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Khan H, Slomovich S, Shah NC, Gress F. Interventional Endoscopic Ultrasonography: Advances in Application. J Clin Med 2025; 14:3286. [PMID: 40429282 PMCID: PMC12112382 DOI: 10.3390/jcm14103286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Revised: 04/27/2025] [Accepted: 05/07/2025] [Indexed: 05/29/2025] Open
Abstract
Technological advances have greatly expanded the diagnostic and therapeutic capabilities of endoscopic ultrasound (EUS). The integration of cutting-edge imaging techniques, including tissue harmonic echo, contrast-enhanced harmonic EUS, elastography, and needle-based confocal laser endomicroscopy, have significantly enhanced lesion characterization and diagnostic accuracy. Additionally, developments in stent design and the introduction of new accessories have broadened the therapeutic applications of EUS. Ongoing innovations in clinical practice have transformed procedures such as drainage, tumor ablation, EUS-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), the placement of fiducial markers, advancements in endohepatology, lesion characterization, and treatment. These developments continue to expand the role of EUS in delivering precise and effective therapeutic interventions.
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Affiliation(s)
| | | | - Neal C. Shah
- Icahn School of Medicine at Mount Sinai South Nassau, Oceanside, NY 11572, USA; (H.K.); (S.S.); (F.G.)
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Zhong YQ, Zhu XX, Huang XT, Luo YJ, Huang CS, Xu QC, Yin XY. Prediction of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy based on multifrequency magnetic resonance elastography. J Gastrointest Surg 2025; 29:101886. [PMID: 39547592 DOI: 10.1016/j.gassur.2024.101886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 11/06/2024] [Accepted: 11/08/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Clinically relevant postoperative pancreatic fistula (CR-POPF) is the major complication of pancreatoduodenectomy, and the pancreatic texture is one of the potential affecting factors. Multifrequency magnetic resonance elastography (MRE) is a novel technique for measuring tissue stiffness, but its value in predicting CR-POPF preoperatively has not been well documented. METHODS A total of 70 patients who underwent multifrequency MRE before pancreatoduodenectomy between July 2021 and April 2024 were retrospectively recruited into the study. The parameters of MRE, shear wave speed (c) and phase angle (φ), and clinical data were collected. Logistic regression and the receiver operating characteristic curve analyses were used to assess the performance of multifrequency MRE in predicting CR-POPF. RESULTS CR-POPF was developed in 14 of 70 patients (20%), all categorized as grade B. The CR-POPF group had significantly lower c (1.339 ± 0.210 m/s) and longer hospital stays (21 [IQR, 15.50-37.75] days) than the no-CR-POPF group. The MRE parameters, c and φ, were moderately correlated with pancreas stiffness (eta2 for φ = 0.189 and eta2 for c = 0.106). Dilated major pancreatic duct (MPD ≥ 3 mm) and higher c were independently associated with a lower risk of CR-POPF in univariant and multivariant analyses (odds ratio [OR] for c, 0.041 [95% CI, 0.002-0.879]; OR for dilated MPD, 0.129 [95% CI, 0.022-0.768]). The area under the curve (AUC) of the predictive model based on c and MPD diameter was 0.786, which was better than the fistula risk score (FRS) (AUC = 0.587) and alternative FRS (AUC = 0.556) in our center, with the DeLong test P = .028 and P = .002, respectively. CONCLUSION The MRE parameters were associated with pancreatic stiffness, and c was an independent predictor of CR-POPF after pancreatoduodenectomy.
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Affiliation(s)
- Yu-Qing Zhong
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao-Xu Zhu
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangdong, China
| | - Xi-Tai Huang
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan-Ji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chen-Song Huang
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiong-Cong Xu
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Zhang H, Gu C, Lan Q, Zhang W, Liu C, Yang J. Learning-based distortion correction enables proximal-scanning endoscopic OCT elastography. BIOMEDICAL OPTICS EXPRESS 2024; 15:4345-4364. [PMID: 39022540 PMCID: PMC11249688 DOI: 10.1364/boe.528522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024]
Abstract
Proximal rotary scanning is predominantly used in the clinical practice of endoscopic and intravascular OCT, mainly because of the much lower manufacturing cost of the probe compared to distal scanning. However, proximal scanning causes severe beam stability issues (also known as non-uniform rotational distortion, NURD), which hinders the extension of its applications to functional imaging, such as OCT elastography (OCE). In this work, we demonstrate the abilities of learning-based NURD correction methods to enable the imaging stability required for intensity-based OCE. Compared with the previous learning-based NURD correction methods that use pseudo distortion vectors for model training, we propose a method to extract real distortion vectors from a specific endoscopic OCT system, and validate its superiority in accuracy under both convolutional-neural-network- and transformer-based learning architectures. We further verify its effectiveness in elastography calculations (digital image correlation and optical flow) and the advantages of our method over other NURD correction methods. Using the air pressure of a balloon catheter as a mechanical stimulus, our proximal-scanning endoscopic OCE could effectively differentiate between areas of varying stiffness of atherosclerotic vascular phantoms. Compared with the existing endoscopic OCE methods that measure only in the radial direction, our method could achieve 2D displacement/strain distribution in both radial and circumferential directions.
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Affiliation(s)
- Haoran Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chengfu Gu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Lan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Weiyi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chang Liu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jianlong Yang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Xu H, Xia Q, Shu C, Lan J, Wang X, Gao W, Lv S, Lin R, Xie Z, Xiong X, Li F, Zhang J, Gong X. In vivo endoscopic optical coherence elastography based on a miniature probe. BIOMEDICAL OPTICS EXPRESS 2024; 15:4237-4252. [PMID: 39022537 PMCID: PMC11249679 DOI: 10.1364/boe.521154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 07/20/2024]
Abstract
Optical coherence elastography (OCE) is a functional extension of optical coherence tomography (OCT). It offers high-resolution elasticity assessment with nanoscale tissue displacement sensitivity and high quantification accuracy, promising to enhance diagnostic precision. However, in vivo endoscopic OCE imaging has not been demonstrated yet, which needs to overcome key challenges related to probe miniaturization, high excitation efficiency and speed. This study presents a novel endoscopic OCE system, achieving the first endoscopic OCE imaging in vivo. The system features the smallest integrated OCE probe with an outer diameter of only 0.9 mm (with a 1.2-mm protective tube during imaging). Utilizing a single 38-MHz high-frequency ultrasound transducer, the system induced rapid deformation in tissues with enhanced excitation efficiency. In phantom studies, the OCE quantification results match well with compression testing results, showing the system's high accuracy. The in vivo imaging of the rat vagina demonstrated the system's capability to detect changes in tissue elasticity continually and distinguish between normal tissue, hematomas, and tissue with increased collagen fibers precisely. This research narrows the gap for the clinical implementation of the endoscopic OCE system, offering the potential for the early diagnosis of intraluminal diseases.
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Affiliation(s)
- Haoxing Xu
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- University of Chinese Academy of Sciences, Beijing 101408, China
| | - Qingrong Xia
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Institute of Medical Imaging, University of South China, Hengyang 421001, China
- Affiliated Nanhua Hospital, University of South China, Hengyang 421002, China
| | - Chengyou Shu
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jiale Lan
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- University of Chinese Academy of Sciences, Beijing 101408, China
| | - Xiatian Wang
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wen Gao
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Shengmiao Lv
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Riqiang Lin
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhihua Xie
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xiaohui Xiong
- University of Chinese Academy of Sciences, Beijing 101408, China
| | - Fei Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China
| | - Jinke Zhang
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xiaojing Gong
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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Wang Z, Bai J, Jiao G, Li P. Quantitative evaluation of endobronchial ultrasound elastography in the diagnosis of benign and malignant mediastinal and hilar lymph nodes. Respir Med 2024; 224:107566. [PMID: 38355018 DOI: 10.1016/j.rmed.2024.107566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/16/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To compare the diagnostic value of different quantitative methods of endobronchial ultrasound elastography in benign and malignant mediastinal and hilar lymph nodes. METHODS This retrospective study included patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal and hilar lymph node enlargement in our hospital between January 2019 and August 2022. We compared different quantitative elastography parameters [red area ratio (RAR, lymph node red area/lymph node area), green area ratio (GAR, lymph node green area/lymph node area), blue area ratio (SAR, lymph node blue area/lymph node area), mixed area ratio (MAR, lymph node green area/lymph node area), blue-green lymph node area/lymph node area), strain rate ratio (SR), strain rate in the target lymph node (LPA), ratio of blue area to total lymph node area outside the center of the target lymph node (PAR), and average grey value (MGV)], in order to find the best quantitative evaluation method. RESULTS A total of 244 patients (346 lymph nodes) were included in this study. All quantitative elastography parameters were statistically significant for the differentiation of benign and malignant lesions except the average grey value of the target lymph nodes. The area under the receiver operating characteristic curve of SAR was 0.872 (95% confidence interval: 0.83-0.91), the cutoff value was 0.409, and the sensitivity, specificity, positive and negative predictive values were 85.4%, 78.0%, 80.4%, and 83.4%, respectively. CONCLUSION Compared with other types of quantitative analysis, SAR has a higher predictive significance for benign and malignant lymph nodes.
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Affiliation(s)
- Zhen Wang
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiayu Bai
- Department of Rheumatology, The 1st Affiliated Hospital of China Medical University, Shenyang, China
| | - Guangyu Jiao
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
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Kalwa PL, Walz S, Granai M, Fend F, Stenzl A, Schäffer TE. Differentiation of bladder cancer with water flow elastography (WaFE). J Mech Behav Biomed Mater 2024; 150:106319. [PMID: 38142569 DOI: 10.1016/j.jmbbm.2023.106319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023]
Abstract
Cancer affects the mechanical properties of tissue. Therefore, elastography techniques can be used to differentiate cancerous from healthy tissue. Due to probe size and restricted handling, most elastography techniques are not applicable in minimally invasive surgery (MIS). Established techniques such as endoscopic ultrasound elastography measure under undefined boundary conditions, making the determination of quantitative mechanical properties challenging. Water flow elastography (WaFE) has recently been introduced for application in MIS. Here, we present an improved WaFE measurement method in which the probe attaches itself to the sample with a small suction pressure. This leads to defined boundary conditions, allowing for a quantitative determination of the Young's modulus of tissue. To facilitate fast measurements, we developed a correction model for the hydrodynamic resistance and the fluid inertia of the tubing. We used WaFE for ex vivo measurements on human bladders and found a significantly larger Young's modulus for cancerous vs. healthy tissue. We determined the optimal classification threshold for the Young's modulus to be 8 kPa and found that WaFE can differentiate between cancerous and healthy tissue with a sensitivity of 0.96 and a specificity of 1. Our results underline that WaFE can be a helpful differentiating tool in MIS.
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Affiliation(s)
- Paul L Kalwa
- Institute of Applied Physics, University of Tübingen, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - Simon Walz
- Department of Urology, University of Tübingen Medical Center, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Massimo Granai
- Institute of Pathology and Neuropathology, University Hospital of Tübingen, Liebermeisterstr. 8, 72076 Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University Hospital of Tübingen, Liebermeisterstr. 8, 72076 Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen Medical Center, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Tilman E Schäffer
- Institute of Applied Physics, University of Tübingen, Auf der Morgenstelle 10, 72076 Tübingen, Germany.
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Wang Z, Li P, Bai J, Liu Y, Jiao G. Quantitative analysis of endobronchial elastography combined with serum tumour markers of lung cancer in the diagnosis of benign and malignant mediastinal and hilar lymph nodes. Pathol Oncol Res 2023; 29:1611377. [PMID: 38099241 PMCID: PMC10719403 DOI: 10.3389/pore.2023.1611377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
Purpose: In malignant tumours, elastography and serum tumour markers have shown high diagnostic efficacy. Therefore, we aimed to quantitatively analyse the results of endobronchial elastography combined with serum tumour markers of lung cancer to accurately distinguish benign and malignant mediastinal and hilar lymph nodes. Methods: Data of patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node enlargement in our hospital between January 2018 and August 2022 were retrospectively collected. The characteristics of quantitative elastography and serum tumour markers were evaluated. Results: We enrolled 197 patients (273 lymph nodes). In the differential diagnosis of benign and malignant mediastinal and hilar lymph nodes, the stiffness area ratio (SAR), strain ratio (SR), and strain rate in lymph nodes were significant, among which SAR had the highest diagnostic value (cut-off value, 0.409). The combination of the four tumour markers had a high diagnostic value (AUC, 0.886). Three types of quantitative elastography indices combined with serum tumour markers for lung cancer showed a higher diagnostic value (AUC, 0.930; sensitivity, 83.5%; specificity, 89.3%; positive predictive value, 88.1%; negative predictive value, 85%) (p < 0.05). In the differential diagnosis of pathological types of lung cancer, different quantitative elastography indicators and serum tumour markers for lung cancer have different diagnostic significance for the differential diagnosis of lung cancer pathological types. Conclusion: The quantitative analysis of endobronchial ultrasound elastography combined with tumour markers can improve the diagnosis rate of benign and malignant mediastinal and hilar lymph nodes, help guide the puncture of false negative lymph nodes, and reduce the misdiagnosis rate.
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Affiliation(s)
- Zhen Wang
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiayu Bai
- Department of Rheumatology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yujia Liu
- College of Traditional Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Guangyu Jiao
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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Sun C, Zhao X, Shi L, Fan X, Qi X. Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities. Endosc Ultrasound 2023; 12:437-444. [PMID: 38948122 PMCID: PMC11213587 DOI: 10.1097/eus.0000000000000035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.
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Affiliation(s)
- Chao Sun
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xingliang Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Sichuan Province, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaolong Qi
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
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Kalwa PL, Schäffer TE. Water flow elastography - A promising tool to measure tissue stiffness during minimally invasive surgery. J Mech Behav Biomed Mater 2023; 145:106004. [PMID: 37418969 DOI: 10.1016/j.jmbbm.2023.106004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
Mechanical properties are important markers for pathological processes in tissue. Elastography techniques are therefore becoming more and more useful for diagnostics. In minimally invasive surgery (MIS), however, the probe size is limited and the handling is restricted, thereby excluding the application of most established elastography techniques. In this paper we introduce water flow elastography (WaFE) as a new technique that benefits from a small and inexpensive probe. This probe flows pressurized water against the sample surface to locally indent it. The volume of the indentation is measured with a flow meter. We use finite element simulations to find the relation between the indentation volume, the water pressure, and the Young's modulus of the sample. We used WaFE to measure the Young's modulus of silicone samples and porcine organs, finding agreement within 10% to measurements with a commercial material testing machine. Our results show that WaFE is a promising technique for providing local elastography in MIS.
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Affiliation(s)
- Paul L Kalwa
- Institute of Applied Physics, University of Tübingen, Auf der Morgenstelle 10, 72076, Tübingen, Germany
| | - Tilman E Schäffer
- Institute of Applied Physics, University of Tübingen, Auf der Morgenstelle 10, 72076, Tübingen, Germany.
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Kikuyama M. A Novel Diagnostic Imaging Method for the Early Detection of Pancreatic Cancer. Diagnostics (Basel) 2023; 13:2080. [PMID: 37370975 DOI: 10.3390/diagnostics13122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis, with a survival rate of less than 10% [...].
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Tokyo Women's Medical University, 8-1 Shinjuku-ku, Tokyo 162-8666, Japan
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Kundu R, Rana SS, Suneel R, Dey P. EUS-guided FNAC in intra-abdominal lesions: Technique of tissue acquisition, ancillary testing, pearls and perils, and prospects. Diagn Cytopathol 2023. [PMID: 37154168 DOI: 10.1002/dc.25153] [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: 03/13/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
Endoscopic ultrasound enables visualization of lesions within and in the vicinity of the gastrointestinal tract. Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNAC) helps in targeting various luminal and extraluminal lesions both diagnostically and therapeutically. Various intra-abdominal organs amenable to EUS-FNA include the gastrointestinal tract (GIT), pancreas, kidney, adrenal gland, liver, bile duct, gallbladder, spleen, and lymph nodes. EUS-FNAC is mostly done for pancreatic and intra-abdominal lymph nodal lesions. In the present review, we have discussed various aspects of EUS-FNAC.
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Affiliation(s)
- Reetu Kundu
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rachagiri Suneel
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Zhou J, Cai T, Wu D, Chen X, Wang F. The role of endoscopic ultrasound-guided fine-needle aspiration/biopsy in the diagnosis of mediastinal lesions. Front Surg 2023; 9:1065070. [PMID: 36684177 PMCID: PMC9852620 DOI: 10.3389/fsurg.2022.1065070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/24/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) is an accurate technique for sampling the pancreas and mediastinum. The aim of this study was to determine the value of EUS-FNA/FNB in the diagnosis of mediastinal lesions. Methods Data from 107 patients who underwent EUS-FNA/FNB for mediastinal lesions were evaluated. Results The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNA/FNB for mediastinal lesions were 92.00%, 100%, 100%, and 85%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNA for malignant mediastinal lesions were 92.00%, 100%, 100%, and 86.00%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNB for malignant mediastinal lesions were 92.00%, 100%, 100%, and 82.00%, respectively. Except for the discomfort caused by conventional gastroscopy, none of the patients had any complications, such as damage to surrounding large blood vessels or nerves. Conclusion EUS-FNA/FNB is an effective tool for diagnosing unknown mediastinal lesions, without any obvious complications.
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Affiliation(s)
- Jingjing Zhou
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ting Cai
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dongwen Wu
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiong Chen
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Fen Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China,Correspondence: Fen Wang
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Ye T, Zong Y, Zhao G, Zhou A, Yue B, Zhao H, Li P. Role of Endoscopy in Esophageal Tuberculosis: A Narrative Review. J Clin Med 2022; 11:jcm11237009. [PMID: 36498584 PMCID: PMC9740747 DOI: 10.3390/jcm11237009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
Esophageal tuberculosis (ET) is a rare infectious disease of the gastrointestinal tract. Awareness of ET is deficient due to its low incidence. Unexplained dysphagia and upper gastrointestinal bleeding are the most common symptoms of ET. The prognosis is generally good if patients are diagnosed properly and receive anti-tubercular treatment promptly. However, ET is difficult to differentiate from other diseases. Endoscopic techniques such as esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), elastography, and endoscopic ultrasound--guided fine-needle aspiration (EUS-FNA) improve the diagnosis of ET. Thus, the characteristics of ET and other difficult-to-detect diseases according to EGD and EUS were summarized. Intriguingly, there is no literature relevant to the application of CH-EUS and elastography in ET. The authors' research center was first in introducing CH-EUS and elastography into the field of ET. The specific manifestation of ET based on CH-EUS was discovered for the first time. Correlative experience and representative cases were shared. The role of endoscopy in acquiring esophageal specimens and treatment for ET was also established. In this review, we aim to introduce a promising technology for the diagnosis and treatment of ET.
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Affiliation(s)
| | | | | | | | | | | | - Peng Li
- Correspondence: (H.Z.); (P.L.)
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14
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Dhar J, Samanta J. The expanding role of endoscopic ultrasound elastography. Clin J Gastroenterol 2022; 15:841-858. [PMID: 35789474 DOI: 10.1007/s12328-022-01662-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/12/2022] [Indexed: 12/17/2022]
Abstract
Endoscopic ultrasound (EUS) is an invaluable tool for assessing various GI diseases. However, using just the conventional B-mode EUS imaging may not be sufficient to accurately delineate the lesion's character. Using the principle of stress-induced tissue strain, EUS elastography (EUS-E) can help in the real-time sonographic assessment of the level of tissue stiffness or hardness of any organ of interest during a routine EUS procedure. Thus, EUS-E can better characterize the lesion's nature and highlight the more suspicious areas within an individual lesion. The most commonly studied lesions with EUS-E are the pancreatic lesions, namely, chronic pancreatitis, pancreatic cancer, and lymph nodes. However, EUS-E is gradually expanding its use for lesion characterization of the liver, bile duct, adrenals, gastrointestinal tract, and even therapy response. Moreover, the use of EUS-E along with other image enhancement techniques such as harmonic EUS and contrast-enhanced EUS can improve the accuracy of the diagnosis. However, several technical aspects need to be standardized before EUS-E can be truly used as a tool for "virtual biopsy". This review focuses on the various technical aspects of the use of EUS-E, it is established and expanding indications and an extensive outline of the various studies on EUS-E. We also discuss the current pitfalls and future trends in EUS-E.
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Affiliation(s)
- Jahnvi Dhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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15
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Wei X, Wang Y, Ge L, Peng B, He Q, Wang R, Huang L, Xu Y, Luo J. Unsupervised Convolutional Neural Network for Motion Estimation in Ultrasound Elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:2236-2247. [PMID: 35500076 DOI: 10.1109/tuffc.2022.3171676] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
High-quality motion estimation is essential for ultrasound elastography (USE). Traditional motion estimation algorithms based on speckle tracking such as normalized cross correlation (NCC) or regularization such as global ultrasound elastography (GLUE) are time-consuming. In order to reduce the computational cost and ensure the accuracy of motion estimation, many convolutional neural networks have been introduced into USE. Most of these networks such as radio-frequency modified pyramid, warping and cost volume network (RFMPWC-Net) are supervised and need many ground truths as labels in network training. However, the ground truths are laborious to collect for USE. In this study, we proposed a MaskFlownet-based unsupervised convolutional neural network (MF-UCNN) for fast and high-quality motion estimation in USE. The inputs to MF-UCNN are the concatenation of RF, envelope, and B-mode images before and after deformation, while the outputs are the axial and lateral displacement fields. The similarity between the predeformed image and the warped image (i.e., the postdeformed image compensated by the estimated displacement fields) and the smoothness of the estimated displacement fields were incorporated in the loss function. The network was compared with modified pyramid, warping and cost volume network (MPWC-Net)++, RFMPWC-Net, GLUE, and NCC. Results of simulations, breast phantom, and in vivo experiments show that MF-UCNN obtains higher signal-to-noise ratio (SNR) and higher contrast-to-noise ratio (CNR). MF-UCNN achieves high-quality motion estimation with significantly reduced computation time. It is unsupervised and does not need any ground truths as labels in the training, and, thus, has great potential for motion estimation in USE.
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16
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Pancreatic Ductal Adenocarcinoma: Relating Biomechanics and Prognosis. J Clin Med 2021; 10:jcm10122711. [PMID: 34205335 PMCID: PMC8234178 DOI: 10.3390/jcm10122711] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer and carries a dismal prognosis. Resectable patients are treated predominantly with surgery while borderline resectable patients may receive neoadjuvant treatment (NAT) to downstage their disease prior to possible resection. PDAC tissue is stiffer than healthy pancreas, and tissue stiffness is associated with cancer progression. Another feature of PDAC is increased tissue heterogeneity. We postulate that tumour stiffness and heterogeneity may be used alongside currently employed diagnostics to better predict prognosis and response to treatment. In this review we summarise the biomechanical changes observed in PDAC, explore the factors behind these changes and describe the clinical consequences. We identify methods available for assessing PDAC biomechanics ex vivo and in vivo, outlining the relative merits of each. Finally, we discuss the potential use of radiological imaging for prognostic use.
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17
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Diehl DL. Artificial intelligence applications in EUS: the journey of a thousand miles begins with a single step. Gastrointest Endosc 2021; 93:1131-1132. [PMID: 33685626 DOI: 10.1016/j.gie.2020.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA
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18
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Zhi X, Chen J, Xie F, Sun J, Herth FJF. Diagnostic value of endobronchial ultrasound image features: A specialized review. Endosc Ultrasound 2021; 10:3-18. [PMID: 32719201 PMCID: PMC7980684 DOI: 10.4103/eus.eus_43_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) technology is important in the diagnosis of intrathoracic benign and malignant lymph nodes (LNs). With the development of EBUS imaging technology, its role in noninvasive diagnosis, as a supplement to pathology diagnosis, has been given increasing attention in recent years. Many studies have explored qualitative and quantitative methods for the three EBUS modes, as well as a variety of multimodal analysis methods, to find the optimal method for the noninvasive diagnosis using EBUS for LNs. Here, we review and comment on the research methods and predictive diagnostic value, discuss the existing problems, and look ahead to the future application of EBUS imaging.
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Affiliation(s)
- Xinxin Zhi
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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19
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Hashimoto R, Chang KJ. Endoscopic ultrasound guided hepatic interventions. Dig Endosc 2021; 33:54-65. [PMID: 32145117 DOI: 10.1111/den.13661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/03/2020] [Indexed: 02/08/2023]
Abstract
Intervention for liver disease has predominantly been performed through the percutaneous approach. However, as endoscopic ultrasound (EUS) applications have expanded, there have emerged various EUS-guided interventions for liver disease, a space we call "Endo-Hepatology". EUS-guided liver biopsy can be considered the "forerunner" of Endo-Hepatology and has become a clinical option for patients requiring histologic diagnosis and staging of their liver disease. EUS also enables direct access to the portal vein. Subsequently, many procedures are being explored, such as angiography, measurement of the portosystemic pressure gradient, portal vein sampling to detect cancer cell or DNA, and EUS-guided transhepatic intrahepatic portosystemic shunt creation. Since the transducer is close to the liver, especially the left and caudate lobes, EUS can be used as a rescue when the percutaneous approach is not favorable and EUS-guided treatments of liver tumor, cyst and abscess have been reported. This review summarizes the available studies of EUS-guided intervention in the liver.
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Affiliation(s)
- Rintaro Hashimoto
- H. H. Chao Comprehensive Digestive Center, University of California Irvine Medical Center, Orange, USA
| | - Kenneth J Chang
- H. H. Chao Comprehensive Digestive Center, University of California Irvine Medical Center, Orange, USA
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20
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Saftoiu A, Napoleon B, Arcidiacono PG, Braden B, Burmeister S, Carrara S, Cui XW, Fusaroli P, Gottschalk U, Hocke M, Hollerbach S, Iglesias-Garcia J, Jenssen C, Kitano M, Larghi A, Oppong KW, Sahai AV, Sun S, Burmester E, Di Leo M, Petrone MC, Santos E, Teoh AYB, Hwang JH, Rimbas M, Sharma M, Puri R, Kahaleh M, Dietrich CF. Do we need contrast agents for EUS? Endosc Ultrasound 2020; 9:361-368. [PMID: 32675463 PMCID: PMC7811706 DOI: 10.4103/eus.eus_20_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023] Open
Abstract
We recently introduced a series of articles that dealt with controversies in EUS. In Part I, the authors discussed which clinical information is necessary prior to EUS and whether other imaging modalities are required before embarking on EUS examinations. Part II focuses on technical details and controversies about the use of EUS in special situations. In this article, important practical issues regarding the application of contrast-enhanced EUS in various clinical settings are raised and controversially discussed from different points of view.
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Affiliation(s)
- Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Johann Wolfgang Goethe University Frankfurt, Germany
- Translational Gastroenterology Unit I John Radcliffe Hospital I Oxford OX3 9DU UK
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Uwe Gottschalk
- Department of Medical, Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, Neuruppin, Germany
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | | | - Anand V Sahai
- Center Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Siyu Sun
- Endoscopy Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | | | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Maria Chiara Petrone
- Pancreatico/Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Erwin Santos
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anthony Y. B. Teoh
- Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA 94305, USA
| | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital Internal Medicine Department, Carol Davila University of Medicine Bucharest, Romania
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Rajesh Puri
- Interventional Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta the Medicity Gurugram, Haryana, India
| | - Michel Kahaleh
- Department of Gastroenterology, The State University of New Jersey, New Jersey, USA
| | - Christoph F. Dietrich
- Johann Wolfgang Goethe University Frankfurt, Germany
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem and Permanence, Bern, Switzerland
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21
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Galvis-García ES, Sobrino-Cossío S, Reding-Bernal A, Contreras-Marín Y, Solórzano-Acevedo K, González-Zavala P, Quispe-Siccha RM. Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasound-elastography. World J Gastroenterol 2020; 26:5169-5180. [PMID: 32982117 PMCID: PMC7495029 DOI: 10.3748/wjg.v26.i34.5169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/27/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS) and endoscopic ultrasound elastography (EUS-E) simulation lessens the learning curve; however, models lack realism, diminishing competitiveness.
AIM To standardize the mechanical properties of polyvinyl alcohol (PVA) hydrogel for simulating organs and digestive lesions.
METHODS PVA hydrogel (Sigma Aldrich, degree of hydrolysis 99%) for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México “Dr. Eduardo Liceaga”, Mexico City. We evaluated physical, contrast, elasticity and deformation coefficient characteristics in lesions, applying Kappa’s concordance and satisfaction questionnaire (Likert 4-points).
RESULTS PVA hydrogel showed stable mechanical properties. Density depended on molecular weight (MW) and concentration (C). PVA bblocks with the greatest density showed lowest tensile strength (r = -0.8, P = 0.01). Lesions were EUS-graphically visible. Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms, exceeding (MW2 = 146000-186000, C9 = 15% and C10 = 20%) with a density under (MW1 = 85000-124000, C1 = 7% and C2 = 9%). We calculated elasticity and deformation parameters of solid (blue) areas, contrasting with the norm (Kappa = 0.8; high degree of satisfaction).
CONCLUSION PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E, facilitating practice and reducing risk. Repetition amplified skills, while reducing the learning curve.
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Affiliation(s)
- Elymir S Galvis-García
- Unidad de Endoscopía Gastrointestinal, Hospital General de México "Dr. Eduardo Liceaga", Mexico 06720, Mexico
| | - Sergio Sobrino-Cossío
- Unidad de Endoscopia y Fisiología Digestiva, Hospital Ángeles del Pedregal, Mexico 10700, Mexico
| | - Arturo Reding-Bernal
- Dirección de Investigación, Hospital General de México “Dr. Eduardo Liceaga”, Mexico 06720, Mexico
| | - Yesica Contreras-Marín
- Unidad Profesional Interdisciplinaria de Biotecnología and Unidad de Investigación y Desarrollo Tecnológico, Instituto Politécnico Nacional and Hospital General de México "Dr. Eduardo Liceaga", Mexico 06720, Mexico
| | - Karina Solórzano-Acevedo
- Unidad Profesional Interdisciplinaria de Biotecnología and Unidad de Investigación y Desarrollo Tecnológico, Instituto Politécnico Nacional and Hospital General de México "Dr. Eduardo Liceaga", Mexico 06720, Mexico
| | - Patricia González-Zavala
- Instituto de Investigaciones en Materiales and Unidad de Investigación y Desarrollo Tecnológico, Universidad Nacional Autónoma de México and Hospital General de México "Dr. Eduardo Liceaga", Mexico 06720, Mexico
| | - Rosa M Quispe-Siccha
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México "Dr. Eduardo Liceaga", Mexico 06720, Mexico
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22
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Dietrich CF, Burmeister S, Hollerbach S, Arcidiacono PG, Braden B, Fusaroli P, Hocke M, Iglesias-Garcia J, Kitano M, Larghi A, Napoleon B, Oppong KW, Rimbas M, Saftoiu A, Sahai AV, Sun S, Dong Y, Carrara S, Hwang JH, Jenssen C. Do we need elastography for EUS? Endosc Ultrasound 2020; 9:284-290. [PMID: 32675464 PMCID: PMC7811716 DOI: 10.4103/eus.eus_25_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023] Open
Abstract
We recently introduced a series of papers "What should be known prior to performing EUS exams." In Part I, the authors discussed which clinical information and whether other imaging modalities are needed before embarking EUS examinations. In Part II, technical controversies on how EUS is performed were discussed from different points of view. In this article, important practical issues regarding EUS elastography will be raised and controversially discussed from very different points of view.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe University Frankfurt, Germany
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sean Burmeister
- Surgical Gastroenterology unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Johann Wolfgang Goethe University Frankfurt, Germany
- Translational Gastroenterology Unit I John Radcliffe Hospital I Oxford OX3 9DU, UK
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | | | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital Internal Medicine Department, Carol Davila University of Medicine Bucharest, Romania
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Anand V. Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Siyu Sun
- Endoscopy Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning province, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Silvia Carrara
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA 94305, USA
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, Neuruppin, Germany
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23
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Uchimura K, Yamasaki K, Sasada S, Hara S, Ikushima I, Chiba Y, Tachiwada T, Kawanami T, Yatera K. Quantitative analysis of endobronchial ultrasound elastography in computed tomography-negative mediastinal and hilar lymph nodes. Thorac Cancer 2020; 11:2590-2599. [PMID: 32691537 PMCID: PMC7471032 DOI: 10.1111/1759-7714.13579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 12/25/2022] Open
Abstract
Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.
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Affiliation(s)
- Keigo Uchimura
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shinji Sasada
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Sachika Hara
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Issei Ikushima
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yosuke Chiba
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Takashi Tachiwada
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Toshinori Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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UTKU ÖG, ERGÜL B, KARATAY E, EFE C, TURHAN N, OĞUZ D. Noninvasive assesment in differentiating benign and malign pancreatic lesions with EUS elastography and strain ratio. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.694535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Costache MI, Cazacu IM, Dietrich CF, Petrone MC, Arcidiacono PG, Giovannini M, Bories E, Garcia JI, Siyu S, Santo E, Popescu CF, Constantin A, Bhutani MS, Saftoiu A. Clinical impact of strain histogram EUS elastography and contrast-enhanced EUS for the differential diagnosis of focal pancreatic masses: A prospective multicentric study. Endosc Ultrasound 2020; 9:116-121. [PMID: 32295969 PMCID: PMC7279079 DOI: 10.4103/eus.eus_69_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 08/11/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent advances in EUS techniques (real-time EUS elastography and contrast-enhanced EUS) have allowed a better characterization of focal pancreatic masses. Mean strain histograms (SHs) are considered a good parameter for the semi-quantitative evaluation of focal pancreatic masses, alongside complementary contrast-enhanced EUS parameters which can be quantified during both the early arterial and late venous phase. MATERIALS AND METHODS The study design was prospective, blinded, and multicentric, assessing real-time EUS elastography and contrast-enhanced EUS results for the characterization of focal pancreatic masses using parametric measurements, in comparison with pathology which is the gold standard. SHs were performed based on the embedded software of the ultrasound system, with the values being reversed as opposed to our initially published data on hue histograms. Consequently, a cutoff of 80 was derived from previous multicentric trials. Contrast-enhanced EUS also allowed the focal masses to be classified as hyper-, iso-, or hypoenhanced in comparison with the normal pancreatic parenchyma. EUS-FNA was then performed for all patients, with a positive cytological diagnosis taken as a final proof of malignancy for the pancreatic masses. The diagnoses obtained by EUS-FNA were verified further either by surgery or during a clinical follow-up of at least 6 months. RESULTS A total number of 97 consecutive patients with focal pancreatic masses were included in the study. Based on previously defined cutoffs of 80, the values of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the mean SHs for the diagnosis of pancreatic cancer were 100%, 29.63%, 78.65%, 100%, and 80.41%, respectively. Corresponding values for contrast-enhanced EUS (taking into consideration hypoenhencement as a predictive factor of malignancy) were 98.57%, 77.78%, 92%, 95.45%, and 92.78%, respectively. Combining contrast enhancement-EUS (hypoenhencement) and semi-quantitative EUS elastography (SH cutoffs <80), the resulting values corresponding for sensitivity, specificity, and accuracy were 98.57%, 81.48%, and 93.81%, respectively. CONCLUSION The current study using objective parametric tools for both EUS elastography and contrast-enhanced EUS confirmed the results of previous studies and meta-analyses that indicated a complementary role for the differential diagnosis of focal pancreatic masses. Moreover, the best values for the receiver operating curves were obtained using a sequential clinical algorithm based on the initial use of elastography, followed by contrast enhancement.
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Affiliation(s)
- Mădălin Ionuț Costache
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Irina M. Cazacu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Marc Giovannini
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Erwan Bories
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | | | - Sun Siyu
- Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Erwin Santo
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Carmen Florina Popescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Pathology, Cytology Laboratory, County Emergency Clinical Hospital, Craiova, Romania
| | - Alina Constantin
- Department of Gastroenterology, Ponderas Academic Hospital, Bucharest, Romania
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
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Kim SH, Yoo IK, Kwon CI, Hong SP, Cho JY. Utility of EUS elastography in the diagnosis of gastric subepithelial tumors: a pilot study (with video). Gastrointest Endosc 2020; 91:172-177.e2. [PMID: 31539527 DOI: 10.1016/j.gie.2019.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS elastography is a real-time imaging technique that analyzes tissue elasticity. The aim of this study was to investigate the applicability of quantitative EUS elastography in the differential diagnosis of gastric subepithelial tumors (SETs). METHODS We prospectively registered 41 consecutive patients with gastric SETs and measured their strain ratios with EUS elastography. The strain ratios of gastric SETs were compared with the histopathologic diagnosis. RESULTS Thirty-one patients (mean age, 51.4 ± 12.6 years) were included in the analysis. The mean size of the SETs was 2.3 ± 0.7 cm. Lipomas had the lowest strain ratio of 1.6 (1.1-2.0), followed by leiomyomas 6.0 (2.0-29.0), ectopic pancreas 11.8 (1.7-29.3), gastrointestinal stromal tumors (GISTs) 51.1 (29.0-67.0), and schwannomas 62.0. With a cut-off value of 22.7, EUS elastography could differentiate GISTs from leiomyomas with sensitivity and specificity of 100% and 94.1%, respectively (P = .001; 95% confidence interval, 0.979-1.000). CONCLUSIONS EUS elastography could be a promising diagnostic adjunct for the assessment of gastric SETs, especially in differentiating GISTs from leiomyomas.
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Affiliation(s)
- Sun Hwa Kim
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - Chang-Il Kwon
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - Sung Pyo Hong
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
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Colaiacovo R, Costa ADS, Paulo GAD, Reimão SM, Camunha MAR. Echoendoscopy with elastography in mediastinal lymph nodes. EINSTEIN-SAO PAULO 2019; 17:eMD5157. [PMID: 31826074 PMCID: PMC6882555 DOI: 10.31744/einstein_journal/2019md5157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/16/2019] [Indexed: 11/29/2022] Open
Abstract
Elastography is a widely used procedure in conventional ultrasonography that has recently been incorporated in echoendoscopy. This is an innovative and promising technology that aims to increase the negative predictive value of endoscopic ultrasonography and fine-needle aspiration punctures. It is useful for directing punctures in suspect areas and, consequently, improves diagnostic performance. This is a non-invasive technique, easy to perform, without additional costs or complications. The main indications are the analysis of solid pancreatic masses, lymph nodes, subepithelial lesions, lesions in the left hepatic lobe and in the left adrenal. Negative or inconclusive cases of fine-needle aspiration can be submitted to elastography when there is a strong suspicion of malignancy. Elastography has a high precision for the differential diagnosis of solid masses and in difficult-to-access anatomic sites, as well as in mediastinal lymph nodes and pancreatic tumors. The procedure is based on the degree of tissue elasticity measurement, with a good correlation between the elasticity index and histopathological features. We report the case of four patients evaluated by echoendoscopy and qualitative elastography who had differential diagnoses in mediastinal lymph nodes: sarcoidosis, lymphoma, histoplasmosis and esophageal neoplasia.
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Affiliation(s)
| | - Altair da Silva Costa
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Dietrich CF, Hocke M. Elastography of the Pancreas, Current View. Clin Endosc 2019; 52:533-540. [PMID: 31311914 PMCID: PMC6900297 DOI: 10.5946/ce.2018.156] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
Ultrasound elastography (USE) of the pancreas allows pancreatic tissue stiffness assessment by virtual palpation. Two main types of USE are used. For the pancreas strain elastography applying by endoscopic ultrasound has been established for the characterisation of small solid pancreatic lesions (SPL). In larger SPL >30 mm the results are less convincing mainly due to the heterogenicity of the lesions but also by concomitant changes of the surrounding pancreatic parenchyma. The current role of shear wave elastography has to be determined. This article reviews the current use of elastography of the pancreas.
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Affiliation(s)
- Christoph F. Dietrich
- Ultrasound Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Internal Medicine, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Michael Hocke
- Department of Internal Medicine, HELIOS Klinikum Meiningen, Meiningen, Germany
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Nakai Y, Takahara N, Mizuno S, Kogure H, Koike K. Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms. Clin Endosc 2019; 52:527-532. [PMID: 31337194 PMCID: PMC6900295 DOI: 10.5946/ce.2019.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/13/2019] [Indexed: 12/15/2022] Open
Abstract
Endoscopic ultrasound (EUS) now plays an important role in the management of pancreatic neoplasms. There are various types of pancreatic neoplasms, from benign to malignant lesions, and the role of EUS ranges from the imaging diagnosis to treatment. EUS is useful for the detection, characterization, and tissue acquisition of pancreatic lesions. Recent advancement of contrast-enhanced harmonic EUS and elastography enables better characterization of pancreatic lesions. In addition to these enhanced EUS imaging techniques, EUS-guided tissue acquisition is now the standard procedure to establish the pathological diagnosis of pancreatic neoplasms. While these diagnostic roles of EUS have been established, EUS-guided interventions such as ablation and drainage are also increasingly utilized in the management of pancreatic neoplasms. However, most of these EUS-guided interventions are not yet standardized in terms of techniques and devices and thus need further investigations.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Lange A, Muniraj T, Aslanian HR. Endoscopic Ultrasound for the Diagnosis and Staging of Liver Tumors. Gastrointest Endosc Clin N Am 2019; 29:339-350. [PMID: 30846157 DOI: 10.1016/j.giec.2018.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endoscopic ultrasound examination may provide complementary information to cross-sectional imaging in lesions of the liver, portal vein, and surrounding lymph nodes. With fine needle aspiration, endoscopic ultrasound examination is a powerful tool for the diagnosis of focal liver lesions and has usefulness in the evaluation of indeterminate liver lesions. Endoscopic ultrasound examination may influence hepatocellular cancer staging and Endoscopic ultrasound examination with fine needle aspiration of locoregional nodes and portal vein thromboses changes management. Contrast-enhanced endoscopic ultrasound examination and endoscopic ultrasound examination elastography are likely to expand the usefulness of endoscopic ultrasound examination in evaluating liver malignancy with technologic improvements.
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Affiliation(s)
- Andrew Lange
- Department of Internal Medicine, Yale University School of Medicine, Yale Primary Care Center, 789 Howard Avenue, New Haven, CT 06511, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Laboratory for Medicine and Pediatrics, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Yale University School of Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520, USA.
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García-Figueiras R, Baleato-González S, Padhani AR, Luna-Alcalá A, Vallejo-Casas JA, Sala E, Vilanova JC, Koh DM, Herranz-Carnero M, Vargas HA. How clinical imaging can assess cancer biology. Insights Imaging 2019; 10:28. [PMID: 30830470 PMCID: PMC6399375 DOI: 10.1186/s13244-019-0703-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
Human cancers represent complex structures, which display substantial inter- and intratumor heterogeneity in their genetic expression and phenotypic features. However, cancers usually exhibit characteristic structural, physiologic, and molecular features and display specific biological capabilities named hallmarks. Many of these tumor traits are imageable through different imaging techniques. Imaging is able to spatially map key cancer features and tumor heterogeneity improving tumor diagnosis, characterization, and management. This paper aims to summarize the current and emerging applications of imaging in tumor biology assessment.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN, UK
| | - Antonio Luna-Alcalá
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
- MRI Unit, Clínica Las Nieves, Health Time, Jaén, Spain
| | - Juan Antonio Vallejo-Casas
- Unidad de Gestión Clínica de Medicina Nuclear. IMIBIC. Hospital Reina Sofía. Universidad de Córdoba, Córdoba, Spain
| | - Evis Sala
- Department of Radiology and Cancer Research UK Cambridge Center, Cambridge, CB2 0QQ, UK
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona and IDI, Lorenzana 36, 17002, Girona, Spain
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital & Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - Michel Herranz-Carnero
- Nuclear Medicine Department, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Galicia, Spain
- Molecular Imaging Program, IDIS, USC, Santiago de Compostela, Galicia, Spain
| | - Herbert Alberto Vargas
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Radiology, 1275 York Av. Radiology Academic Offices C-278, New York, NY, 10065, USA
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Altonbary AY, Hakim H, El-Shamy AM. Endoscopic Ultrasound Elastography for Evaluation of Lymph Nodes: A Single Center Experience. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2018; 2018:7186341. [PMID: 30425445 PMCID: PMC6217875 DOI: 10.1155/2018/7186341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM The differentiation between malignant and benign lymph nodes (LNs) is important for tumor staging, for detection of prognosis, and for selection of the best treatment strategy in many cancers. On B-mode EUS, there are some known criteria that suggest the malignant nature of LNs; these criteria may be found in benign LNs. The aim of the work is to evaluate the effectiveness of elasticity score and SR to differentiate between benign and malignant LNs. PATIENTS AND METHODS The study was designed as a retrospective study that included 40 patients with abdominal or mediastinal LNs, either associated with primary masses or isolated, referred for EUS evaluation. Elasticity scores and SR were determined during the examination and finally, EUS-FNA was done at the end of the procedure. RESULTS In this 2-years study, 40 patients were enrolled (24 malignant; 16 benign). There were 23 males and 17 females. Their mean age was 52.5 years (range: 28-77). ES alone had a specificity of 87.5%, sensitivity of 41.7%, PPV of 83.3%, NPV of 50%, and accuracy of 60%. Based on the ROC curve analysis results, the best cut-off level of SR to obtain the maximum area under the curve (AUC) was 6.7 with a specificity of 99.9%, sensitivity of 57.1%, PPV of 99.9%, NPV of 64%, and accuracy of 77.5%. CONCLUSION The use of elasticity score and SR increases the reliability of differentiation between benign and malignant LNs and can decrease the number of unnecessary biopsies.
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Affiliation(s)
- Ahmed Youssef Altonbary
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - Hazem Hakim
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
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Dietrich CF, Sirli R, Ferraioli G, Popescu A, Sporea I, Pienar C, Kunze C, Taut H, Schrading S, Bota S, Schreiber-Dietrich D, Yi D. Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients. APPLIED SCIENCES 2018; 8:944. [DOI: 10.3390/app8060944] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Studies performed using transient elastography (TE), point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have shown that these techniques are all feasible and accurate in children for the evaluation of liver fibrosis due to several etiologies. However, for some specific pediatric pathologies, such as biliary atresia, the evidence is still limited. As shown in adults, inflammation is a confounding factor when assessing fibrosis severity and care should be taken when interpreting the results. Due to the scarce comparative data between serological tests and elastography techniques in children, a definite conclusion regarding which is the best cannot be drawn. Neither non-invasive elastographic techniques nor laboratory scores allow determination of the presence and the degree of inflammation, necrosis, iron or copper deposits.
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Affiliation(s)
- Christoph F. Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980 Bad Mergentheim, Germany
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Giovanna Ferraioli
- Ultrasound Unit, Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, 27100 Pavia, Italy
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Corina Pienar
- Pediatrics Department, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Christian Kunze
- Klinik für Radiologie, Abteilung Kinderradiologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany
| | - Heike Taut
- Klinik und Poliklinik für Kinder-und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, 01307 Dresden, Germany
| | - Simone Schrading
- Klinik für Diagnostische und Interventionelle Radiologie, University of Aachen, 52062 Aachen, Germany
| | - Simona Bota
- Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt am Wörthersee, Austria
| | - Dagmar Schreiber-Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980 Bad Mergentheim, Germany
| | - Dong Yi
- Department of ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200433, China
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Dong Y, Jürgensen C, Puri R, D’Onofrio M, Hocke M, Wang WP, Atkinson N, Sharma M, Dietrich CF. Ultrasound imaging features of isolated pancreatic tuberculosis. Endosc Ultrasound 2018; 7:119-127. [PMID: 28721972 PMCID: PMC5914183 DOI: 10.4103/2303-9027.210901] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Isolated pancreatic tuberculosis (PTB) is extremely rare worldwide. The purpose of this multicenter retrospective study is to analyze imaging features of histologically confirmed isolated PTB in order to determine the diagnostic features of the new methods contrast enhanced ultrasound (CEUS), ultrasound elastography and contrast enhanced endoscopic ultrasound (CE-EUS). PATIENTS AND METHODS: We report on a retrospective data collection of 12 cases of PTB confirmed by histology or cytology. All examinations were interpreted by two independent readers in consensus. CEUS, CE-EUS and ultrasound elastography were performed according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. RESULTS: In PTB patients the common bile duct was never dilated. Multiple retroperitoneal lymph nodes are the second important B-mode ultrasound feature detected in 75% of PTB patients. CE-EUS was performed in three PTB patients demonstrating hyperenhancement. On elastography, all PTB lesions were markedly stiffer than surrounding pancreatic parenchyma. CONCLUSIONS: Here we report the first time on CEUS and elastography features of PTB. PTB had some typical imaging features with iso- or hyperenhancement on CE(E) US. PTB is markedly stiffer on elastography. If clinicians are aware of clinical features of PTB and conduct appropriate investigations with multiple modalities including B-mode ultrasound, CEUS, and EUS guided fine needle aspiration, diagnosis of PTB without laparotomy is possible and the disease can be effectively treated with anti-tuberculous drugs.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Christian Jürgensen
- Department of Hepatology and Gastroenterology, Charité University, 10117 Berlin, Germany
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Mirko D’Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Nathan Atkinson
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, India
| | - Christoph F. Dietrich
- Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, Germany
- Medical Department, Caritas-Krankenhaus, Germany
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Fiorino S, Bacchi-Reggiani ML, Birtolo C, Acquaviva G, Visani M, Fornelli A, Masetti M, Tura A, Sbrignadello S, Grizzi F, Patrinicola F, Zanello M, Mastrangelo L, Lombardi R, Benini C, Di Tommaso L, Bondi A, Monetti F, Siopis E, Orlandi PE, Imbriani M, Fabbri C, Giovanelli S, Domanico A, Accogli E, Di Saverio S, Grifoni D, Cennamo V, Leandri P, Jovine E, de Biase D. Matricellular proteins and survival in patients with pancreatic cancer: A systematic review. Pancreatology 2018; 18:122-132. [PMID: 29137857 DOI: 10.1016/j.pan.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 02/05/2023]
Abstract
Extracellular matrix (ECM) plays a fundamental role in tissue architecture and homeostasis and modulates cell functions through a complex interaction between cell surface receptors, hormones, several bioeffector molecules, and structural proteins like collagen. These components are secreted into ECM and all together contribute to regulate several cellular activities including differentiation, apoptosis, proliferation, and migration. The so-called "matricellular" proteins (MPs) have recently emerged as important regulators of ECM functions. The aim of our review is to consider all different types of MPs family assessing the potential relationship between MPs and survival in patients with pancreatic ductal adenocarcinoma (PDAC). A systematic computer-based search of published articles, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement issued in 2009 was conducted through Ovid interface, and literature review was performed in May 2017. The search text words were identified by means of controlled vocabulary, such as the National Library of Medicine's MESH (Medical Subject Headings) and Keywords. Collected data showed an important role of MPs in carcinogenesis and in PDAC prognosis even though the underlying mechanisms are still largely unknown and data are not univocal. Therefore, a better understanding of MPs role in regulation of ECM homeostasis and remodeling of specific organ niches may suggest potential novel extracellular targets for the development of efficacious therapeutic strategies.
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Affiliation(s)
- Sirio Fiorino
- Internal Medicine Unit C, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy.
| | - Maria Letizia Bacchi-Reggiani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Cardiology Unit, Policlinico S. Orsola-Malpighi, University of Bologna, via Massarenti 9, Bologna, Italy
| | - Chiara Birtolo
- Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Giorgia Acquaviva
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), University of Bologna, Azienda USL di Bologna, Largo Nigrisoli 3, Bologna, Italy
| | - Michela Visani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), University of Bologna, Azienda USL di Bologna, Largo Nigrisoli 3, Bologna, Italy
| | - Adele Fornelli
- Anatomic Pathology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Michele Masetti
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Via Giuseppe Moruzzi 1, Padova, Italy
| | | | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy
| | - Federica Patrinicola
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy
| | - Matteo Zanello
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Laura Mastrangelo
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Raffaele Lombardi
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Claudia Benini
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Luca Di Tommaso
- Department of Pathology, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy
| | - Arrigo Bondi
- Anatomic Pathology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Francesco Monetti
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Elena Siopis
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Paolo Emilio Orlandi
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Michele Imbriani
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Silvia Giovanelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Andrea Domanico
- Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Esterita Accogli
- Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Salomone Di Saverio
- Surgical Emergency Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Daniela Grifoni
- Department of Pharmacy and Biotechnology, University of Bologna, via San Donato 15, Bologna, Italy
| | - Vincenzo Cennamo
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Paolo Leandri
- Surgical Emergency Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Elio Jovine
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, via San Donato 15, Bologna, Italy.
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Dietrich CF, Bibby E, Jenssen C, Saftoiu A, Iglesias-Garcia J, Havre RF. EUS elastography: How to do it? Endosc Ultrasound 2018; 7:20-28. [PMID: 29451165 PMCID: PMC5838723 DOI: 10.4103/eus.eus_49_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/28/2017] [Indexed: 02/06/2023] Open
Abstract
Strain elastography as used in EUS (EUS-real-time tissue elastography [RTE]) is a qualitative technique and provides information on the relative stiffness between one tissue and another. This article reviews the principles, technique, and interpretation of EUS-RTE in various organs. It includes information on how to optimize the technique as well as a discussion on pitfalls and artifacts. We also refer to the article describing RTE using conventional ultrasound transducers.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Internal Medicine, Caritas-Krankenhaus Bad Mergentheim, Uhlandstraße 7, D-97980 Bad Mergentheim, Germany
- Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhenzhou, Henan Province, China
| | - Ellison Bibby
- Consultant, Hitachi Medical Systems Europe Holding Ltd., Craiova, Romania
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Teaching Hospital Medical University Brandenburg “Theodor Fontane”, Brandenburg, Germany
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Spain
| | - Roald F. Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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Genere JR, Siddiqui UD. Endoscopic ultrasound-guided tissue acquisition of lymph nodes. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hocke M, Braden B, Jenssen C, Dietrich CF. Present status and perspectives of endosonography 2017 in gastroenterology. Korean J Intern Med 2018; 33:36-63. [PMID: 29161800 PMCID: PMC5768548 DOI: 10.3904/kjim.2017.212] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound has become an essential tool in modern gastroenterology and abdominal surgery. Compared with all other endoscopic methods, it has the most potential for innovation and its future looks bright. Thus, we compiled this summary of established and novel applications of endoscopic ultrasound methods to inform the reader about what is already possible and where future developments will lead in improving patient care further. This review is structured in four parts. The first section reports on developments in diagnostic endoscopic ultrasound, the second looks at semi-invasive endoscopic ultrasound, and the third discusses advances in therapeutic endoscopic ultrasound. An overview on the future prospects of endoscopic ultrasound methods concludes this article.
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Affiliation(s)
- Michael Hocke
- Internal Medicine II, Helios Hospital Meiningen, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
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39
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Wang H, Nieskoski MD, Marra K, Gunn JR, Trembly SB, Pogue BW, Doyley MM. Elastographic Assessment of Xenograft Pancreatic Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2891-2903. [PMID: 28964615 PMCID: PMC5693710 DOI: 10.1016/j.ultrasmedbio.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/01/2017] [Accepted: 08/09/2017] [Indexed: 05/04/2023]
Abstract
High tissue pressures prevent chemotherapeutics from reaching the parenchyma of pancreatic ductal adenocarcinoma, which makes it difficult to treat this aggressive disease. Researchers currently use invasive probes to monitor the effectiveness of pressure-reducing therapies, but this practice introduces additional complications. Here, we hypothesize that Young's modulus is a good surrogate for tissue pressure because collagen density and hyaluoronic acid, the key features of the tumor microenvironment responsible for high tissue pressures, also affect modulus elastograms. To corroborate this hypothesis, we used model-based quasi-static elastography to assess how the Young's modulus of naturally occurring AsPc-1 pancreatic tumors varies with collagen density and hyaluoronic acid concentration. We observed that Young's moduli of orthotopically grown xenograft tumors were 6 kPa (p < 0.05) higher than that of their subcutaneously grown counterparts. We also observed a strong correlation between Young's modulus and regions within the tumors with high collagen (R2 ≈ 0.8) and hyaluoronic acid (R2 ≈ 0.6) densities. These preliminary results indicate that hyaluronic acid and collagen density, features of the pancreatic ductal adenocarcinoma tumor microenvironment responsible for high tissue pressure, influence Young's modulus.
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Affiliation(s)
- Hexuan Wang
- Department of Electrical and Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA
| | - Michael D Nieskoski
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Kayla Marra
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Stuart B Trembly
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Marvin M Doyley
- Department of Electrical and Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA.
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40
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Friedberg SR, Lachter J. Endoscopic ultrasound: Current roles and future directions. World J Gastrointest Endosc 2017; 9:499-505. [PMID: 29085560 PMCID: PMC5648992 DOI: 10.4253/wjge.v9.i10.499] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/20/2017] [Accepted: 06/13/2017] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS), developed in the 1980s, was initially predominantly used for guidance of fine needle aspiration; the last 25 years, however, have witnessed a major expansion of EUS to various applications, both diagnostic and therapeutic. EUS has become much more than a tool to differentiate different tissue densities; tissue can now be characterized in great detail using modalities such as elastography; the extent of tissue vascularity can now be learned with increasing precision. Using these various techniques, targets for biopsy can be precisely pinpointed. Upon reaching the target, tissue can then be examined microscopically in real-time, ensuring optimal targeting and diagnosis. This article provides a comprehensive review of the various current roles of EUS, including drainage of lesions, visualization and characterization of lesions, injection, surgery, and vascular intervention. With EUS technology continuing to develop exponentially, the article emphasizes the future directions of each modality.
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Affiliation(s)
- Scott R Friedberg
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
| | - Jesse Lachter
- Rambam Healthcare Campus, Technion Israel Institute of Technology, Haifa 3109601, Israel
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Coban S, Basar O, Brugge WR. Future Directions for Endoscopic Ultrasound: Where Are We Heading? Gastrointest Endosc Clin N Am 2017; 27:759-772. [PMID: 28918811 DOI: 10.1016/j.giec.2017.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic ultrasound (EUS) plays an important role as a diagnostic and therapeutic modality in gastroenterology. New developments have emerged, especially in the last decade, and are being introduced to endoscopists. The ability to readily visualize and access organs in the gastrointestinal tract has allowed endoscopists to perform new interventional procedures. EUS procedures have taken the place of conventional approaches for the treatment of various gastrointestinal diseases, including pancreatic cystic lesions. This article focuses on the advances and future of diagnostic and therapeutic EUS.
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Affiliation(s)
- Sahin Coban
- Department of Medicine, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA 01655, USA
| | - Omer Basar
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - William R Brugge
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
Endoscopic ultrasound (EUS) is a major imaging method in the management of several diseases of the gastrointestinal tract and surrounding structures. Elastography is a novel technique providing additional information to standard B-mode imaging on the tissue stiffness. Elastography can be performed under EUS guidance. This method has proven to be an accurate and additional tool in the evaluation of pancreatic diseases and lymph nodes analysis. Possible uses include the study of liver lesions, subepithelial masses, and many more. This article reviews current knowledge and future perspectives.
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Dietrich CF, Barr RG, Farrokh A, Dighe M, Hocke M, Jenssen C, Dong Y, Saftoiu A, Havre RF. Strain Elastography - How To Do It? Ultrasound Int Open 2017; 3:E137-E149. [PMID: 29226273 PMCID: PMC5720889 DOI: 10.1055/s-0043-119412] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.
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Affiliation(s)
| | - Richard G. Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Manjiri Dighe
- Department of Biology, University of Washington, Radiology, Seattle, United States
| | - Michael Hocke
- HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Adrian Saftoiu
- University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
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Korrungruang P, Boonsarngsuk V. Diagnostic value of endobronchial ultrasound elastography for the differentiation of benign and malignant intrathoracic lymph nodes. Respirology 2017; 22:972-977. [PMID: 28102963 DOI: 10.1111/resp.12979] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Endobronchial ultrasound (EBUS) findings can be used for benign/malignant differentiation of lymph nodes (LNs). Recently, EBUS elastography has been introduced as a complementary modality in the evaluation of intrathoracic lymphadenopathy. We evaluated the ability of EBUS elastography to differentiate between benign and malignant LNs. METHODS A prospective study was conducted on patients sent for evaluation of intrathoracic lymphadenopathy. LNs were classified qualitatively according to elastographic colour pattern: type 1, predominantly non-blue; type 2, partly blue, partly non-blue and type 3, predominantly blue. Quantitative elastography of LNs was measured by the strain ratio (SR). Qualitative and quantitative elastographies were compared for the final diagnosis of LNs. RESULTS There were 120 LNs from 72 patients who underwent EBUS elastography. The final diagnosis included 96 malignant and 24 benign LNs. All of the 16 type 1 LNs proved to be benign diseases, while 95 of the 101 type 3 LNs were finally diagnosed as malignancies. Three LNs classified as type 2 proved to be two benign and one malignant. Malignant LNs presented a higher median SR than benign LNs (73.50 vs 1.29, P = 0.001). An SR of >2.5 and non-type 1 elastographic pattern achieved similar diagnostic performance in benign/malignant differentiation (sensitivity, 100% vs 100%; specificity, 70.8% vs 66.7%; positive predictive value, 93.2% vs 92.3%; negative predictive value, 100% vs 100%). CONCLUSION EBUS elastography is a promising diagnostic modality for the differentiation of benign and malignant LNs during EBUS-guided transbronchial needle aspiration (TBNA). Qualitative and quantitative EBUS elastographies provide similar diagnostic performance.
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Affiliation(s)
- Potjanee Korrungruang
- Division of Pulmonary Medicine, Department of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Iglesias-Garcia J, Lariño-Noia J, Domínguez-Muñoz JE. New diagnostic techniques for the differential diagnosis of pancreatic mass: Elastography helps me 100. Endosc Ultrasound 2017; 6:S115-S118. [PMID: 29387706 PMCID: PMC5774067 DOI: 10.4103/eus.eus_76_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Lariño-Noia
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Enrique Domínguez-Muñoz
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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46
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Costache MI, Dumitrescu D, Săftoiu A. Technique of qualitative and semiquantitative EUS elastography in pancreatic examination. Endosc Ultrasound 2017; 6:S111-S114. [PMID: 29387705 PMCID: PMC5774066 DOI: 10.4103/eus.eus_75_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mădălin Ionuţ Costache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.,Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Craiova, Romania
| | - Daniela Dumitrescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Craiova, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.,Department of Endoscopy, Gastro-Unit, Copenhagen University Hospital Herlev, Denmark
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Dietrich CF, Dong Y. Shear wave elastography with a new reliability indicator. J Ultrason 2016; 16:281-287. [PMID: 27679731 PMCID: PMC5034022 DOI: 10.15557/jou.2016.0028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/23/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
Non-invasive methods for liver stiffness assessment have been introduced over recent years. Of these, two main methods for estimating liver fibrosis using ultrasound elastography have become established in clinical practice: shear wave elastography and quasi-static or strain elastography. Shear waves are waves with a motion perpendicular (lateral) to the direction of the generating force. Shear waves travel relatively slowly (between 1 and 10 m/s). The stiffness of the liver tissue can be assessed based on shear wave velocity (the stiffness increases with the speed). The European Federation of Societies for Ultrasound in Medicine and Biology has published Guidelines and Recommendations that describe these technologies and provide recommendations for their clinical use. Most of the data available to date has been published using the Fibroscan (Echosens, France), point shear wave speed measurement using an acoustic radiation force impulse (Siemens, Germany) and 2D shear wave elastography using the Aixplorer (SuperSonic Imagine, France). More recently, also other manufacturers have introduced shear wave elastography technology into the market. A comparison of data obtained using different techniques for shear wave propagation and velocity measurement is of key interest for future studies, recommendations and guidelines. Here, we present a recently introduced shear wave elastography technology from Hitachi and discuss its reproducibility and comparability to the already established technologies.
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Affiliation(s)
- Christoph F. Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
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48
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Domínguez-Muñoz JE. Predicting Pancreatic Exocrine Insufficiency With EUS Elastography. Gastroenterol Hepatol (N Y) 2016; 12:511-512. [PMID: 27917087 PMCID: PMC5114498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- J Enrique Domínguez-Muñoz
- Director, Department of Gastroenterology and Hepatology University Hospital of Santiago de Compostela Santiago de Compostela, Spain
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49
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Dietrich CF, Jenssen C, Herth FJF. Endobronchial ultrasound elastography. Endosc Ultrasound 2016; 5:233-238. [PMID: 27503154 PMCID: PMC4989403 DOI: 10.4103/2303-9027.187866] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 12/20/2022] Open
Abstract
Elastographic techniques have recently become available as advanced diagnostic tools for tissue characterization. Strain elastography is a real-time technique used with transcutaneous ultrasound (US) and endoscopic US. Convincing evidence is available demonstrating a significant value of strain elastography for the discrimination of benign and malignant lymph nodes (LNs). This paper reviews preliminary data demonstrating the feasibility of performing real-time elastography during endobronchial US (EBUS) and a potential application of this technique for selection of LNs for EBUS-guided transbronchial needle aspiration in patients with lung cancer and extrathoracic malignancies.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus Bad Mergentheim, Uhlandstr, 7, 97980 Bad Mergentheim, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, 15344 Strausberg, Germany
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
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