Highlights • ARFI elastography of the pancreas is feasible . • Shear wave velocities in patients with acute or chronic pancreatitis or carcinoma are higher than those occurring in normal tissue . • ...ARFI values considerable overlap between different pathologies.
Objectives
We compared the interobserver agreement for the recently introduced contrast-enhanced ultrasound (CEUS)-based algorithm CEUS-LI-RADS (Liver Imaging Reporting and Data System) versus the ...well-established magnetic resonance imaging (MRI)-LI-RADS for non-invasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.
Methods
Focal liver lesions in 50 high-risk patients (mean age 66.2 ± 11.8 years; 39 male) were assessed retrospectively with CEUS and MRI. Two independent observers reviewed CEUS and MRI examinations, separately, classifying observations according to CEUS-LI-RADSv.2016 and MRI-LI-RADSv.2014. Interobserver agreement was assessed with Cohen’s kappa.
Results
Forty-three lesions were HCCs; two were intrahepatic cholangiocarcinomas; five were benign lesions. Arterial phase hyperenhancement was perceived less frequently with CEUS than with MRI (37/50 / 38/50 lesions = 74%/78% CEUS; observer 1/observer 2 versus 46/50 / 44/50 lesions = 92%/88% MRI; observer 1/observer 2). Washout appearance was observed in 34/50 / 20/50 lesions = 68%/40% with CEUS and 31/50 / 31/50 lesions = 62%/62%) with MRI. Interobserver agreement was moderate for arterial hyperenhancement (ĸ = 0.511/0.565 CEUS/MRI) and “washout” (ĸ = 0.490/0.582 CEUS/MRI), fair for CEUS-LI-RADS category (ĸ = 0.309) and substantial for MRI-LI-RADS category (ĸ = 0.609). Intermodality agreement was fair for arterial hyperenhancement (ĸ = 0.329), slight to fair for “washout” (ĸ = 0.202) and LI-RADS category (ĸ = 0.218)
Conclusion
Interobserver agreement is substantial for MRI-LI-RADS and only fair for CEUS-LI-RADS. This is mostly because interobserver agreement in the perception of washout appearance is better in MRI than in CEUS. Further refinement of the LI-RADS algorithms and increasing education and practice may be necessary to improve the concordance between CEUS and MRI for the final LI-RADS categorization.
Key Points
• CEUS-LI-RADS and MRI-LIRADS enable standardized non-invasive diagnosis of HCC in high-risk patients.
• With CEUS, interobserver agreement is better for arterial hyperenhancement than for “washout”.
• Interobserver agreement for major features is moderate for both CEUS and MRI.
• Interobserver agreement for LI-RADS category is substantial for MRI, and fair for CEUS.
• Interobserver-agreement for CEUS-LI-RADS will presumably improve with ongoing use of the algorithm.
Background
Microvascularization of the bowel wall can be visualized and quantified non-invasively by software-assisted analysis of derived time-intensity curves.
Purpose
To perform software-based ...quantification of bowel wall perfusion using quantitative contrast-enhanced ultrasound (CEUS) according to clinical response in patients with inflammatory bowel disease treated with vedolizumab.
Material and Methods
In a prospective study, in 18 out of 34 patients, high-frequency ultrasound of bowel wall thickness using color Doppler flow combined with CEUS was performed at baseline and after 14 weeks of treatment with vedolizumab. Clinical activity scores at week 14 were used to differentiate between responders and non-responders. CEUS parameters were calculated by software analysis of the video loops.
Results
Nine of 18 patients (11 with Crohn’s disease and seven with ulcerative colitis) showed response to treatment with vedolizumab. Overall, the responder group showed a significant decrease in the semi-quantitative color Doppler vascularization score. Amplitude-derived CEUS parameters of mural microvascularization such as peak enhancement or wash-in rate decreased in responders, in contrast with non-responders. Time-derived parameters remained stable or increased during treatment in all patients.
Conclusion
Analysis of bowel microvascularization by CEUS shows statistically significant changes in the wash-in-rate related to response of vedolizumab therapy.
OBJECTIVESTwo-dimensional shear-wave elastography (2D-SWE) is an ultrasound-based technique for the noninvasive assessment of tissue stiffness. In contrast to the well-established point-shear-wave ...elastography (pSWE) method acoustic radiation force impulse imaging, there is little evidence on the performance and usefulness of 2D-SWE in the assessment of liver stiffness. Thus, the aim of our study was to compare 2D-SWE versus pSWE.
MATERIALS AND METHODS2D-SWE and pSWE were performed in 20 cirrhotic patients, 20 healthy individuals and an elasticity phantom. Stiffness values, examination time and number of measurements were compared. For 2D-SWE, the influence of size of the region of interest (ROI) was assessed.
RESULTSElastography values in healthy individuals were slightly higher for 2D-SWE versus pSWE (1.4 m/s, range1.21–1.68 vs. 1.23 m/s, range1.07–1.39). In cirrhotic patients, there were no significant differences (3.06 m/s, range1.83–5.35 vs. 3 m/s, range1.67–4.37 m/s). Examination times were significantly longer for 2D-SWE in both patient groups (mean values for healthy/cirrhotic patients129.6/157.1 vs. 75/71.6 s). For 2D-SWE, variation of ROI size (5, 10, 20 mm) produced comparable results. After eight measurements, 90% of cirrhotic patients showed less than 5% of deviation from the results after the gold standard of 10 measurements; for healthy individuals, this was observed after six measurements.
CONCLUSION2D-SWE seems to be comparable to pSWE (acoustic radiation force impulse-imaging) in cirrhotic patients, with slightly higher values in healthy individuals. 2D-SWE measurements require considerably more time. For 2D-SWE, ROI size seems to be of minor importance; multiple measurements should be obtained as single measurements differ. These preliminary results should be confirmed in larger patient collectives with histology as the reference standard.
The polarization observables T,E,P,H, and G in photoproduction of η mesons off protons are measured for photon energies from threshold to W=2400 MeV (T), 2280 MeV (E), 1620 MeV (P,H), or 1820 MeV ...(G), covering nearly the full solid angle. The data are compared to predictions from the SAID, MAID, JüBo, and BnGa partial-wave analyses. A refit within the BnGa approach including further data yields precise branching ratios for the Nη decay of nucleon resonances. A Nη-branching ratio of 0.33±0.04 for N(1650)1/2− is found, which reduces the large and controversially discussed Nη-branching ratio difference of the two lowest mass JP=1/2−-resonances significantly.
AbstractIntroduction.Acoustic Radiation Force Impulse (ARFI) elastography evaluates hepatic fibrosis non-invasively and has been mainly validated in viral hepatitis. Data on rare liver diseases such ...as autoimmune hepatitis (AIH), overlap syndrome, primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC) are sparse. Material and methods. 85 patients (including 31 AIH, 26 PBC, 16 PSC and 3 PSC-and 9 PBC-AIH-overlap syndromes) were retrospectively analysed pointing at ARFI elastography of the liver and the correlation with histologic Ishak fibrosis score (F0-6). Results of shear wave velocities (m/s) were expressed as mean ± standard deviation. Results. The mean shear wave velocity of all 85 patients showed 1.80 ± 0.84 m/s (0.74-3.98). The ARFI elastography values correlated with the degree of fibrosis in all patients overall and in patients with AIH, overlap syndrome and PSC, respectively. The subgroup of 26 patients with PBC (only with Ishak F > 3) revealed no correlation between ARFI and these early fibrosis stages (r = 0.019, p = 0.927). ARFI elastography correlated with bilirubin, AST, but not with patient age, body mass index or measurement depth. The cut-off of 2.04 m/s for detecting cirrhosis (Ishak F > 5) leads to a sensitivity of 90.0% and specificity of 74.7% (AUROC 87.2%). Conclusion. ARFI elastography can evaluate fibrosis in AIH, PSC and PSC-/PBC-AIH-overlap syndrome with good accuracy for the detection of hepatic cirrhosis. Shear wave velocities in PBC should be interpreted with caution in early stages of fibrosis.
The target asymmetry
T
, recoil asymmetry
P
, and beam-target double polarization observable
H
were determined in exclusive
π
0
and
η
photoproduction off quasi-free protons and, for the first time, ...off quasi-free neutrons. The experiment was performed at the electron stretcher accelerator ELSA in Bonn, Germany, with the Crystal Barrel/TAPS detector setup, using a linearly polarized photon beam and a transversely polarized deuterated butanol target. Effects from the Fermi motion of the nucleons within deuterium were removed by a full kinematic reconstruction of the final state invariant mass. A comparison of the data obtained on the proton and on the neutron provides new insight into the isospin structure of the electromagnetic excitation of the nucleon. Earlier measurements of polarization observables in the
γ
p
→
π
0
p
and
γ
p
→
η
p
reactions are confirmed. The data obtained on the neutron are of particular relevance for clarifying the origin of the narrow structure in the
η
n
system at
W
=
1.68
GeV
. A comparison with recent partial wave analyses favors the interpretation of this structure as arising from interference of the
S
11
(
1535
)
and
S
11
(
1650
)
resonances within the
S
11
-partial wave.
The γp→K+Σ0 differential cross section at extremely forward angles was measured at the BGOOD experiment. A three-quarter drop in strength over a narrow range in energy and a strong dependence on the ...polar angle of the K+ in the centre-of-mass of the reaction is observed at a centre-of-mass energy of 1900 MeV. Residing close to multiple open and hidden strangeness thresholds, the structure appears consistent with meson-baryon threshold effects which may contribute to the reaction mechanism.
γ
p
→
K
+
Λ
differential cross sections and recoil polarisation data from threshold for extremely forward angles are presented. The measurements were performed at the BGOOD experiment at ELSA, ...utilising the high angular and momentum resolution forward spectrometer for charged particle identification. The high statistics and forward angle acceptance enables the extraction of the cross section as the minimum momentum transfer to the recoiling hyperon is approached.
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