrasound elastography. Both the force measurements and the elastographic maps were acquired and displayed on the laptop computer in real time. Four targets of the same diameter(10.4 mm), the same depth (3 cm) and different stiffness levels (8, 14, 45 and 80 kPa) were examined by a HITACHI preirus, L74M linear-array transducer. Each target was evaluated 45 times with two different method (i.e., freehand elastography and quantitative elastography), yielding 180 evaluations. The data were divided into the following three groups: group Ⅰ(80 kPa vs 45, 14 and 8 kPa), group Ⅱ(80, 45kPa vs 14, 8 kPa) and group Ⅲ(80, 45 and 14 kPa vs 8 kPa). Area under ROC curves(AUC) were calculated for different stiffness levels.
Results
In group Ⅲ, quantitative elastography yielded an greater AUC level than that of freehand elastography(P=0.0379). In group Ⅰ and group Ⅱ, two methods yielded the similar AUC levels (P=1.000). However, quantitative elastography was able to discern 8 kPa and 14 kPa targets (P<0.001), while freehand elastography was hard to differentiate them (P=0.258).
Conclusions
In comparison with freehand elastography, quantitative ultrasound elastography is able to improve the accuracy for discerning different target stiffnesses.
Key words:
Elasticity imaging techniques; Pressure; Phantom study; Diagnostic accuracy
Ultrasound Elastography
Quantitative assessment
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The purpose of elastography is to characterize from mechanical point of view a material (the soft biological tissues in the medical field). Ultrasound elastography is based on the comparison of ultrasound images, when the material is submitted under axial force (compression). This work presents the advances in the instrumentation of an ultrasound scanner, to acquire a sequence of images which will be processed in the aim of elastography. First, motion estimation between two or more images is processed. The estimated displacement gives the possibility to obtain detailed deformation elastograms. Thus, the presence of a hard inclusion (that simulates a tumor a pathological tissue) within a phantom mimicking soft tissues can be more easily detected, which may lead to a better cancer diagnosis.
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Instrumentation
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Objective:To further improve the clinical diagnostic rate of thyroid lesions,and to analyze and discuss the necessity of using conventional ultrasound combined with ultrasound elastography.Methods:Randomly chose 139cases who were scheduled for ultrasound and ultrasound elastography examination from June 2012to June 2013,of which 162patients had thyroid lesions,and to analyze feasibility of application of ultrasound elastography in diagnosis of thyroid lesions by comparing examination results with pathologic results.Results:Conventional ultrasonic testing results showed sensitivity was 84.48%,the specificity was 82.69%,the accuracy was 83.33%;ultrasound elastography(UE)test results showed a sensitivity of 91.38%and specificity of 89.42%,the accuracy was 89.02%.The difference in identification of benign thyroid lesions from malignant ones was significant between the two methods(P0.05).Conclusions:Ultrasound elastography shows diagnostic value in differentiating benign from malignant thyroid lesions,ultrasound elastography has some diagnostic value,and it can be used combining with conventional ultrasound for diagnosis.
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Objective To explore the utility of ultrasonic elastography and conventional ultrasound in the differentiating benign from malignant breast tumors,and to analyze the elements of influence.Method We collected 154 patients with 158 breast tumors,all of whom were examined by ultrasonic elastography and conventional ultrasound.The result was compared with operative pathology.Results Among 158 breast tumors,there were 115 benign and 43 malignant tumors.In the diagnosis of breast tumors,the consistency of conventional ultrasound,ultrasonic elastography and the ultrasonic elastography combined with conventional ultrasound with postoperative pathology were Kappa = 0.605 9,0.728 3,0.813 7 respectively.Conclusion Routine ultrasound examination is the basis for breast ultrsound,ultrasonic elastography can disserentiate beteen benign and malignant breast lisions.Combing conventional ultrasound with ultrasonic elastography can improve the accuracy of differentiating benign from malignant breast tumors.
Ultrasound Elastography
Breast ultrasound
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Noticing the phenomenon that biological tissues will change its elasticity by orders of magnitude after it was frozen, we proposed in principle the strategy of using ultrasound elastography to monitor the formation and thawing of the iceball when performing a cryosurgery. Following our former theoretical evaluation, conceptual experiments were designed to apply ultrasound elastography to monitor three kinds of testing samples which includes: phantom embedded with glass block, phantom with tissues at normal temperature and phantom with frozen tissues inside. It was demonstrated for the first time that the ultrasound elastography could provide a high contrast picture on the ice ball during cryosurgery. The measurement errors involved in the application of the method was preliminarily analyzed and approaches to further improve the method were pointed out. With a much different value in elastography than that of water, monitoring the ice ball, the imaging target in clinics, is expected to be an important area for the application of ultrasound elastography.
Cryosurgery
Ultrasound Elastography
Elasticity
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