Background: The differential diagnosis between uterine fibroid and adenomyosis is sometimes difficult; a precise diagnosis is required in women with infertility because of the different choice of treatments. Ultrasound elastography (UE) is a novel technique to evaluate the elasticity or the stiffness of the tissue of interest. The present study aims to compare UE shear wave velocity (SWV) among normal uterine myometrium, uterine fibroid, and adenomyosis, and assess the accuracy of shear wave elastography in the diagnosis of adenomyosis. Materials and Methods: This cross-sectional study recruited 25 subjects for each group (control, adenomyosis, and fibroid) from April 2019 to April 2020. Transvaginal UE using an Aplio 500 (Toshiba Medical Systems, Japan) with ultrasound mapping for point of tissue biopsy was performed for all subjects. The diagnosis was confirmed by histol ogy. Masson’ s trichrome staining for collagen was performed and quantified. Results: The mean ± standard deviation (SD) for SWV was 3. 44 ± 0. 95 m/seconds (control group), 4. 63 ± 1. 45 m/ seconds (adenomyosis group), and 4. 53 ± 1. 07 m/seconds (fibroid group). The mean SWV differed when comparing normal myometrium and adenomyosis after adjustments for age and endometrial pathology (P=0. 019). The cut-off point of SWV at 3. 465 m/seconds could differentiate adenomyosis from the normal uterus with an 80% sensitivity, 80% specificity, and an area under the curve (AUC) of 0. 80 (95% confidence interval [CI]: 0. 68-0. 93) (P<0. 001). No significant difference in SWV between the adenomyosis and fibroid groups was detected. Conclusion: Shear wave elastography could be an alternative tool to distinguish between normal myometrium and adeno myosis; however, it could not differentiate adenomyosis from uterine fibroid or uterine fibroid from normal myometriu

Background: The objective of the study is to evaluate elastography ultrasound findings in patients with scleroderma (SS) and to clarify the effectiveness of elastosonography to differentiate scleroderma lesions from any skin lesion considering tissue elasticity. Methods: Thirty‑ six SS patients definite diagnosis of systemic sclerosis according to American College of Rheumatology criteria and 36 healthy subjects were enrolled. Volar aspect of the middle forearm and arm in addition to the dorsal aspect of the fingers were evaluated by sonoelastography. The RGB (red, green, blue) image is a three‑ dimensional matrix. A color image RGB is an M × N × 3 array of color pixels. The total pixels, total blue pixels, and blue index compared between SS cases and controls. Results: Mean age of patients was 41. 3 ± 10. 3 years and mean age of controls was 39. 8 ± 9. 3 years. Mean‑ modified Rodnan skin score of the whole body was 11. 9 and mean duration of disease was 6. 2 years. Mean total blue pixels in the arm were significantly different between cases and controls. Mean total image pixels, total blue pixels, and blue index in the forearm were significantly different between cases and controls. Elastography findings in the finger were not significantly different between cases and controls. Conclusions: Sonoelastography could be used for evaluating skin of forearm in sclerodermic cases which will be helpful for disease evaluation in clinical course.

Background: Elastography is a non-invasive diagnostic imaging technique that assesses the elasticity or stiffness of tissues. This study aimed to compare the diagnostic performance of Shear Wave Elastography (SWE) and Strain Elastography (SE) in distinguishing benign from malignant breast masses.Methods: In a retrospective study, 447 women with breast masses were evaluated divided into two groups: 223 underwent SE, and 224 underwent SWE. Histopathological findings served as the gold standard. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Receiver Operating Characteristic (ROC) curves were calculated for both techniques. Data analysis was performed using R software (version 4.3), with t-tests and chi-square tests for group comparisons.Results: The mean age of participants was 46.1±9.8 years. Significant differences were observed between the benign and malignant groups in terms of age, mass size, and family history of breast cancer (p<0.05). For SWE, sensitivity, specificity, PPV, and NPV were 92, 93, 89, and 95%, respectively, compared to 85, 87, 82, and 89%, respectively for SE. The diagnostic accuracy of SWE was higher than SE (93 vs. 86%). The area under the ROC curve was 0.94 for SWE and 0.88 for SE.Conclusion: SWE demonstrated superior diagnostic performance compared to SE in differentiating benign and malignant breast masses. This non-invasive technique can serve as a valuable clinical tool to improve diagnostic accuracy for malignancies and reduce unnecessary biopsies. However, multicenter studies with larger, more diverse samples are needed to validate these findings.

The principles and limitations of current imaging modalities are described. It may help to determine the most effective radiologic technique, minimizing the cost of examination as well as the exposure to radiation. It is important to choose the appropriate mo-duality for specific types of orthopedic abnormalities. It is important to reemphasize that conventional radiography remains the most effective tool for demon-starting a bone and joint abnormality. Use of radiological techniques differs in evaluating the presence, type, and extent of various bone, joint, and soft-tissue abnormalities. Therefore, both the radiologist and orthopedic surgeon must know the in-dictation for use of each technique, the limitations of a particular modality, and the appropriate imaging approaches for abnormalities at specific sites. The question; "what modality should I use for this particular problem?" is frequently asked by radiologists and or-thopedic surgeons. Although numerous algorithms are available to evaluate various problems at different anatomic sites, the answer cannot always be clearly stated. The choice of techniques for imaging bone and soft-tissue abnormalities is dictated not only by clinical presentation, but also by equipment availability, ex-parties, and cost. Restriction may also be imposed by the needs of individual patients. Most of the time, the choice of imaging technique is dictated by the type of suspected abnormality. The purpose of this study was to review imaging techniques in orthopedics.

Background: Reversibility of advanced fibrosis after HCV-clearance is an important goal of therapy. Objectives: Measuring liver stiffness (LS) by transient elastography (TE) might be helpful in this setting.Patients and Methods: We evaluated 104 patients with biopsy-proven chronic hepatitis C (CHC) and sustained virological response (SVR) after Peg-Interferon (IFN) plus ribavirin since at least 18 months. HCV-eradication was confirmed searching for serum HCV-RNA (TMA® sensitivity>5-10 IU/ml). Data from literature reported the best LS cut-off values for different stages of liver fibrosis were 7.1 kPa for Metavir stage 2 (F2), 9.5 kPa for F3 and 12.5 for cirrhosis (F4).Results: TE was not reliable in four SVR obese patients. Metavir-stage of biopsy was F0-1 in 28, F2 in 47, F3 in 17 and F4 in eight patients. The median interval elapsed since achieving SVR was 36 months (range: 18-77, SD¬¬:18). Stratifying patients according to the histological stage assessed before treatment, a clear-cut gradient of LS values was observed from F0-1: median: 3.8 kPa (range: 3.5-4.9) to F2: 4.6 kPa (3.8-6.0), F3: 6.2 kPa (4.8-8.6) and F4: 8.4 kPa (6.2-9.2) (P=0.001). Overall, 86 patients had lower values of LS than the expected LS values according to Metavirstage. At multivariate logistic analysis γ-GT and histological steatosis were independently associated with persistence of higher values of LS. Conclusion: Long term responders to IFN-based therapies have lower LS values than those who are untreated and still viraemic. High levels of g-GT and liver steatosis, all markers of insulin resistance, may hamper reduction of liver stiffness after HCV-clearance.

Background: The myocardial performance index (MPI), also known as the Tei index, was introduced by Tei et al. to evaluate cardiac function in adults with dilated cardiomyopathy. This index is defined as the sum of isovolumic contraction time (ICT) and isovolumic relaxation time (IRT), divided by ejection time (ET).Objectives: To determine the correlation between pulsed doppler (Pd) - and tissue doppler imaging (TdI) -derived Tei indices in fetuses. Patients and Methods: Right and left ventricle Pd and TdI echocardiographic data were obtained from 59 fetuses (11 pregnant women who were positive for anti-SSA-Ro or anti-SSB-La antibodies, 18 women who were referred due to dysrhythmia, and 30 women who had normal clinical findings).Results: Mean fetal gestational age was 27±6.4 weeks. Mean Pd Tei index of the mitral and tricuspid valve was 0.58±0.05 and 0.53±0.08, respectively. Mean TdI indices for the mitral and tricuspid valve were 0.56±0.09 and 0.55±0.08, respectively. There were no significant differences between mitral and tricuspid Pd- and TdI-derived Tei indices (P=0.87, P=0.21), but the Bland-Altman diagrams showed no fine agreement between the indices (the mean difference ±1 standard deviation of the right ventricular Pd- and TdI-derived Tei indices was 0.24±0.02 and 0.29±0.04 for the left ventricle). There were no significant differences in Pd- and TdI-derived Tei indexes between groups of evaluated fetuses (Mitral valve: Pd-Tei P=0.69, TdI-Tei P=0.49; Tricuspid valve: Pd-Tei P=0.41, TdI-Tei P=0.36).Conclusions: Although the mean values of the two indices did not differ significantly, the TdI-derived and Pd-derived Tei indices did not have fine agreement.

Aim: The current study was designed to evaluate the role of semi-quantitative EUS-elastography (strain ratio) in staging malignant pancreatic lesions. Background: Pancreatic cancer is considered one of the most lethal malignancies with a survival rate of only 5% worldwide. Pancreatic lesions include a wide range of diagnoses from benign to malignant forms. Biopsy and pathological study are the gold standard for the differentiation of malignant lesions and staging of tumors. Recently, endoscopic ultrasound sonography (EUS) elastography has been noticed as a non-invasive diagnosis modality. Nevertheless, no evidence of its potential to determine different stages of malignant tumors is available. Methods: This prospective study included 81 adult patients with a confirmed diagnosis of malignant pancreatic lesion in different clarified stages. All diagnoses were confirmed after endoscopic ultrasound sonography via pathological investigation of surgical specimens or needle biopsies. The results of EUS-elastography based on tumor size (T staging), involved lymph nodes (N staging), and metastasis (M staging) were compared with the gold standard. Results: The mean age of patients was 60. 11± 13. 57 years. The mean SR elastography value was 52. 78± 48. 97. Elastography could not significantly discriminate T stage, N stage, or M stage of tumors (p=0. 57, p=0. 92, p=0. 11, respectively). Moreover, the Spearman rank correlation coefficients for the correlation between T staging, N staging, M staging and SR elastography were not significant (p=0. 40, p=0. 94, p=0. 39, respectively). Conclusion: The non-invasive modality EUS-elastography cannot replace the gold standard in staging tumors; however, EUSelastography seemed to differentiate benign lesions from malignant ones.