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1.
Niger J Clin Pract ; 23(10): 1339-1344, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047689

RESUMO

Backround: Ultrasonography is difficult to distinguish between endometrial pathologies and often requires curettage. ARFI (Acoustic Radiation Force-Based Elasticity Imaging) is a new ultrasonography elastography method. Using ARFI, it is possible to obtain information about the likelihood of the tissue benign or malignant. Aim: The aim of this study is to evaluate the contribution of ARFI to differentiate endometrial pathologies in hysterectomy specimens. Subjects and Methods: Our study was prospectively, January-May 2017, performed in randomly 45 cases of 41-91 years of age (mean 58.3 years) who have decided to have hysterectomy. Hysterectomy was performed for uterine prolapse and endometrial hyperplasia in elderly patients and menorrhagia in young patients. Pathology results were compared with ARFI values and endometrial thickness. ANNOVA test was used for the comparison of ARFI values. Results: Pathology revealed 14 cases of endometrial atrophy, 11 cases of proliferative phase, 10 cases of polyp, 6 cases of endometrial hyperplasia, and 4 cases of endometrium cancer. There is a statistically significant difference between mean ARFI values of endometrium, subendometrium, and myometrium of the groups (P < 0.05). There was a statistically significant difference between the mean endometrial thickness of the groups (P < 0.05). Conclusion: Endometrium ARFI contributes to the differential diagnosis of endometrial pathologies. Subendometrial and myometrial ARFI values decrease in polyps and increase in hyperplasia. Our study shows that the addition of subendometrium ARFI to gray-scale sonography before deciding on invasive procedures in endometrial pathologies may improve diagnostic accuracy. We concluded that further in vivo studies will establish the usefulness of this technique for preoperative diagnostic measures.


Assuntos
Hiperplasia Endometrial/cirurgia , Endométrio/diagnóstico por imagem , Histerectomia , Menorragia/cirurgia , Prolapso Uterino/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem por Elasticidade/métodos , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio , Feminino , Humanos , Menorragia/patologia , Pessoa de Meia-Idade , Pólipos/patologia , Ultrassonografia/métodos , Prolapso Uterino/patologia
2.
Z Gastroenterol ; 58(9): 847-854, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32947630

RESUMO

BACKGROUND: The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. METHODS: Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21-74 years, 37 males) with 58 FLLs located on the right lobe of liver were prospectively studied. The Aplio i900 series diagnostic ultrasound system (Canon Medical systems) equipped with a curvilinear PV1-475BX transducer (1-8 MHz) was used. SWD slope and viscosity measurements were expressed as mean ± standard deviation for both liver tumors and background liver parenchyma. Histopathological results after surgery were regarded as the gold standard for diagnosis. RESULTS: Final diagnosis included 40 cases of malignant and 18 cases of benign FLLs. The mean viscosity value were 14.78 ±â€Š1.86 m/s/kHz for hepatocellular carcinoma (n = 30), 14.81 ±â€Š2.35 m/s/kHz for liver metastasis lesions (n = 10), 13.23 ±â€Š1.31 m/s/kHz for hemangioma (n = 13), and 13.67 ± 2.72 m/s/kHz for focal nodular hyperplasia (n = 5). Malignant FLLs showed higher mean viscosity values (14.79 ±â€Š3.15 m/s/KHz) than benign FLLs (13.36 ±â€Š2.76 m/s/KHz) (p < 0.05). The best performing cut-off value of lesion viscosity was 13.15 m/s/kHz (sensitivity 83.3 %; specificity 56.5 %; area under the curve (AUC) 0.71) for malignancy) (p < 0.05). CONCLUSIONS: The analysis of SWD slope and liver viscosity parameters provide additional viscoelastic information about FLLs before operation.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste , Diagnóstico Diferencial , Humanos , Fígado/patologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Ultrassonografia , Viscosidade , Adulto Jovem
3.
Clinics (Sao Paulo) ; 75: e1670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935822

RESUMO

OBJECTIVES: Acoustic radiation force impulse (ARFI) elastography, the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 (FIB-4) index are widely used to assess liver fibrosis. However, efficacies of these methods in the evaluation of hepatic functional reserve remain unclear. In this study, we investigated the relationship between ARFI elastography combined with either AAR, APRI, or FIB-4 index and Child-Pugh (CP) class for the evaluation of hepatic functional reserve in patients with chronic hepatitis B (CHB)-related cirrhosis. METHODS: The shear wave velocities of 104 patients with clinically confirmed CHB-related cirrhosis were determined using the ARFI; and clinical serum markers (e.g. ALT, AST, PLT) were used to calculate the AAR, APRI, and FIB-4 index. Cirrhosis patients were scored according to their CP class. The ARFI, AAR, APRI, and FIB-4 index were compared with the CP class. The efficacy of each indicator in diagnosis was analyzed using the receiver operating characteristic (ROC) curve and the ARFI combined with either the AAR, APRI, or FIB-4 index, which is used to predict decompensated cirrhosis. RESULTS: No significant differences were observed in gender and age among CP classes A, B, and C patients (p>0.05). The ARFI values and the AAR, APRI, and FIB-4 index of patients with CP classes A, B, and C were significantly different (p<0.05). With an increasing CP class, the ARFI, AAR, APRI, and FIB-4 values increased. The correlation between the ARFI and the CP class was stronger than that between the AAR, APRI, and FIB-4 index and the CP class. The area under the ROC curve for the diagnosis of decompensated cirrhosis using the ARFI was 0.841, which was higher than that for the AAR, APRI, and FIB-4 index. According to the area under the curve results, no significant differences were found when the ARFI was combined with either the AAR, APRI, or FIB-4 index and when the ARFI alone was used. CONCLUSIONS: The ARFI value has a strong correlation with the CP class. Therefore, ARFI elastography complements CP class in the assessment of the hepatic functional reserve in patients with CHB-related cirrhosis.


Assuntos
Acústica , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Técnicas de Imagem por Elasticidade , Cirrose Hepática/patologia , Biomarcadores/sangue , Biópsia , Criança , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico por imagem , Masculino , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença
4.
Lancet Gastroenterol Hepatol ; 5(11): 996-1007, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32805205

RESUMO

BACKGROUND: The laxative drug lubiprostone improves intestinal permeability in healthy volunteers. We aimed to assess efficacy and safety of lubiprostone in patients with non-alcoholic fatty liver disease (NAFLD) with constipation via attenuation of intestinal permeability. METHODS: This randomised, double-blind, placebo-controlled, phase 2a study in Yokohama City University Hospital, Japan, recruited patients (aged 20-85 years) with NAFLD and constipation, alanine aminotransferase (ALT) at least 40 U/L, liver stiffness (≤6·7 kPa), and hepatic fat fraction at least 5·2% when assessed by MRI-proton density fat fraction. Eligible patients were randomly assigned (11:10:9) by a computer-based system and stratified by age and sex to receive 24 µg lubiprostone, 12 µg lubiprostone, or placebo, orally, once per day for 12 weeks. The primary endpoint was the absolute changes in ALT at 12 weeks. Efficacy analysis was done by intention to treat. Safety was assessed in all treated patients. This trial was registered with University Hospital Medical Information Network Clinical Trials Registry (UMIN000026635). FINDINGS: Between March 24, 2017, and April 3, 2018, we screened 288 patients, of whom 150 (52%) were randomly assigned to treatment: 55 patients were assigned to receive 24 µg lubiprostone, 50 to receive 12 µg lubiprostone, and 45 to receive placebo. A greater decrease in the absolute ALT levels from baseline to 12 weeks was seen in the 24 µg lubiprostone group (mean -13 U/L [SD 19]) than in the placebo group (1 U/L [24]; mean difference -15 U/L [95% CI -23 to -6], p=0·0007) and in the 12 µg lubiprostone group (-12 U/L [21]) than in the placebo group (mean difference -13 U/L [-22 to -5], p=0·0023). 18 (33%) of 55 patients in the 24 µg group had at least one adverse event, as did three (6%) of 47 patients in the 12 µg group and three (7%) of 43 in the placebo group. The most common adverse event was diarrhoea (17 [31%] of patients in the 24 µg group, three [6%] in the 12 µg group, none in the placebo group). No life-threatening events or treatment-related deaths occurred. INTERPRETATION: Lubiprostone was well tolerated and reduced the levels of liver enzymes in patients with NAFLD and constipation. Further studies are necessary to better define the efficacy and tolerability of lubiprostone in patients with NAFLD without constipation. FUNDING: Mylan EPD G.K.


Assuntos
Alanina Transaminase/sangue , Diarreia , Fígado , Lubiprostona , Hepatopatia Gordurosa não Alcoólica , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/etiologia , Diarreia/induzido quimicamente , Diarreia/diagnóstico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Monitoramento de Medicamentos/métodos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Laxantes/administração & dosagem , Laxantes/efeitos adversos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Testes de Função Hepática , Lubiprostona/administração & dosagem , Lubiprostona/efeitos adversos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(32): e21652, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769936

RESUMO

To investigate the diagnostic value of multimodal ultrasound imaging composed of conventional ultrasonography (US), contrast-enhanced ultrasonography (CEUS), and shear wave elastography (SWE) for liver tumors.Between October 2017 and October 2019, US, CEUS, and SWE examinations of a total of 158 liver tumors in 136 patients at The First Affiliated Hospital of Nanchang University were performed. The histopathological or imaging diagnostic results were used as controls to evaluate the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US, CEUS, SWE, and multimodal ultrasound imaging, which combines these 3 modes, in the differential diagnosis of benign and malignant liver tumors.Among the 158 tumors, there were 64 benign tumors, including 55 cases of hepatic hemangioma, 3 cases of focal nodular hyperplasia of the liver, 4 cases of hepatic cyst, and 2 cases of focal nonuniform distribution of fat in the liver. There were 94 malignant tumors, including 32 cases of hepatocellular carcinoma, 22 cases of intrahepatic cholangiocellular carcinoma, 29 cases of metastatic liver cancer, and 11 cases of dysplastic nodules in cirrhotic liver. In the diagnosis of benign and malignant liver tumors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 82.56%, 68.06%, 75.96%, 75.53%, and 76.56% for US; 92.39%, 86.36%, 89.87%, 90.43%, and 89.06% for CEUS; 87.14%, 76.81%, 82.91%, 82.98%, and 82.81% for SWE; and 97.85%, 95.38%, 96.83%, 96.81%, and 96.88% for multimodal ultrasound imaging, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were all significantly higher for multimodal ultrasound imaging than those values for US, CEUS, and SWE (all P < .05). The areas under the receiver operating characteristic curve for US, CEUS, SWE, and multimodal ultrasound imaging in the diagnosis of benign and malignant liver tumors were 0.760, 0.897, 0.829, and 0.968, respectively.US, CEUS, and SWE all have diagnostic value in the diagnosis of benign and malignant liver tumors. Multimodal ultrasound imaging could significantly increase the accuracy of the diagnosis of benign and malignant liver tumors and has higher value for clinical application.


Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Meios de Contraste/uso terapêutico , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/instrumentação , Imagem Multimodal/métodos , Ultrassonografia/instrumentação
6.
Niger J Clin Pract ; 23(8): 1095-1102, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788487

RESUMO

Aims: The purpose of this study is to compare the thickness and elasticity of the masseter muscle before and after orthognathic surgery in patients with class III skeletal deformity and to investigate the relationship between the sonographic changes in the masseter muscle and the amount of mandibular setback. Subjects and Methods: The study group consisted of 14 patients with skeletal class III malocclusions who had orthognathic surgery. The control group consisted of 14 patients who had dental and skeletal class I occlusion. Muscle thickness measurements were performed with B-mode and high-frequency linear scanning probe of the ultrasound device. Elastography feature and muscle hardness ratio were obtained by applying compression and decompression on muscles at rest and during maximum contraction in the transverse plane. Patients were categorized into two groups according to the mandibular setback as <5 mm and ≥5 mm. Results: The masseter muscle thickness after surgery was found statistically increased bilaterally in both at rest and during contraction for the study group (P < 0.05). No difference was found between preoperative orthognathic measurements and postoperative measurements for elasticity index ratio measurements (P > 0.05). Conclusion: We believe that in the present study important findings have been emphasized for further research aiming to investigate the possible relationship between masticatory alterations and surgical outcomes after orthognathic surgery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Má Oclusão de Angle Classe III/cirurgia , Mandíbula/diagnóstico por imagem , Músculo Masseter/diagnóstico por imagem , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Adulto , Cefalometria , Feminino , Humanos , Masculino , Músculo Masseter/fisiologia , Resultado do Tratamento , Ultrassonografia
7.
Indian J Gastroenterol ; 39(3): 253-260, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32833144

RESUMO

BACKGROUND: Liver fibrosis is a frequent complication of chronic hepatitis C virus (HCV) infection. Its evaluation is very important for the prognosis of these patients. The aim of this study was to evaluate the possibility of exploiting the platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio as non-invasive predictive markers of liver fibrosis. METHODS: We recruited 120 patients with chronic HCV infection. They were subjected to various clinical investigations to assess the severity of fibrosis. Transient elastography and some serological tests were performed, and the platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio were estimated. RESULTS: Sixty-four patients had F4 fibrosis (defined by elastography) and their platelet to lymphocyte ratio (69.92 ± 26.47) was lower than in patients with non-F4 fibrosis (95.19 ± 48.15) (p = 0.001). The neutrophil to lymphocyte ratio was also estimated, but the difference between the 2 groups of patients was not significant statistically (p = 0.07). CONCLUSION: The platelet to lymphocyte ratio can be used as a predictive biomarker of liver fibrosis, unlike the neutrophil to lymphocyte ratio which is not predictive of this HCV-related chronic hepatitis complication. More studies are needed to validate this hypothesis.


Assuntos
Hepatite C Crônica/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Contagem de Linfócitos , Contagem de Plaquetas , Idoso , Biomarcadores/sangue , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Contagem de Leucócitos , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neutrófilos , Valor Preditivo dos Testes
8.
Lancet Gastroenterol Hepatol ; 5(11): 970-985, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32763196

RESUMO

BACKGROUND: Non-invasive tests that can identify patients with non-alcoholic steatohepatitis (NASH) at higher risk of disease progression are lacking. We report the development and validation of a blood-based diagnostic test to non-invasively rule in and rule out at-risk NASH (defined as non-alcoholic fatty liver disease [NAFLD] activity score [NAS] ≥4 and fibrosis stage ≥2). METHODS: In this prospective derivation and global validation study, blood samples, clinical data, and liver biopsy results from three independent cohorts with suspected NAFLD were used to develop and validate a non-invasive blood-based diagnostic test, called NIS4. Derivation was done in the discovery cohort, which comprised 239 prospectively recruited patients with biopsy-confirmed NASH (NAFLD NAS ≥3; fibrosis stage 0-3) from the international GOLDEN-505 phase 2b clinical trial. A complete matrix based on 23 variables selected for univariate association with the presence of at-risk NASH and avoiding high multi-collinearity was used to derive the model in a bootstrap-based process that minimised the Akaike information criterion. The overall diagnostic performance of NIS4 was externally validated in two independent cohorts: RESOLVE-IT diag and Angers. The RESOLVE-IT diag cohort comprised the first 475 patients screened for potential inclusion into the RESOLVE-IT phase 3 clinical trial. Angers was a retrospective cohort of 227 prospectively recruited patients with suspected NAFLD and clinical risk factors for NASH or fibrosis stage 2 or more according to abnormal elastography results or abnormal liver biochemistry. Both external validation cohorts were independently analysed and were combined into a pooled validation cohort (n=702) to assess clinical performance of NIS4 and other non-invasive tests. FINDINGS: The derived NIS4 algorithm comprised four independent NASH-associated biomarkers (miR-34a-5p, alpha-2 macroglobulin, YKL-40, and glycated haemoglobin; area under the receiver operating characteristics curve [AUROC] 0·80, 95% CI 0·73-0·85), and did not require adjustment for age, sex, body-mass index (BMI), or aminotransferase concentrations. Clinical cutoffs were established within the discovery cohort to optimise both rule out and rule in clinical performance while minimising indeterminate results. NIS4 was validated in the RESOLVE-IT diag cohort (AUROC 0·83, 95% CI 0·79-0·86) and the Angers cohort (0·76, 0·69-0·82). In the pooled validation cohort, patients with a NIS4 value less than 0·36 were classified as not having at-risk NASH (ruled out) with 81·5% (95% CI 76·9-85·3) sensitivity, 63·0% (57·8-68·0) specificity, and a negative predictive value of 77·9% (72·5-82·4), whereas those with a NIS4 value of more than 0·63 were classified as having at-risk NASH (ruled in) with 87·1% (83·1-90·3) specificity, 50·7% (45·3-56·1) sensitivity, and a positive predictive value of 79·2% (73·1-84·2). The diagnostic performance of NIS4 within the external validation cohorts was not influenced by age, sex, BMI, or aminotransferase concentrations. INTERPRETATION: NIS4 is a novel blood-based diagnostic that provides an effective way to non-invasively rule in or rule out at-risk NASH in patients with metabolic risk factors and suspected disease. Use of NIS4 in clinical trials or in the clinic has the potential to greatly reduce unnecessary liver biopsies in patients with lower risk of disease progression. FUNDING: Genfit.


Assuntos
Proteína 1 Semelhante à Quitinase-3/análise , Hemoglobina A Glicada/análise , Cirrose Hepática , Fígado , MicroRNAs/análise , Hepatopatia Gordurosa não Alcoólica , alfa-Macroglobulinas/análise , Área Sob a Curva , Biomarcadores/sangue , Biópsia/métodos , Testes de Química Clínica/métodos , Testes de Química Clínica/normas , Regras de Decisão Clínica , Progressão da Doença , Técnicas de Imagem por Elasticidade/métodos , Humanos , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Gravidade do Paciente , Valor Preditivo dos Testes , Medição de Risco/métodos
9.
Arch Gynecol Obstet ; 302(3): 753-762, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32712928

RESUMO

PURPOSE: The purpose of this study was to evaluate stiffness changes occurring in the healthy uterine cervix according to age, parity, phase of the menstrual cycle and other factors by shear wave elastography (SWE). METHODS: Evaluations of cervical speed and stiffness measurements were performed in 50 non-pregnant patients without gynaecological pathology using SWE transvaginal ultrasound. We performed the evaluation in the midsagittal plane of the uterine cervix with measurements at 0.5, 1 and 1.5 cm from external cervical os, at both anterior and posterior cervical lips. RESULTS: We evaluated 44 patients by SWE and obtained a total average velocity of 3.48 ± 1.08 m/s and stiffness of 42.39 ± 25.33 kPa. We found differences in speed and stiffness according to the cervical lip and depth evaluated; thus, we observed a velocity of 2.70 m/s at 0.5 cm of depth in the anterior lip and 3.53 m/s at 1.5 cm of depth in the posterior lip (p < 0.05). We observed differences according to parity, obtaining a wave transmission speed of 2.67 m/s and 4.41 m/s at the cervical canal of nulliparous and multiparous patients, respectively (p < 0 0.002). We observed differences according to patient age (from a speed of 2.75 m/s at the cervical canal in the age group of 20-35 years to 5.05 m/s in the age group > 50 years) (p < 0.008). We did not observe differences in speed or stiffness according to the phase of the menstrual cycle, BMI, smoking status or the presence or absence of non-HPV infections. CONCLUSIONS: The wave transmission speed and stiffness of the uterine cervix evaluated by SWE varies according to the cervical lip and depth of the evaluation as well as according to the parity and age of the patient.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Adolescente , Adulto , Idoso , Colo do Útero/fisiopatologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-32665398

RESUMO

OBJECTIVE: Severe liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19. DESIGN: We investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness. RESULTS: 12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death. CONCLUSION: Transient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/complicações , Técnicas de Imagem por Elasticidade/métodos , Hepatopatias/diagnóstico , Fígado/diagnóstico por imagem , Pneumonia Viral/complicações , Idoso , Biópsia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , DNA Viral/análise , Feminino , Humanos , Hepatopatias/etiologia , Testes de Função Hepática , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
11.
Croat Med J ; 61(3): 223-229, 2020 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-32643338

RESUMO

AIM: To determine the relationship between breast stiffness assessed with sonoelastography (elasticity) and breast tissue density assessed with mammography (MG) and ultrasound (US). METHODS: This cross-sectional study involved 100 women who underwent MG, gray-scale US, and shear-wave sonoelastography during 2013. Mammographic density was categorized into four groups and sonographic density into three groups according to Breast Imaging-Reporting and Data System criteria. The stiffness of breast parenchymal and adipose tissue in all breast quadrants was quantified by shear-wave sonoelastography. Mean elastographic estimates were compared with MG- and US-derived density estimates. RESULTS: Parenchymal and adipose tissue elasticity positively correlated with MG- and US-derived breast density (for parenchyma: for MG Kendall's tau b 0.522; Jonckheere-Terpstra test P<0.001 and for US Kendall's tau b 0.533; Jonckheere-Terpstra test P<0.001); the higher was the breast density on MG and US, the higher was the elastographic stiffness. CONCLUSION: Sonoelastographic breast stiffness strongly positively correlated with breast density. Thus, sonoelastography may have a potential for estimating the breast cancer risk, which allows a novel application of this technique in routine clinical practice.


Assuntos
Tecido Adiposo/fisiologia , Densidade da Mama/fisiologia , Mama/diagnóstico por imagem , Mama/fisiologia , Técnicas de Imagem por Elasticidade/métodos , Tecido Parenquimatoso/fisiologia , Ultrassonografia Mamária/métodos , Adulto , Idoso , Estudos Transversais , Elasticidade/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Ultrassonografia
12.
Clin Hemorheol Microcirc ; 76(1): 63-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538828

RESUMO

PURPOSE: To evaluate the value of spleen shear-wave elastography (sound touch elastography [STE], sound touch quantification [STQ]) in indirect prediction of liver fibrosis in patients with chronic hepatitis B (CHB). METHODS: The Young's modulus (kPa) of spleen STE, STQ and liver FibroScan were measured in 112 patients with CHB. The final diagnosis was according to histological results from liver biopsy based on Scheure G/S scoring system and liver FibroScan was considered as a reference index of prediction efficiency. Grouped by the stage of liver fibrosis, data were analyzed by Spearman correlation analysis, Mann-Whitney test and receiver operating characteristic curve (ROC). RESULTS: Spleen STE was positively correlated with the degree of liver fibrosis, but spleen STQ was not. STEmean and STEmax of spleen were statistically different between the groups categorized by S = 2, S = 3 and S = 4 (all p < 0.05), respectively. Spleen STEmean had the best predicting performance on staging liver fibrosis. The areas under the ROC (AUC) for spleen STEmean were 0.66 (95% confidence interval [CI], 0.56-0.76) for stage S = 2 or higher, 0.72 (95% CI, 0.60-0.83) for S = 3 or higher, 0.83 (95% CI, 0.74-0.92) for S = 4 (all P < 0.01). The differences between the AUC for spleen STEmean and liver FibroScan in liver fibrosis staging were not statistically significant when the groups categorized by S = 2 and S = 4 (P = 0.146 and P = 0.052). But when categorized by S = 3, the evaluating performance of liver FibroScan was better (P = 0.004). CONCLUSION: STEmean of spleen is applicable in indirect predicting fibrosis stage in patients with CHB.


Assuntos
Hepatite B Crônica/complicações , Cirrose Hepática/diagnóstico , Baço/patologia , Adulto , Idoso , Técnicas de Imagem por Elasticidade/métodos , Feminino , Hepatite B Crônica/patologia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade
13.
Clinics (Sao Paulo) ; 75: e1594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578823

RESUMO

OBJECTIVE: Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard. METHODS: In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted. RESULTS: Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology. CONCLUSION: Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.


Assuntos
Biópsia por Agulha Fina/métodos , Técnicas de Imagem por Elasticidade/métodos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tireotropina/sangue
14.
Clinics (Sao Paulo) ; 75: e1720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578824

RESUMO

OBJECTIVES: Ultrasound-guided fine-needle aspiration biopsies are recommended for the detection of suspicious thyroid nodules. However, the best approach regarding suspicious ultrasound features for thyroid nodules is still unclear. This study aimed to evaluate the effect of location and size of thyroid nodules on the diagnostic performance of strain ultrasound elastography. In addition, this study evaluated whether ultrasound elastography predicts malignancy in thyroid nodules. METHODS: Data regarding the size, depth, and distance from the carotid artery of nodules, the elasticity contrast index, and the nature of nodules were analyzed. RESULTS: There was no significant difference in the depth (p=0.092) and the distance from the carotid artery (p=0.061) between benign and suspicious nodules. Suspicious nodules were smaller than benign nodules (p<0.0001, q=23.84) and had a higher elasticity contrast index (p<0.0001, q=21.05). The depth of nodules and the size of the nodule were not associated with the correct value of the elasticity contrast index (p>0.05 for both). The diagnostic performance of ultrasound elastography was not affected by the distance of the nodules from the carotid artery if they were located ≥15 mm from the carotid artery (p=0.5960). However, if the suspicious nodules were located <15 mm from the carotid artery, the diagnostic accuracy was hampered (p=0.006). CONCLUSIONS: The strain ultrasound elastography should be carefully evaluated when small thyroid nodules are located near the carotid artery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Br J Radiol ; 93(1112): 20190974, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32479108

RESUMO

OBJECTIVES: To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) <3 cm in size. METHODS: The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. RESULTS: In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. CONCLUSIONS: This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. ADVANCES IN KNOWLEDGE: In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Meios de Contraste , Técnicas de Imagem por Elasticidade/métodos , Neoplasias Renais/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Pelve Renal/diagnóstico por imagem , Pessoa de Meia-Idade , Adulto Jovem
16.
PLoS One ; 15(6): e0234359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520959

RESUMO

PURPOSE: Shear-wave elastography has been recognized a useful tool for quantifying muscle stiffness, commonly reported as shear modulus, however the reports on reliability are often limited to test-retest correlations. In this study, we explored the reliability of shear-wave elastography for assessment of the trapezius muscle stiffness and its relationship with low-level muscle activity. METHODS: Twenty participants were included in a two-session experiment. Measurements of shear modulus and muscle activity were performed at rest and during low-level activity, induced by shoulder abduction without additional external resistance. RESULTS: Good to excellent intra-session repeatability (ICC > 0.80) and moderate inter-rater and inter-session reproducibility (ICC = 0.66-0.74) were observed. Typical errors were acceptable (7.6% of the mean value) only for intra-session measurements in resting conditions, but not acceptable for all conditions with low-level muscle activity (10.2-16.6% of the mean value). Inverse relationships between shear modulus and muscle activity at 40° and 60° of shoulder abduction (r = -0.53 and -0.57) were observed on a group level. We also found higher shear modulus in males compared to females, for the parallel probe position compared to the perpendicular position (in relation to muscle fiber orientation), and for the dominant side of the body compared to the non-dominant side. CONCLUSIONS: This study showed an inverse relationship between muscle activity in low-level range and shear modulus on a group level, suggesting inherent passive stiffness could account for a larger portion of the variance (compared to muscle activity) in shear modulus when the muscle activity is low. Our results imply that shear-wave elastography can be used in research exploring muscle stiffness, however, caution is needed since only intra-session examination in resting conditions showed acceptable within-participant typical errors. The secondary analyses of the study showed higher shear modulus for males, for the non-dominant side of the body and for the parallel orientation of the ultrasound probe.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Força Muscular/fisiologia , Músculos Superficiais do Dorso/fisiologia , Adulto , Módulo de Elasticidade/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Movimento/fisiologia , Músculo Esquelético/fisiologia , Reprodutibilidade dos Testes , Ombro/fisiologia , Ultrassonografia/métodos
17.
Arch Gynecol Obstet ; 302(1): 109-115, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32430754

RESUMO

OBJECTIVE: To compare the placental elasticity in fetuses with or without intrauterine growth restriction (IUGR). MATERIALS AND METHODS: One hundred pregnant women (50 IUGR and 50 healthy) with anteriorly located placenta were evaluated during the third trimester of pregnancy. Measurements were carried out by a machine that has a real-time elastographic ultrasonography feature. After obtaining the optimum image, three areas (subcutaneous tissue, center, and the edge of the placenta) were provided to identify the placental strain values. Then, the placental strain ratio (PSR) value was calculated automatically. Two groups compared in terms of their PSR values. RESULTS: There was a significant difference in placental elasticity between the groups (P < 0.001). PSR value was 2.8 ± 1.2 in the IUGR group and 1.3 ± 0.6 in the control group. A PSR value of 1.78 had an 86% sensitivity (OR 4.3) and 80% specificity (OR 0.17) in IUGR cases. The positive predictive value was 81.1% and the negative predictive value was 85.1% for this cut-off value. CONCLUSIONS: We have shown that placental strain ratio is increased during the third trimester of pregnancy in fetuses with IUGR. Increased stiffness and elasticity may be responsible for the onset of IUGR in some cases.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Retardo do Crescimento Fetal/fisiopatologia , Placenta/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto Jovem
18.
Cancer Imaging ; 20(1): 35, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398076

RESUMO

BACKGROUND: Anti-angiogenic treatment of glioblastoma (GBM) complicates radiologic monitoring. We evaluated magnetic resonance elastography (MRE) as an imaging tool for monitoring the efficacy of anti-VEGF treatment of GBM. METHODS: Longitudinal studies were performed in an orthotopic GBM xenograft mouse model. Animals treated with B20 anti-VEGF antibody were compared to untreated controls regarding survival (n = 13), classical MRI-contrasts and biomechanics as quantified via MRE (n = 15). Imaging was performed on a 7 T small animal horizontal bore MRI scanner. MRI and MRE parameters were compared to histopathology. RESULTS: Anti-VEGF-treated animals survived longer than untreated controls (p = 0.0011) with progressively increased tumor volume in controls (p = 0.0001). MRE parameters viscoelasticity |G*| and phase angle Y significantly decreased in controls (p = 0.02 for |G*| and p = 0.0071 for Y). This indicates that untreated tumors became softer and more elastic than viscous with progression. Tumor volume in treated animals increased more slowly than in controls, indicating efficacy of the therapy, reaching significance only at the last time point (p = 0.02). Viscoelasticity and phase angle Y tended to decrease throughout therapy, similar as for control animals. However, in treated animals, the decrease in phase angle Y was significantly attenuated and reached statistical significance at the last time point (p = 0.04). Histopathologically, control tumors were larger and more heterogeneous than treated tumors. Vasculature was normalized in treated tumors compared with controls, which showed abnormal vasculature and necrosis. In treated tumors, a higher amount of myelin was observed within the tumor area (p = 0.03), likely due to increased tumor invasion. Stiffness of the contralateral hemisphere was influenced by tumor mass effect and edema. CONCLUSIONS: Anti-angiogenic GBM treatment prolonged animal survival, slowed tumor growth and softening, but did not prevent progression. MRE detected treatment effects on tumor stiffness; the decrease of viscoelasticity and phase angle in GBM was attenuated in treated animals, which might be explained by normalized vasculature and greater myelin preservation within treated tumors. Thus, further investigation of MRE is warranted to understand the potential for MRE in monitoring treatment in GBM patients by complementing existing MRI techniques.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Neoplasias Encefálicas/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Glioblastoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Inibidores da Angiogênese/uso terapêutico , Animais , Anticorpos/efeitos adversos , Anticorpos/imunologia , Anticorpos/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Feminino , Glioblastoma/tratamento farmacológico , Camundongos , Camundongos Nus , Fator A de Crescimento do Endotélio Vascular/imunologia
19.
Ultrasonics ; 107: 106170, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32417695

RESUMO

Zebrafish are being increasingly used as animal models for human diseases such as cardiomyopathy and neuroblastoma. Owing to a nearly fully sequenced genome and efficient genetics/chemical genetics, zebrafish open new research opportunities for human diseases research. The purpose of this study was to develop zebrafish ultrasound vibro-elastography (ZUVE) for measuring the shear wave speed of zebrafish. An adult female zebrafish was anesthetized for three minutes for the ZUVE testing. A 0.1 s gentle harmonic vibration was generated on the tail using a sphere tip indenter with 3 mm diameter. Shear wave propagation in the zebrafish was measured using a high frequency 18 MHz ultrasound probe. Shear wave speeds were measured at 300, 400, and 500 Hz. Shear wave speeds were, respectively, 3.13 ± 1.20 (m/s) for 300 Hz, 4.28 ± 1.36 (m/s) for 400 Hz, and 5.07 ± 1.45 (m/s) for 500 Hz for zebrafish 1 in a region of interest (ROI) which covered the central body. The shear wave speed dispersions were similar for four zebrafish and shear wave speeds ranged between 2.5 (m/s) and 5 (m/s) from 300 Hz to 500 Hz. The experimental setup and testing for a zebrafish lasted less than three minutes. All tested zebrafish were alive after testing. ZUVE is safe, fast, and noninvasive, making the testing of elastic properties of zebrafish feasible.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Cauda/diagnóstico por imagem , Peixe-Zebra , Animais , Estudos de Viabilidade , Modelos Animais , Vibração
20.
Br J Radiol ; 93(1110): 20200063, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32271626

RESUMO

Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.


Assuntos
Doenças dos Genitais Masculinos/diagnóstico por imagem , Escroto/diagnóstico por imagem , Ultrassonografia/métodos , Abscesso/diagnóstico por imagem , Adolescente , Fatores Etários , Criança , Contraindicações de Medicamentos , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Cistos/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Técnicas de Imagem por Elasticidade/métodos , Epididimite/diagnóstico por imagem , Humanos , Recém-Nascido , Infarto/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Masculino , Fosfolipídeos/administração & dosagem , Fosfolipídeos/efeitos adversos , Escroto/lesões , Torção do Cordão Espermático/diagnóstico por imagem , Hexafluoreto de Enxofre/administração & dosagem , Hexafluoreto de Enxofre/efeitos adversos , Neoplasias Testiculares/diagnóstico por imagem , Testículo/irrigação sanguínea , Testículo/diagnóstico por imagem , Testículo/lesões
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