Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules

The Application of Shear Wave Elastography to Determine the Elasticity of the Levator Ani Muscle and Vaginal Tissue in Patients With Pelvic Organ Prolapse

OBJECTIVES

The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP.

METHODS

Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM.

RESULTS

A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P: .012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P: .03) and the middle third of the anorectal canal (P: .019).

CONCLUSION

It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP.

Ultrasound Shear Elastography With Expanded Bandwidth (USEWEB): A Novel Method for 2D Shear Phase Velocity Imaging of Soft Tissues

Ultrasound shear wave elastography (SWE) is a noninvasive approach for evaluating mechanical properties of soft tissues. In SWE either group velocity measured in the time-domain or phase velocity measured in the frequency-domain can be reported. Frequency-domain methods have the advantage over time-domain methods in providing a response for a specific frequency, while time-domain methods average the wave velocity over the entire frequency band. Current frequency-domain approaches struggle to reconstruct SWE images over full frequency bandwidth. This is especially important in the case of viscoelastic tissues, where tissue viscoelasticity is often studied by analyzing the shear wave phase velocity dispersion. For characterizing cancerous lesions, it has been shown that considerable biases can occur with group velocity-based measurements. However, using phase velocities at higher frequencies can provide more accurate evaluations. In this paper, we propose a new method called Ultrasound Shear Elastography with Expanded Bandwidth (USEWEB) used for two-dimensional (2D) shear wave phase velocity imaging. We tested the USEWEB method on data from homogeneous tissue-mimicking liver fibrosis phantoms, custom-made viscoelastic phantom measurements, phantoms with cylindrical inclusions experiments, and in vivo renal transplants scanned with a clinical scanner. We compared results from the USEWEB method with a Local Phase Velocity Imaging (LPVI) approach over a wide frequency range, i.e., up to 200-2000 Hz. Tests carried out revealed that the USEWEB approach provides 2D phase velocity images with a coefficient of variation below 5% over a wider frequency band for smaller processing window size in comparison to LPVI, especially in viscoelastic materials. In addition, USEWEB can produce correct phase velocity images for much higher frequencies, up to 1800 Hz, compared to LPVI, which can be used to characterize viscoelastic materials and elastic inclusions.

Sonographic Characterization of the Pericruciate Fat Pad with the Use of Compression Elastography-A Cross-Sectional Study among Healthy and Post-Injured Patients

Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them with cases of post-traumatic injuries. Methods: Conducted as a retrospective cross-sectional study (n = 110 knees each) following STROBE guidelines, it employed grayscale ultrasound with echogenicity measurement, compression elastography with elasticity measurement, and Color Doppler for blood flow assessment. Results: PCFP showed a homogenic and hyperechoic echostructure. The echogenicity of the PCFP was higher than that of the posterior cruciate ligament (PCL) (p < 0.001, z-score = 8.97) and of the medial head of gastrocnemius (MHG) (p = 0.007, z-score = 2.72) in healthy knees, but lower than subcutaneous fat (SCF) (p < 0.001, z-score = -6.52). Post-injury/surgery, PCFP echogenicity surpassed other structures (p < 0.001; z-score for PCL 12.2; for MHG 11.65 and for SCF 12.36) and notably exceeded the control group (p < 0.001, z-score = 8.78). PCFP elasticity was lower than MHG and SCF in both groups, with significantly reduced elasticity in post-traumatic knees (ratio SCF/PCFP 15.52 ± 17.87 in case group vs. 2.26 ± 2.4 in control group; p < 0.001; z-score = 9.65). Blood flow was detected in 71% of healthy PCFPs with three main patterns. Conclusions: The main findings, indicating increased echogenicity and reduced elasticity of PCFP post-trauma, potentially related to fat pad fibrosis, suggest potential applications of echogenicity and elasticity measurements in detecting and monitoring diverse knee pathologies. The description of vascularity variations supplying the PCFP adds additional value to the study by emphasizing the clinically important role of PCFP as a bridge for the middle genicular artery on its way to the inside of the knee joint.

Mechanical properties of human tumour tissues and their implications for cancer development

The mechanical properties of cells and tissues help determine their architecture, composition and function. Alterations to these properties are associated with many diseases, including cancer. Tensional, compressive, adhesive, elastic and viscous properties of individual cells and multicellular tissues are mostly regulated by reorganization of the actomyosin and microtubule cytoskeletons and extracellular glycocalyx, which in turn drive many pathophysiological processes, including cancer progression. This Review provides an in-depth collection of quantitative data on diverse mechanical properties of living human cancer cells and tissues. Additionally, the implications of mechanical property changes for cancer development are discussed. An increased knowledge of the mechanical properties of the tumour microenvironment, as collected using biomechanical approaches capable of multi-timescale and multiparametric analyses, will provide a better understanding of the complex mechanical determinants of cancer organization and progression. This information can lead to a further understanding of resistance mechanisms to chemotherapies and immunotherapies and the metastatic cascade.

The evaluation of retrobulbar fat tissue in Graves' orbitopathy with shear-wave ultrasound elastography

PURPOSE

To evaluate retrobulbar adipose tissue of patients with active and inactive Graves' orbitopathy (GO) by shear-wave ultrasound elastography (SWE).

METHODS

Followed-up in our ophthalmology clinic due to GO, 72 eyes of 36 patients and 38 eyes of 19 healthy controls were included in this cross-sectional case-control study. Graves' patients were divided into two subgroups under clinical activity score (CAS): active Graves' orbitopathy (AGO) (CAS ≥ 3) and inactive Graves' orbitopathy (IGO) (CAS < 3). SWE measurement values of retrobulbar adipose tissue of all participants were recorded in meters/second, and the intergroup comparisons were performed.

RESULTS

Thirty-four eyes of 17 patients in AGO, 38 eyes of 19 patients in IGO, and 38 eyes of 19 participants in the control group were included in the study. Mean values measured from retrobulbar adipose tissue through SWE were 1.00 ± 0.01 m/sec in AGO, 1.16 ± 0.01 m/sec in IGO, and 0.94 ± 0.01 m/sec in the control groups. Even so, the mean SWE value was significantly higher in the IGO group than in the other groups (p < 0.001). Mean SWE values were significantly higher in the AGO group than in the controls (p = 0.008). In the correlation analysis performed, a significant positive correlation was found between SWE and Hertel exophthalmometer measurement values (p = 0.026, r = 0.212), and thyroid-stimulating hormone receptor antibody (TSHR-Ab) levels (p = 0.018, r = 0.224).

CONCLUSION

We detected SWE values of retrobulbar adipose tissue high in GO, especially in the IGO group. Such a situation, which we associated with the development of fibrosis, may be an indicator of unresponsiveness to immunomodulatory treatments.

In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis

Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.

On the Role of Coherent Plane Wave Compounding in Shear Wave Elasticity Imaging: The Convolution Effect and Its Implications

OBJECTIVE

The clinical applicability of shear wave elasticity imaging (SWEI) has been confounded by its appreciable inter-system variability and unsatisfactory sensitivity. While SWEI relies on plane wave imaging (PWI) to achieve real-time rendering, it has been rarely noticed that PWI can affect SWEI's performance. This work is aimed at demonstrating that the use of coherent plane wave compounding (CPWC) can be a factor causing SWEI's underperformance.

METHODS

We presented a model to formally describe the slow-time behavior of CPWC in motion tracking. This model reveals that CPWC introduces temporal convolution on the observed motion, making the motion sampling process a low-pass filter (LPF). For validation, shear waves were produced in a phantom in the same way but sampled via PWI using different compounding numbers (CN) and pulse repetition frequencies (PRF), with the obtained signals compared with the inferences drawn from our model. Similar experiments were performed to reconstruct two small targets in the phantom in order to appraise the impact of CPWC on SWEI's sensitivity.

DISCUSSION

The validation experiment shows that the measurements match well with the model inferences, which verifies the LPF nature of CPWC. The phantom study also shows that either increasing CN or decreasing PRF can cause the loss of high-frequency motion information, leading to blurred target delineation by SWEI.

CONCLUSION

The convolution effect can help understand the variability of SWEI. Researchers should beware this effect when working on SWEI standardization. Clinicians using SWEI should also be cautious because this effect makes it harder to identify small lesions.

Four-dimensional computational ultrasound imaging of brain hemodynamics

Four-dimensional ultrasound imaging of complex biological systems such as the brain is technically challenging because of the spatiotemporal sampling requirements. We present computational ultrasound imaging (cUSi), an imaging method that uses complex ultrasound fields that can be generated with simple hardware and a physical wave prediction model to alleviate the sampling constraints. cUSi allows for high-resolution four-dimensional imaging of brain hemodynamics in awake and anesthetized mice.

The value of quantitative and a new qualitative color pattern shear wave elastography for the differentiation of ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm

Objective

This study aims to evaluate the diagnostic performance of quantitative shear wave elastography (SWE) and a new qualitative color pattern SWE for the differentiation of benign and malignant American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR TI-RADS) 4 or 5 category thyroid nodules measuring ≤10 mm.

Materials and methods

From May 2020 to July 2022, a total of 237 patients with 270 thyroid nodules were enrolled, and conventional ultrasound and SWE examinations were performed for each patient. Each ACR TI-RADS 4 or 5 category thyroid nodule measuring ≤10 mm was evaluated by quantitative SWE and a new qualitative color pattern SWE. The diagnostic performance of quantitative SWE parameters, the new qualitative color pattern SWE, and the combination of SWE with ACR TI-RADS, respectively, for the differentiation of benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm was evaluated and compared.

Results

Among 270 thyroid nodules in 237 patients, 72 (26.67%) thyroid nodules were benign and 198 (73.33%) thyroid nodules were malignant. The qualitative color pattern SWE showed better diagnostic performance than the quantitative SWE parameters. When combining the qualitative color pattern SWE with ACR TI-RADS scores, with the optimal cutoff value of the total points ≥8, the thyroid nodules were considered malignant. The sensitivity, specificity, accuracy, and AUC were 89.90%, 56.94%, 81.11%, and 0.820 (95% CI: 0.768-0.864), respectively. Compared with using qualitative color pattern SWE alone, the combination of qualitative color pattern SWE and ACR TI-RADS had better diagnostic performance, which was significantly different (p < 0.05).

Conclusion

The combination of qualitative SWE color patterns and ACR TI-RADS had high sensitivity and accuracy, which might be a convenient and useful method to differentiate benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm. It would be helpful for the management of thyroid nodules and improving prognosis.

Impact of Region-of-Interest Size on the Diagnostic Performance of Shear Wave Elastography in Differentiating Thyroid Nodules

This study investigated the impact of different region-of-interest (ROI) sizes (Max, 1 mm, and 2 mm) on shear wave elastography (SWE) in differentiating between malignant and benign thyroid nodules. The study cohort comprised 129 thyroid nodules (50 malignant, 79 benign) and 78 normal subjects. Diagnostic efficacy was assessed through pairwise comparisons of area under the curve (AUC) values in receiver operating characteristic analysis by using DeLong's test. Our results indicated significant differences in all SWE elasticity metrics between the groups, with malignant nodules exhibiting higher values than benign nodules (p < 0.05). Smaller ROIs (1 and 2 mm) were found to outperform the max ROI in terms of diagnostic accuracy, particularly for the Emax and Emin elasticity metrics. Emax(1mm) had the highest diagnostic accuracy, with an AUC of 0.883, sensitivity of 74.0%, and specificity of 86.1%. This study underscores the significant influence of ROI size selection on the diagnostic performance of SWE, offering valuable insights for future research and clinical applications in thyroid nodule assessment.

Deltoid Muscle Tension Alterations Post Reverse Shoulder Arthroplasty: An Investigation Using Shear Wave Elastography

INTRODUCTION

This study aimed to evaluate the utility of shear wave elastography (SWE) in assessing changes in deltoid muscle properties following reverse shoulder arthroplasty (RSA).

METHODS

Our cohort consisted of 18 patients who underwent RSA due to various conditions, including osteoarthritis, cuff arthropathy, and irreducible proximal humeral fractures. Pre- and postoperative muscle elasticity and stiffness were measured using SWE and were compared with functional outcomes and radiological parameters.

RESULTS

Our results showed significant changes in deltoid muscle elasticity after RSA, particularly in the anterior and middle portions. However, these alterations were not correlated with postoperative functional outcomes or specific radiological parameters. The study also underscored the potential of SWE for future applications, including the preoperative assessment of deltoid function, postoperative monitoring, and intraoperative use for optimal component positioning during RSA.

CONCLUSION

Further research, involving larger, more homogeneous patient cohorts is needed to confirm these findings and to explore the potential influence of these changes on the biomechanical design of implants and prosthesis positioning in RSA.

Comparison of sound touch elastography and quantification for assessing the renal pathologic changes in patients with proteinuria

OBJECTIVE

Sound touch elastography (STE) and sound touch quantification (STQ) are novel imaging methods to evaluate tissue stiffness. This study aims to investigate renal stiffness in patients with chronic kidney disease (CKD) by STE and STQ, using renal biopsy as 'gold standard'.

METHODS

Between 2019 January and 2022 June, 60 patients who underwent renal biopsy for proteinuria (cases) and 45 healthy volunteers (controls) at our hospital were included in this study. The maximum and mean elastic modulus (Emax, Emean) of region of interest in right kidney were measured by STE and STQ techniques. Biochemical profiles and renal biopsy findings were recorded.

RESULTS

Both Emax and Emean measured by STE were significantly different between cases and controls. ROC analysis of STE measurements revealed using a cutoff of 13.53 kPa for Emax and 10.16 kPa for Emean, the area under the curve (AUC) to distinguish nephropathy from healthy was 0.718 and 0.744. Analysis of ROC for STQ measurements showed that using a cutoff value of 15.87 kPa for Emax and 9.95 kPa for Emean, the AUC for the nephropathy was 0.612 and 0.569. Emax and Emean values were significantly different among CKD patients with mild, moderate and severe pathological stage. The Emax value for STE was positively related to Scr, β2-MG (r = 0.257, 0.292, p < 0.05).

CONCLUSION

Both STE and STQ are non-invasive, feasible methods to quantitatively evaluate renal stiffness. STE is more effective than STQ in the diagnosis of CKD patients with proteinuria.

CRITICAL RELEVANCE STATEMENT

Sound touch elastography is more effective than sound touch quantification in the diagnosis of chronic kidney disease patients with proteinuria.

KEY POINTS

• Emax and Emean measured by STE were different between cases and controls. • Emax and Emean were different among CKD patients with different pathological stages. • The Emax value for STE was positively related to serum creatinine, β2-microglobulin.

Evaluating Variability of Commercial Liver Fibrosis Elastography Phantoms

OBJECTIVE

Liver fibrosis has been found to increase the mechanical stiffness of the liver. To mimic different stages of liver fibrosis, commercially available phantoms (Model 039, CIRS, Inc.) have been produced for clinical quality assurance and research purposes. The purpose of this study was to investigate the mechanical property variability of the phantoms in two lots of CIRS Model 039 phantoms.

METHODS

Each lot consisted of phantoms of four stiffness types, and there were 8-10 phantoms of each type. Shear wave elastography measurements were conducted on each phantom at 10 different angles. Group velocity measurements and phase velocity curves were calculated for every SWE acquisition. Multilevel functional principal component analysis (MFPCA) was performed on phase velocity data, which decomposes each phase velocity curve into the sum of eigenfunctions of two levels. The variance of the component scores of levels 1 and 2 were used to represent inter-phantom and intra-phantom variability, respectively. The 95% confidence intervals of phase velocity in a phantom type were calculated to reflect curve variability.

DISCUSSION

The standard deviations of the group velocity for phantoms of any type were less than 0.04 and 0.02 m/s for lots 1 and 2, respectively. For both lots, in every type, the phase velocity curves of most individual phantoms fall within the 95% confidence interval.

CONCLUSION

MFPCA is an effective tool for analyzing the inter- and intra-phantom variability of phase velocity curves. Given the known variability of a fully tested lot, estimation of the variability of a new lot can be performed with a reduced number of phantoms tested.

Contrast-enhanced ultrasound and shear wave elastography in the diagnosis of ACR TI-RADS 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis

Objective

This study aims to evaluate the value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and their combined use in the differentiation of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis (HT).

Materials and methods

A total of 133 pathologically confirmed ACR TI-RADS 4 and 5 category nodules coexisting with HT in 113 patients were included; CEUS and SWE were performed for all nodules. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and the area under the receiver operating characteristic curve (AUC) of the SWE, CEUS, and the combined use of both for the differentiation of benign and malignant nodules were compared, respectively.

Results

Using CEUS alone, the sensitivity, specificity, PPV, NPV, and accuracy were 89.2%, 66.0%, 81.3%, 78.6%, and 80.5%, respectively. Using SWE alone, Emax was superior to Emin, Emean, and Eratio for the differentiation of benign and malignant nodules with the best cutoff Emax >46.8 kPa, which had sensitivity of 65.1%, specificity of 90.0%, PPV of 91.5%, NPV of 60.8%, and accuracy of 74.4%, respectively. Compared with the diagnostic performance of qualitative CEUS or/and quantitative SWE, the combination of CEUS and SWE had the best sensitivity, accuracy, and AUC; the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 94.0%, 66.0%, 82.1%, 86.8%, 83.5%, and 0.80 (95% confidence interval: 0.713, 0.886), respectively.

Conclusion

In conclusion, CEUS and SWE were useful for the differentiation of benign and malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT. The combination of CEUS and SWE could improve the sensitivity and accuracy compared with using CEUS or SWE alone. It could be a non-invasive, reliable, and useful method to differentiate benign from malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT.

A New Estimation Scheme for Improving the Performance of Shear Wave Elasticity Imaging

Shear wave velocity (SWV) reconstruction based on time-of-flight (TOF) is widely adopted to realize shear wave elasticity imaging (SWEI). It typically breaks down the reconstruction of a SWV image into many kernels and treats them independently. We hypothesized that information exchange among kernels improves the performance of SWEI. Therefore, we propose the approach of iterative re-weighted least squares based on inter-kernel communication (IKC-IRLS). We also hypothesized that time-to-peak (TTP) is superior to cross-correlation (CC) in visualizing small targets because TTP uses higher shear wave frequencies than CC. To examine the hypotheses, IKC-IRLS was combined with TTP data and compared with four established methods. The five methods were tested by imaging several small-size stiff targets (2.5, 4.0 and 6.4 mm in diameter) using different kernel sizes in the simulation and real experiments. The results indicate that the IKC-IRLS approach can mitigate speckle noise and is robust to TTP outliers. Consequently, the proposed method achieves the highest contrast-to-noise ratio and the lowest mean absolute percentage error of target in almost all tested cases.

Evaluation of the clinical value of shear wave elastography for early detection and diagnosis of diabetic peripheral neuropathy: a controlled preliminary prospective clinical study

PURPOSE

This study aims to analyze the clinical application value of shear wave elastography (SWE) technique for early diagnosis of diabetic peripheral neuropathy (DPN).

METHODS

Diabetic patients hospitalized in the Department of Endocrinology of the First Affiliated Hospital of Anhui Medical University from August 2021 to February 2022 were enrolled as DPN group (n=38) and non-DPN group (n=35) based on the neurophysiological examination results. 30 healthy subjects were recruited as the control group during the same period. Ultrasound examination of the tibial nerve and related laboratory tests were examined and collected for the total 103 study subjects. Statistical analysis of the collected data, and the receiver operating characteristic(ROC) curve for determination of the optimal cut-off values of mean stiffness of tibial nerve to detect DPN, with determination of area under curve (AUC), specificity, sensitivity, and Youden index.P value < 0.05 is considered statistically significant.

RESULTS

Gender, age and BMI differences among three groups were insignificant (P>0.05). The difference of serological indicators between DPN and non-DPN groups was also not found (P>0.05), whereas longer duration of diabetes was observed in DPN group as compared to non-DPN group. As to the ultra-sound relevant parameters, the cross-sectional area and elastic modulus of the tibial nerve in both lower extremities among these three groups were not significantly different (Oneway ANOVA analysis) although the differences were indeed observed if we compared DPN group exclusively with non-DPN group, or compared non-DPN group with healthy group, or compared DPN group with healthy group (t test). Additionally, the mean elasticity (Emean) cut-off value for the diagnosis of DPN was preferably taken as 67.55 kPa.

CONCLUSION

SWE has unique advantages in early detection and diagnosis of DPN, which deserve further research.

Using Shear-Wave Elastography to Assess Exercise-Induced Muscle Damage: A Review

Shear-wave elastography is a method that is increasingly used to assess muscle stiffness in clinical practice and human health research. Recently, shear-wave elastography has been suggested and used to assess exercise-induced muscle damage. This review aimed to summarize the current knowledge of the utility of shear-wave elastography for assessment of muscle damage. In general, the literature supports the shear-wave elastography as a promising method for assessment of muscle damage. Increases in shear modulus are reported immediately and up to several days after eccentric exercise, while studies using shear-wave elastography during and after endurance events are showing mixed results. Moreover, it seems that shear modulus increases are related to the decline in voluntary strength loss. We recommend that shear modulus is measured at multiple muscles within a muscle group and preferably at longer muscle lengths. While further studies are needed to confirm this, the disruption of calcium homeostasis seems to be the primary candidate for the underlying mechanism explaining the increases in shear modulus observed after eccentric exercise. It remains to be investigated how well the changes in shear modulus correlate with directly assessed amount of muscle damage (biopsy).

MALİGN VE BENİGN TIROİD NODÜLLERİNİN AYRIMINDA ARFI ELASTOGRAFİ

AMAÇ: Malign ve benign tiroid nodüllerini ayırd etmede “Acoustic Radiation Force Impulse” (ARFI) elastografinin “virtual touch tissue elastografi” modunun tanısal performansını değerlendirmek MATERYAL VE METOD: Çapı &gt; 5 mm olan ikiyüzdört adet solid ve ağırlıklı solid nodül prospektif olarak ultrasonografi, ARFI elastografinin VTQ modu, ince iğne aspirasyon biyopsisi ve endike olduğunda doku patolojisi ile değerlendirildi. Yüzdoksanaltı nodülde üç makaslama dalgası hızı (shear wave velocity-SWV) ölçümü yapıldı. Her bir nodül için SWV oranı, nodülün SWV'sinin ortalama değerinin komşu parankimin ortalama değerine bölünmesiyle hesaplandı. SWV değeri ve SWV oranının tanısal performansı, ROC analizi ile değerlendirildi. SONUÇLAR: Benign ve malign tiroid nodüllerinde normal parankimdeki ortalama SWV değeri sırasıyla 2,13±0,44 m/s, 2,06±0,80 m/s ve 2,06±0,88 m/s idi. SWVoranları benign tiroid nodülleri için 0.97±0.37 ve malign tiroid nodülleri için 1.02±0.40 idi. Ortalama SWV değerleri (t=0,008) (P=0,994) veya SWV oranları (t=0,596; P=0,527) açısından benign ve malign nodüller arasında anlamlı fark yoktu. Maligniteyi öngörmek için herhangi bir cut-off noktası bulunmadı. Alt grup analizinde, SWV ve SWV oranı için AUC'ler, ˂10 mm ve ≥10 mm nodüller arasında önemli ölçüde farklıydı. Bunun dışında herhangi iki grup arasında anlamlı fark saptanmadı (tümü P&gt;0.05). SWV ve SWV oranı için en iyi cut-off noktaları, &lt;10 mm nodüller için sırasıyla SWV için 2.59 m/s ve SWV oranı için 1.0 idi. SONUÇ: ARFİ görüntülemenin VTQ modu, maligniteyi saptamak için iyi bir tanısal performansa sahip değildir ve gereksiz tiroid biyopsilerinin azaltılmasına katkıda bulunamaz.

Malign ve benign tiroid nodüllerinin ayrımında ARFI elastografi

Aim: To examine the diagnostic performance of virtual touch tissue quantification (VTQ) mode of Acoustic Radiation Force Impulse (ARFI) elastography imaging in differentiating benign and malignant thyroid nodules. Materials and Methods: Two hundred four solid and mostly solid nodules >5mm were prospectively evaluated with ultrasonography, VTQ mode of ARFI elastography, fine needle aspiration biopsy, and when indicated with tissue pathology. Three shear-wave velocities (SWV) measurements were done in 196 nodules. The SWV ratio for each nodule was calculated as the mean value of the SWV of the nodule divided by the mean value of the adjacent parenchyma. The diagnostic performance of SWV value and SWV-ratio were assessed by a receiver-operating characteristic (ROC) curve analysis. Results: The mean SWV value in the normal parenchyma, in benign and malign thyroid nodules, were 2.13±0.44 m/s, 2.06±0.80 m/s, and 2.06±0.88 m/s respectively. The SWV-ratios were 0.97±0.37 for benign thyroid nodules and 1.02±0.40 for malignant thyroid nodules. There was no significant difference between benign and malign nodules in terms of mean SWV values (t=0.008) (P=0.994) or SWV-ratios (t =0.596; P=0.527). No cut-off point was found to predict malignancy. In subgroup analysis, AUCs for the SWV and SWV-ratio were significantly different between nodules ˂10 mm and those ≥10 mm, but not with any other two groups (all P>0.05) (Table-2). The cutoff points for the differential diagnosis were 2.59 m/s for SWV and 1.0 for SWV- ratio respectively for nodules

Elasticity of the Scalene Muscles in Collegiate Baseball Pitchers Using Shear Wave Elastography

Background:

Thoracic outlet syndrome is more common in overhead athletes. The anterior and middle scalene muscles have been associated with thoracic outlet syndrome; however, the relationship between the elastic moduli of the scalene muscles and the overhead-throwing position has not been evaluated.

Purpose:

To investigate the elastic moduli of the anterior and middle scalene muscles in simulated throwing positions using shear wave elastography.

Study Design:

Descriptive laboratory study.

Methods:

We enrolled collegiate baseball players who underwent preseason medical checkups in January and February 2020. The anterior and middle scalene muscles were visualized in the short-axis view using ultrasound. In this view, the elastic moduli of the anterior and middle scalene muscles were measured using shear wave elastography in the following arm and neck positions: (1) adduction and neutral rotation of the shoulder (neutral), (2) 90° of abduction and external rotation of the shoulder (ABER), and (3) ABER with neck rotation toward the nonthrowing side (ABER+NR). Repeated-measures analysis of variance and a paired t test were used to compare the elastic modulus values among the 3 positions and between the 2 muscles, respectively.

Results:

Overall, 30 baseball players were included. In both scalene muscles, the elastic moduli were significantly greater in the ABER versus neutral position (anterior scalene: 14.4 ± 3.8 vs 9.4 ± 2.0 kPa, respectively [P < .001]; middle scalene: 15.8 ± 5.0 vs 10.9 ± 3.4 kPa, respectively [P < .001]). In the neutral position, the elastic modulus was significantly greater in the middle scalene than the anterior scalene (10.9 ± 3.4 vs 9.4 ± 2.0 kPa, respectively; P = .03). In the ABER+NR position, the elastic modulus was significantly greater in the anterior scalene than the middle scalene (18.1 ± 4.6 vs 15.8 ± 2.6 kPa, respectively; P = .03).

Conclusion:

Because the ABER position was a simulation of the throwing position, these results indicate that this position could be associated with high elastic moduli of the scalene muscles, and both the anterior and middle scalene muscles may be involved.

Deep learning in ultrasound elastography imaging: A review

It is known that changes in the mechanical properties of tissues are associated with the onset and progression of certain diseases. Ultrasound elastography is a technique to characterize tissue stiffness using ultrasound imaging either by measuring tissue strain using quasi-static elastography or natural organ pulsation elastography, or by tracing a propagated shear wave induced by a source or a natural vibration using dynamic elastography. In recent years, deep learning has begun to emerge in ultrasound elastography research. In this review, several common deep learning frameworks in the computer vision community, such as multilayer perceptron, convolutional neural network, and recurrent neural network are described. Then, recent advances in ultrasound elastography using such deep learning techniques are revisited in terms of algorithm development and clinical diagnosis. Finally, the current challenges and future developments of deep learning in ultrasound elastography are prospected. This article is protected by copyright. All rights reserved.

Validation of shear wave elastography as a noninvasive measure of pelvic floor muscle stiffness

OBJECTIVES

To investigate the validity of shear wave elastography (SWE) as a measure of stiffness of the puborectalis muscle by examining: (1) the relationship between puborectalis muscle stiffness and pelvic floor muscle (PFM) activation at different intensities; and (2) the relationship between puborectalis stiffness and pelvic floor morphometry during contractions at different intensities.

METHODS

Fifteen healthy asymptomatic women performed 6-s isometric PFM contractions at different intensities (0, 10%, 20%, 30%, 50%, 75%, and 100% of maximal voluntary contraction) guided by intravaginal electromyography (EMG). Stiffness of the puborectalis muscle was measured using SWE by calculating the average shear modulus in regions of interest that contained puborectalis muscle fibers parallel to the transducer. Pelvic floor morphometry was assessed in the mid-sagittal plane using transperineal B-mode ultrasound imaging. Shear modulus, EMG (root mean square amplitude) and pelvic floor morphometry parameters were normalized to the value recorded during maximal voluntary contraction. To assess the relationship between stiffness and pelvic floor activation/morphometry, coefficient of determination (r² ) was calculated for each participant and a group average was computed.

RESULTS

Shear modulus and EMG were highly correlated (average r² ; left 0.90 ± 0.08, right 0.87 ± 0.15). Shear modulus also strongly correlated with bladder neck position (x-axis horizontal coordinates relative to the pubic symphysis), anorectal rectal angle and position, levator plate angle, and antero-posterior diameter of the levator hiatus (average r² : range 0.62-0.78).

CONCLUSIONS

These findings support the validity of SWE to assess puborectalis muscle stiffness in females. Stiffness measures were strongly associated with PFM EMG and pelvic floor morphometry and may be used to indirectly assess the level of activation of the puborectalis muscle without the use of more invasive techniques. By overcoming limitations of current assessment tools, this promising noninvasive and real-time technique could enable important breakthrough in the pathophysiology and management of pelvic floor disorders.

SuperSonic shear imaging for the differentiation between benign and malignant thyroid nodules: a meta-analysis

PURPOSE

To assess the diagnostic value of SuperSonic shear imaging (SSI) for the differentiation between benign and malignant thyroid nodules through meta-analysis.

METHODS

Online database searches were performed on PubMed, EMBASE, the Cochrane Library, and the Web of Science until 31 July 2021. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of the included studies. Three measures of diagnostic test performance were used to examine the value of SSI, including the summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratio (DOR), and the summary sensitivity and specificity. Heterogeneity was explored using meta-regression and subgroup analyses.

RESULTS

Finally, 21 studies with 3376 patients were included in this study. There were a total of 4296 thyroid nodules, in which 1806 malignant nodules and 2490 benign ones were involved. Thyroid nodules exhibited a malignancy rate of 42.0% (range 5.6-79.8%), 95.1% of which were of papillary variant. SSI showed a summary sensitivity of 74% [95% confidence interval (CI) 67-79%], specificity of 82% (95% CI 77-87%) and AUROC of 0.85 (95% CI 0.82-0.88) for the differentiation between benign and malignant thyroid nodules. The summary positive likelihood ratio (LR), negative LR, and DOR were 4.2 (95% CI 3.3-5.3), 0.32 (95% CI 0.26-0.40), and 13 (95% CI 9-18), respectively.

CONCLUSIONS

SSI showed high accuracy in the diagnostic differentiation between benign and malignant thyroid nodules and can be served as a noninvasive and important adjunct for thyroid nodule evaluation.

The European Institute of Oncology Thyroid Imaging Reporting and Data System for Classification of Thyroid Nodules: A Prospective Study

Background: To evaluate the performance, quality and effectiveness of “IEO-TIRADS” in assigning a TI-RADS score to thyroid nodules (TN) when compared with “EU-TIRADS” and the US risk score calculated with the S-Detect software (“S-Detect”). The primary objective is the evaluation of diagnostic accuracy (DA) by “IEO-TIRADS”, “S-Detect” and “EU-TIRADS”, and the secondary objective is to evaluate the diagnostic performances of the scores, using the histological report as the gold standard. Methods: A radiologist collected all three scores of the TNs detected and determined the risk of malignancy. The results of all the scores were compared with the histological specimens. The sensitivity (SE), specificity (SP), and diagnostic accuracy (DA), with their 95% confidence interval (95% CI), were calculated for each method. Results: 140 TNs were observed in 93 patients and classified according to all three scores. “IEO-TIRADS” has an SE of 73.6%, an SP of 59.2% and a DA of 68.6%. “EU-TIRADS” has an SE of 90.1%, an SP of 32.7% and a DA of 70.0%. “S-Detect” has an SE of 67.0%, an SP of 69.4% and a DA of 67.9%. Conclusion: “IEO-TIRADS” has a similar diagnostic performance to “S-Detect” and “EU-TIRADS”. Providing a comparable DA with other reporting systems, IEO-TIRADS holds the potential of being applied in clinical practice.

Ultrasound shear-wave elastography applicability in estimation of post-mortem time

Introduction

Post-mortem rigidity of the tissues is one of the basic principles in forensic medicine to estimate the time of death. Qualitative methods to determine the stiffness of the corpse may have some limitations. Methods that provide quantitative values may be useful. We intended to evaluate the applicability of ultrasound shear-wave elastography of the tissues to estimate the post-mortem interval (PMI).

Methods

For 80 corpses, shear-wave elastography of the liver, sartorius muscle, testis, thyroid and parotid was performed before autopsy. Based on the forensic reports as the reference method to define post-mortem interval, the corpses were divided into four groups: group 0 (PMI < 24 hours), group 1 (PMI ≥24 hours and <48 hours), group 2 (PMI ≥ 48 hours and <72 hours), and group 3 (PMI ≥ 72 hours). There were 24, 38, 13, and 5 corpses, respectively, in groups 0, 1, 2, and 3.

Results

A significant rise in the elasticity values in comparison to elasticity of normal tissues in live adults was seen very early in the post-mortem period. Between-group comparisons showed that a significant difference in the liver elasticity was present among the groups. The mean (SD) liver elasticity was 10.29 (±0.83) in group 0, 14.98 (±1.56) in group 1, 12.49 (±1.09) in group 2, and 15.64 (±1.68) kilopascals (kPa) in group 3 (P = 0.035). Nevertheless, elasticity measurements in other tissues were not helpful in distinguishing post-mortem interval groups.

Conclusion

It is possible to use liver quantitative shear-wave elastography to estimate the time of death.

Electronic and Near-Infrared-II Optical Properties of I-Doped Monolayer MoTe2: A First-Principles Study

Near-infrared-II (NIR-II, 1000-1700 nm) fluorescence imaging is widely used for in vivo biological imaging. With the unique electronic structures and capability of band-gap engineering, two-dimensional (2D) materials can be potential candidates for NIR-II imaging. Herein, a theoretical investigation of the electronic structure and optical properties of iodine (I)-doped monolayer MoTe₂ systems with different doping concentrations is carried out through simulations to explore their NIR optical properties. The results suggest that the emergence of impurity levels due to I doping effectively reduces the bandwidth of I-doped monolayer MoTe₂ systems, and the bandwidth decreases with the increase in the I doping concentration. Although the I and Mo atoms possess clear covalent-bonding features according to the charge density difference, impurity levels induced by the strong hybridization between the I 5p and Mo 4d orbitals cross the Fermi level, making the doped systems exhibit metallic behavior. In addition, with the increase in the I doping concentration, the energy required for electron transition from valence bands to impurity levels gradually decreases, which can be linked to the enhancement of the optical absorption in the red-shifted NIR-II region. Meanwhile, with a higher I doping concentration, the emission spectra, which are the product of the absorption spectra and quasi-Fermi distributions for electrons and holes, can be enhanced in the NIR-II window.

Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis

RATIONALE AND OBJECTIVE

This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules.

METHODS

PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve.

RESULTS

After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively.

CONCLUSION

Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

Shear Wave Elastography and Thyroid Imaging Reporting and Data System (TIRADS) for the Risk Stratification of Thyroid Nodules-Results of a Prospective Study

Purpose: To compare the diagnostic performance of thyroid imaging reporting and data system (TIRADS) in combination with shear wave elastography (SWE) for the assessment of thyroid nodules. Methods: A prospective study was conducted with the following inclusion criteria: preoperative B-mode ultrasound (US) including TIRADS classification (Kwak-TIRADS, EU-TIRADS), quantitative SWE and available histological results. Results: Out of 43 patients, 61 thyroid nodules were detected; 10 nodules were found to be thyroid cancer (7 PTC, 1 FTC, 2 HüCC) and 51 were benign. According to Kwak-TIRADS the majority of benign nodules (47 out of 51, 92.2%) were classified in the low-risk- and intermediate-risk class, four nodules were classified as high-risk (7.8%). When using EU-TIRADS, the benign nodules were distributed almost equally across all risk classes, 21 (41.2%) nodules were classified in the low-risk class, 16 (31.4%) in the intermediate-risk class and 14 (27.4%) in the high-risk class. In contrast, most of the malignant nodules (eight out of ten) were classified as high-risk on EU-TIRADS. One carcinoma was classified as low-risk and one as intermediate-risk nodule. For SWE, ROC analysis showed an optimal cutoff of 18.5 kPa to distinguish malignant and benign nodules (sensitivity 80.0%, specificity 49.0%, PPV 23.5% and NPV 92.6%). The addition of elastography resulted in an increase of accuracy from 65.6% to 82.0% when using Kwak-TIRADS and from 49.2% to 72.1% when using EU-TIRADS. Conclusion: Our data demonstrate that the combination of TIRADS and SWE seems to be superior for the risk stratification of thyroid nodules than each method by itself. However, verification of these results in a larger patient population is mandatory.

Estimation of Mechanical and Transport Parameters in Cancers Using Short Time Poroelastography

Mechanical and transport properties of cancers such as Young's modulus (YM), Poisson's ratio (PR), and vascular permeability (VP) have great clinical importance in cancer diagnosis, prognosis, and treatment. However, non-invasive estimation of these parameters in vivo is challenged by many practical factors. Elasticity imaging methods, such as "poroelastography", require prolonged data acquisition, which can limit their clinical applicability. In this paper, we investigate a new method to perform poroelastography experiments, which results in shorter temporal acquisition windows. This method is referred to as "short-time poroelastography" (STPE). Finite element (FE) and ultrasound simulations demonstrate that, using STPE, it is possible to accurately estimate YM, PR (within 10% error) using windows of observation (WoOs) of length as short as 1 underlying strain Time Constant (TC). The error was found to be almost negligible (< 3%) when using WoOs longer than 2 strain TCs. In the case of VP estimation, WoOs of at least 2 strain TCs are required to obtain an error < 8% (in simulations). The stricter requirement for the estimation of VP with respect to YM and PR is due its reliance on the transient strain behavior while YM and PR depend on the steady state strain values only. In vivo experimental data are used as a proof-of-principle of the potential applicability of the proposed methodology in vivo. The use of STPE may provide a means to efficiently perform poroelastography experiments without compromising the accuracy of the estimated tissue properties.

Accuracy of Ultrasound Diagnosis of Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis

BACKGROUND

Distinguishing between benign and malignant thyroid nodules remains difficult. Ultrasound has been established as a non-invasive and relatively simple imaging technique for thyroid nodules. This study aimed to assess the diagnostic accuracy of conventional ultrasound and ultrasound elastography for the differentiation between benign and malignant thyroid nodules by meta-analyzing published studies.

METHODS

Literature was retrieved from the PubMed and Embase databases from inception to May 31, 2022. The literature was screened using inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS2) scale was used to assess the quality of the included literature. Publication bias of the included studies was assessed by Deek's funnel plot. Heterogeneity tests were performed using Cochrane Q statistic and I² statistic.

RESULTS

Finally, 9 articles were included. The meta-analysis showed that the combined sensitivity and specificity of ultrasound for the diagnosis of thyroid nodules were 0.88 [95% CI (0.83-0.91)] and 0.86 [95% CI (0.79-0.90)], respectively. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) was 0.92 [95% CI (0.90-0.94)]. There was no significant publication bias in this study. Discussion. Existing evidence shows that ultrasound has a certain accuracy in diagnosing benign and malignant thyroid nodules, providing a scientific basis for thyroid assessment and diagnosis.

Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles

OBJECTIVE

To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs).

ANIMALS

11 healthy Beagles.

PROCEDURES

For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined.

RESULTS

SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent.

CONCLUSIONS AND CLINICAL RELEVANCE

SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.

Conventional ultrasound, color Doppler, TI-RADS, and shear wave elastography for thyroid nodule differentiation: a study of efficacy compared with the histopathology results

Background

Although a minority of the thyroid nodules is malignant, usually the invasive diagnostic procedures are warranted. This prospective study aims to assess the diagnostic performance of the US criteria in addition to the TI-RADS score and the SWE for the differentiation between the benign and malignant thyroid nodules as a potential surrogate for the invasive procedures.

Results

Ninety-nine patients with thyroid nodules (79 females and 20 males, with a mean age of 45.9 ± 7.7 years; 30–69 years) were enrolled in this study and underwent conventional ultrasound, color Doppler, TI-RADS scoring, and shear wave elastography (SWE); the findings were correlated to the histopathological results.

Our results revealed a significant increase in SWE elasticity indices (EIs) and presence of color Doppler signals in malignant nodules as compared with the benign ones (ρ < 0.05). Combined TI-RADS and SWE as well as TI-RADS and color Doppler imaging had given a better sensitivity for detection of malignancy.

Conclusion

Elasticity indices had shown a significantly high diagnostic performance that is almost approaching the histopathological results. Combined SWE, color Doppler and TI-RADS, as a sum of findings, could effectively differentiate between benign and malignant thyroid nodules. Furthermore, it had offered a non-invasive tool for accurate risk stratification of malignant nodules.

Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles

OBJECTIVE

To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs).

ANIMALS

11 healthy Beagles.

PROCEDURES

For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined.

RESULTS

SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent.

CONCLUSIONS AND CLINICAL RELEVANCE

SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.

Influence of lesion size on shear wave elastography in the diagnosis of benign and malignant thyroid nodules

In shear wave elastography (SWE) studies, the optimal cutoff value of Young's modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method. The objective of this study was to evaluate the influence of thyroid nodule size on the clinical diagnostic efficacy of SWE. A total of 356 thyroid nodules of 280 patients were divided into three groups according to size (Group A: ≤ 1 cm; Group B: 1-2 cm; Group C: ≥ 2 cm). SWE was used to measure the maximum Young's modulus (Emax) values of all thyroid nodules. Receiver operating characteristic (ROC) curves were drawn with pathological results as the gold standard. For all nodules, the optimal cutoff value of Emax in SWE for diagnosing malignant thyroid nodules was 36.2 kPa. The sensitivity and specificity were 76.5% and 78.4%, respectively. Groups A, B, and C had different optimal Emax cutoff values of 33.7 kPa, 37.7 kPa, and 55.1 kPa, respectively. The area under the ROC curve (AUC) values of Groups A, B, and C (0.844, 0.886, and 0.935, respectively) were all greater than the values for all lesions (0.830). The specificity values of Groups A, B, and C (86.4%, 82.6%, and 88.2%, respectively) were all increased, and the sensitivity values of Groups B and C (89.7% and 96.4%, respectively) were also increased compared with the values for all lesions. Thyroid nodule size affects the optimal Emax cutoff value of SWE. We suggest that different cutoff values be used to diagnose benign and malignant thyroid nodules according to lesion size.

Evaluation of thyroid nodules by shear wave elastography: a review of current knowledge

PURPOSE

Shear wave elastography (SWE), as a tool for diagnosing thyroid malignancy, has gathered considerable attention during the past decade. Diverging results exist regarding the diagnostic performance of thyroid SWE.

METHODS

A comprehensive literature review of thyroid SWE was conducted using the terms "Thyroid" and "shear wave elastography" in PubMed.

RESULTS

The majority of studies found SWE promising for differentiating malignant and benign thyroid nodules on a group level, whereas results are less convincing on the individual level due to huge overlap in elasticity indices. Further, there is lack of consensus on the optimum outcome reflecting nodule elasticity and the cut-off point predicting thyroid malignancy. While heterogeneity between studies hinders a clinically meaningful meta-analysis, the results are discussed in a clinical perspective with regard to applicability in clinical practice as well as methodological advantages and pitfalls of this technology.

CONCLUSION

Technological as well as biological hindrances seem to exist for SWE to be clinically reliable in assessing benign and malignant thyroid nodules. Structural heterogeneity of thyroid nodules in combination with operator-dependent factors such as pre-compression and selection of scanning plane are likely explanations for these findings. Standardization and consensus on the SWE acquisition process applied in future studies are needed for SWE to be considered a clinically reliable diagnostic tool for detection of thyroid cancer.

Accuracy of shear wave elastography in characterization of thyroid nodules in children and adolescents

BACKGROUND

Thyroid nodules are an important health problem in children and adolescents. They possess a higher risk of malignancy in comparison to adults. This fact forms a great dilemma for clinicians. The aim of this study was to evaluate the reliability of shear wave elastography (SWE) as a non-invasive technique in the characterization of thyroid nodules in children and adolescents.

METHODS

This prospective study included 56 patients with thyroid nodules. All the patients underwent clinical assessment, laboratory investigations, ultrasound, and Doppler examination, followed by an SWE assessment. Statistical analysis was performed and the best cut-off value to differentiate benign from malignant nodules was determined using the ROC curve and AUC.

RESULTS

Seventy-two nodules were detected in the examined patients (ages ranged from 11 to 19 years, with mean age of 14.89 ± 2.3 years). Fifty-eight nodules (80.6%) were benign, and fourteen nodules (19.4%) were malignant (histopathologically proved). Highly suspicious criteria for prediction of malignancy by ultrasound and Doppler were hypoechoic echopattern, internal or internal and peripheral vascularity, microcalcifications, taller-than-wide dimensions, irregular outlines, and absence of halo (p < 0.05). The diagnostic performance for their summation was 70.69% sensitivity, 82.8% specificity, 80.45% accuracy, a 63.79% positive predictive value (PPV), and 87.9% negative predictive values (NPV). Regarding SWE, our results showed that 42.2 kPa was the best cut-off value, with AUC = 0.921 to differentiate malignant from benign nodules; the diagnostic performance was 85.71% sensitivity, 94.83% specificity, 93.06% accuracy, 76.9% PPV, and 93.2% NPV.

CONCLUSION

Shear wave elastography is a non-invasive technique that can assist in the diagnosis of malignant thyroid nodules among children and adolescents.

Reliability of shear wave elastography in the evaluation of diffuse thyroid diseases in children and adolescents

PURPOSE

Thyroid diseases are common yet serious in children that lead to many metabolic and growth disorders; the most common among these are diffuse thyroid diseases (DTD). This study aimed to evaluate the reliability of shear wave elastography (SWE) to differentiate and diagnose DTD from normal thyroid tissue.

METHOD

This prospective study included normal participants and patients with DTD. The subjects were assessed by clinical evaluation, laboratory investigation, conventional ultrasound, and Doppler examination, followed by SWE assessments. Statistical analysis was performed using the t-test and one-way ANOVA test, as appropriate. Receiver operating characteristic (ROC) curves were used to determine the best cutoff values to differentiate healthy participants from those with DTD and to differentiate between different types of DTD.

RESULTS

The study included 74 patients with DTD and 20 healthy participants. The mean SWE values were 10.9 ± 1.78, 12.8 ± 2.1, 15.31 ± 2.95, and 17.26 ± 4.2 kPa for the normal participants and for patients with simple goiter, Hashimoto's thyroiditis (HT), or Grave's disease (GD), respectively. Statistically significant differences were noted between the mean SWE of the normal participants and that of patients with DTD, as well as between the mean SWE of patients with different types of DTD (P < 0.05). The best SWE cutoff values to differentiate a normal thyroid from DTD, HT from GD, HT from simple goiter, and GD from simple goiter were 12.8, 17.8, 13.4, and 13.9 kPa, respectively.

CONCLUSIONS

SWE is a reliable diagnostic tool for differentiating normal thyroid tissue from DTD, as well as for differentiating between different types of DTD.

Sequential Changes in Posterior Shoulder Muscle Elasticity After Throwing as Assessed via Ultrasound Shear Wave Elastography

Background

Improvements in ultrasound diagnostic equipment and techniques can enable muscle stiffness to be measured quantitatively as muscle elasticity using ultrasound shear wave elastography (USWE), where high muscle elasticity values represent muscle stiffness.

Purpose

To use USWE to analyze the sequential changes in muscle elasticity in the posterior shoulder before and after pitching.

Study Design

Descriptive laboratory study.

Methods

The authors evaluated 14 baseball players who had played in high school or college at an intermediate level. The elasticity of the supraspinatus, infraspinatus (ISP), middle trapezius, lower trapezius (LT), rhomboideus, and serratus anterior muscles of the throwing shoulder was measured using USWE at 3 time points: before, immediately after, and 24 hours after a throwing session of 100 pitches. The authors analyzed the sequential changes in the mean elasticity values of the respective muscles at the 3 time points.

Results

The mean elasticity values before, immediately after, and 24 hours after throwing were as follows: supraspinatus: 32.9, 53.4, 43.8 kPa; ISP: 22.7, 44.8, 43.7 kPa; middle trapezius: 45.1, 70.3, 59.9 kPa; LT: 32.8, 45.5, 46.5 kPa; rhomboideus: 29.1, 47.5, 38.8 kPa; and serratus anterior: 19.2, 36.9, 26.5 kPa, respectively. The mean elasticity values for all tested muscles were significantly higher immediately after throwing compared with before throwing (P ≤ .0086 for all), and elasticity values in the ISP and LT remained significantly higher 24 hours after throwing compared with before throwing (P ≤ .019 for both).

Conclusion

The study results indicated that pitching significantly increased ISP and LT muscle elasticity even after 24 hours.

Transvaginal Real-Time Shear Wave Elastography in the Diagnosis of Endometrial Lesions

Background

To explore the value of transvaginal real-time shear wave elastography (SWE) in the diagnosis of endometrial lesions.

Methods

A total of 140 female patients with endometrial lesions, confirmed by pathological results, were divided into three groups: 45 cases of endometrial polyps, 29 cases of endometrial hyperplasia and 66 cases of endometrial cancer. A total of 100 cases of normal endometrium were used as the control group, including 52 cases in the proliferative stage and 48 cases in the secretory stage. Transvaginal real-time shear wave elastography was performed in all four groups.

Results

Emean, Emax and Esd were expressed as the average standard deviation. Among the control group, the results were 26.24±9.74, 38.09±9.18, and 4.25±2.73 kPa, respectively, in the proliferative endometrium cases and 12.51±7.46, 27.22±11.32, 4.40±2.52 kPa, respectively, in the secretory endometrium cases. Among the experimental group, the result was 15.68±8.18, 27.28±10.28 and 3.62±1.81 kPa respectively in the endometrial polyps cases; 21.20 ± 12.57, 36.32 ± 15.04, and 5.09 ±3.93 kPa in the endometrial hyperplasia cases; 49.36±25.51, 86.66±42.27 and 14.86±10.63 kPa in the endometrial cancer cases. The difference was statistically significant (P <0.05). When the truncation values of Emean, Emax and Esd were 28.50, 52.45 and 9.05 kPa, respectively, to distinguish between normal endometrium and endometrial cancer, Emax has the highest diagnostic value.

Conclusion

Real-time SWE technology might be used as an auxiliary method in the diagnosis and differential diagnosis of endometrial cancer. More quantitative indicators are conducive to diagnosis.

Evaluation of Ovaries in Patients with Polycystic Ovary Syndrome using Shear Wave Elastography

BACKGROUND

Shear wave electrography (SWE) is a novel non-invasive imaging technique which demonstrate tissue elasticity. Recent research evaluating the elasticity properties of normal and pathological tissues emphasize the diagnostic importance of this technique.

AIMS

Polycystic ovarian syndrome (PCOS), which is characterized by menstrual irregularity, hyperandrogenism, and polycystic overgrowth, may cause infertility. The aim of this study was to evaluate the elasticity of ovaries in patients with PCOS using SWE.

METHODS

66 patients diagnosed with PCOS according to the Rotterdam criteria (PCOS = group I) and 72 patients with non-PCOS (Control = group II), were included in the study. Demographic and clinical characteristics of the participants were recorded. Ovarian elasticity was assessed in all patients with SWE, and speed values were obtained from the ovaries. The elasticity of the ovaries was compared between the two groups.

RESULTS

While there were statistically significant differences between the groups in body mass index (BMI), right and left ovarian volumes, luteinizing hormone and testosterone levels (p<0.05), no significant differences were found between groups I and II in the velocity (for the right ovary 3.89±1.81 vs. 2.93±0.72, p=0.301; for the left ovary 2.88±0.65 vs. 2.95±0.80, p=0.577) and elastography (for the right ovary 36.62±17.78 vs. 36.79±14.32, p=0.3952; for the left ovary 36.56±14.15 vs. 36.26±15.10, p=0.903) values, respectively.

CONCLUSION

We could not obtain different velocity and elastography values from the ovaries of the patients with PCOS using SWE. Therefore, further large-scale studies are needed to elucidate this issue.

Is sonographic intra-nodular vascularity a reliable predictor of thyroid malignancy? A UK tertiary centre study

OBJECTIVE

British Thyroid Association 2014 guidelines emphasised ultrasound assessment of nodules. One ultrasonographic differentiator of debatable relevance is intra-nodular vascularity. This is the first UK study conducted to address this question.

METHODS

Ultrasound reports for thyroid surgery patients over 10 years were retrospectively reviewed. Reports documenting 'intra-nodular vascularity or flow' were analysed. Reports identifying peripheral vascularity only or no intra-nodular flow formed the control group. Concordance with final histology was used to determine the odds ratio for malignancy.

RESULTS

A total of 306 patients were included, and 119 (38.9 per cent) nodules demonstrated intra-nodular vascularity. Of these, 60 (50.4 per cent) were malignant compared with 42 per cent in the control group. Intra-nodular vascularity was not a statistically significant predictor of malignancy with an odds ratio of 1.39 (p = 0.18, 95 per cent confidence interval, 0.86-2.23).

CONCLUSION

Intra-nodular vascularity in isolation was not a reliable predictor of malignancy. This supports other world literature studies. Although intra-nodular flow should not be relied upon in isolation, interpretation in conjunction with other suspicious findings enhances the predictive value.

Evaluation of the relationship between shear wave elastography measurements with laboratory and Doppler US parameters in patients with adult Hashimoto’s thyroiditis

Background/aim

Hashimoto thyroiditis (HT) is an autoimmune disease that leads to tissue stiffening secondary to lymphocyte infiltration of the thyroid gland. Gray-scale ultrasound (US) is widely used in its diagnosis. Numerous studies have been conducted comparing elastography findings of HT with tissue stiffness and immunoreactivity levels. This study aims to reveal the relationship between shear wave elastography (SWE) and Doppler parameters in patients with HT.

Materials and methods

The study group consisted of 45 patients diagnosed with HT, and 20 control patients without thyroid pathology. Thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) values were examined in patients with HT. Thyroid gland volume and echo patterns were evaluated in the gray-scale US. Doppler measurements –peak systolic velocity (Vmax), end-diastolic velocity (Vmin), pulsatility index (PI), resistivity index (RI)– from the superior thyroidal artery and SWE measurements were taken from both thyroid lobes.

Results

The mean age of men and women in the HT group was 44.8 and 43.4 years. The mean TSH value (normal value: 0.3–4.2 uIU/ mL) was 3.90 ± 6.6 uIU/mL, and the anti-TPO value (normal value: < 35 IU/mL) was 235.47 ± 271.12 IU/mL. The average thyroid gland volume was 10.12 ± 2.71 mL in the HT group and 6.62 ± 2.11 mL in the control group (P = 0.034). HT group mean Vmax, mean Vmin, mean PI and RI values were significantly lower compared to normal subjects (P = 0.022, P = 0.026, P = 0.042, P = 0.046, respectively). The average SWE value of the thyroid gland was 24.56 ± 18.04 kPa in the experimental group and 7.34 ± 3.54 (P < 0.05) in the control group.

Conclusion

A positive correlation was found between PI and RI values and elastography values. An increase in SWE and decreases in Vmax and Vmin were found as high diagnostic value for HT.

Anterior deltoid muscle tension quantified with shear wave ultrasound elastography correlates with pain level after reverse shoulder arthroplasty

INTRODUCTION

Reverse shoulder arthroplasty (RSA) leads to medialization and distalization of the centre of rotation of the shoulder joint resulting in lengthening of the deltoid muscle. Shear wave ultrasound elastography (SWE) is a reliable method for quantifying tissue stiffness. The purpose of this study was to analyse if deltoid muscle tension after RSA correlates with the patients' pain level. We hypothesized that higher deltoid muscle tension would be associated with increased pain.

MATERIAL AND METHODS

Eighteen patients treated with RSA were included. Constant score (CS) and pain level on the visual analogue scale (VAS) were analysed and SWE was performed on both shoulders. All three regions of the deltoid muscle were examined in resting position and under standardized isometric loading.

RESULTS

Average patient age was 76 (range 64-84) years and average follow-up was 15 months (range 4-48). The average CS was 66 points (range 35-89) and the average pain level on the VAS was 1.8 (range 0.5-4.7). SWE revealed statistically significant higher muscle tension in the anterior and middle deltoid muscle region in patients after RSA compared to the contralateral non-operated side. There was a statistically significant correlation between pain level and anterior deltoid muscle tension.

CONCLUSION

SWE revealed increased tension in the anterior and middle portion of the deltoid muscle after RSA in a clinical setting. Increased tension of the anterior deltoid muscle portion significantly correlated with an increased pain level. SWE is a powerful, cost-effective, quick, dynamic, non-invasive, and radiation-free imaging technique to evaluate tissue elasticity in the shoulder with a wide range of applications.

LEVEL OF EVIDENCE

Diagnostic study, Level III.

Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Gliomas are the most invasive and fatal primary malignancy of the central nervous system that have poor prognosis, with maximal safe resection representing the gold standard for surgical treatment. To achieve gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of currently available equipment, developing a real-time image-guided resection technique that provides reliable functional and anatomical information during intraoperative settings is imperative. Nowadays, the application of intraoperative ultrasound (IOUS) has been shown to improve resection rates and maximize brain function preservation. IOUS, which presents an attractive option due to its low cost, minimal operational flow interruptions, and lack of radiation exposure, is able to provide real-time localization and accurate tumor size and shape descriptions while helping distinguish residual tumors and addressing brain shift. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound, three-dimensional ultrasound, navigable ultrasound, ultrasound elastography, and functional ultrasound, could help to achieve GTR during glioma surgery. The current review describes current advancements in ultrasound technology and evaluates the role and limitation of IOUS in glioma surgery.

Percutaneous Two-Dimensional Shear Wave Elastography for Diagnosis of Pancreatic Tumor

BACKGROUND

To investigate the efficacy of two-dimensional shear wave elastography (2D-SWE) for the diagnosis of pancreatic mass lesions.

METHODS

This ethics committee-approved cross-sectional study included 52 patients with histologically-proven pancreatic tumors (pancreatic ductal adenocarcinoma (PDAC), 36; tumor-forming pancreatitis (TFP), 15; neuroendocrine tumor, 1) and 33 control subjects. The 2D-SWE was performed for the tumor/non-tumor tissues, and SWE-mapping patterns and propagation quality were assessed.

RESULTS

Three mapping patterns were detected based on the size and distribution of the coloring areas. Pattern A (whole coloring) was detected in all non-tumor tissues and TFP, whereas pattern C (multiple small coloring spots) was detected in PDAC only. Pattern B (partial coloring with smaller spots) was detected in other lesions. The specificity and positive predictive value of pattern A for non-PDAC and those of pattern C for PDAC were 100%. The SWE value was higher in tumor lesions than in the non-tumor tissues (38.1 vs. 9.8 kPa; p < 0.001) in patients with PDAC. The SWE value in the non-tumor lesion was higher in patients with PDAC than in control (9.8 vs. 7.5 kPa; p < 0.001).

CONCLUSIONS

2D-SWE may play a role as a novel diagnostic tool for PDAC to detect a specific mapping pattern with quantitative assessment.

A Comparative Analysis of Two Machine Learning-Based Diagnostic Patterns with Thyroid Imaging Reporting and Data System for Thyroid Nodules: Diagnostic Performance and Unnecessary Biopsy Rate

Background: The risk stratification system of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for thyroid nodules is affected by low diagnostic specificity. Machine learning (ML) methods can optimize the diagnostic performance in medical image analysis. However, it is unknown which ML-based diagnostic pattern is more effective in improving diagnostic performance for thyroid nodules and reducing nodule biopsies. Therefore, we compared ML-assisted visual approaches and radiomics approaches with ACR TI-RADS in diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rate for thyroid nodules. Methods: This retrospective study evaluated a data set of ultrasound (US) and shear wave elastography (SWE) images in patients with biopsy-proven thyroid nodules (≥1 cm) from the Shanghai Tenth People's Hospital (743 nodules in 720 patients from September 2017 to January 2019) and an independent test data set from the Ma'anshan People's Hospital (106 nodules in 102 patients from February 2019 to April 2019). Six US features and five SWE parameters from the radiologists' interpretation were used for building the ML-assisted visual approaches. The radiomics features extracted from the US and SWE images were used with ML methods for developing the radiomics approaches. The diagnostic performance for differentiating thyroid nodules and the unnecessary FNAB rate of the ML-assisted visual approaches and the radiomics approaches were compared with ACR TI-RADS. Results: The ML-assisted US visual approach had the best diagnostic performance than the US radiomics approach and ACR TI-RADS (area under the curve [AUC]: 0.900 vs. 0.789 vs. 0.689 for the validation data set, 0.917 vs. 0.770 vs. 0.681 for the test data set). After adding SWE, the ML-assisted visual approach had a better diagnostic performance than US alone (AUC: 0.951 vs. 0.900 for the validation data set, 0.953 vs. 0.917 for the test data set). When applying the ML-assisted US+SWE visual approach, the unnecessary FNAB rate decreased from 30.0% to 4.5% in the validation data set and from 37.7% to 4.7% in the test data set in comparison to ACR TI-RADS. Conclusions: The ML-assisted dual modalities visual approach can assist radiologists to diagnose thyroid nodules more effectively and considerably reduce the unnecessary FNAB rate in the clinical management of thyroid nodules.

Shear Wave Elastography Combined with Thyroid Imaging Report and Data System for Risk Stratification of Thyroid Nodule Malignant Tumor

Benign and malignant thyroid cancer diagnosis is crucial. Our study intends to evaluate the role of shear wave elastography (SWE) and thyroid imaging report and data system (TI-RADS) in diagnosing the benign and malignant thyroid nodules. 100 thyroid nodules patients were recruited and evaluated by SWE and TI-RADS before fine needle biopsy and/or surgery. The maximum elastic index (Emax), mean elasticity index of thyroid nodules (Emean), minimum elastic index (Emin) and elastic ratio (ER) was measured and compared between different imaging. Ultrasound diagnosis showed solid nodules with significant hypoechoic, unclear boundary, and microcalcification. TI-RADS value was measured based on suspected ultrasound features. Combination of SWE and TI-RADS was performed. Among the 100 nodules, 38 were benign (38.0%), 62 were malignant (62.0%), and malignant nodules had significantly elevated SWE and TI-RADS compared with benign nodules (P < 0.001). The optimal SWE threshold for Emax was 51.95 kPa, with a sensitivity of 81.44% and specificity of 83.19%. There were two methods for combining SWE and TI-RADS. One was sequential detection, with a specificity of 95.80%, positive similarity ratio of 18.16 and PPV of 96.73%; the other was parallel detection method with a sensitivity of 94.85%, negative similarity ratio of 0.07 and PPV of 90.00%. Our results suggest that combination of SWE and TI-RADS might be applied to identify benign and malignant thyroid cancers.

DSWE-Net: A deep learning approach for shear wave elastography and lesion segmentation using single push acoustic radiation force

Ultrasound-based non-invasive elasticity imaging modalities have received significant consideration for tissue characterization over the last few years. Though substantial advances have been made, the conventional Shear Wave Elastography (SWE) methods still suffer from poor image quality in regions far from the push location, particularly those which rely on single focused ultrasound push beam to generate shear waves. In this study, we propose DSWE-Net, a novel deep learning-based approach that is able to construct Young's modulus maps from ultrasonically tracked tissue velocity data resulting from a single acoustic radiation force (ARF) push. The proposed network employs a 3D convolutional encoder, followed by a recurrent block consisting of several Convolutional Long Short-Term Memory (ConvLSTM) layers to extract high-level spatio-temporal features from different time-frames of the input velocity data. Finally, a pair of coupled 2D convolutional decoder blocks reconstructs the modulus image and additionally performs inclusion segmentation by generating a binary mask. We also propose a multi-task learning loss function for end-to-end training of the network with 1260 data samples obtained from a simulation environment which include both bi-level and multi-level phantom structures. The performance of the proposed network is evaluated on 140 synthetic test data and the results are compared both qualitatively and quantitatively with that of the current state of the art method, Local Phase Velocity Based Imaging (LPVI). With an average SSIM of 0.90, RMSE of 0.10 and 20.69 dB PSNR, DSWE-Net performs much better on the imaging task compared to LPVI. Our method also achieves an average IoU score of 0.81 for the segmentation task which makes it suitable for localizing inclusions as well. In this initial study, we also show that our method gains an overall improvement of 0.09 in SSIM, 4.81 dB in PSNR, 2.02 dB in CNR, and 0.09 in RMSE over LPVI on a completely unseen set of CIRS tissue mimicking phantom data. This proves its better generalization capability and shows its potential for use in real-world clinical practice.