Spleen stiffness measurement by shear wave elastography using acoustic radiation force impulse in predicting the etiology of splenomegaly

Abstract

Purpose To measure spleen stiffness by shear wave elastography (SWE) using acoustic radiation force impulse (ARFI) in patients with splenomegaly and to evaluate utility of elastography technique in identifying etiology of splenomegaly. Methods Sixty-one treatment-naïve patients with splenomegaly were enrolled. The control group consisted of 20 healthy subjects without history of any disease including diabetes and hypertension, alcohol consumption, or biochemical or ultrasonographic findings indicating hepatic and renal diseases. B-mode ultrasonography and elastographic examinations were performed by a radiologist blinded to the participants. Spleen stiffness was measured by SWE using ARFI. Shear wave velocity (SWV) values were given in m/s. Results Splenomegaly patients were assigned into three groups according to their etiologies as hepatoportal (n = 21), myeloproliferative (n = 23), and infectious (n = 17). Splenomegaly groups and control group were comparable regarding age and sex. Spleen size was higher in the splenomegaly groups than in the controls. Median SWV was significantly higher in the hepatoportal (3.85 m/s) and myeloproliferative (3.42 m/s) groups than in the infectious (2.66 m/s) and control (2.22 m/s) groups. The correlation between SWV and spleen size was not significant in any of the groups. The cut-off value was 3.42 (sensitivity 80.9%, specificity 56.5%) in distinguishing hepatoportal from myeloproliferative etiology; 3.02 (sensitivity 100%, specificity 100%) in distinguishing hepatoportal from infectious etiology; and 2.84 (sensitivity 91.3%, specificity 88.2%) in distinguishing myeloproliferative from infectious etiology. Conclusion Spleen stiffness measured by elastographic techniques in splenomegaly patients was higher than that in healthy subjects. SWV appeared to be beneficial in predicting the etiology of splenomegaly.

Accuracy of B-mode ultrasound and ARFI elastography in predicting malignancy of splenic lesions in dogs: Preliminary study

“…The increased stiffness observed in malignant splenic lesions in this study may be correlated with different pathological processes, such as type III collagen deposition, areas of brosis or microcalci cations 17 , while benign lesions, such as for example hematomas/clots, are basically formed by red blood cells and brin 30 , causing a decrease in this stiffness, making it even less rigid than in healthy tissue and free from injury.…”

“…For quantitative ARFI evaluation, tissue elasticity was automatically measured using the shear wave velocity (SWV) of the regions of interest (ROIs) de ned by the operator by placing a 2.5 mm² calipter on the elastogram images according to the following criteria: In spleens with one or more circumscribed lesions, at least three ROIs (those necessary to include the entire affected area) were selected from the abnormal area to obtain the mean SWV values, taking care to exclude vascular structures and cystic areas as described previously in evaluations of focal liver lesions in humans 30 . In addition, two ROIs were selected in each of the anatomical regions of the spleen (without apparent abnormalities): cranial extremity, body and caudal extremity to calculate the mean SWV of the apparently healthy tissue as already described in dogs 31 .…”

Accuracy of B-mode ultrasound and ARFI elastography in predicting malignancy of canine splenic lesions

“…The increased stiffness observed in malignant splenic lesions in this study may be correlated with different pathological processes, such as type III collagen deposition, areas of fibrosis or microcalcifications 17 , while benign lesions, such as for example hematomas/clots, are basically formed by red blood cells and fibrin 32 , causing a decrease in this stiffness, making it even less rigid than in healthy tissue and free from injury.…”

“…For quantitative ARFI evaluation, tissue elasticity was automatically measured using the shear wave velocity (SWV) of the regions of interest (ROIs) defined by the operator by placing a 2.5 mm 2 calipter on the elastogram images according to the following criteria: In spleens with one or more circumscribed lesions, at least three ROIs (those necessary to include the entire affected area) were selected from the abnormal area to obtain the mean SWV values, taking care to exclude vascular structures and cystic areas as described previously in evaluations of focal liver lesions in humans 32 . In addition, two ROIs were selected in each of the anatomical regions of the spleen (without apparent abnormalities): cranial extremity, body and caudal extremity to calculate the mean SWV of the apparently healthy tissue as already described in dogs 19 .…”

Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes

“…It is noteworthy that in SWE, the shear waves generated from acoustic radiation in tissues could be accepted by the ultrasound tracking equipment, thus the elastic modulus (E value) and speed of shear-wave velocity (SWV) of the tissue can both be measured, presenting as kilopascals (kPa) and meters per second (m/s), respectively ( 8 , 9 ). For clinical application especially, SWE has been extensively applied in thyroid ( 10 , 11 ), breast ( 12 , 13 ), liver ( 14 , 15 ), and other organs ( 16 – 18 ) due to its effective diagnosis through qualitative and quantitative evaluation of tissue stiffness using color map and SWV ( 1 ). Featured with non-invasive and quick operating, it could be applied especially in LN detection.…”