Background: Quantitative shear wave elastography (SWE) has been developed and utilized to aid in the differentiation between benign and malignant breast lesions based on their stiffness. Objectives: The purpose of this study was to evaluate the clinical effects of the additional use of SWE to conventional ultrasound (US) according to the maximum (Emax) and mean (Emean) elasticitiy values. Patients and Methods: A total 115 patients with 133 lesions were assessed using conventional US and SWE. All patients underwent US-guided core needle biopsy or surgery, and the pathological results were used as reference standards. We compared the diagnostic values including sensitivities, specificities, positive predictive values (PPVs) and negative predictive values (NPVs) and accuracies of conventional US and SWE according to the Emax and Emean values. Next, we obtained the optimal Emax and Emean cutoff values for SWE. Using these cutoff values, we analyzed the clinical effects of the additional use of SWE to conventional US based on the corrected results. Results: Of the 133 breast lesions, 32 were malignant and 101 were benign. In the differentiation of benign and malignant lesions, conventional US resulted in sensitivity of 100 %, specificity of 43. 0 %, PPV of 57. 1 %, NPV of 36. 7 %, and accuracy of 100 %. Regarding SWE, the sensitivity, specificity, PPV, NPV, and accuracy values based on Emax were 84. 4 %, 89. 1 %, 71. 1 %, 94. 7 %, and 88. 0 %, respectively, and the corresponding values based on Emean were 84. 8 %, 93. 0 %, 91. 0 %, 80. 0 %, and 94. 9 %, respectively. The optimal Emax and Emean cutoff values were 81. 3 and 60. 7 kPa, respectively. However, there was no significant difference between Emax and Emean. The corrected results related to the additional use of SWE to conventional US indicated 97. 0 % sensitivity, 93. 0 % specificity, 82. 1 % PPV, 98. 9 % NPV, and 94. 0 % accuracy (P < 0. 0001). Conclusion: The additional use of SWE to conventional US resulted in marked improvements in specificity, PPV, and accuracy and slight diminutions in sensitivity and NPV for the differentiation benign and malignant breast lesions. Both Emax and Emean were effective diagnostic parameters, and there was no significant difference between these two parameters.

Background: The placenta is a soft organ with vital importance. Increased placental stiffness was reported in pathological conditions emerging during pregnancy, such as diabetes mellitus and hypertension. Nowadays, placental stiffness can be quantitatively measured using the shear wave elastography (SWE) technique. Objectives: We aimed to assess the factors affecting elasticity by finding the normal elastogram values of healthy pregnancy placentas using the SWE technique due to the importance of early diagnosis in risky pregnancies. Patients and Methods: In total, 288 healthy pregnant women in the second or third trimester were included in our prospective study. The pregnant women who had pathology in their fetus and its appendices or a posteriorly located placenta were excluded from the study. Obstetric ultrasonography and a placental elasticity assessment were performed in all the pregnant women. Speed values were obtained from five different locations of the placenta, including the central S1, S2, S3, S4 and peripheral P regions. The elasticity of the regions were compared, and the factors affecting elasticity were investigated. Results: There were significant differences among the velocity values obtained from five different areas of the placenta. The mean velocity values obtained from the central region were higher than those of the peripheral region (P < 0. 001). There was also a significant difference in the mean velocity measurements obtained from the central region (P < 0. 001). The hardest region of the placenta was the maternal surface, while the softest region was the peripheral surface. The elastographic velocity values of the placenta were found to correlate with maternal age, body mass index, placental localization, thickness, and grade, whereas it did not correlate with gravidity, parity, gestational week, and amniotic fluid index. Conclusion: The elasticity of the placenta varied according to the region and surface, whereas it did not change according to gestational week. It may be convenient to use the elasticity values obtained by SWE from specified regions in the follow-up of placentas in high-risk pregnancies. However, considering the affecting factors and contradictory study results, a large number of large-scale studies is required to strengthen the efficiency of SWE in the placental assessment.

Background: Non-alcoholic fatty liver disease (NAFLD) is the second most common cause of liver transplantation in the United States, with a continuously growing prevalence. There are several non-invasive methods to detect liver fibrosis, which is defined as the accumulation of extracellular matrix proteins, particularly collagens. It is most commonly associated with chronic liver diseases, such as NAFLD. Objectives: This study aimed to investigate the concordance between transient elastography (TE) and shear wave elastography (SWE) for liver fibrosis staging and also to examine the congruence between the controlled attenuation parameter (CAP) and the B-mode hepatorenal ratio for hepatic steatosis grading in patients with NAFLD. Patients and Methods: In this cross-sectional study conducted during March 2018-2019, NAFLD patients, referred to the liver clinic of our center for the non-invasive assessment of hepatic fibrosis, were enrolled. However, patients with sonographic features of cirrhosis, multiple hepatic masses, or moderate to large ascites were excluded,also, patients who were uncooperative during the tests were excluded. Measurements obtained by different tools were recorded. Kolmogorov-Smirnov test, Chi-square test, independent t-test, or Mann-Whitney tests, as well as Pearson’, s correlation coefficient test, were used to analyze the data. Results: Sixty-five patients (male-to-female ratio, 1: 13), with a median age of 47 years, were included in the study. The tools for assessing fibrosis (r = 0. 9538, 95% CI: 0. 9252-0. 9717, P < 0. 0001) and steatosis (r = 0. 429, 95% CI: 0. 2048-0. 6104, P < 0. 0001) were perfectly and moderately correlated, respectively. Sex, age, and body mass index (BMI) did not affect the results. Conclusion: The two elastography modalities showed a strong correlation for fibrosis staging in our study population. Also, the CAP and B-mode hepatorenal ratio were moderately correlated for grading hepatosteatosis. Overall, selection of the best assessment method among the studied modalities depends on factors other than internal validity.

Background: Sonoelastography is extensively used for clinical diagnosis. Different types of elastography can be used to assess the elastic properties (stiffness) of tissues. For quantitative analyses, shear wave elastography (SWE) has been applied as a noninvasive method in the past decade. Today, SWE is widely used for diagnosing diseases. However, a limited number of studies have investigated musculoskeletal injuries and neoplastic diseases. Objectives: This study aimed to evaluate the postoperative functional recovery of Achilles tendon ruptures by SWE to determine the Achilles tendon function and provide reliable evidence for clinicians. Methods: SWE was used to measure elasticity in 67 patients with Achilles tendon ruptures. In the postoperative stage, 17 patients were lost to follow-up. The remaining 50 patients with Achilles tendon ruptures were examined. Each patient was followed-up for one, three, and six months postoperatively. The 0° flexion of the ankle joint was considered as the standard position. The mean elasticity (Emean) of the Achilles tendon was measured and recorded at different time points before and after surgery. Besides, the thickness and width of the Achilles tendon were measured at the corresponding time points. Results: Themeanelasticity (Emean) of normal and ruptured Achilles tendons was 447. 4 59. 57 and 63. 84 45. 18 kPa, respectively in 50 patients with ruptured Achilles tendons before surgery. On the other hand, the Emean values of ruptured Achilles tendons in one-, three-, and six-month follow-ups were 110. 3 35. 60, 183. 4 46. 08, and 279. 1 48. 18 kPa in 50 patients, respectively. Regarding the Emean, the difference between the five time points was significant (F = 418. 5, P < 0. 01). With prolongation of postoperative recovery, the Emean of the Achilles tendon gradually increased; the Emean value significantly increased at six months after surgery. Conclusions: The quantitative analysis of the postoperative function of Achilles tendon, based on the Emean value obtained by SWE, can be helpful in guiding clinicians to objectively examine the prognosis of patients.

Background: Non-invasive evaluation of hepatic fibrosis, especiallyserumbiomarkersandultrasound elastography, has vigorously developed during the past decades. Objectives: The purpose of this study was to evaluate the diagnostic performance of the latest generation of ultrasound elastography-two-dimensional real-time shear wave elastography (SWE) in accessing liver fibrosis progression in comparison with serologic tests in a rat model. Materials and Methods: Liver fibrosis was induced in 108 rats (control group: 18 rats, experiment group: 90 rats) by intraperitoneal injection of thioacetamide (300mg/kg, twice a week for 12 weeks). SWE examination was done by two operators. Hyaluronic acid (HA), aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) were used for serology tests. Histological fibrosis stages (F0-F4) according to the Scheuer scoring system were referred as the gold standard. Diagnostic performance of elastography and serology methods were determined by the areas under receiver operating characteristic curve (AUROC). Results: Liver stiffness values increased with the progression of hepatic fibrosis. Liver stiffness assessed by SWE exhibited a strong positive correlation with histological fibrosis stages (r = 0. 849, P < 0. 001). SWE showed a better diagnostic performance than the selected serological biomarkers HA, APRI, and AAR (AUROC for SWE, HA, APRI, and AAR were 0. 933, 0. 707, 0. 714, and 0. 691 in diagnosing F F2 and 0. 986, 0. 807, 0. 870, and 0. 770 in diagnosing F = F4, respectively). Conclusion: Ultrasound elastographySWEtechnique is a reliable method for noninvasive evaluation of liver fibrosis in comparison with the serological biomarkers, HA, APRI, and AAR.

Background: Primary open-angle glaucoma is a multifactorial serious disease characterized by progressive retinal ganglion cell death and loss of visual field.Objectives: The purposes of this study were to investigate shear wave elastography (SWE) use in the evaluation of the optic nerve (ON) and peripapillary structures, and to compare the findings between glaucomatous and control eyes.Patients and Methods: A case-controlled study, including 21 patients with primary open-angle glaucoma and 21 age-matched control subjects, was carried out. All of the participants had comprehensive ophthalmological exams that included corneal biomechanical measurements with ocular response analyzer. In vivo evaluation of the biomechanical properties of the ON and peripapillary structures were performed with SWE in all participants. The Kolmogorov–Smirnov test was used to analyze the normal distribution of data. Differences of parameters in ophthalmologic data and stiffness values of patients with and without glaucoma were evaluated using the Mann-Whitney U test.Results: There were no statistically significant differences between the glaucoma and control groups in terms of age (P>0.05) and gender (P>0.05). Corneal hysteresis was lower in the glaucoma group (P<0.05). Corneal compensated intraocular pressure and Goldmann correlated intraocular pressure were higher in the glaucoma group (P<0.0001 for both). The mean stiffness of the ON and peripapillary structures were significantly higher in glaucoma patients for each measured region (P<0.05).Conclusion: The study evaluated the biomechanical properties of theONandperipapillary structures in vivo withSWEin glaucoma.We observed stifferONand peripapillary tissue in glaucomatous eyes, indicating thatSWEclaimsnewperspectives in the evaluation of ON and peripapillary structures in glaucoma disease.

Background: Shear wave elastography (SWE) is a non-invasive and easily applicable imaging modality, which can provide quantitative information of tissue stiffness. Peritumoral high SWE elasticity values (stiff rim sign) has been reported in many studies. Lysyl oxidase (LOX) enzyme is implicated in the formation of peri-tumoral stiffness. Objectives: The aim of the study was to investigate the correlation between SWE measures with LOX gene expression levels in breast cancer patients. Patients and Methods: Forty sevenwomenwere included in the study. The lesions evaluated by SWE and ultrasound guided tru-cut biopsies were performed from both of the central and peripheral parts. SWE values, LOX family gene expression levels, histopathological features of the lesions, as well as axillary and distant metastasis statuses were evaluated statistically. Results: Thirty of the patients had breast cancer (BC) (the patient group) and 17 of themhad fibroadenoma (the control group). Lysyl oxidase like1 (LOXL1) expression level in BC samples (central parts) were found to be significantly higher than the control group (P = 0. 022). Stiff rim sign was present in all BC lesions and none of the control group. The elastography values of the patient group were significantly higher than the control group statistically (P < 0. 05). There was no statistically significant relationship between LOX, LOXL1, LOXL2 expressions and SWE parameters (P > 0. 05) both for patient and control groups. Conclusion: Although there were no significant correlations between LOX expressions and SWE parameters in our study, axillary and distant metastasis were found to be correlated with SWE features, which emphasized the prognostic potential of SWE.

Background: Hepatic fibrosis is part of chronic liver disorders such as chronic hepatitis, cirrhosis, or metabolic disorders. Twodimensional shear wave elastography (2D SWE) is one of the newest elastography techniques, which enables the assessment of the liver fibrosis in a non-invasive way. Objectives: The aim of the study was to determine how many measurements are necessary to assess liver fibrosis in a healthy population and patients with hepatitis B and C. Methods: We analyzed the retrospective data of 642 patients who underwent the complex ultrasonic abdomen examination and liver 2D SWE examination. We analyzed the statistical differences and the interclass correlation coefficient between the value of the first measurement, the median value of the first three measurements, and the median value of all five measurements. Results: There was no statistical difference between the 2D SWE value of the first measurement and the median value of the first three and the first five measurements in healthy controls. In the group of patients with hepatitis B, the median value of the first five 2D SWE measurements was significantly higher than the value of the first 2D SWE measurement. Our study presented no statistical difference between the median of the first three measurements and the median value of all five measurements in the group of HCV positive patients. The analysis of the assignment to the METAVIR groups with respect to the median value of the first three 2D SWE measurements revealed no statistical difference in comparison with the assignment of patients with respect to the all five 2D SWE measurements of the liver. Conclusions: Depending on the patients’ condition, different numbers of 2D SWE measurements can affect the median values of liver stiffness although they do not affect the assignment to the METAVIR scale.

Background: Elastography is used to determine tissue stiffness. Objectives: The aim of the study was (i) to determine the normal values of liver and splenic stiffness in a pediatric population, (ii) to assess if these values are comparable or not when the linear probe is used, and finally (iii) to assess the impact of potential confounding factors such as age, and gender. PatientsandMethods: This prospective study consists of 97 healthy volunteersbetween6monthsand14 years of age. These volunteers were divided into four groups based on age. The shear wave velocities (SWVs) were obtained from each hepatic lobe and splenic parenchyma by each transducer (linear 9L4 and convex 4C1). Results: Splenic parenchyma values were significantly higher than the liver parenchyma regardless of the probe used (P = 0. 001). There was no statistically significant differences obtained when using the 9L4 probe for both hepatic lobes and the splenic parenchyma under the age of 2 years (P = 0. 352, 0. 898 and 0. 876). The variance was similar in both lobes with the 4C1 probe (t = 0. 6471, non-significant). Whereas, with the 9L4 probe, the variance was slightly higher in the left lobe (t =-4. 16, P = 0. 01). Gender had no effect on SWV (P 0. 1 for all sites). Conclusion: The velocity values obtained from the different parts of the liver and spleen could be used as reference values to enlighten further studies. For children under the age of 2 years, a linear probe could be a better choice for assessing liver and splenic parenchymal tissue stiffness.