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Kucukbas GN, Soylu AR. Comparison of fetal and maternal tissue elasticity between euploid and aneuploid pregnancies by shear wave elastography. J Obstet Gynaecol Res 2023; 49:568-576. [PMID: 36404125 DOI: 10.1111/jog.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/18/2022] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
AIM B-mode ultrasonography utilized for fetal screening of common trisomies is referred to as a genetic sonogram and includes determining major abnormalities and soft markers such as hypoplastic nasal bone and increased thickness of the nuchal fold. Elastography is a novel ultrasound technique giving information about tissue stiffness used for diagnosing cancer, transplant rejection, and organ fibrosis. This study aimed to determine via shear wave elastography (SWE) whether euploid and aneuploid fetal soft marker tissues vary in stiffness. METHODS The participants were all singleton pregnancies between 19 and 23 weeks of gestation; 35 euploid and 14 aneuploid fetus pregnancies were enrolled. Fetal bowel, kidney, liver, nasal bone, nuchal fold, placenta, and myometrium were investigated with SWE using acoustic radiation impulse force. Images were analyzed with a novel software calibrated and written by us using MATLAB. Statistical analysis was completed with the SPSS Program. Shapiro-Wilk normality distribution analysis, Student's t-test, and Mann-Whitney U methods were used. RESULTS The mean shear wave speed of fetal nasal bone was significantly lower in aneuploid fetuses. There was no difference between other tissues in mean shear wave velocity. CONCLUSIONS Euploid and aneuploid fetuses have different elastic properties of the nasal bone and this may have a role in differentiating aneuploid fetuses noninvasively.
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Affiliation(s)
- Gokce Naz Kucukbas
- Kocaeli Derince Training and Research Hospital, Department of Obstetrics and Gynecology, Perinatology Division, Karadenizliler Mahallesi İzmit Kadın Doğum ve Çocuk Hastanesi, İzmit/Kocaeli, Turkey.,Perinatology Division, Department of Obstetrics and Gynecology, Van Yuzuncu Yil University, Van, Turkey
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Hacettepe University School of Medicine, Ankara, Turkey
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Wang XL, Lin S, Lyu GR. Advances in the clinical application of ultrasound elastography in uterine imaging. Insights Imaging 2022; 13:141. [PMID: 36057675 PMCID: PMC9440970 DOI: 10.1186/s13244-022-01274-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Changes in tissue stiffness by physiological or pathological factors in tissue structure are identified earlier than their clinical features. Pathological processes such as uterine fibrosis, adenomyosis, endometrial lesions, infertility, and premature birth can manifest as tissue elasticity changes. In clinical settings, elastography techniques based on ultrasonography, optical coherence tomography, and magnetic resonance imaging are widely used for noninvasive measurement of mechanical properties in patients, providing valuable tool and information for diagnosis and treatment. Ultrasound elastography (USE) plays a critical role in obstetrics and gynecology clinical work because of its simplicity, non-invasiveness, and repeatability. This article reviews the recent progress of USE in uterine tumor diagnosis (especially early diagnosis and treatment effect evaluation), prediction of preterm birth, and intrauterine insemination. We believe that USE, especially shear wave elastography, may serve as a potential means to assess tissue stiffness, thereby improving the diagnosis and treatment of adenomyosis, fibroids, endometrial lesions, cervical cancer, and precise management of preterm birth and intrauterine insemination monitoring.
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Affiliation(s)
- Xia-Li Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian Province, China
| | - Shu Lin
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Diabetes and Metabolism Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Guo-Rong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian Province, China.
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Anuk AT, Tanacan A, Erol SA, Alkan M, Altinboga O, Celen S, Keskin HL, Sahin D. Value of shear-wave elastography and cerebral-placental-uterine ratio in women diagnosed with preeclampsia and fetal growth restriction in prediction of adverse perinatal outcomes. J Matern Fetal Neonatal Med 2022; 35:10001-10009. [PMID: 35647897 DOI: 10.1080/14767058.2022.2081804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to measure placental stiffness with shear-wave elastography technique and to evaluate the relationship with cerebral-placental-uterine ratio (CPUR) and adverse perinatal outcomes in patient groups diagnosed with preeclampsia (PE) and fetal growth restriction (FGR) in the second and third trimesters compared to the control group. MATERIALS AND METHODS This prospective cross-sectional study was conducted at our hospital between March 2019 and March 2020. The study groups were divided into three groups: PE, FGR, and low risk pregnancy (LRP) group. The study population had singleton pregnancies and the placental site was at the anterior wall. Both shear-wave elasticity (SWE) and shear-wave velocity (SWV) were measured in the placenta during pregnancy. CPUR was calculated for each group. RESULTS A total of 147 patients were included in this study. The mean SWE (kilopascals) values in the PE group were significantly higher than in the FGR and controls (difference of means = 3.67, 9.45; 95% CI (1.23-6.1, 7-11.8); p < .05), respectively. The mean SWV values were significantly higher in PE and FGR groups than controls (p < .05). CPUR showed correlation with central maternal surface of placenta (p: .02, r: -0.184), central fetal surface of placenta (p < .001, r: -0.288), peripheral maternal surface of placenta (p: .002, r: -0.252), and peripheral fetal surface of placenta SWE values (p: .03, r: -0.181). NICU admission was correlated with central fetal surface of placenta SWE values (p: .002, r: 0.258). CONCLUSION In conclusion, we demonstrated increased placental stiffness in both the PE and the FGR group. Also, this difference was found to be more prominent in preeclampsia. This technique seems useful for assessment of placental function and may strengthen the utility of Doppler parameters for predicting adverse perinatal outcomes in high-risk pregnancies.
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Affiliation(s)
- Ali Taner Anuk
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Seyit Ahmet Erol
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Mihriban Alkan
- Department of Radiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Orhan Altinboga
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sevki Celen
- Department of Obstetrics and Gynecology, Division of Perinatology, Etlik Zübeyde Hanım Maternity & Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Hüseyin Levent Keskin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Wear KA. Hydrophone Spatial Averaging Correction for Acoustic Exposure Measurements From Arrays-Part I: Theory and Impact on Diagnostic Safety Indexes. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:358-375. [PMID: 33186102 PMCID: PMC8325172 DOI: 10.1109/tuffc.2020.3037946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This article reports underestimation of mechanical index (MI) and nonscanned thermal index for bone near focus (TIB) due to hydrophone spatial averaging effects that occur during acoustic output measurements for clinical linear and phased arrays. TIB is the appropriate version of thermal index (TI) for fetal imaging after ten weeks from the last menstrual period according to the American Institute of Ultrasound in Medicine (AIUM). Spatial averaging is particularly troublesome for highly focused beams and nonlinear, nonscanned modes such as acoustic radiation force impulse (ARFI) and pulsed Doppler. MI and variants of TI (e.g., TIB), which are displayed in real-time during imaging, are often not corrected for hydrophone spatial averaging because a standardized method for doing so does not exist for linear and phased arrays. A novel analytic inverse-filter method to correct for spatial averaging for pressure waves from linear and phased arrays is derived in this article (Part I) and experimentally validated in a companion article (Part II). A simulation was developed to estimate potential spatial-averaging errors for typical clinical ultrasound imaging systems based on the theoretical inverse filter and specifications for 124 scanner/transducer combinations from the U.S. Food and Drug Administration (FDA) 510(k) database from 2015 to 2019. Specifications included center frequency, aperture size, acoustic output parameters, hydrophone geometrical sensitive element diameter, etc. Correction for hydrophone spatial averaging using the inverse filter suggests that maximally achievable values for MI, TIB, thermal dose ( t 43 ), and spatial-peak-temporal-average intensity ( [Formula: see text]) for typical clinical systems are potentially higher than uncorrected values by (means ± standard deviations) 9% ± 4% (ARFI MI), 19% ± 15% (ARFI TIB), 50% ± 41% (ARFI t 43 ), 43% ± 39% (ARFI [Formula: see text]), 7% ± 5% (pulsed Doppler MI), 15% ± 11% (pulsed Doppler TIB), 42% ± 31% (pulsed Doppler t 43 ), and 33% ± 27% (pulsed Doppler [Formula: see text]). These values correspond to frequencies of 3.2 ± 1.3 (ARFI) and 4.1 ± 1.4 MHz (pulsed Doppler), and the model predicts that they would increase with frequency. Inverse filtering for hydrophone spatial averaging significantly improves the accuracy of estimates of MI, TIB, t 43 , and [Formula: see text] for ARFI and pulsed Doppler signals.
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Issaoui M, Balandraud X, Grédiac M, Blaysat B, Ouchchane L, Delabaere A, Sauvant-Rochat MP, Lemery D. Temperature Rise Caused by Shear Wave Elastography, Pulse Doppler and B-Mode in Biological Tissue: An Infrared Thermographic Approach. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:325-335. [PMID: 31735465 DOI: 10.1016/j.ultrasmedbio.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine the interest in and relevance of the use of infrared thermography, which is a non-invasive full-field surface temperature measurement technique, to characterize the heterogeneous heating caused by ultrasound in biological tissue. Thermal effects of shear wave elastography, pulse Doppler and B-mode were evidenced in porcine tissue. Experiments were performed using a high-frequency echography Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). For all three modes, ultrasound was applied continuously for 360 s while the temperature at the sample surface was recorded with a Cedip Jade III-MWIR infrared camera (Flir, Torcy, France). Temperature changes were detected for the three modes. In particular, "heat tunnels" crossing the sample were visualized from the early stages of the experiment. Heat conduction from the transducer was also involved in the global warming of the sample. The study widens the prospects for studies on tolerability, potentially in addition to classic approaches such as those using thermocouples.
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Affiliation(s)
- Maha Issaoui
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Xavier Balandraud
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Grédiac
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Benoit Blaysat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique, Unité de Biostatistique et Informatique Médicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amelie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Pierre Sauvant-Rochat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique et Environnement, Université Clermont-Auvergne, UFR Pharmacie, Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Feasibility of two-dimensional ultrasound shear wave elastography of human fetal lungs and liver: A pilot study. Diagn Interv Imaging 2019; 101:69-78. [PMID: 31447393 DOI: 10.1016/j.diii.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE The first aim was to evaluate feasibility and reproducibility of 2-dimensional ultrasound (2D) shear wave elastography (SWE) of human fetal lungs and liver between 24 and 34weeks of gestation. The second aim was to model fetal lung-to-liver elastography ratio (LLE ratio) and to assess its variations according to gestational age and maternal administration of corticosteroids. MATERIAL AND METHODS 2D-SWE examinations were prospectively performed in fetuses of women with an uncomplicated pregnancy (group 1) and fetuses of women with a threatened preterm labor requiring administration of corticosteroids (group 2). Two 2D-SWE examinations were performed at "day 0" and "day 2" in group 1; before and 24hours after a course of corticosteroid in group 2. Three operators performed 2 cycles of 3 measurements on the lung (regions A1, A2, A3) and the liver (regions IV, V, VI). Repeatability and reproducibility of measurements were calculated. The fetal LLE ratio was modeled from the most reproducible regions. RESULTS Fifty-five women were enrolled in group 1 and 48 in group 2. For the lung, 8.6% of measurements were considered invalid and 6.9% for the liver. The most reproducible region for the lung was A3 [ICC between 0.70 (95% CI: 0.42-0.85) and 0.78 (95% CI: 0.48-0.90)] and region VI for the liver [ICC between 0.70 (95% CI: 0.40-0.85) and 0.84 (95% CI: 0.60-0.94)]. According to gestational age, a moderate positive linear correlation was found for stiffness values of A3 (R=0.56), V (R=0.46) and VI (R=0.44). LLE ratio values at "day 0" were not different between the two groups but decreased at "day 2" in group 2 (0.2; 95% CI: 0.07-0.34; P<0.001). CONCLUSION Quantitative fetal lung and liver stiffness measurements are possible with 2D-SWE with acceptable reproducibility.
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Mottet N, Metz JP, Chaussy Y. Evolution of fetal lung stiffness during gestation in two different congenital malformations. J Obstet Gynaecol Res 2019; 45:931-934. [PMID: 30854743 DOI: 10.1111/jog.13894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
This report is aimed at opening a new reflexion about exploration of fetal lungs malformations with 2-D ultrasound shear wave elastography (2D-SWE) in two fetuses. These preliminary results are drawn from the ELASTOMAP study, which was designed to explore feasibility of 2D-SWE on fetal lungs. Fetus A presented Congenital Pulmonary Airway Malformation and fetus B congenital obstructive emphysema. We estimated every 3 weeks the Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of the malformation and we evaluated stiffness by 2D-SWE. Stiffness of the lesion and the normal lung were compared to liver stiffness using Lung to Liver Elastography (LLE) ratio. Interestingly, CVR and LLE ratios evolved differently in these two lesions caused by distinct physiopathological processes. In both cases, LLE ratio' variations preceded that of CVR. LLE ratio of the normal lung was constant through gestation. 2D-SWE could be a promising tool to describe stiffness evolution in fetal lungs malformations.
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Affiliation(s)
- Nicolas Mottet
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz Besançon, Université de Franche Comté, Besancon, France.,Nanomedicine Laboratory, Imagery and Therapeutics, INSERM EA4662, University of Franche-Comte, Besancon, France
| | - Jean-Patrick Metz
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz Besançon, Université de Franche Comté, Besancon, France
| | - Yann Chaussy
- Nanomedicine Laboratory, Imagery and Therapeutics, INSERM EA4662, University of Franche-Comte, Besancon, France.,Department of Paediatric Surgery, University Hospital Jean Minjoz Besançon, Université de Franche Comté, Besancon, France
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Mottet N, Ramanah R. Comment on "Shear wave elastography safety in fetus: A quantitative health risk assessment". Diagn Interv Imaging 2018; 99:577-578. [PMID: 30177448 DOI: 10.1016/j.diii.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/09/2023]
Affiliation(s)
- N Mottet
- Department of Obstetrics and Gynecology, Hopital Jean Minjoz, Université de Franche Comté, 25000 Besançon, France; Inserm EA4662, Nanomedecine laboratory, University of Franche-Comte, 25000 Besançon, France.
| | - R Ramanah
- Department of Obstetrics and Gynecology, Hopital Jean Minjoz, Université de Franche Comté, 25000 Besançon, France; Inserm EA4662, Nanomedecine laboratory, University of Franche-Comte, 25000 Besançon, France
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