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Thứ Tư, 26 tháng 2, 2014

JUM 3-2014




1.    Abstract 1 of 2 Original Research
Shear Wave Elastography for Liver Stiffness Measurement in Clinical Sonographic Examinations
Evaluation of Intraobserver Reproducibility, Technical Failure, and Unreliable Stiffness Measurements
Objectives—The purpose of this study was to determine the optimal minimum number of liver stiffness measurements on shear wave elastography (SWE) and to evaluate the frequency of technical failures and unreliable stiffness measurements and the intraobserver reproducibility of SWE.
Methods—This retrospective study was approved by our Institutional Review Board, and informed consent was waived. From August 2011 to January 2013, 540 patients underwent abdominal sonography, including SWE. In 86 patients (group 1), the minimum number of examinations was determined by comparing the intraclass correlation coefficient (ICC) of subsets of the first 2 to 14 measurements with that from 15 measurements. In 454 patients (group 2), 2 SWE sessions were performed in the right lobe within 1 day. Technical failure was defined as when no or little signal was obtained in the elastogram during the first 5 acquisitions; unreliable SWE results were defined as when the interquartile range/median liver stiffness value exceeded 30%. Intraobserver reproducibility was assessed using ICCs and Bland-Altman plots. 

Results—In group 1, the ICCs did not significantly increase after the first 6 measurements. In group 2, there were technical failures and unreliable results in 47 patients (10.35%) and 74 patients (16.29%), respectively. In 407 patients, after excluding technical failures, there was no significant difference in the median liver stiffness values between the 2 sessions (6.95 versus 6.86 kPa; P > .05). The overall intraobserver reproducibility was excellent (ICC, 0.95).
Conclusions—In this study, the optimal minimum number of SWE measurements was 6, and SWE using 6 measurements showed excellent intraobserver reproducibility.
o    Received March 28, 2013.
o    Revision received May 6, 2013.
o    Accepted June 27, 2013.
o    © 2014 by the American Institute of Ultrasound in Medicine
2.    Abstract 2 of 2 Original Research
Real-time Ultrasound Elastography for Differentiation of Benign and Malignant Thyroid Nodules
A Meta-analysis
Objectives—The clinical challenge of managing thyroid nodules nowadays is to diagnose the minority of malignant disease. Real-time ultrasound elastography, which can measure tissue elasticity, is used as a complement to conventional sonography for improving the diagnosis of thyroid tumors. There are 2 common criteria for evaluating an elastogram: the elasticity score and strain ratio. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ultrasound elastography in differentiating benign and malignant thyroid nodules for elasticity score and strain ratio assessment.
Methods—The MEDLINE, EMBASE, PubMed, and Cochrane Library databases up to January 31, 2013, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random-effects model. The extent and sources of heterogeneity were explored.
Results—A total of 5481 nodules in 4468 patients for elasticity score studies and 1063 nodules in 983 patients for strain ratio studies were analyzed. The overall mean sensitivity and specificity of ultrasound elastography for differentiation of thyroid nodules were 0.79 (95% confidence interval [CI], 0.77–0.81) and 0.77 (95% CI, 0.76–0.79) for elasticity score assessment and 0.85 (95% CI, 0.81–0.89) and 0.80 (95% CI, 0.77–0.83) for strain ratio assessment, respectively. The areas under the curve for the elasticity score and strain ratio were 0.8941 and 0.9285.
Conclusions—These results confirmed those obtained in the previous meta-analysis. Ultrasound elastography has high sensitivity and specificity for identification of thyroid nodules. It is a promising tool for reducing unnecessary fine-needle-aspiration biopsy.
o    Received March 20, 2013.
o    Revision received May 14, 2013.
o    Accepted July 13, 2013.
o    © 2014 by the American Institute of Ultrasound in Medicine

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