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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 17207

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Special Issue Editors

Prof. Dr. Ioana Mozos

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Guest Editor

Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
Interests: pathophysiology; arterial stiffness; elastography; cardiovascular research; liver disease; renal disease; risk assessment

Prof. Dr. Dana Stoian

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Guest Editor

Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
Interests: endocrinology; elastography; viscosity; contrast-enhanced ultrasound; multiparametric evaluation; thyroid disease; renal disease; liver fibrosis; hyperparathyroidism
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Special Issue Information

Dear Colleagues,

Elastography estimates elastic restoring forces generated in the tissues in response to applied shear stress. Hard tissues are displaced less than soft tissues, and these tissue displacements can be measured by elastography, which provides qualitative and quantitative information about tissue stiffness. It has been successfully validated in many clinical areas, including breast tumors, liver fibrosis, thyroid nodules, testicular cancer, primary hyperparathyroidism, renal and salivary gland disorders. This Special Issue aims to gather the most recent research about mechanisms explaining elastography changes in different diseases and the role of elastography in the differential diagnosis of superficial disorders, to establish the different diagnostic power of integrated elastography in the risk assessment algorithms, to compare strain elastography versus monoplane and biplane shear wave elastography and to assess the predictive value of elastography.

Topics for this Special Issue include but are not limited to the following:

the role of elastography in the differential diagnostic of superficial injuries: thyroid nodules, soft tissue tumors, parathyroid injuries, prostate tumors, endocervical injury
the diagnostic power of integrated elastography in the conventional risk assessment algorithms
comparison of strain elastography versus monoplane and biplane shear wave elastography
elastography as predictive method by itself, or associated with conventional ultrasound information
elastography in liver and kidney disorders
elastography in breast and testicular cancer
elastography in salivary gland disorders

Prof. Dr. Ioana Mozos
Prof. Dr. Stoian Dana
Guest Editors

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Keywords

cancer risk prediction
strain elastography
shear wave elastography
thyroid nodules
risk assessment algorithms
liver fibrosis
renal disorders

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Published Papers (6 papers)

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Research

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11 pages, 2064 KiB

Open AccessArticle

Renal Acoustic Radiation Force Impulse Elastography in Hypertensive Nephroangiosclerosis Patients

by Alexandru Caraba, Andreea Munteanu, Stela Iurciuc and Mircea Iurciuc

Appl. Sci. 2021, 11(22), 10612; https://doi.org/10.3390/app112210612 - 11 Nov 2021

Cited by 1 | Viewed by 1894

Abstract

Objective: Hypertensive nephroangiosclerosis (HN) represents the second most common cause of chronic kidney disease. Kidney damage secondary to high blood pressure favors the appearance of serum and urinary changes, but also imaging, highlighted by ultrasonography (B-mode, Doppler, Acoustic Radiation Force Impulse Elastography). Acoustic Radiation Force Impulse Elastography (ARFI) represents a new imagistic method which characterizes renal stiffness in the form of shear wave velocity (SWV). Aim: This study aims to investigate renal stiffness in HN patients, and to assess the correlations between it and urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and intrarenal resistive index (RRI). Material and Methods: This cross-sectional study was performed on a group of 80 HN patients and 50 healthy, sex and age-matched, as controls. UACR (urinary immunoturbidimetry), eGFR (Jaffe method), RRI, and renal SWV (Siemens Acuson 2000) were determined in all patients and controls. Data were expressed as mean ± standard deviation. Statistical analysis was done by means Pearson’s test and t-Student test, p values of less than 0.05 were considered statistically significant. Results: UACR, eGFR, RRI and SWV showed statistically significant differences between the HN patients and controls (p < 0.0001). In the hypertensive patients group, statistically significant correlations were observed between the SWV and UACR (r = −0.7633, p < 0.00001), eGFR (r = 0.7822, p = 0.00001), and RRI (r = −0.7978, p = 0.00001). Conclusions: Kidney sonoelastography characterizes imagistically the existence of intrarenal lesions associated with essential hypertension, offering a new diagnosis method for these patients. Full article

(This article belongs to the Special Issue Elastography and Applications)

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12 pages, 599 KiB

Open AccessArticle

Diagnostic Value of Different Risk-Stratification Algorithms in Solid Breast Lesions

by Ivana Eremici, Catalin Dumitru, Dan Navolan, Marius Craina, Viviana Ivan, Florin Borcan, Cristina Adriana Dehelean, Ioana Mozos and Dana Stoian

Appl. Sci. 2020, 10(19), 6943; https://doi.org/10.3390/app10196943 - 4 Oct 2020

Cited by 4 | Viewed by 2296

Abstract

In the past few years, elastography has gained ground as a complementary method to ultrasonography in noninvasive breast cancer screening. Despite positive outcomes, there is a further need to refine the method, especially regarding BIRADS scores 3 and 4A, where the distinction between benignancy and malignancy is established. The aim of the present study was to evaluate the best risk-stratification system using both qualitative and semiquantitative elastographic methods for solid breast nodules. A total of 1405 solid nodules, described in 657 female patients, were examined in our endocrine unit between January 2018 and December 2019. The inclusion criterion for our retrospective study was the presence of any solid breast mass in women of all ages (mean, 40.85 ± SD 27.11), detected during ultrasound examination using a HITACHI PREIRUS machine (Hitachi Medical Corporation, Tokyo, Japan). The Breast Imaging Reporting and Data System (BIRADS)–US criteria were used in the assessment of each nodule by conventional US (gray-scale mode) and Doppler evaluation. The Ueno score and strain ratio were also measured for all the described lesions. We considered multiple algorithms for the risk reassessment of solid breast nodules: classical BIRADS–US, EFSUMB BIRADS, worst-case scenario BIRADS and BIRADS TM. There were 93 malignant nodules out of 1405. The diagnosis was based on histopathological results for all the malignant lesions. Benign lesions were diagnosed based on histopathological results, Tru-Cut biopsy, mammography and MRI. The Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy (Acc) were obtained for all the proposed risk-stratification reporting systems: conventional BIRADS-US (Se, 74.23%; Sp, 63.95%; PPV, 13.53%; NPV, 97.79%; Acc, 65%); EFSUMB BIRADS (Se, 71.23%; Sp, 81.55%; PPV, 22.68%; NPV, 97.99%; Acc, 81%); worst-case scenario BIRADS (Se, 84.23%; Sp, 58.23%; PPV, 13.29%; NPV, 98.84%; Acc, 60%); BIRADS TM (Se, 81.23%; Sp, 75.84%; PPV, 20.35%; NPV, 98.81%; Acc, 77%). We found that the most efficient risk-stratification reporting system was the proposed one, BIRADS TM, which considers both upgrading and downgrading the conventional BIRADS-US, followed by the worst-case scenario BIRADS and EFSUMB BIRADS. Full article

(This article belongs to the Special Issue Elastography and Applications)

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13 pages, 6677 KiB

Open AccessFeature PaperArticle

Thyroid Multimodal Ultrasound Evaluation—Impact on Presurgical Diagnosis of Intermediate Cytology Cases

by Andreea Borlea, Dana Stoian, Laura Cotoi, Ioan Sporea, Fulger Lazar and Ioana Mozos

Appl. Sci. 2020, 10(10), 3439; https://doi.org/10.3390/app10103439 - 16 May 2020

Cited by 6 | Viewed by 2567

Abstract

Fine needle aspiration (FNA) is recommended as the final evaluation in diagnosing thyroid nodules. Intermediate cytology is observed in about 15%–25% of the FNA results and has divergent recommendations: follow-up or surgery, either hemi- or total thyroidectomy. The present study aimed to assess the benefit of multimodal ultrasound (US) evaluation in clarifying the attitude in cases with intermediate cytology on FNA. Sixty-four successive cases with Bethesda III or IV cytology results were evaluated using two-dimensional B-mode US (2B), qualitative strain elastography, as well as planar and volumetric (3D) color Doppler using both a linear multifrequency probe and a linear volumetric probe (Hitachi Preirus Machine, Hitachi Inc. Japan). The analyzed nodules were all categorized as low, intermediate, or high risk, based on the following US criteria: taller-than-wide shape, marked hypoechogenicity, irregular borders, inhomogeneity, microcalcifications, or the presence of suspicious adenopathy. Elastographic criteria included stiff lesions, while volumetric Doppler criteria included moderate and marked perinodular vascularization, as suspicious for malignancy. The gold standard for the analysis was the result of the pathology report after thyroidectomy. Our results showed that the prevalence of cancer was 25% (16 cases). In five cases, borderline follicular neoplasia was identified, group which requires watchful waiting. These lesions were also considered as malignant in the final analysis, with a total number of 21 neoplasm cases. Sixteen of the 21 malignant nodules presented with high stiffness, while 15/21 had increased perinodular vascularization. Eight of the 21 cases displayed both important stiffness and perinodular vascularization. Cancer prevalence increased both with severity of stiffness (9.0%–15.0%–66.6%–80.0%) and intensity of vascularization in the adjacent perinodular parenchyma (18.2%–27.7%–35.29%–50.0%). Combining the use of grayscale US, elastography, and 3D Doppler in the evaluation of intermediate cytology cases showed a sensitivity of 85.7%, a specificity of 88.3%, and an accuracy of 90.3% in detecting thyroid cancer cases. We can conclude that the identification of highly suspicious US characteristics observed in 2B, qualitative elastography, and volumetric Doppler increases the risk of malignancy. Full article

(This article belongs to the Special Issue Elastography and Applications)

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Review

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11 pages, 1843 KiB

Open AccessReview

Renal Ultrasound Elastography: A Review of the Previous Reports on Chronic Kidney Diseases

by Takuji Iyama, Takaaki Sugihara, Tomoaki Takata and Hajime Isomoto

Appl. Sci. 2021, 11(20), 9677; https://doi.org/10.3390/app11209677 - 17 Oct 2021

Cited by 8 | Viewed by 3670

Abstract

The early detection of a kidney injury is essential to protect against the progression of kidney damage owing to the progressive nature of chronic kidney disease. A renal biopsy is the gold standard for the assessment of pathological alterations such as interstitial fibrosis and glomerulosclerosis. However, there are concerns regarding potential complications including bleeding and a reduction in renal function. Ultrasound elastography is an ideal modality for assessing the alterations in various organs and diagnosing malignant tumors. This technique has the potential to help detect early changes in renal function and pathological alterations. However, the careful application and interpretation of this technique in the kidney is required because of its complex hemodynamics and architecture. Shear wave elastography is the most widely investigated technique among ultrasound elastography. This review aims to summarize the previous investigations of the kidney using shear wave elastography, particularly for renal malignancy, kidney transplantation, and chronic kidney disease. Additionally, we have highlighted the influencing factors concerning the practical measurement of renal elasticity. Full article

(This article belongs to the Special Issue Elastography and Applications)

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24 pages, 8990 KiB

Open AccessReview

Elastography—A Bona Fide Non-Invasive Method for Assessing Non-Alcoholic Fatty Liver Disease in Children

by Cristina Oana Mărginean, Lorena Elena Meliț and Maria Oana Săsăran

Appl. Sci. 2021, 11(7), 3240; https://doi.org/10.3390/app11073240 - 4 Apr 2021

Cited by 4 | Viewed by 3206

Abstract

Pediatric obesity has become a major public health problem worldwide, resulting in a wide spectrum of systemic complications. Liver disease associated with obesity, also known as nonalcoholic fatty liver disease (NAFLD), is currently the most common chronic liver condition in children. Therefore, its timely and proper diagnosis is essential for preventing further development of cirrhosis. Multiple studies focused on identifying the most accurate non-invasive diagnostic method for liver fibrosis or cirrhosis. Although liver biopsy remains the gold-standard in terms of this hepatopathy, elastography methods emerged as a relatively reliable alternative to liver biopsy. Thus, recent studies revealed the great importance of these non-invasive methods not only in diagnosing pediatric NAFLD, but also in its staging. MRE is commonly considered to have a greater accuracy than ultrasound-based elastography methods, but with lower availability and higher costs. Ultrasound-based elastography methods (transient elastography (TE), p-SWE, and 2-dimensional shear wave elastography (2D-SWE)) were proved to have similar accuracy in NAFLD staging. Nevertheless, multiple confounding factors account for potential challenges when using elastography for liver stiffness measurement, such as age, obesity itself (i.e., BMI), transaminase levels, or portal flow. A potential solution for facing these challenges might be represented by a complex approach based on the combination between elastography, clinical and laboratory findings. Although the studies that assessed the role of elastography in pediatric NAFLD staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy. Therefore, elastography might become a cornerstone in staging pediatric NAFLD. Full article

(This article belongs to the Special Issue Elastography and Applications)

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Other

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13 pages, 878 KiB

Open AccessSystematic Review

Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis

by Felix-Mihai Maralescu, Milena Chiodan, Alexandru Sircuta, Adalbert Schiller, Ligia Petrica and Flaviu Bob

Appl. Sci. 2022, 12(5), 2359; https://doi.org/10.3390/app12052359 - 24 Feb 2022

Cited by 10 | Viewed by 2532

Abstract

Background: We require an quantitative imaging technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in recent years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic. Methods: The databases of PubMed, Medscape, Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (SWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results, and outcome data were all collected from each study according to a set protocol. Results: We found 37 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of kidney SWS between studies we found increased heterogeneity Q = 513.133; DF = 10; p < 0001, I² (inconsistency) = 98.12% (95% CI for I² 97.52–98.57%). With a standardized mean difference of −0.216, patients with CKD have a lower kidney SWS than healthy controls. A positive association between kidney SWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, p < 0.001), Q = 73.3, DF = 5, p < 000.1, I² = 93.18% (95% CI for I² 87.86 to 96.18). The pooled area under the ROC curve for kidney SWS to predict chronic kidney disease was 0.831 (95% CI, p < 0.001), Q = 28.32, DF = 6, p = 0.0001, I² = 78.8% (95% CI for I² 56.37 to 89.72). In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve (AUC) values are used to compare distinct characteristics (differentiating kidney SWS between mildly and moderately impaired kidneys, between non-diabetic/prediabetic/diabetic patients, or kidney SWS between the CKD and control group), therefore not being suitable for further evaluation. Conclusions: The results show that patients with CKD have a lower kidney SWS than healthy controls. However, the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity. Further research is needed to determine which factors actually influence kidney SWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice. Full article

(This article belongs to the Special Issue Elastography and Applications)

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