Original article
Protocol for acquisition of images and measurement of transabdominal ultrasound pancreatic two-dimensional shear wave elastography (2D-SWE)
Protocolo de adquisición de imágenes y medición de la elasticidad pancreática mediante elastografía por onda de cizallamiento bidimensional (2D-SWE) transabdominal
Eva Marín-Serrano
, Ana Barbado Cano, Rubén Fernández Martos, Marta Abadía Barno, Antonio Olveira Martín, Maria Dolores Martín Arranz
Corresponding author
Servicio de Aparato Digestivo, Hospital La Paz, Madrid, Spain
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Estándares de organización y funcionamiento para un servicio centrado en el paciente" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 962 "Ancho" => 1667 "Tamanyo" => 65732 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hospital discharges for pancreatic cancer and acute pancreatitis, 2016–2021.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. 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It is based on the emission of an ultrasound pulse which generates shear waves in the tissue being studied, at a velocity directly proportional to the hardness of the tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The majority of studies using transabdominal 2D-SWE (TA-2D-SWE) have focused on estimating liver fibrosis and its complications. Few studies, however, have assessed pancreatic stiffness with this technique.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study is to establish a protocol for the acquisition and measurement of pancreatic stiffness using TA-2D-SWE, estimate the minimum number of measurements that ensure measurement reliability, and define variables that may increase variability or reduce the precision of the measurements.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sample</span><p id="par0020" class="elsevierStylePara elsevierViewall">We included thirty healthy volunteers over 18 years of age who had come to our centre for an abdominal ultrasound and had signed the informed consent form.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Equipment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Scans were performed by a single experienced sonographer (to avoid interindividual variability) using an Aplio i800 ultrasound system (Canon Medical Systems, Otawara, Tochigi, Japan) and an ultra-wideband transducer (1.8–6.2<span class="elsevierStyleHsp" style=""></span>MHz).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protocol</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient had to have been fasting (at least six hours), and be in a supine position with their arms under their head. With the transducer at a cross-section, perpendicular to the skin and without applying pressure, the elastographic box (2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm) was placed over the best visualised segment of the pancreas, and with the patient in suspended shallow breathing, a film of at least 10<span class="elsevierStyleHsp" style=""></span>s was acquired using the “multishot” technique. For measurements, the region of interest or ROI (5-mm circle) had to be placed on the propagation map over sharp, parallel, curved or straight waves at a depth of less than 6<span class="elsevierStyleHsp" style=""></span>cm; from each ROI, a velocity measurement (cm/s) and stiffness measurement (kPa) with its standard deviation (SD) were obtained. The final value was the median of 10 measurements of pancreatic velocity/stiffness. This value was considered valid if the IQR/median was <30%. The depth of the ROI and the distance between the surface of the pancreas and the ROI (SP-ROI) were also analysed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Qualitative variables were expressed as frequencies and percentages, and quantitative variables as mean, SD, median and 25th and 75th percentiles. Differences in the distribution of qualitative variables were analysed using the Chi-square test or Fisher’s exact test. The normality of continuous variables was tested using the Kolmogorov–Smirnov test and the comparison between groups of continuous variables was performed using the Student’s t, Mann–Whitney, ANOVA or Kruskal–Wallis tests. Correlations between quantitative variables were analysed using Spearman correlation coefficients. The reproducibility and reliability of the technique was assessed using repeated measurement analysis of variance models and repeatability analysis with estimation of the corresponding Cronbach’s alpha and intraclass correlation coefficients. Bland–Altman plots were performed to analyse the number of optimal measurements.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The variability of the stiffness/velocity measurements was estimated by means of the IQR/median and SD/mean (coefficient of variation [CV]) ratios, and precision by the percentage difference of individual measurements relative to the final set of 10 measurements. The criteria for defining the classification categories of the factors associated with the variability and precision of the measurements were established based on the percentile distribution of these factors. We did not assess intra- and inter-operator reliability.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The statistical analyses were performed using the IBM SPSS® Statistics 26.0 software (IBM Corp. Armonk, NY, USA). For all tests, a p value <0.05 was considered statistically significant.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This study was approved by the institution's Ethics Committee and conducted in accordance with the principles of the Declaration of Helsinki.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">We included 30 healthy volunteers, 70% female, aged 49.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.7 years, weighing 65.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.9<span class="elsevierStyleHsp" style=""></span>kg and with a body mass index (BMI) of 24.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.2<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (min.: 18.3–max.: 36.5) on average. The TA-2D-SWE was performed on the body (70%), tail (16.7%) and head (13.3%). The mean median of the velocity and stiffness of the 10 measurements was 1.46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.25<span class="elsevierStyleHsp" style=""></span>cm/s and 6.46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.87<span class="elsevierStyleHsp" style=""></span>kPa respectively. Using the median of the 10 measurements, we found that the mean ROI depth was 4.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm (min.: 2.3<span class="elsevierStyleHsp" style=""></span>cm; max.: 5.8<span class="elsevierStyleHsp" style=""></span>cm) and the mean SP-ROI distance was 5.2<span class="elsevierStyleHsp" style=""></span>mm (min.: 1<span class="elsevierStyleHsp" style=""></span>mm; max.: 13<span class="elsevierStyleHsp" style=""></span>mm).</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Analysis of repeated measures and reliability of the measurements made</span><p id="par0060" class="elsevierStylePara elsevierViewall">The repeated measures analysis showed that there were no statistically significant differences between the 10 measurements taken. The reliability analysis showed that the measurements showed highly relevant internal consistency and repeatability (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Estimation of the minimum number of measurements to be made</span><p id="par0065" class="elsevierStylePara elsevierViewall">The minimum number of measurements to be carried out to obtain final values consistent with the 10 reference measurements was estimated from the results of the analysis of the differences between the final values of the 10 reference measurements and each of the sets of 2, 3, …, 9 measurements, and from the reliability analysis of each of these sets of measurements. It was found that there were no statistically significant differences between the values calculated for the sets of 2, 3, 4, 5, 6, 7, 8 and 9 measurements and the final values of the 10 reference measurements. Furthermore, reliability analyses showed high values of internal consistency and test repeatability (Cronbach’s alpha and ICC greater than 0.9) in all sets of measurements. Performing five or more measurements provided median values of velocity and stiffness that were highly consistent with the 10 reference measurements. The graph representation of the mean difference between the two methods (10 measurements vs sets of 2, 3, …, 9 measurements) using the Bland–Altman method confirmed that 5–6 measurements ensured a high degree of agreement in the values of the medians of stiffness and velocity with the values obtained with the 10 reference measurements (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Variability and precision of stiffness and velocity measurements</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The variability</span> of the measurements of stiffness/velocity was estimated using the ratio IQR/median and the CV. These indicators were not affected by the factors gender, age, BMI or ROI depth. Statistically significant differences were only obtained in the CV of stiffness based on the SP-ROI: they were significantly lower in intermediate values (between 0.3 and 0.6<span class="elsevierStyleHsp" style=""></span>cm). The same trend was observed in the ratio IQR/median, although it was not statistically significant.</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The precision</span> of individual stiffness and velocity measurements was estimated by their absolute and percentage difference from the final median value obtained after the 10 reference measurements. The objective of this analysis was to determine whether there was any threshold value of other covariates that would minimise these differences. The only variable that was positively and significantly correlated with the differences in velocity/stiffness was the depth of the ROI: the greater the depth, the lower the precision of the measurement (Rho coefficient (p): 0.11 (0.04) and 1.14 (0.012) respectively). Thus, the measurement accuracy was greater if it was performed at a depth of less than 4.8<span class="elsevierStyleHsp" style=""></span>cm (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01). No significant differences were obtained with the rest of the covariates, although the percentage precision of the stiffness measurement improved with a lower CV of the velocity (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.1).</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Optimisation of the technique</span><p id="par0080" class="elsevierStylePara elsevierViewall">The only variable that showed a statistically significant impact on the percentage accuracy of the stiffness measure was the ROI depth. The CV of velocity appeared to have some effect on improving accuracy, although it did not reach statistical significance.</p><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows the gain in precision in stiffness measurement when the ROI was placed at a distance less than 4.8<span class="elsevierStyleHsp" style=""></span>cm, and when the velocity CV was less than 0.1, compared to not applying either of these criteria. Firstly, it was observed that the minimum number of measurements to be performed would be 4 (precision ≤5%) and the maximum 7, as from this point onwards no appreciable improvement was obtained. The sets of measurements carried out under the ROI depth criteria <4.8<span class="elsevierStyleHsp" style=""></span>cm or velocity CV<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.1 were more accurate than if they were not applied. However, this improvement in the precision of the stiffness measurement was not statistically significant, as the median stiffness values obtained differed by <5% with the final reference values, whether the criteria ROI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>4.8<span class="elsevierStyleHsp" style=""></span>cm or velocity CV<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.1 were applied or not.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Taking four measurements would mean a percentage difference in the median stiffness of 3.6% (2.2–6.3). This difference would be reduced to 3.3% (0.9–6.0) if measurements were made at a depth of the ROI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>4.8<span class="elsevierStyleHsp" style=""></span>cm and 3.3% (0.9–9.5) if the ratio SD/mean of the velocity was <0.1 (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0095" class="elsevierStylePara elsevierViewall">With five measurements, the percentage difference in the median stiffness would be 3.2% (1.2–5.4), a difference that would be reduced to 2.1% (0–5.2) if the measurements were made at an ROI depth <4.8<span class="elsevierStyleHsp" style=""></span>cm and 2.7% (0–5.2) if the ratio SD/mean of the velocity was <0.1 (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Finally, carrying out six measurements would mean a percentage difference in the stiffness median of 2.8% (0.9–4.7), a difference that would be reduced to 2.4% (0.7–4.4) if the measurements were carried out at an ROI depth <4.8<span class="elsevierStyleHsp" style=""></span>cm and at 2% (0.7–5.1) if the ratio SD/mean of the velocity was <0.1 (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Transabdominal elastography of the pancreas is a technique which is still under development today, even though the first study was published by Uchida et al. in 2005.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The delay in the implementation of this procedure is due in part to the limitations inherent to the technique itself: the impossibility of verifying elastometry measurements with histological data or of exploring the pancreas in 9% of the examinations. The result is even more discouraging if we consider that there have been few studies assessing pancreatic stiffness using TA elastography, that there are two types of elastography (Strain and SWE) and that elastometry measurements differ between methods and makes of equipment.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In this study, we propose an image acquisition and measurement protocol to measure pancreatic stiffness using TA-2D-SWE, as well as a minimum number of measurements to be performed for the technique to be reliable.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The choice of the portion of the pancreas to study is the subject of debate. It should be noted that studies carried out in healthy volunteers have shown that pancreatic fibrosis is distributed homogeneously in the different portions of the gland and that 2D-SWE (unlike strain elastography) can measure pancreatic stiffness in any portion of the pancreas.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–15</span></a> These observations are relevant, since they allow us to measure pancreatic stiffness using TA-2D-SWE in the most accessible portion of the pancreas with the best acoustic window, avoiding unnecessary or suboptimal measurements. Furthermore, as we have seen in this study, the choice of the best visualised portion of the pancreas does not increase the variability of the measurements.</p><p id="par0120" class="elsevierStylePara elsevierViewall">We found that the pancreatic stiffness values were significantly lower when the measurement was made between 3 and 6<span class="elsevierStyleHsp" style=""></span>mm from the surface of the pancreas. This data is interesting as it would indicate that, just as in the liver we should place the box more than 15–20<span class="elsevierStyleHsp" style=""></span>mm from the Glisson capsule, in the pancreas we should avoid measuring on its surface.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The next aspect to take into account is the acquisition of the images, since the quality of the elastogram will be determined by the reliability of the measurements.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> If a strict methodology is followed for the acquisition of images, as occurred in this study, the elastometry measurements are very homogeneous and a minimum of five measurements ensures a high level of concordance with the reference measurements.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Furthermore, we know that one of the main limitations of TA-2D-SWE is depth, with measurements taken at depths greater than 6<span class="elsevierStyleHsp" style=""></span>cm being unreliable. In this study, individual stiffness measurements were significantly more accurate when the ROI depth was less than 4.8<span class="elsevierStyleHsp" style=""></span>cm.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The development of this protocol for image acquisition and measurement of pancreatic stiffness using TA-2D-SWE elastography can serve as a basis for evaluating the utility of this technique in clinical practice in future studies, especially in the diagnosis of chronic pancreatitis<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> or fatty pancreas.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion, to assess pancreatic stiffness using TA-2D-SWE, we propose a strict image acquisition and measurement protocol, taking a minimum of five measurements in the best visualised and most accessible portion of the pancreas, if possible at a depth less than 4.8<span class="elsevierStyleHsp" style=""></span>cm.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical considerations</span><p id="par0145" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the Declaration of Helsinki and received approval from our centre’s Independent Ethics Committee (IEC). All patients signed an informed consent form.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2268599" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1891715" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2268598" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1891716" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Equipment" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Protocol" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical methods" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Analysis of repeated measures and reliability of the measurements made" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Estimation of the minimum number of measurements to be made" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Variability and precision of stiffness and velocity measurements" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Optimisation of the technique" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Ethical considerations" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-11-15" "fechaAceptado" => "2024-02-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1891715" "palabras" => array:3 [ 0 => "Pancreatic elastography" 1 => "2-D shear wave elastography (2D-SWE)" 2 => "Transabdominal ultrasound" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1891716" "palabras" => array:3 [ 0 => "Elasticidad pancreática" 1 => "<span class="elsevierStyleItalic">2-D shear wave elastography</span> (2D-SWE)" 2 => "Ecografía abdominal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Transabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Establish a protocol for image acquisition and measurement of TU pancreatic — 2D-SWE elastography and estimate the minimum number of measurements to be performed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ten measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The 70% of the participants were women, with an average age, weight, and BMI of 49.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.7 years, 65.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.9<span class="elsevierStyleHsp" style=""></span>kg, and 24.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.2<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.25<span class="elsevierStyleHsp" style=""></span>cm/s and 6.46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.87<span class="elsevierStyleHsp" style=""></span>kPa, respectively. The ROI depth was 4.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm and the SP-ROI distance was 5.2<span class="elsevierStyleHsp" style=""></span>mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5–6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3–0.6<span class="elsevierStyleHsp" style=""></span>cm). The measurement accuracy was higher when performed at a depth less than 4.8<span class="elsevierStyleHsp" style=""></span>cm.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">To measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8<span class="elsevierStyleHsp" style=""></span>cm.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La elastografía pancreática transabdominal (TA) usando 2D-SWE es una técnica en desarrollo que requiere ser protocolizada.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Establecer un protocolo de adquisición de imágenes y medición de la elasticidad pancreática usando 2D-SWE-TA y estimar el número mínimo de medidas a realizar.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y métodos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se tomaron 10 medidas de la elasticidad pancreática en voluntarios sanos usando 2D-SWE-TA, siguiendo un protocolo estricto de adquisición de imágenes y medición.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El 70% eran mujeres, con una edad, peso e IMC de 49,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15,7<span class="elsevierStyleHsp" style=""></span>años, 65,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11,9<span class="elsevierStyleHsp" style=""></span>kg y 24,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,2<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, de media, respectivamente. Las mediciones se realizaron en cuerpo (70%), cola (16,7%) y cabeza (13,3%/30) pancreática. La media de la mediana de la velocidad y elasticidad fue de 1,46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.25<span class="elsevierStyleHsp" style=""></span>cm/s y 6,46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,87<span class="elsevierStyleHsp" style=""></span>KPa, respectivamente. La profundidad del ROI fue 4,12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm y la distancia SP-ROI fue 5,2<span class="elsevierStyleHsp" style=""></span>mm, de media. No hubo diferencias estadísticamente significativas entre las 10 medidas. El análisis de fiabilidad de las medidas mostró una elevada consistencia interna y repetibilidad. La toma de 5–6 medidas aseguraba una alta concordancia con las 10 medidas de referencia. Las medidas eran significativamente inferiores cuando los valores de SP-ROI eran intermedios (0,3–0,6<span class="elsevierStyleHsp" style=""></span>cm). La precisión en la medida era mayor si se realizaba a una profundidad inferior a 4,8<span class="elsevierStyleHsp" style=""></span>cm.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Para medir la elasticidad pancreática mediante 2D-SWE-TA proponemos un protocolo estricto de adquisición de imágenes y medición, la toma de un mínimo de 5 medidas en la porción pancreática mejor visualizada y accesible, y a ser posible a una profundidad menor de 4,8<span class="elsevierStyleHsp" style=""></span>cm.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1555 "Ancho" => 2000 "Tamanyo" => 330614 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">SWE-2D elastography of pancreas.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1426 "Ancho" => 2000 "Tamanyo" => 118216 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman plots.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1182 "Ancho" => 1750 "Tamanyo" => 165691 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Percentage accuracy of the median stiffness.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">95% CI: 95% confidence interval; ICC: intraclass correlation coefficient; ROI: region of interest; SD: standard deviation; SP-ROI: distance between the surface of the pancreas and the ROI.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Correlation between elements \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Cronbach’s alpha \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ANOVA</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hotelling’s test</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intraclass correlation coefficient</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ROI depth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.858 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.740 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 (1.00–1.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distance skin/pancreas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.440 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 (1.00–1.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SP-ROI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.851 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.736 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 (0.97–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Velocity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.589 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.762 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (0.98–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD ROI velocity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.272 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.427 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80 (0.67–0.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elastometry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.516 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.792 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (0.98–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD ROI stiffness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.447 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.254 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92 (0.87–0.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3685433.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Reliability analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound elastography: review of techniques and clinical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.M.S. 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