Two-dimensional SWE was also performed on fasting patients using the AixPlorer US system (SuperSonic Imagine, Aix-en-Provence, France) with a convex broadband probe (SC6-1, 1–6 MHz). A radiologist (X.L. Tian) with more than 30 years of experience in performing ultrasonic examinations carried out the procedures and was also blinded to the patients’ clinical data and TE results. The patients were placed in the supine position, and the right arm was in maximal abduction. The SWE measurements were then performed on the right lobe of the liver through the intercostal spaces. When the target area was located, SWE was started, and the patient was asked to hold their breath during quiet breathing for approximately 5 s. The elasticity image box, which was approximately 4 cm × 3 cm, was in an area of the liver parenchyma free of large vessels and bile ducts. A circular region of interest (ROI) with a 2 cm diameter was then positioned in an area of homogeneous color, and the mean, minimum, maximum, and standard deviation (SD) of liver stiffness values were calculated automatically. The mean value was used in the analysis to represent the LSMs. Measurements were considered to have failed when little or no signal was obtained.
Aixplorer us system
Manufactured by SuperSonic Imagine
Sourced in France
The Aixplorer US system is an ultrasound imaging device designed for diagnostic and clinical applications. It utilizes advanced ultrasound technology to generate high-quality images for medical professionals. The system's core function is to provide detailed visualization of internal structures and organs within the human body.
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13 protocols using aixplorer us system
1
Liver Stiffness Measurement Using 2D-SWE
2
Bowel Ultrasound and Elastography Protocol
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All transabdominal ultrasounds were performed by ultrasonographers who had more than 10 years of experience in bowel ultrasound. Patients were asked to fast for a period of at least 8 h before the ultrasound examinations, which were performed using an Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France). A convex broadband probe SC6-1 (3.5~5.5 MHz) was used to observe the whole intestine and locate the lesion. A linear array probe SL15-4 (4~15 MHz) was then used to evaluate the bowel wall thickness and blood flow patterns. Limberg grading [23 (link)] of bowel vascularization in the lesions was recorded by color doppler imaging: grade I, bowel wall thickening (>3 mm) without vascularization; grade II, bowel wall thickening with spot vascular signals; grade III, bowel wall thickening with longer vascular signals; and grade IV, bowel wall thickening with longer vascular signals extending from the mesentery. In the longitudinal section of intestinal segments, the probe was fixed in position and then switched to SWE mode, with Young’s modulus set in kPa. In addition, the patients were required to breath hold for 3~5 s. After the elastogram was uniform and stable, the frame was fixed and stored. The Q-box region of interest was placed in the elastogram to measure Emean (the average values of SWE) with 3 times, and averaged values were used for final data analysis.
3
Breast Ultrasound and Shear Wave Elastography
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Breast US examinations were performed using the Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France), which was equipped with a 4–15-MHz linear-array transducer, by one of four radiologists with 5–10 years of experience in breast US exams. The investigators were aware of the clinical examination and mammography results at the time of examination. After obtaining gray-scale US, SWE images were obtained for breast masses that were scheduled for biopsy or surgical excision. The built-in region-of-interest (ROI) (Q-box; SuperSonic Imagine) of the system was set to include the lesion and surrounding normal tissue, which was displayed as a gray-scale image overlaid with a semitransparent color map of tissue stiffness, ranging from dark blue, which indicated the lowest stiffness, to red, which indicated the highest stiffness (0–180 kPa). Areas of black on the SWE images represented tissue in which no shear wave was detected. Fixed 2×2-mm ROIs were placed by an investigator over the stiffest part of the lesion, including immediate adjacent stiff tissue or halo. The system calculated the mean elasticity values in kPa for the mass.
4
Shear Wave Elastography for Breast Lesion Evaluation
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SWE was performed after conventional US examination using the AixPlorer US system (SuperSonic Imagine, Aix-en-Provence, France) with an L14-5 linear array probe operating at 4–15 MHz. Furthermore, the same sonographer, with more than 10 years of clinical experience, performed all US and SWE examinations for the breast masses. The probe was applied as lightly as possible to avoid excessive pressure and was maintained as steadily as possible for at least 10–20 s during elastic image acquisition. Additionally, the participants were asked to hold their breath to prevent motion artifacts. Furthermore, to enable a comparison with histopathological data, the maximum imaging section of the lesion was obtained to measure the stiffness of the breast lesion. Conventional US was used to obtain the maximum imaging section of the breast lesion and then start the SWE check, freezing, and measurement. Conversely, attention was paid while adjusting the region of interest (ROI) to include any halo or inelastic abnormal edge lesions while minimizing any normal tissue. The Eratio was obtained by placing the ROI in the normal breast tissue at the same depth as the lesion. This process was repeated three times, and the final values of Emax, Emean, Emin, and Eratio were the average values of these three repetitions.
5
Transrectal and Transvaginal Ultrasound-Guided Biopsy
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An experienced radiologist (S.Y.P.; 6 years’ experience with TRUS-and TVUS-guided biopsy) performed the biopsy. Local anesthesia with 10 mL of 1% lidocaine via a 21-gauge 15-cm Chiba needle (Cook Medical, Bloomington, IN, USA) was administered to the rectal or vaginal mucosa. The biopsy was performed using an 18-gauge 20-cm biopsy gun (ACECUT, TSK Laboratory, Tochigi, Japan) under US guidance (Aixplorer US system, SuperSonic Imagine, Aix-en-Provence, France). The left lateral decubitus position was used for the TRUS approach and the lithotomy position was applied for the TVUS approach. Prophylactic antibiotics (e.g., second or third-generation cephalosporin, or fluoroquinolone) were administered intravenously before biopsy and orally after biopsy for 7 days because the biopsy routes, which involved the rectal or vaginal canal, were not completely aseptic. In addition, a prebiopsy enema with glycerin solution was conducted 1-2 hours before TRUS-guided biopsy. All patients were discharged 4-6 hours after the biopsy to monitor immediate complications. No patients were hospitalized for the biopsy.
6
Shear Wave Elastography for Breast Lesions
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Using AixPlorer US system (SuperSonic Imagine, Aix-en-Provence, France) with a L14-5 linear array probe operating at 4–15 MHz, SWE was performed after conventional US. The same sonographer with more than 10 years of clinical experience, performed all US and SWE examinations. The basic information of the lesion and the presence or absence of ALN metastasis were obtained by conventional US, which was then converted to the SWE mode. The SWE imaging was performed in 2 perpendicular planes for each lesion with minimal pressure, lasting for approximately 10 seconds until stable color maps were generated. Elastography boxes were adjusted to encompass the maximum areas of stiffness, including at least 5 mm of normal breast tissue adjacent to the lesions, because the maximum areas in malignant lesions were always found in the peritumoral region of the lesion, coded in orange or red, which was the origin of the stiff ring sign (13 (link)). Emax, Emean, Emin, ESD, “stiff rim sign”, and Eratio in 2 perpendicular planes were recorded and the mean was calculated. The Eratio was obtained by placing the ROI in normal breast tissue at the same depth as the lesion.
7
Shear Wave Elastography for Breast Mass Evaluation
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Breast US examinations were performed using the Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France), which was equipped with a 4–15-MHz linear-array transducer by one of four radiologists with 5–10 years of breast US examination experience. The investigators were aware of the clinical examination and mammography results at the time of examination. After obtaining gray-scale US images, SWE images were obtained for breast masses that were scheduled for biopsy or surgical excision. The built-in region of interest (ROI) (Q-box; SuperSonic Imagine) of the system was set to include the lesion and surrounding normal tissue, which was displayed as a grayscale image overlaid with a semitransparent color map of tissue stiffness ranging from dark blue (lowest stiffness) to red (highest stiffness), from 0–180 kPa. Areas of black on the SWE images represented tissue in which no shear waves were detected. Fixed 2 × 2-mm ROIs were placed by an investigator over the stiffest part of the lesion, including the immediate adjacent stiff tissue or halo. The system calculated the mean elasticity value in kPa for the mass. Tumor stiffness was measured in terms of mean, maximal, and minimal elasticity values, and elasticity ratio, which was comparable to that of the adjacent fat tissue (Figure 1 ).
8
Ultrasound Elastography Protocol for Shoulder Muscle
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The instrument used to acquire SWE images of the MD elasticity was Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France), with an SL 10–2 linear probe operating at 2–10 MHz. The musculoskeletal mode was preset. The ultrasound probe was placed parallel to the muscle fiber orientation15 (link),16 (link). The tip of the transducer was covered with several millimeters of US gel and placed perpendicularly to the shoulder skin smoothly without applying any pressure on the skin17 (link). All participants were prohibited from exercising for 72 h before the experiment. And they were instructed to stay completely rested for 20 min before the examination. The SWE examination was performed on all participants by two experienced sonographers (A and B) who received SWE training. They were blinded to each other’s results for the entire study. 20 participants were randomly selected for consistency analysis. These 20 participants were examined by sonographer B and then measured again by sonographer A on the second day. The 20 participants were recalled to be checked again by sonographer A after a 1-wk interval.
9
Breast Ultrasound and Shear Wave Elastography
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Breast US examinations were conducted by one of four radiologists with 5–10 years of experience, utilizing the Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France) equipped with a 4–15 MHz linear array transducer. Investigators were provided with clinical and mammographic results during the breast US exam. Following grayscale ultrasound imaging, Shear Wave Elastography (SWE) images were captured statically for breast masses slated for biopsy or surgical resection. The system’s integrated region of interest (ROI) (Q-box, SuperSonic Imagine) was configured to encompass the lesion and surrounding normal tissue, presenting a grayscale image overlaid with a translucent color map. The tissue stiffness was represented from dark blue (indicating the lowest stiffness) to red (indicating the highest stiffness) within a range of 0–180 kPa (Supplementary Figure S1 ). Black regions in the SWE image indicated areas where no shear waves were detected. An investigator placed a fixed 2 × 2 mm ROI in the most rigid part of the lesion, encompassing the immediately adjacent tissue or halo. Elasticity measurements were taken using the average, maximum, and minimum elasticity values, as well as the elasticity ratio, which compares values with adjacent fat tissue.
10
Thyroid Nodule Evaluation with US and SWE
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Thyroid B-mode ultrasonography (US) and SWE examinations were performed with an Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France), which was equipped with an SL15-4 multifrequency linear array transducer. All nodules were examined by the same radiologist who has more than 10 years of experience in the differential diagnosis of thyroid diseases and was proficient in SWE image collection.
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