Objectives To discuss challenges in assessing hepatic steatosis using ultrasound hepatorenal index (HRI). Methods We retrospectively analyzed HRI and liver magnetic resonance imaging‐based proton density fat fraction (MRI‐PDFF) in 134 adult participants (53 men and 81 women, mean age 55 years). The diagnostic performance of HRI for determining hepatic steatosis was tested by the area under the receiver operating characteristic curve (AUROC) using liver MRI‐PDFF as the reference. Regression plots were employed to compare the sampling sites in liver and kidney that were used to calculate HRIs. Results In 11 of 134 cases (8.2%), we failed to acquire HRI measurements. In the remaining 123 cases, AUROC for HRI (cutoff: 1.69 ± 0.13 [mean ± standard deviation]) for defining the HRI threshold for diagnosing hepatic steatosis was 0.83. In 60 of 123 cases (49%) with HRI measurement IQR/median >0.3, slopes of the regression lines in the liver showed backscatter intensity changes consistent with signal attenuation. However, in the kidney, the backscatter intensity was inverted yielding position‐dependent HRI cutoff values, mid‐pole = 2.24 ± 0.20 and upper pole = 1.08 ± 0.16. Conclusions HRI is used to estimate liver steatosis based on backscattered ultrasound. In order to compensate for effects such as body habitus and transducer frequency, the liver backscatter is divided by backscatter from a corresponding region at the same depth in the right renal cortex. Theoretically, this compensation should make HRI sampling position independent. Yet, due to renal cortical backscatter anisotropy, this compensation method does not work in general, potentially producing inaccurate liver fat estimates.

Introduction: The serum-based endoscopic healing index (EHI) test identifies endoscopic Crohn’s disease (CD) activity. Data are lacking on the relationship between EHI with other endpoints. We assessed the relationship between EHI and the simplified Magnetic Resonance Index of Activity. Materials and Methods: Data were prospectively collected on patients with CD with either an EHI or fecal calprotectin (FCAL) within 90 days of magnetic resonance enterography (MRE). Diagnostic accuracy was assessed using area under the receiver operator characteristics. Proportions with any, severe, and terminal ileum MR inflammation were compared above/below identified thresholds for both EHI and FCAL. Results: A total of 241 MREs paired to either EHI or FCAL from 155 patients were included. Both EHI and FCAL had similar accuracy to diagnose inflammation (area under the receiver operator characteristics: EHI: 0.635 to 0.651, FCAL: 0.680 to 0.708). Optimal EHI values were 42 and 26 for inflammation on MRE and endoscopy, respectively. Patients with EHI ≥42 (100% vs. 63%, P =0.002), FCAL >50 µg/g (87% vs. 64%, P <0.001) and FCAL >250 µg/g (90% vs. 75%, P =0.02) had higher rates of simplified Magnetic Resonance Index of Activity ≥1 compared with lower values. EHI differentiated ileitis numerically more than FCAL (delta: 24% to 25% vs. 11% to 21%). Patients with FCAL ≥50 µg/g had higher rates of severe inflammation compared with FCAL <50 µg/g (75% vs. 47%, P <0.001), whereas smaller differentiation existed for EHI threshold of 42 (63% vs. 49%, P =0.35). Conclusion: Both EHI and FCAL were specific in their confirmation of inflammation and disease activity on MRE in patients with CD. However, MRE-detected inflammation was frequently present in the presence of low EHI and FCAL in similar proportions.

PurposeTo assess diagnostic performance of quantitative ultrasound (QUS) biomarkers in assessing hepatic steatosis.MethodsWe prospectively recruited 125 participants (mean age 54 years) who underwent liver QUS, magnetic resonance imaging (MRI), and laboratory tests within 30 days in this IRB approved study. Based on MRI‐proton density fat fraction (MRI‐PDFF) and MRE, we divided 125 participants into normal liver, nonalcoholic fatty liver (NAFL) and liver fibrosis (≥F1) groups. We examined diagnostic performance of ultrasound attenuation coefficient (AC), normalized local variance (NLV), superb microvascular imaging‐based vascularity index (SMI‐VI), and shear wave velocity (SWV) for determining hepatic steatosis and fibrosis using area under receiver operating characteristic curve (AUC). We also analyzed correlations of QUS biomarkers to MRI using Spearman correlation coefficient.ResultsWe observed significant differences in AC, NLV, and SMI‐VI among the three groups (22 participants with normal liver, 78 with NAFL, and 25 with liver fibrosis). AUC of AC, NLV, and SMI‐VI for determining ≥ mild steatotic livers (MRI‐PDFF ≥5%) was 0.95, 0.90, and 0.92, respectively. AUC of SWV for determining ≥ F1 liver fibrosis was 0.93. The correlation of MRI‐PDFF was positive to AC (r = 0.91) and negative to NLV (r = −0.74), SMI‐VI (r = −0.8) in NAFL group. There was a significant difference in regression slope of AC to MRI‐PDFF in livers with and without ≥F1 (0.84 vs 0.91, P = .02).ConclusionsQUS biomarkers have high sensitivity and specificity to determine and grade hepatic steatosis and detect liver fibrosis. The effect of liver fibrosis on the performance of QUS biomarkers in quantifying liver fat content warrants further investigation.

Higher ustekinumab concentrations were associated with improved radiologic (Simplified Magnetic Resonance Index of Activity for Crohn's Disease) and stringent biomarker (calprotectin) outcomes. The high concentration needed for these novel endpoints validates previous studies using the same assay.

You have accessJournal of UrologyCME1 May 2022MP33-19 INTRADUCTAL CARCINOMA OF THE PROSTATE IN THE ERA OF MPMRI-TARGETED PROSTATE BIOPSIES: CLINICAL, PATHOLOGIC AND MRI CHARACTERISTICS Jonathan Fainberg, Christine Chen, Johnson Chen, Adithya Balasubramanian, Christopher Barbieri, Leo Dreyfus, Beerinder Karir, Francesca Khani, Daniel Margolis, Timothy McClure, Himanshu Nagar, and Brian Robinson Jonathan FainbergJonathan Fainberg More articles by this author , Christine ChenChristine Chen More articles by this author , Johnson ChenJohnson Chen More articles by this author , Adithya BalasubramanianAdithya Balasubramanian More articles by this author , Christopher BarbieriChristopher Barbieri More articles by this author , Leo DreyfusLeo Dreyfus More articles by this author , Beerinder KarirBeerinder Karir More articles by this author , Francesca KhaniFrancesca Khani More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Timothy McClureTimothy McClure More articles by this author , Himanshu NagarHimanshu Nagar More articles by this author , and Brian RobinsonBrian Robinson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since 2018, there is increasing adoption of mpMRI to detect prostate cancer, particularly in the pre-biopsy setting. Recent studies showed that mpMRI is a sensitive tool for detecting cancers harboring intraductal carcinoma of the prostate (IDC-P). The presence of IDC-P has been associated with adverse pathological features and worse clinical outcomes. The goals of this study were to 1) determine frequency of IDC-P detected on biopsy in the mpMRI era and 2) assess the MRI and pathologic characteristics of biopsy proven IDC-P. METHODS: The pathology archives were retrospectively analyzed under an IRB-approved protocol. All prostate biopsy and radical prostatectomy (RP) reports were reviewed for the presence or absence of IDC-P, Grade Group, pathological stage, presence of MRI targeted biopsies and MRI characteristics. We reviewed cases from 2018-2020 (MRI biopsy years) and analyzed MRI features of all IDC-P proven biopsies. RESULTS: Between the years 2018-2020 86 patients had an mpMRI and IDC-P on prostate biopsy or prostatectomy specimen. Pathologic characteristics revealed: six (7%) GG1, thirty-two (37%) GG2, twenty-one (24%) GG3, three (4%) GG4, and twenty-four (28%) GG5. When IDC-P was present on biopsy, it appeared in 79% of the MRI targets, accounting for over half (52%) of all IDC-P cases detected on biopsy. In our cohort, 60 patients had IDC-P detected in the MRI target or in the systematic sextant concordant with an MRI lesion. 90% of these lesions were PIRADS 4 or 5 [25% PIRADS 4; 65% PIRADS 5]. 93% of the lesions were in the peripheral zone (PZ). Average lesion size was 1.97 cm. Average ADC mean was 723.9 and 80% of lesions were positive for dynamic contrast enhancement (DCE). 93% of these lesions were >GG2. CONCLUSIONS: These findings suggest that when IDC-P is present on biopsy, it is typically visible on pre-biopsy MRI as a targetable lesion that is PIRADS 4 or 5. These lesions tend to be large, positive for DCE and have low ADC scores. Cancers harboring IDC-P that are detected in the MRI era continue to be associated with aggressive radiologic and pathologic features. Further studies are needed to better characterize the mpMRI characteristics of IDC-P. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e577 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Fainberg More articles by this author Christine Chen More articles by this author Johnson Chen More articles by this author Adithya Balasubramanian More articles by this author Christopher Barbieri More articles by this author Leo Dreyfus More articles by this author Beerinder Karir More articles by this author Francesca Khani More articles by this author Daniel Margolis More articles by this author Timothy McClure More articles by this author Himanshu Nagar More articles by this author Brian Robinson More articles by this author Expand All Advertisement PDF DownloadLoading ...

This review summarizes the current state of non-invasive diagnosis of non-alcoholic fatty liver disease (NAFLD). This begins with a brief discussion of blood-based analysis (serum biomarkers) then progresses through various imaging modalities (imaging biomarkers) including magnetic resonance (MR), computed tomography (CT), and ultrasound-based imaging methods. The review concludes with comment on the advantages, disadvantages, and prospects of commercially available modalities and the impact they may have on diagnosis and management of patients with NAFLD.

Background While Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions typically warrant prostate biopsy and PI-RADS 1 and 2 lesions may be safely observed, PI-RADS 3 lesions are equivocal. Purpose To construct and cross-validate a machine learning model based on radiomics features from T-2-weighted imaging (T2WI) of PI-RADS 3 lesions to identify clinically significant prostate cancer (csPCa), that is, pathological Grade Group >= 2. Study type Single-center retrospective study. Population A total of 240 patients were included (training cohort, n = 188, age range 43-82 years; test cohort, n = 52, age range 41-79 years). Eligibility criteria were 1) magnetic resonance imaging (MRI)-targeted biopsy between 2015 and 2020; 2) PI-RADS 3 index lesion identified on multiparametric MRI; (3) biopsy performed within 1 year of MRI. The percentages of csPCa lesions were 10.6% and 15.4% in the training and test cohorts, respectively. Field strength/sequence A 3 T; T2WI turbo-spin echo, diffusion-weighted spin-echo echo planar imaging, dynamic contrast-enhanced MRI with time-resolved T1-weighted imaging. Assessment Multislice volumes-of-interest (VOIs) were drawn in the PI-RADS 3 index lesions on T2WI. A total of 107 radiomics features (first-order histogram and second-order texture) were extracted from the segmented lesions. Statistical Tests A random forest classifier using the radiomics features as input was trained and validated for prediction of csPCa. The performance of the machine learning classifier, prostate specific antigen (PSA) density, and prostate volume for csPCa prediction was evaluated using receiver operating characteristic (ROC) analysis. Results The trained random forest classifier constructed from the T2WI radiomics features good and statistically significant area-under-the-curves (AUCs) of 0.76 (P = 0.022) for prediction of csPCa in the test set. Prostate volume and PSA density showed moderate and nonsignificant performance (AUC 0.62, P = 0.275 and 0.61, P = 0.348, respectively) for csPCa prediction in the test set. Conclusion The machine learning classifier based on T2WI radiomic features demonstrated good performance for prediction of csPCa in PI-RADS 3 lesions. Evidence Level 4 Technical Efficacy 2

The aim of the study was to evaluate the feasibility of using ultrasound elastography to assess the effect of botulinum toxin A (BoNT-A) treatment on post-stroke spasticity of the upper limb. In this prospective study, we performed ultrasound elastography (strain imaging and acoustic radiation force impulse-based shear wave elastography) of the spastic biceps brachii muscle in seven patients (five men and two women, mean age: 45y) who underwent BoNT-A injection treatment for post-stroke spasticity of the upper limb. We measured ultrasound elasticity parameters including axial strain ratio (SR) (SR = muscle strain/reference strain), longitudinal SR and shear wave velocity of the biceps muscle immediately before and 17-30 d (mean: 22 d) after BoNT-A injection. Statistical analyses included a two-tailed paired t-test to examine the difference in ultrasound elasticity parameters of bilateral biceps muscles before and after BoNT-A treatment and a Spearman rank correlation coefficient (rs) to analyze the correlation of ultrasound elasticity parameters to clinical assessment with the Modified Ashworth Scale (MAS) and Tardieu Scale (TS). The difference in ultrasound elasticity parameters before and after BoNT-A treatment was significant (p < 0.05) in the treated spastic muscle. The correlation of ultrasound elasticity parameters with MAS and the angle of catch and range of motion in TS were also significant (rs = 0.55-0.95, p < 0.05). Our results suggest that ultrasound elastography is feasible in assessment of the effectiveness of BoNT-A treatment for post-stroke spasticity of the upper limb.

We prospectively investigated the feasibility of using quantitative ultrasound imaging (QUI) to assess the biceps brachii muscle (BBM) in individuals with chronic post-stroke spasticity. To quantify muscle echogenicity and stiffness, we measured QUI parameters (gray-scale pixel value and shear wave velocity [SWV, m/s]) of the BBM in three groups: 16 healthy BBMs; 12 post-stroke, non-spastic BBMs; and 12 post-stroke, spastic BBMs. The QUI results were compared with the Modified Ashworth Scale and Tardieu Scale. A total of 20 SWVs were measured in each BBM, once at elbow in 90 degrees flexion and again at maximally achievable extension using acoustic radiation force impulse imaging. BBM pixel value was measured in gray-scale images captured at 90 degrees elbow flexion using ImageJ software. Statistical analyses included analysis of variance for examining the difference in SWV and pixel values among the three groups; Bonferroni correction for testing the difference in SWV and pixel values in a paired group; t-test for examining the difference in SWV values measured at two elbow angles; and Pearson correlation coefficient for analyzing the correlation of QUI to Modified Ashworth Scale and Tardieu Scale. SWV significantly differed between spastic BBMs and non-spastic or healthy BBMs. For pixel values, each of the three groups significantly differed from the others at elbow 90 degrees flexion. The difference in SWV measured between the two elbow angles was also significant (p < 0.01). A strong negative correlation was found between SWV and passive range of motion (R-2 = -0.88, p < 0.0001) in spastic upper limbs. These results suggest that the use of QUI is feasible in quantitative assessment of spastic BBM. (C) 2017 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

OBJECTIVE:To assess differences in biceps brachii muscle (BBM) stiffness as evaluated by ultrasound shear wave elastography (SWE). METHODS:The passive stiffness of the BBM was quantified with shear wave velocity (SWV) measurements obtained from 10 healthy volunteers (5 men and 5 women, mean age 50years, age range 42-63 years) with the elbow at full extension and 30° flexion in this IRB-approved study. Potential differences between two depths within the muscle, two elbow positions, the two arms, and sexes were assessed by using two-tailed t-test. The reproducibility of SWV measurements was tested by using intraclass correlation coefficient (ICC). RESULTS:Significantly higher passive BBM stiffness was found at full elbow extension compared to 30° of flexion (p≤0.00006 for both arms). Significantly higher passive stiffness in women was seen for the right arm (p=0.04 for both elbow positions). Good correlation of shear wave velocity measured at the different depths. The ICC for interobserver and intraobserver variation was high. CONCLUSIONS:SWE is a reliable quantitative tool for assessing BBM stiffness, with differences in stiffness based on elbow position demonstrated and based on sex suggested.

The assessment of post-stroke muscle spasticity is challenging due to lack of a gold standard. The Modified Ashworth Scale (MAS), commonly used in evaluating spasticity is neither quantitative or reliable. We have reported the use of ultrasound strain imaging (USI) to assess rigid biceps brachii muscle (BBM) in Parkinson's disease [1]. We have now extended the application of USI to determining spastic BBM in stroke survivors. We performed USI in 8 healthy volunteers and 8 subjects with chronic post-stroke spasticity of the upper limb. BBM axial deformation was produced by external compression using a sandbag (1.0 kg) tied transducer [2]. Lengthening and shortening of BBM was generated by manual passive elbow extension (from 90° to 0°) and flexion (from 0° to 90°), respectively. We used offline 2-D speckle tracking to estimate axial strain (representing BBM stiffness) as well as lateral strain and tissue velocity (representing BBM dynamic displacement). ANOVA was used to assess statistically significant differences in USI between healthy controls and both non-spastic and spastic BBMs in stroke survivors. The Bonferroni correction was then applied to test the difference in the paired groups (healthy vs non-spastic; non-spastic vs spastic; and healthy vs non-spastic). We observed significant differences in USI parameters between healthy and spastic BBM, and between non-spastic and spastic BBM (all p <;0.01). Our results suggest that USI seems to be feasible in determining chronic post-stroke spasticity of the BBM (MSA>1 + ).

We appreciate the interest in our article and the opportunity to discuss our findings further. The female subjects in our study had significantly higher passive biceps brachii muscle (BBM) stiffness for the right arm at two different joint positions, as measured by shear wave elastography (SWE), compared to men [ [1] Chen J. O'Dell M. He W. LJ Du Li P.C. Gao J. Ultrasound shear wave elastography in the assessment of passive biceps brachii muscle stiffness: influences of sex and elbow position. Clin Imaging. 2017; 45: 26-29 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar ]. Ours is the second report in the literature demonstrating a tendency to a difference between sexes in BBM stiffness [ [2] Eby S.F. Cloud B.A. Brandenburg J.E. Giambini H. Song P. Chen S. et al. Shear wave elastography of passive skeletal muscle stiffness: influences of sex and age throughout adulthood. Clin Biomech (Bristol, Avon). 2015; 30: 22-27 Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar ]. The underlying factor influencing these findings is an area of uncertainty. We posit that it may be related to changes in estrogen levels, namely likely relatively decreased for our cohort of perimenopausal/menopausal female subjects, given a prior report describing a negative relationship between estrogen levels and musculotendinous stiffness of the hamstrings [ [3] Bell D.R. Blackburn J.T. Norcorss M.F. Ondrak K.S. Hudson J.D. Hackney A.C. et al. Estrogen and muscle stiffness have a negative relationship in females. Knee Surg Sports Traumatol Arthrosc. 2012; 20: 361-367 Crossref PubMed Scopus (47) Google Scholar ]. That same report found free testosterone levels were positively correlated with stiffness. Thus decreased testosterone levels – as may be seen in an older male cohort as was in our study – may contribute to decreased male BBM stiffness and to the sex difference we observed. In addition, many of the reports in the literature which have found no significant sex difference in passive stiffness in other muscle groups measured by SWE had significantly younger study populations.

We prospectively evaluated the feasibility of using ultrasound strain imaging (USI) to assess biceps brachii muscle (BBM) stiffness and dynamic motion in 10 healthy adults. The BBM axial deformation was produced by external compression with a sandbag (1.0 kg) tied onto the transducer. The BBM lateral movement was produced by manual passive elbow flexion and extension. By use of 2-D speckle tracking, captured 5-s real-time ultrasound data of BBM were processed to estimate axial strain, representing muscle stiffness, and lateral strain and tissue velocity, representing muscle dynamic motion. Axial (lateral) strain ratio was defined as BBM strain divided by subcutaneous soft tissue strain. There was no significant difference in lateral strain or tissue velocity between the left and right BBM (lateral strain ratio: 4.69 +/- 0.07 vs. 4.51 +/- 0.08 for extension, 4.82 +/- 0.09 vs. 4.69 +/- 0.11 for flexion; tissue velocity: 1.58 +/- 0.32 cm/s vs. 1.78 +/- 0.85 cm/s for extension, -2.03 +/- 0.63 vs. -2.03 +/- 0.59 for flexion; all p values > 0.05) or between men and women (lateral strain ratio: 4.52 +/- 0.06 vs. 4.67 +/- 0.1 for extension, 4.71 +/- 0.11 vs. 4.83 +/- 0.09 for flexion; tissue velocity, cm/s: 1.76 +/- 0.76 vs. 1.66 +/- 0.65 for extension, -2.21 +/- 0.65 vs. -1.88 +/- 0.52 for flexion, all p values > 0.05). The difference in axial stain between men and women was significant (axial strain ratio: 3.09 +/- 0.43 vs. 3.52 +/- 0.26, p = 0.02). Inter-and intra-observer reliability in performing USI of the BBM was good (all intra-class correlation coefficients [ICCs]> 0.75). Our results suggest that USI seems to be feasible for and reproducible in estimating BBM mechanical properties and motion dynamics in healthy adults. (C) 2017 World Federation for Ultrasound in Medicine & Biology.

Objectives-To quantitatively assess the correlation between the corticomedullary strain ratio and cortical fibrosis in renal transplants.Methods-Using quasistatic ultrasound elasticity imaging, we prospectively assessed the corticomedullary strain ratio in renal allografts of 33 patients who underwent renal transplant sonography and biopsy. Based on Banff score criteria for renal cortical fibrosis, 33 allografts were divided into 2 groups: group 1 (n = 19), with mild (<25%) fibrosis; and group 2 (n = 14), with moderate (>26%) fibrosis. We used 2-dimensional speckle-tracking software to perform offline analysis of cortical and medullary strain induced by external compression by the ultrasound transducer. We then calculated the corticomedullary strain ratio (cortical normalized strain/medullary normalized strain; normalized strain = developed strain/applied strain [deformation from the abdominal wall to the pelvic muscles]). An unpaired 2-tailed t test was used to determine differences in normalized strain and the strain ratio between the groups. Receiver operating characteristic curve analysis was performed to determine the best strain ratio cutoff value for identifying moderate fibrosis.Results-Normalized strain differed between the cortex and medulla (mean +/- SD: group 1, 4.58 +/- 2.02 versus 2.58 +/- 1.38; P = .002; group 2, 1.71 +/- 0.42 versus 2.60 +/- 0.87; P = .0011). The strain ratio in group 1 was higher than in group 2(2.06 +/- 1.33 versus 0.70 +/- 0.20; P = .0007). The area under the receiver operating characteristic curve was 0.964. The sensitivity and specificity of a strain ratio cutoff value of 0.975 for determining moderate fibrosis were 92.9% and 94.7%, respectively.Conclusions-Strain values vary in different compartments of the kidney. The corticomedullary strain ratio on ultrasound elasticity imaging decreases with increasing renal cortical fibrosis, which makes it potentially useful as a noninvasive quantitative marker for monitoring the progression of fibrosis in renal transplants.

To assess fly through ultrasound imaging (FTUS) in evaluation of carotid artery atherosclerosis, we prospectively performed conventional sonography and FTUS of the carotid artery on 66 patients with suspicion for atherosclerosis. Characteristics of arterial intima, atherosclerotic plaque, luminal narrowing, and carotid stent graft displayed on FTUS were compared with that on conventional sonography. On FTUS, normal carotid artery wall was smooth in appearance, mild carotid atherosclerosis appeared focal arterial wall irregularity and small plaque formation, arterial luminal reduction resulted from progressive artery plaques, and carotid stent had irregular inner lumen and tight fit against the arterial wall. A total of 38 plaques were detected by conventional sonography, while 48 plaques were depicted by FTUS in 25 patients. Using magnetic resonance angiography as a reference standard, 17 cases with >50% and 3 cases with <50% luminal reduction measured on FTUS. However, all those 20 cases were measured with >50% luminal reduction on conventional sonography. Compared with conventional sonography, FTUS can dynamically display intraluminal structure on real-time three-dimensional imaging morphologically to improve the accuracy in detecting atherosclerotic plaque and assessing luminal narrowing in the carotid artery.

To prospectively assess changes in spleen stiffness and splenoportal venous flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement.

Objectives-To prospectively assess changes in spleen stiffness and splenoportal venous flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement.Methods-We prospectively evaluated spleen stiffness measured by the mean shear wave velocity with acoustic radiation force impulse imaging and the splenoportal venous velocity with color Doppler sonography in 12 patients (mean age +/- SD, 42.6 +/- 11.0 years; range, 29-65 years) who underwent TIPS placement for portal hypertension and gastroesophageal bleeding. The mean shear wave velocity and angle-corrected splenoportal venous velocity at the main portal and splenic veins were measured 1 day before and 3 to 9 days after TIPS placement (mean interval, 6.0 +/- 1.95 days; range, 4-10 days) and were compared with portal vein pressure measured during the procedure.Results-There was a significant difference in portal vein pressure before and after TIPS (25.34 +/- 6.21 versus 15.66 +/- 6.07 mm Hg; P = .0005). After TIPS, the mean shear wave velocity decreased significantly in all 12 cases (3.50 +/- 0.46 versus 3.15 +/- 0.39 m/s before and after TIPS; P = .00015). The flow velocity at the main portal vein increased significantly after TIPS (22.21 +/- 4.13 versus 47.25 +/- 12.37 cm/s; P = .0000051). The splenic vein velocity and spleen index measured 25.57 +/- 6.98 cm/s and 55.99 +/- 21.27 cm(2), respectively, before TIPS and 35.72 +/- 11.10 cm/s and 50.11 +/- 21.12 cm(2) after TIPS (P = .0004 and .003).Conclusions-A significant decrease in the mean shear wave velocity and increase in the splenoportal venous velocity occurred with reduced portal vein pressure after TIPS placement. Hence, both parameters can be used as noninvasive quantitative markers for monitoring TIPS function after placement.