Search Results (377)

Background/Objectives: Fatigue is the most common systemic manifestation of chronic liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD). Fatigue not only adversely affects quality of life in MASLD patients but also complicates the attainment of therapeutic goals and contributes to a worse prognosis. This study aimed to analyze the relationship between clinically significant fatigue and laboratory parameters reflecting systemic inflammation, liver function, body composition, muscle strength, and blood pressure in patients with MASLD. Methods: A total of 154 patients with a confirmed diagnosis of MASLD were enrolled in this study. All participants underwent anthropometric assessment, laboratory testing, abdominal ultrasonography, and point shear-wave elastography. Muscle strength was evaluated using handgrip strength (GS) measurement and the Five Times Sit-to-Stand Test (5TSTS). Skeletal muscle mass (SMM) was quantified using dual-energy X-ray absorptiometry (DXA). Fatigue was evaluated using the Fatigue Assessment Scale (FAS), with scores ≥ 22 indicating clinically significant fatigue. Results: Patients with FAS scores ≥ 22 exhibited significantly lower hemoglobin levels (p = 0.004) and erythrocyte counts (p = 0.011), along with a significantly elevated erythrocyte sedimentation rate (ESR; p = 0.002) and C-reactive protein level (CRP; p = 0.007). Furthermore, MASLD patients with FAS scores ≥ 22 demonstrated significantly reduced relative grip strength (p = 0.012) and took longer to complete the 5TSTS (p = 0.011). Additionally, these patients had higher maximum systolic and diastolic blood pressure values compared to those with FAS scores < 22 (p = 0.028 and p = 0.019, respectively). Conclusions: These findings underscore the multifactorial nature of fatigue in MASLD and highlight the need for a comprehensive management strategy. Such a strategy should include dietary modification, increased physical activity, targeted treatment of systemic manifestations of MASLD, and appropriate management of comorbidities. Full article

Background/Objectives: A varicocele is a common, treatable cause of male infertility involving testicular alterations. Shear wave elastography (SWE) is a noninvasive imaging technique that may detect testicular changes. This study aimed to assess the testicular volume and stiffness (using SWE), compare them with healthy controls, and examine the associations with venous diameter and semen parameters. Methods: This prospective comparative study included 69 patients with a varicocele and 76 healthy controls. The testicular stiffness and volume were measured and compared among three groups: testes with a varicocele (Group A), contralateral healthy testes of the same patients (Group B), and testes of healthy individuals (Group C). In varicocele patients, the semen analysis results were compared with testicular stiffness and volume. The statistical analyses included an ANOVA, Kruskal–Wallis tests, a correlation analysis, and a receiver operating characteristic curve analysis. Results: Group A showed a significantly lower testicular volume compared to Group B (p = 0.004) and Group C (p < 0.001), and significantly higher SWE values compared to both groups (p < 0.001). No significant differences were observed between Group B and Group C (volume: p = 0.642; SWE: p = 0.094). In oligospermic varicocele patients, the testicular stiffness tended to be higher, though the difference was not significant (p = 0.051). The correlations between the testicular stiffness and volume (Group A: p = 0.488; Group B: p = 0.872; Group C: p = 0.222), between the venous diameter and stiffness (p = 0.067), and between the venous diameter and testicular volume (p = 0.245) were not statistically significant. The SWE cut-off value of 9.26 kPa provided a sensitivity of 73.1% (95% CI: 62.3–81.7%) and a specificity of 79.6% (95% CI: 72.5–85.2%) for identifying varicoceles. Conclusions: Varicoceles are associated with an increased testicular stiffness and a decreased volume, which may indicate possible structural parenchymal alterations. Shear wave elastography appeared to be capable of noninvasively detecting these changes and may have potential as a quantitative adjunct tool for evaluating testicular parenchymal changes in varicocele patients. However, further studies are required to validate these preliminary findings. Full article

Background/Objectives: Differentiating between benign and malignant cervical lymph nodes (LNs) is a critical challenge in the clinical setting. We assessed the ability of shear wave elastography (SWE) to distinguish between lymphomas and solid tumor metastases presenting as cervical adenopathy. Methods: We performed a single-center, prospective, observational study in adults with clinically suspicious cervical lymph nodes. The ultrasound examination included conventional ultrasound and SWE with quantitative assessment (tissue stiffness in kPa). Pathology examination was the definitive confirmation method. Simple univariate binary logistic regression and multiple univariate binary logistic regression were used. Results: The maximum shear wave velocity (SWV) in patients with benign pathologies was 35 kPa, lower than the minimal values for lymphoma (40 kPa) and metastases (50 kPa). Furthermore, squamous cell carcinoma and distant metastases were more prevalent among men. Independent from other factors used in the statistical model, we found a positive association between sex and the presence of metastatic lymph nodes. Finally, each 1 kPa from SWE measurement was associated with a 3% increase in the risk for LNs to present metastatic adenopathy. Conclusions: This study highlights the potential of SWE for the preoperative assessment of nodal status in patients with various malignancies affecting the head and neck region, thyroid, and other areas. Full article

Background/Objectives: Accurate diagnosis of thyroid cancer is critical but challenging due to overlapping ultrasound (US) features of benign and malignant nodules. This study aimed to evaluate the diagnostic performance of non-invasive and minimally invasive US techniques, including B-mode US, shear wave elastography (SWE), color Doppler, superb microvascular imaging (SMI), and TI-RADS, in patients with suspected thyroid lesions and to assess their reliability and cost effectiveness compared with fine needle aspiration (FNA) biopsy. Methods: A prospective, single-center study (October 2023–February 2025) enrolled 300 patients with suspected thyroid cancer at a Spanish tertiary hospital. Of these, 296 patients with confirmed diagnoses underwent B-mode US, SWE, Doppler, SMI, and TI-RADS scoring, followed by US-guided FNA and Bethesda System cytopathology. Lasso-penalized logistic regression and a bootstrap analysis (1000 replicates) were used to develop diagnostic models. A utility function was used to balance diagnostic reliability and cost. Results: Thyroid cancer was diagnosed in 25 patients (8.3%). Elastography combined with SMI achieved the highest diagnostic performance (Youden index: 0.69; NPV: 97.4%; PPV: 69.1%), outperforming Doppler-only models. Intranodular vascularization was a significant risk factor, while peripheral vascularization was protective. The utility function showed that, when prioritizing cost, elastography plus SMI was cost effective (α < 0.716) compared with FNA. Conclusions: Elastography plus SMI offers a reliable, cost-effective diagnostic rule for thyroid cancer. The utility function aids clinicians in balancing reliability and cost. SMI and generalizability need to be validated in higher prevalence settings. Full article

Background: Plantar fasciitis (PF) is a common enthesopathy in patients with ankylosing spondylitis (AS). Shear wave elastography (SWE) and the Belgrade ultrasound enthesitis score (BUSES) may detect PF, but their comparative diagnostic performance is unclear. Objective: To compare SWE with the BUSES for identifying PF in individuals with and without AS. Methods: In this cross-sectional study, 96 participants were stratified into AS and non-AS populations, each further divided based on the presence or absence of clinical PF. Demographic data, the American Orthopedic Foot and Ankle Society Score (AOFAS), and the BASDAI score were recorded. All subjects underwent grayscale ultrasonography, the BUSES scoring, and SWE assessment of the plantar fascia. Logistic regression models were constructed for each population, controlling for age, body mass index (BMI), and fascia–skin distance. ROC curve analyses were performed to evaluate diagnostic accuracy. Results: In both AS and non-AS groups, SWE and the BUSES were significant predictors of PF (p < 0.05). SWE demonstrated slightly higher diagnostic accuracy, with area under the curve (AUC) values of 0.845 (AS) and 0.837 (non-AS), compared to the BUSES with AUCs of 0.785 and 0.831, respectively. SWE also showed stronger adjusted odds ratios in regression models. The interobserver agreement was good to excellent for both modalities. Conclusions: Both SWE and the BUSES are effective for PF detection, with SWE offering marginally superior diagnostic performance, particularly in AS patients. SWE may enhance the early identification of biomechanical changes in the plantar fascia. Full article

Varicocele is a common, potentially correctable condition associated with impaired male fertility. Despite being frequently encountered in clinical andrology, its pathophysiological mechanisms, diagnostic criteria, and therapeutic approaches remain areas of active investigation and debate. The authors conducted a comprehensive literature search, using the PubMed database, covering clinical studies, systematic reviews, meta-analyses, and current international guidelines from the past ten years. Emphasis was placed on studies investigating novel diagnostic modalities, therapeutic innovations, and prognostic markers. Emerging evidence supports the multifactorial pathophysiology of varicocele, involving oxidative stress, hypoxia, inflammatory pathways, and potential genetic predisposition. Biomarkers, including microRNAs, antisperm antibodies, and sperm DNA fragmentation, offer diagnostic and prognostic utility, though their routine clinical implementation requires further validation. Advances in imaging, such as shear wave elastography, may improve diagnostic accuracy. While microsurgical subinguinal varicocelectomy remains the gold standard, technological refinements and non-surgical alternatives are being explored. Indications for treatment have expanded to include selected cases of non-obstructive azoospermia, hypogonadism, and optimization for assisted reproduction, though high-level evidence is limited. Full article

Background: Seiza, a traditional sitting posture requiring deep ankle plantarflexion and knee flexion, often becomes difficult after ankle fracture surgery because of restricted mobility. Increased stiffness of the tibialis anterior (TA) muscle, particularly in its deep and superficial fibres, may limit plantarflexion and affect functional recovery. This study aimed to investigate the relationship between TA muscle stiffness, assessed using shear wave elastography (SWE), and the ability to assume the seiza posture after ankle fracture surgery. We also sought to determine whether the stiffness in the deep or superficial TA fibres was more strongly correlated with seiza ability. Methods: In this cross-sectional study, 38 patients who underwent open reduction and internal fixation for ankle fractures were evaluated 3 months postoperatively. Seiza ability was assessed using the ankle plantarflexion angle and heel–buttock distance. The shear moduli of the superficial and deep TA fibres were measured using SWE. Ankle range of motion, muscle strength, and self-reported seiza pain were also measured. Multiple linear regression was used to identify the predictors of seiza performance. Results: The shear moduli of both deep (β = −0.454, p < 0.001) and superficial (β = −0.339, p = 0.017) TA fibres independently predicted ankle plantarflexion angle during seiza (adjusted R², 0.624). Pain during seiza was significantly associated with reduced plantarflexion, whereas muscle strength was not a significant predictor. Conclusions: TA muscle stiffness, especially in the deep fibres, was significantly associated with limited postoperative seiza performance. Targeted interventions that reduce deep TA stiffness may enhance functional outcomes. Full article

Background/objectives: Polycystic ovary syndrome (PCOS) and metabolic dysfunction-associated steatotic liver disease (MASLD) are common co-morbidities in women of reproductive age. PCOS is highly heterogeneous and is, therefore, divided into four phenotypes. MASLD leads to numerous systemic complications. Studies to date have shown an association between PCOS and MASLD. This study was designed to compare the FIB-4 score (based on age, alanine aminotransferase, aspartate aminotransferase and platelet count) and the results of shear wave elastography in assessing the risk of developing MASLD by patients with PCOS divided by phenotypes. Methods: The study enrolled 242 women age 18–35 years with PCOS diagnosed according to Rotterdam criteria, hospitalized at the Department of Gynaecological Endocrinology of the University Clinical Centre in Katowice. The study subjects were assigned to phenotypes A to D. Clinical and biochemical assessments were performed (including androgens and metabolic parameters), and the FIB-4 index was calculated. Liver fibrosis was evaluated by shear wave elastography. To balance the group sizes of phenotypes, oversampling with replacement was applied (PROC SURVEYSELECT, SAS), increasing the number of observations for phenotypes B, C, and D fivefold. Statistical analyses were performed based on data distribution (Shapiro–Wilk test), using ANOVA or the Kruskal–Wallis test with Dunn’s correction. Statistical significance was set at p < 0.05. Results: The FIB-4 score was the highest in phenotype B patients (0.50 ± 0.15), and the lowest in phenotypes A and C (0.42 ± 0.14). The highest rate of positive elastography findings was recorded in phenotype A patients (34.7%) and the lowest in phenotype C group (13.5%). Significant differences between the phenotypes were also found in terms of androgen levels, insulin, HOMA-IR, and the lipid profile. Among patients with positive elastography, the highest FIB-4 scores were recorded in phenotype C group (0.44 ± 0.06), but the differences between the phenotypes were not statistically significant. Conclusions: The FIB-4 score was the highest in phenotype B patients and differed significantly from phenotypes A, C and D. In the elastography exam, the fibrosis index was statistically significantly higher in phenotype A compared to other phenotypes. No correlation was detected between the FIB-4 index and positive elastography. The findings suggest that the FIB-4 index may be used for MASLD screening, but its usefulness as a predictor of eligibility for elastography requires more research. Full article

Background: Transient elastography (TE), using Fibroscan^® and point shear wave elastography (pSWE), are two techniques used to estimate liver fibrosis. The aim of our study was to compare, for the first time, these two techniques in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), stratifying the analysis on the basis of the grades of steatosis. Methods: We recruited 85 consecutive MAFLD patients who underwent liver stiffness (LS) measurement performed by Fibroscan^® and pSWE on the same day. Severity of steatosis was estimated by Fibroscan^® and expressed as controlled attenuation parameter (CAP), ranging from S0 to S3. Spearman’s “r” coefficient was used to calculate the correlation and Bland–Altman graphs was used to evaluate the agreement. Results: In general, the correlation and agreement between Fibroscan^® and pSWE were substantial (r = 0.66, p < 0.001 and bias= −0.64 ± 2.48, respectively). When data were analyzed according to the grade of steatosis, an increasing significant correlation was observed going from S0 to S2 (r = 0.79, r = 0.81, and r = 0.85, respectively), whereas a low correlation and agreement were observed for S3 patients (r = 0.48, p = 0.003, bias= −0.95 ± 2.51). Conclusions: Fibroscan^® and pSWE are equivalent techniques to estimate liver fibrosis in patients with mild to moderate steatosis, while in presence of severe steatosis their agreement is low. Full article

Objective: To determine reference values of liver stiffness during the first week of extrauterine life in healthy newborns, according to gestational age, sex, and birth weight, using three elastography techniques: point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) with convex and linear probes. Materials and Methods: This was a cross-sectional observational study conducted at a single center on a hospital-based cohort of 287 newborns between 24 and 42 weeks of gestation, admitted between January 2023 and May 2024. Cases with liver disease, significant neonatal morbidity, or technically invalid studies were excluded. Hepatic elastography was performed during the first week of life using pSWE and 2D-SWE with both convex and linear probes. Clinical and technical neonatal variables were recorded. Liver stiffness values were analyzed in relation to gestational age, birth weight, and sex. Linear regression models were applied to assess associations, considering p-values < 0.05 as statistically significant. Results: After applying exclusion criteria, valid liver stiffness measurements were obtained in 208 cases with pSWE, 224 with 2D-SWE (convex probe), and 222 with 2D-SWE (linear probe). A statistically significant inverse association between liver stiffness and gestational age (p < 0.03) was observed across all techniques except for 2D-SWE with the linear probe. Only 2D-SWE with the convex probe showed a significant association with birth weight. No significant differences were observed based on neonatal sex. The 2D-SWE technique with the convex probe demonstrated significantly shorter examination times compared to pSWE (p < 0.001). Conclusions: Neonatal liver stiffness measured by pSWE and 2D-SWE with a convex probe shows an inverse correlation with gestational age, potentially reflecting the structural and functional maturation of the liver. These techniques are safe, reliable, and provide useful information for distinguishing normal findings in preterm neonates from early hepatic pathology. The values obtained represent a valuable reference for clinical hepatic assessment in the neonatal period. Full article

Background: The relationship between spleen and bone marrow stiffness, and other features of abnormal myeloproliferation has long been described. However, the scientific knowledge in this area remains very superficial. This review evaluated the diagnostic effectiveness of various ultrasound (US) methods in the assessment of neoplastic myeloproliferation using spleen stiffness measurement (SSM). Aim: To explore the diagnostic accuracy of US techniques in assessing spleen stiffness, determining which of them may be suitable for the diagnosis of myeloproliferative diseases in adults. Methods: The review included original retrospective or prospective studies published in the last five years (2019–2024) in peer-reviewed medical journals that reported receiver operating characteristics (ROCs) for SSM and the articles concerning the relation between SSM values and neoplastic myeloproliferation. The studies were identified through PubMed searches on 1 July and 1 December 2024. Quality was assessed using the QUADAS-2 tool. Results were tabulated according to the diagnostic method separately for myeloproliferative neoplasms (MNs) and for other clinical findings. Results: The review included 52 studies providing ROCs for SSM or compatibility between operators, and five studies covering the relation between SSM values and MNs. Conclusions: Acoustic radiation force impulse (ARFI), two-dimensional shear wave elastography (2D-SWE), transient elastography (TE), and point shear wave elastography (p-SWE) are promising methods for measuring SSM that can be incorporated into the diagnosis, screening, and monitoring system in MNs. Full article

Background/Objectives: Esophageal varices (EVs) are a serious complication of liver cirrhosis. Guidelines for cirrhosis/chronic liver diseases (CLDs) do not specify a follow-up period or the need for esophagogastroduodenoscopy (EGD). EGD is a useful but uncomfortable procedure for the assessment of varices. Follow-up with abdominal ultrasonography (AUS) is recommended in patients with CLDs. If EVs are assessed by AUS, more patients eligible for endoscopic screening of EVs can be selected. We aimed to investigate whether AUS elastography [shear wave (Vs) and F-index] can predict the diagnosis, severity, and treatment indication of EVs. Methods: Between April 2018 and October 2022, we retrospectively collected data of 194 patients who underwent elastography and EGD for CLDs. The correlations between Vs/F-index values and presence/severity of EVs were evaluated. Each cut-off value for diagnosis and treatment indication of EVs was investigated. Results: 85 patients without exclusion criteria were enrolled. Vs and F-index values were significantly higher in patients with EVs than in patients without EVs (p = 0.0005 and 0.0021, respectively) and positively correlated with severity of EVs. The cut-off Vs and F-index values for the presence of EVs were 1.63 m/s and 1.88, respectively, with 88.1%/83.3% sensitivity, 48.8%/51.2% specificity, and 0.71/0.70 area under the curve (AUC). The cut-off Vs and F-index values for treatment indication were 1.71 m/s and 2.08, respectively, with 100%/88.2% sensitivity, 45.6%/52.9% specificity, and 0.69/0.70 AUC. There were no significant differences between the two modalities. Conclusions: Elastography may provide objective assessment and thus be a non-invasive screening tool for diagnosis and treatment indication of EVs. Full article

Background and Aims: Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease frequently associated with fatigue and mild cognitive impairment. Brain-derived neurotrophic factor (BDNF) plays key roles in neuroplasticity, immune regulation, and metabolism. This study aimed to evaluate plasma BDNF levels in early-stage PBC and examine their clinical and biochemical associations. Methods: In this observational study, plasma BDNF, IL-6, and IL-18 concentrations were measured by ELISA in 45 patients with early-stage PBC and 31 age- and sex-matched healthy controls (mean age 60.5 years; 96% women). All participants underwent liver elastography using point shear wave elastography (ElastPQ), Doppler ultrasound, laboratory testing, and assessment of cognitive function (PHES) and fatigue severity (MFIS). Non-invasive fibrosis scores (APRI, FIB-4) were calculated. Results: Median plasma BDNF concentrations were significantly higher in PBC patients than in controls [median: 21.04 ng/mL (IQR: 10.68–38.07) vs. 5.80 ng/mL (IQR: 4.58–7.54); p < 0.0001]. In PBC patients, higher BDNF levels correlated inversely with liver stiffness measured by ElastPQ (R = −0.39, p = 0.0258), spleen dimensions, splenic vein flow volume (R = −0.49, p = 0.0018), suggesting an association with milder liver fibrosis and early hemodynamic alterations. A trend toward association between BDNF and IL-6 levels was observed in multivariate analysis. No significant associations were found between BDNF concentrations and markers of hepatocellular injury, cognitive performance, or fatigue severity. Conclusions: Plasma BDNF concentrations are elevated in early-stage PBC and inversely correlate with liver fibrosis severity. No significant associations were found with hepatocellular injury, cognitive function, or fatigue. These findings suggest that BDNF may play a protective role against hepatic fibrogenesis, or alternatively, that BDNF concentrations may decline with advancing liver disease. Further studies are needed to clarify its significance in PBC. Full article

Soft tissue tumors (STTs) are a heterogeneous group of mesenchymal neoplasms requiring accurate differentiation for optimal patient management. While histopathology remains the gold standard, imaging plays a crucial role in non-invasive assessment. Multiparametric ultrasound (mpUS) has emerged as a promising, cost-effective alternative to MRI, integrating B-mode, color and power Doppler, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) to provide comprehensive morphological, vascular, and biomechanical insights. Each modality offers distinct yet complementary diagnostic value, enhancing accuracy and potentially reducing unnecessary biopsies. This narrative review aims to serve as a practical guide, providing a readily accessible reference for mpUS parameters useful in the differential diagnosis of soft tissue tumors. Full article

Medical phantoms are essential to imaging calibration, clinician training, and the validation of therapeutic procedures. However, most ultrasound phantoms prioritize acoustic realism while neglecting the viscoelastic and anisotropic properties of fibrous soft tissues. This gap limits their effectiveness in modeling realistic biomechanical behavior, especially in wave-based diagnostics and therapeutic ultrasound. Current materials like gelatine and agarose fall short in reproducing the complex interplay between the solid and fluid components found in biological tissues. To address this, we developed a soft, anisotropic composite whose dynamic mechanical properties resemble fibrous biological tissues such as skin and skeletal muscle. This material enables wave propagation and vibration studies in controllably anisotropic media, which are rare and highly valuable. We demonstrate the tunability of damping and stiffness aligned with fiber orientation, providing a versatile platform for modeling soft-tissue dynamics and validating biomechanical simulations. The phantoms achieved Young’s moduli of 7.16–11.04 MPa for skin and 0.494–1.743 MPa for muscles, shear wave speeds of 1.51–5.93 m/s, longitudinal wave speeds of 1086–1127 m/s, and sound absorption coefficients of 0.13–0.76 dB/cm/MHz, with storage, loss, and complex moduli reaching 1.035–6.652 kPa, 0.1831–0.8546 kPa, and 2.138–10.82 kPa. These values reveal anisotropic response patterns analogous to native tissues. This novel natural fibrous composite system affords sustainable, low-cost ultrasound phantoms that support both mechanical fidelity and acoustic realism. Our approach offers a route to next-gen tissue-mimicking phantoms for elastography, wave propagation studies, and dynamic calibration across diverse clinical and research applications. Full article