Parotid elastography: a potential alternative to replace labial biopsy in classification of patients with primary Sjögren’s syndrome?

Clinical Rheumatology - There has been a substantial improvement in classifying patients with primary Sjögren’s syndrome (pSS), with the new 2016 ACR/EULAR classification criteria. It...     

Interobserver variability and stiffness measurements of normal common extensor tendon in healthy volunteers using shear wave elastography

Skeletal Radiology - The purposes of our study are to determine the quantitative elasticity values of normal common extensor tendon (CET) and to assess the interobserver variability of stiffness...     

Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography

PURPOSEWe aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM).METHODSWe prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients’ overall body composition.RESULTST1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05).CONCLUSIONSTCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.

Researchers have shown that the mortality rate in type 1 diabetes mellitus (T1DM) patients is three times higher than in the general population (1). The major cause of mortality in T1DM patients of both sexes is atherosclerosis; on average, cardiovascular events occur 10 years earlier in this population than in the general population (1, 2). Long-term nonenzymatic glycosylation of arterial wall proteins and excessive superoxide production are thought to play a role in the etiology (3). Advanced glycation end-products (AGEs) accumulate at a high rate in T1DM and form abnormal protein-protein crosslinks on the collagen molecule. AGEs-mediated crosslinks may prevent enzymatic digestion and slow degradation, resulting in increased overall collagen content in the arterial wall and collagen:elastin ratio (4). These factors are thought to play a role in the etiology, cause endothelial dysfunction, stiffening of the arterial wall, and consequently atherosclerotic changes (3).Studies have shown that the atherosclerotic process typically manifest early in the carotid arteries (5). Therefore, evaluation of carotid arteries is very important in cardiovascular risk assessment. Carotid B-mode ultrasonography allows for noninvasive evaluations of atherosclerotic changes, including the measurement of carotid intima media thickness (CIMT), as well as the presence and extent of carotid plaque and arterial stiffness (6–9). The existence of carotid plaque or thickened CIMT is indicative of the morphological changes that result from the progression of atherosclerosis in the carotid artery. The local common carotid artery (CCA) stiffness parameters such as the elastic modulus, distensibility coefficient, strain, strain rate reflect the functional characteristics of atherosclerotic alterations in the carotid artery; these functional alterations manifest before structural alterations such as the intimal thickening of the artery wall and carotid plaque (10).Applanation tonometry is the gold standard technique used to evaluate arterial wall stiffness. However, this technique is time consuming, requires dedicated equipment and is not widely used in clinical routine (11, 12). Moreover, it assumes vascular homogeneity and does not provide sufficient information about the localized deformation characteristics of the arterial wall (13).Another approach to evaluate arterial wall stiffness is the speckle tracking carotid strain (STCS) method, which enables both morphological and functional analysis of the CCA by providing arterial stiffness measurements and CIMT measurements, and which leads to earlier detection of cardiovascular disease, especially for at-risk populations (14). Studies have shown that the STCS method can be an alternative to applanation tonometry in the evaluation of arterial wall stiffness (15, 16). The feasibility of STCS method has been validated by in vitro, in silico, and in vivo studies (15, 17–22). Arterial analysis software using an ultrasound-based STCS method provides the measurement of changes in arterial diameter created by each pulse pressure. From the diameter and pressure measurement, variables concerning arterial wall stiffness such as distensibility, compliance, elastic modulus index, β-stiffness index, and pulse wave velocity (PWV) and variables concerning arterial strain such as displacement, strain and strain rate can be calculated. Studies have shown that subclinical signs of arterial wall stiffening due to increased cardiovascular risk can be detected by the STCS method (10, 15, 17, 18, 23–25). Moreover, it has been proposed that the STCS method allows determination of the vulnerability of atherosclerotic plaques (26). Also, in another study, STCS imaging-based measurements have been shown to allow early assessment of potential effects of statins on vascular function (27). This suggests that early determination of arterial stiffness has the potential to be a valuable tool in the prevention of cardiovascular events. In several studies, the STCS method has been used to identify cardiovascular risk in many different patient populations such as atherothrombotic stroke, end-stage renal disease, rheumatoid arthritis, obstructive sleep apnea, and hypertension (28–32). This method promises to be beneficial, noninvasive, quick, and easily applicable, especially in the evaluation of the CCA (11, 32).Arterial stiffness has been defined as an early marker of atherosclerosis in T1DM patients (3, 33). However, to the best of our knowledge, no prior study evaluated the effectiveness of the STCS method and arterial analysis software in the detection of early atherosclerotic signs in adult T1DM patients.We aimed to evaluate the effectiveness of STCS technique, which enables measuring arterial stiffness and strain parameters in the detection of early atherosclerotic findings in T1DM.