Compression Sonoelastography Research Articles

Biomechanical changes in the gastrocnemius medius-Achilles tendon complex in people with hypermobility spectrum disorders: A cross-sectional compression sonoelastography study.

This study aimed to assess the biomechanical impact of Hypermobility Spectrum Disorders (HSD) on the elasticity of the gastrocnemius medius-Achilles tendon (GM-AT) complex. Using a cross-sectional design, the GM-AT complex elasticity was compared using sonoelastography (SEG) in an HSD group and healthy controls during rest and maximal isometric plantar flexion contraction. The HSD group comprised 28 patients (26 women); mean ± SD age 28.7 ± 8.4 years, compared to 28 controls (26 women); 31.5 ± 8.7 years. During rest, greater elasticity was identified in HSD relative to controls at the GM-AT musculotendinous junction (strain ratio 2.05 ± 1.31 vs. 1.48 ± 0.49), mid-AT (3.60 ± 1.97 vs. 2.66 ± 1.00), and distal AT (4.57 ± 2.69 vs. 3.22 ± 1.94) (all p < 0.05). During contraction, no significant differences were found between groups at the GM-AT musculotendinous junction (3.40 ± 2.16 vs. 2.62 ± 1.07), mid AT (10.75 ± 5.29 vs. 8.49 ± 3.53), or distal AT (8.55 ± 5.39 vs. 8.83 ± 3.51) (all p > 0.05). No significant differences were found between groups in the GM strain ratio during rest (4.05 ± 1.43 vs. 3.62 ± 0.78), or contraction (4.23 ± 1.29 vs. 4.19 ± 1.31). Exploratory Receiver Operator Characteristics curve analysis suggested low sensitivity and specificity of the strain ratio for the diagnosis of HSD. People with HSD have greater GM-AT complex elasticity. Although statistically significant group differences were identified, further research is required to establish the diagnostic, clinical, and research utility of strain ratio measurements.

Role of compression sonoelastography in aiding differentiation of benign and malignant solid hepatic lesions

Role of compression sonoelastography in aiding differentiation of benign and malignant solid hepatic lesions

Sonoelastography evaluation in the diagnosis of endometrial pathology combined with chronic endometritis in infertile women.

Endometrial pathology, including hyperplastic processes in the structure of reproductive disorders, occupies one of the leading places along with inflammatory diseases of the pelvic organs, contributing to infertility in 80% of cases and irregular menstrual cycle in 40–43%. This study aims to optimize the diagnostic algorithm in patients with endometrial hyperplasia combined with chronic endometritis and determine qualitative indicators of compression sonoelastography in patients with endometrial pathology and infertility. A comprehensive clinical and laboratory examination of 90 infertile patients aged 25 to 45 years with endometrial hyperplasia combined with chronic inflammation, retention cysts, and benign ovarian tumors was carried out. The results of clinical-laboratory and complex ultrasound examination with compression sonoelastography were compared with the data of pathomorphological and immunohistochemical studies. A high percentage of pelvic inflammatory disease (55.0%), benign lesions of the cervix (67.5%), hyperplastic processes of the myometrium (37.5%), an increasing number of polyps by 2.9 times, leiomyomas and adenomyosis – by 2.3 times (p<0.05) was established. In the case of a combination of endometrial hyperplasia and ovarian cysts, a high percentage of comorbidity of gynecological pathology is verified (37.8%), and the use of compression sonoelastography allows to establish class II and class III elastograms in 91.1% of cases which characterize benign endometrial lesions, reduce the number of false-positive results in 95.6% of cases, correctly interpret the nature of pathological changes and increase the sensitivity of ultrasound techniques.

REAL-TIME strain elastography: Applications in musculoskeletal system

BackgroundStrain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy. ObjectivesTo assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE. Materials and methodsA prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years. Statistical analysis of distribution, mean, associations, sensitivity, specificity, area under Receiver Operating Characteristic curve (AUROC) for B-mode, ES, SR combined B-mode/CE and their comparison was done. ResultsSignificant association was noted between SR in muscles and tendons with sex. Significant correlation was noted between ES/SR with B-mode. CE and B-mode had 100% and 52.4% sensitivity respectively for diagnosing diffuse pathologies. For differentiating benign and malignant masses sensitivity, specificity, and diagnostic accuracy of B-mode was 71.43%, 86.36% and 82.76%; of SR was 71.43%, 90.91% and 86.21%; of Combined B-mode with CE was 100%, 90.91% and 93.1% respectively. Elastographic pattern had highest diagnostic accuracy and largest AUROC. ConclusionCE as a screening test had higher diagnostic accuracy, supporting need for standardizing it for clinical use in MSK. EUS being a widely available, fast and affordable modality, can aid follow up of chronic MSK pathologies, response to medication, physiotherapy and surgery and mitigate the need for MRI.

The importance of compression sonoelastography in multiparametric ultrasound examination in the detection of malignant formations of ovaries

In Ukraine ovarian cancer ranks third among pelvic malignancies in women of childbearing age and ranks first in the structure of mortality of women from oncogynecological pathology. The aim of the study – to increase the diagnostic value of multiparametric ultrasound examination of ovarian malignancies using compression sonoelastography. Material and methods. A comprehensive radiological study of 48 patients with ovarian cancer was performed. The average age of patients was (45.22 ± 4.08) years. Ultrasound was performed on a HITACHI ALOCA ARIETTA 70 using a cavitary multifrequency sensor with a frequency of 7.5-10 mHz Compression elastography was used to assess the rigidity of the detected formation. Results. In 30 (62.5%) women in the sonoelastography mode different elastotype was detected, because the liquid component had a blue-green-red color corresponding to 0 elastotype, and the solid component and papillary growths were mapped mostly blue, rarely with green admixtures, ie. had IV-V elastotype on the UENO scale. The hardness index of the solid component ranged from 4.3 to 46 um.od. In 18 (37.5%) patients malignant were mapped in blue, which corresponded to the V elanotype according to UENO and had a high hardness index, which ranged from 5.2 to 56 um.od. All of these formations were classified as high-risk - O-RADS 5, as all formations were characterized by ultrasonic descriptors with a high degree of prediction of malignancy. Conclusions. Innovative technology of sonoelastography provides qualitatively new information about the elasticity of tissues and allows to assess the stiffness of ovarian tumors with high accuracy and specificity.

Biomechanical Changes in the Gastrocnemius Medius–Achilles Tendon Complex in People with Hypermobility Spectrum Disorders: A Compression Sonoelastography Study

Biomechanical Changes in the Gastrocnemius Medius–Achilles Tendon Complex in People with Hypermobility Spectrum Disorders: A Compression Sonoelastography Study

DIAGNOSTIC ROLE OF COMPRESSION SONOELASTOGRAPHY IN MULTIPARAMETRIC ULTRASOUND INVESTIGATION IN THE DETECTION OF BENIGN OVARIAN FORMATION

Properly diagnosed benign ovarian tumors are a condition for optimal treatment tactics. Qualitative assessment of signs detected by multiparametric ultrasound, including compression elastography, is highly effective in the differential diagnosis of benign ovarian tumors. Our study became especially relevant for women in the reproductive period, because the correct diagnosis influenced the choice of surgical treatment in order to preserve the ovarian reserve. A comprehensive radiological study of 51 women with benign ovarian tumors was performed. The age of patients averaged 37.3 ± 8.7 years. In the structure of benign ovarian tumors, the frequency of serous cystadenoma was 31.38%, serous superficial papillomas - 25.49%, mucinous cystadenoma - 17.65%, mature teratomas - 15.68%, fibroma - 9.8%. Ultrasound was performed on a HITACHI ALOCA ARIETTA 70 using a cavitary multifrequency sensor with a frequency of 7.5-10 mHz and a sector sensor with a frequency of 2-5 mHz. The article analyzes the detailed sonographic picture of these formations in B-mode, Doppler mode and compression sonoelastography mode. Color and energy Doppler mapping techniques, as well as pulsed Doppler mode, which gave a quantitative characterization of blood flow, were used to study blood vessels. Vessel localization was determined using color Doppler mapping, and detailed qualitative assessment of blood flow loci was determined using energy Doppler. For all types of benign ovarian formations, a qualitative feature was determined - elastotype on the Ueno scale and stiffness index - Strain Ratio (coefficient of deformation) - a quantitative indicator. It was found that serous and mucinous cystadenomas belong to 0 and I elastotype on the Ueno scale, the papillary component of serous superficial papillomas was mapped with I and II elastotype, fibroids mainly belonged to II and III elastotype, and mature teratomas - to IV end V elastotype. Quantitative deformation rate for all benign ovarian tumors ranged from 0,63 to 24,9. Thus, the cardiac index of stiffness in serous cystadenomas was 0.92 ± 0.46, and in mature teratomas - 16.7 ± 8.4. The increased density of the latter in comparison with other representatives of benign formations can be explained by the presence in their structure of such elements as fibroblasts, bundles of spindle-shaped cells and bundles of collagen fibers (fibroids), bone and cartilage (mature teratoma). In addition to all the above research methods, the mobile application IOTA ADNEX 2014 was used, which helped to calculate the risk of malignancy. This is a simple calculator, which loads the data of the ultrasound examination, the patient's age, the level of CA-125. Our results showed that ultrasound examination of ovarian tumors is an accurate and highly informative method for stratification of risks according to the O-RADS classification. For stratification and the ultrasound risk management system, the O-RADS system was guided by consensus guidance from the American College of Radiology, which reduces or eliminates ambiguity in the interpretation of data in ultrasound protocols and provides a more accurate definition of ovarian malignancy. The O-RADS working group includes 5 categories: O-RADS 0 - incomplete examination score, O-RADS 1 - normal unchanged premenopausal ovary, O-RADS 2 - almost always benign (risk of malignancy - &lt;1%), O-RADS 3 - the presence of education with a low level of malignancy - from 1 to 10%, O-RADS 4 - medium risk of malignancy - from 10 to 50% and O-RADS 5 - education with a high level of malignancy -&gt; 50%.

The Use of Compression Sonoelastography in Multiparametric Ultrasound Examination in Cases of Benign Ovarian Formations

Properly diagnosed benign ovarian formations are a condition for appropriate treatment choice. Qualitative assessment of signs detected by multiparametric ultrasound, including compression elastography, is highly effective in the differential diagnosis of benign ovarian formations. Our study became especially relevant for women in the reproductive period since the correct diagnosis influenced the choice of surgical treatment in order to preserve the ovarian reserve. The detailed sonographic aspect of these formations in B-mode, Doppler mode and compression sonoelastography mode is analyzed in the article. Color Flow Mapping, power Doppler and pulsed wave Doppler were used to study blood vessels. Pulsed wave Doppler characterized blood flow quantitatively. Color Flow Mapping was used to determine vessels localization, and power Doppler was used to provide a detailed qualitative assessment of blood flow loci. Elastotype according to the Ueno scale as a qualitative feature and Strain Ratio (coefficient of deformation) as a quantitative indicator were determined for all types of benign ovarian formations. Serous and mucinous cystadenomas were found to belong to elastotypes 0 and I according to the Ueno scale, the papillary component of serous superficial papillomas was mapped as elastotype I and II, fibroids predominantly belonged to elastotype II and III, mature teratoma appertained to elastotypes IV and V. Quantitative coefficient of deformation for all benign ovarian formations ranged from 0.63 to 24.9. According to our results, ultrasound examination of ovarian formations is an accurate and highly informative method for stratification of risks in accordance with the O-RADS classification.

The importance of compression sonoelastography in improving the diagnostics of the pathology of myometrium

The diversity of the clinical picture and the asymptomatic nature of the clinical manifestations of myometrial pathology cause difficulties in diagnosis. There is a lack of reliable diagnostic criteria for this pathology, in particular, imaging, especially with the simultaneous combination of adenomyosis and leiomyoma.&#x0D; The aim of the research. Determination of the possibility of compression sonoelastography in the diagnosis of myometrial pathology and determination of its sonoelastography characteristics in leiomyoma and adenomyosis, as well as comparison of sonoelastography results with histological data.&#x0D; Materials and methods. Elastography images of 155 patients with adenomyosis and leiomyoma, as well as combined pathology, were analyzed, the elastography diagnosis of which was confirmed by histological examination.&#x0D; Results. Leiomyoma and adenomyosis had different elastography characteristics (strain ratios) with different color mapping; their specific characteristics and main differences are determined. Based on sonoelastography, the majority of patients (n=30) were suspected of having uterine fibroids, 14 had adenomyosis, and 42 had adenomyosis and fibroids. Sonoelastography revealed histological signs of adenomyosis in 3 patients with uterine leiomyoma.&#x0D; Conclusions. Ultrasound examination using compression sonoelastography in such pathological conditions of the myometrium as adenomyosis and leiomyoma, as well as unchanged myometrium, makes it possible to determine changes in the degree of elasticity of the myometrium in the corresponding pathology. Sonoelastography allows the identification of clear distinguishing features of fibroids and adenomyosis. The unchanged myometrium has a certain elasticity, which can be equated to a specific numerical value – the coefficient of deformation. This indicator has different meanings in myoma and adenomyosis, which makes it possible to differentiate these pathological conditions of the myometrium. Compression sonoelastography is able to identify clear distinguishing features of leiomyoma and adenomyosis, and consistency of diagnoses based on sonoelastography and histology is significant but not optimal.

Sonoelastographic Findings in Clubfeet.

PurposeOne of the main features of congenital idiopathic clubfoot is the increased stiffness of soft tissues. With the growing popularity and availability of sonoelastography as a method to assess the stiffness of different tissues, we considered applying it to congenital clubfeet in order to to determine whether sonoelastography can be a useful imaging method for the evaluation of clubfeet, to assess whether there are any differences in stiffness of specific tendons between clubfeet and normal contralateral feet and to observe which treatment methods have an impact on the aspect of these structures on the elastograms.Patients and MethodsA case-control study was performed involving 10 adolescent patients with unilateral idiopathic congenital clubfeet who were treated either with the Ponseti method or surgically with posteromedial release (PMR) during early infancy. Using compression sonoelastography, we obtained semi-quantitative data expressed as fat to tendon ratios in treated clubfeet and normal contralateral feet. The tendons of the following muscles were examined: tibialis anterior, tibialis posterior, flexor hallucis longus, peroneus longus and Achilles tendon at three levels (calcaneal insertion, lengthened zone and musculotendinous junction).ResultsThe only statistically significant difference in the strain ratio (p = 0.023) between clubfeet and normal feet was at the level of the calcaneal insertion of the Achilles tendon, which was stiffer in clubfeet. Although other differences were not statistically significant, they may reflect some of the pathological modifications of clubfeet.ConclusionOverall, sonoelastography may be a useful examination tool in the quantitative and qualitative assessment of soft tissue stiffness in clubfeet, but further research is necessary.

Applicability of sonoelastography in leiomyoma and adenomyosis

Background. Uterine leiomyoma and endometriosis are common gynecological diseases of women in childbearing potential. This fact necessitates developing an optimal protocol for examination of patients in order to implement an individual approach to treatment. Diagnosis of mixed forms of pathological myometrium conditions causes some difficulties. Elastography technique makes it possible to assess the density of the myometrium, which may be essential for differentiating the diagnosis of leiomyoma and adenomyosis in mixed forms.&#x0D; Рurpose – to ascertain the potential of transvaginal ultrasound along with compression sonoelastography to determine the deformation coefficient in differential diagnosis of various pathological myometrium conditions.&#x0D; Materials and methods. The paper presents the analysis of elastographic findings of the uterus in 155 women obtained via compression sonoelastography performed by means of HITACHI AVIUS device. Patients were divided into 4 groups: control, women with uterine leiomyoma, uterine adenomyosis, with combined leiomyoma and adenomyosis. The transabdominal/ transvaginal ultrasound findings were confirmed by histopathological examination. The standard point scale was used to determine the deformation coefficient.&#x0D; Results. Elastographic characteristics were assessed in accordance with sonoelastography findings, i. e. deformation coefficients common in leiomyoma and adenomyosis. The maximum values of the deformation coefficient were obtained in leiomyoma (in an amount of 2 to 6.0 units). In case of diffuse or focal adenomyosis, the deformation coefficient was in an amount of 0.5 to 1.5 units indicating high myometrial elasticity vs the unchanged myometrium. For its part, in Group I (control), the deformation coefficient ranged from 1 to 1.7 units. High myometrial elasticity in adenomyosis vs the unchanged myometrium as well low elasticity or high density of the myometrium in leiomyoma were observed.&#x0D; Conclusions. The deformation coefficients in patients with leiomyoma and adenomyosis and unchanged myometrium were obtained via ultrasound with compression sonoelastography and they made it possible to determine the degree of elasticity of the myometrium and its changes in the relevant pathology. Elastography is capable of identifying clear distinctive features of leiomyoma and adenomyosis. The coincidence of the diagnosis of adenomyosis based on elastography and histology is significant, but not optimal. The unchanged myometrium has a certain elasticity, which can be equated to a numerical value, i. e. the deformation coefficient, and this param changes in case of leiomyoma or adenomyosis, which makes it possible to differentiate these pathological conditions of the myometrium.

The use of high-frequency skin ultrasound in the diagnosis of lipodermatosclerosis.

IntroductionLipodermatosclerosis is a symptom of severe venous insufficiency, the diagnosis of which is based on the clinical picture. Although the histopathology of the skin and the subcutaneous tissue allows for the most reliable diagnosis, it is not recommended due to healing disorders.AimThe aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis.Materials and methodsThe study included 10 patients with lipodermatosclerosis who underwent Duplex Doppler ultrasound of lower limb veins, high-frequency ultrasound of the tibial skin, and radiography of the lower leg, all of which were analyzed in correlation with clinical symptoms.ResultsThe study group included 9 women and 1 man aged 39–81 years. Manifestations of lipodermatosclerosis were detected in 14 limbs. High-frequency ultrasound showed that the mean dermis thickness at the affected sites was 2.63 mm, and was significantly thicker compared to healthy skin (1.45 mm) (p = 0.00002). Higher echogenicity was detected in the affected body regions in 85.7% of cases for the skin and 92.9% of cases for the subcutaneous tissue. Subcutaneous and vascular wall calcifications were detected in 92.9% and 78.6% of cases, respectively. Fibrosis was observed in all limbs, and compression sonoelastography showed that the compliance of the subcutaneous tissue was lower than that of muscles. The border between the skin and the subcutaneous tissue was blurred in 57.1% of cases. Radiography revealed thickening of the affected skin regions in all limbs, with calcifications detected in 85.7% of cases. A blurred border between the skin and the subcutaneous tissue was observed in 35.7% of limbs.ConclusionHigh-frequency ultrasonography of the skin and the subcutaneous tissue in the lower legs supported with radiological findings is highly useful in the diagnosis of lipodermatosclerosis.

Intra-rater reliability and smallest detectable change of compression sonoelastography in quantifying the material properties of the musculoskeletal system.

Musculoskeletal conditions can change tissue elasticity. Knowledge of musculoskeletal elasticity could therefore aid clinical diagnosis and management. Sonoelastography is an ultrasound-based system that examines the material properties of tissues, and it may be useful in musculoskeletal practice. Therefore, it is important to establish its clinimetric properties. This study aimed to explore the intra-rater reliability and the smallest detectable changes of sonoelastography in examining musculoskeletal structures. A quantitative reliability design was used to examine 22 healthy participants using a compression sonoelastography system that produces color-coded images. The deltoid, biceps brachii, brachioradialis, rectus femoris, gastrocnemius medius muscles, and Achilles tendon were examined twice at 1-hr intervals to assess the intra-rater reliability. The sonoelastography images were analyzed using the strain index, strain ratio, and color pixels. The intra-rater reliability and the smallest detectable changes of each outcome variable were determined. The intra-class correlation coefficient was used to quantify the repeatability of the measurements, and the smallest detectable changes were calculated to determine clinically important differences above the error of measurement. The intra-rater reliability for the strain index, strain ratio, and color pixel analysis ranged from moderate to excellent (intra-class correlation coefficients: .734-.950, .776-.921, and .754-.990, respectively), with color pixel analysis demonstrating the highest reliability. The smallest detectable changes were determined for all structures, including the Achilles tendon (0.11 for the higher boundary of the strain index, 1.80 for the strain ratio, and 2.90% for red pixels, representing soft tissues). Color pixel analysis may be more reliable for sonoelastography interpretation compared with the strain index and strain ratio. The calculated smallest detectable changes could be used to identify clinically important differences.

The effectiveness of multiparametric ultrasound and compressive elastography in the early diagnosis of breast cancer

Modern ultrasound examination (US), unlike other modalities, allows to assess the stiffness of the lesions, with the help of a new technology named sonoelastography (SEG). According to many scientific studies, with the addition of SEG to the B-mode, the diagnostic efficiency of ultrasound of breast lesions significantly increases. According to Thomas et al. B-mode has a sensitivity of 91,8% and a specificity of 78%. When a compression SEG is added to a diagnostic study, the specificity increases to 91,5%. The purpose of this study was to determine the diagnostic effectiveness of SEG and compare it with the effectiveness of B-mode and color Doppler mapping (CDC) in the primary diagnosis of breast tumors, as well as to identify diagnostically and statistically significant SEG signs of breast cancer ( ВС ). Materials and methods . The study was performed from 2017 to 2019 on the basis of the «NMRC Oncology. named after N. N. Petrov» Ministry of Health of Russia. 277 women with complaints of lump or pain in the breast were included in the study, for all of them there was performed the multiparametric ultrasound examination with application of CDM and SEG. According to our own results, SEG is more effective at detection of malignant and benign lesions, than ultrasoumd examination in B and CDM modes. Results: 0, 1, 2, 3 elastotypes are the highly significant diagnostic signs of benign process, and the elastotype 5 is a reliable diagnostic marker of malignant process. The effectiveness of CDM and SEG in the differential diagnosis of breast lesions showed: sensitivity — 77,6% vs. 85,5%; specificity — 51,7% vs. 84,6%; accuracy — 58,8% vs. 84,8%. Conclusions: according to our own research results, SEG is more effective in detecting malignant and benign tumors than ultrasound in B and CDM modes.

Multiparametric Ultrasound Examination in Tumor-Like Formations of the Ovaries.

Properly diagnosed tumor-like formations of the ovaries facilitate the correct selection of patients who may not require surgery, or choose surgery with minimal access if such intervention is required. Subjective assessment of the features of tumor-like formations with the help of ultrasound diagnostics, including compression elastography, proved to be highly effective in the differential diagnosis of bulky ovarian formations. All tumor-like formations have their sonographic features that allow making a reliable diagnosis of a particular formation. The article reveals data on the diagnostic significance of multiparametric ultrasound imaging in the detection of ovarian tumor-like formations. A detailed sonographic picture of tumor-like formations in B-mode, color, and pulse Doppler mode and compression sonoelastography mode was analyzed. This examination was especially relevant for women of reproductive age, as it depended on the further tactics of treatment of each patient. For all types of tumor-like formations ovaries, a qualitative feature was determined - elastotype on the Ueno scale and the index of stiffness (Strain Ratio) - a quantitative indicator. Follicular cysts, endometrioid and periovarian cysts were found to belong to the 0 elastotype. Cysts of the corpus luteum belonged to the II elastotype on the Ueno scale. The lowest values of the stiffness index were seen in follicular and periovarian cysts, and the highest value was observed in endometrioid cysts. Our results have shown that ultrasound examination of ovarian tumors is an accurate and highly informative method.

Cognitive mpMRI/TRUS biopsy of the prostate with using strain elastography

Purpose. To evaluate the effectiveness of prostate cancer detection with method of cognitive mpMRI/TRUS fusion biopsy using strain sonoelastography.Materials and methods. Cognitive transrectal fusion biopsy of prostate was performed in 32 patients. According to the data of a preliminary conducted mpMRI, 33 foci suspicious of prostate cancer were included (PIRADSv2 = 3–5). Before the biopsy, all patients underwent ultrasound planning using compression sonoelastography.Results. The overall sensitivity was 76% for the targeted biopsy, and 49% for systematic biopsy. The number of biopsy specimens with a clinically significant Gleason grade in the targeted biopsy group was 85% of all columns with cancer specimens, in the systematic biopsy group this number was 68%. On average, the Gleason grade after targeted biopsy was 7.5 ± 0.9, and it was 7.2 ± 0.9 in the columns after systematic biopsy. On average, the percentage of tumor in the columns after targeted biopsy was 72% ± 29% and it was 55% ± 35% in the columns after systematic biopsy. The false positive for mpMRI was 15%. The overall sensitivity for the strain sonoelastography was 69% in this study, clinically significant cancer was detected in 71% of all columns with cancer specimens. False positive for elastography was observed in 18% of cases.Conclusion. Comparing with systematic biopsy, cognitive mpMRI / TRUS fusion biopsy can improve the detection rate of clinically significant prostate cancer and reduce the number of detected cases of clinically insignificant cancer. In cases of a total or subtotal tumor lesion in the peripheral zone detected on mpMRI, it is possible to take fewer columns for morphological verification of the tumor. The use of compression sonoelastography as an additional parameter of navigation in cognitive mpMRI/TRUS fusion biopsy can be considered as a promising way to increase the detection rate of clinically significant prostate cancer.

Accuracy and Reproducibility of Sonoelastography for the Assessment of Fibroids and Adenomyosis, with Magnetic Resonance Imaging as Reference Standard

The aims of this prospective diagnostic evaluation study were (i) to estimate the inter-observer agreement and reproducibility of real-time sonoelastography and real-time gray-scale ultrasound in the measurement of uterine and fibroid volumes; (ii) to evaluate the agreement between real-time gray-scale ultrasound, sonoelastography and magnetic resonance imaging with respect to these outcomes; and (iii) to evaluate the diagnostic accuracy of sonoelastography in the diagnosis of uterine pathology on stored sonoelastography and gray-scale cine loops. Women without a history of uterine pathology and with the diagnosis intrauterine fibroids or adenomyosis were included. All participants underwent gray-scale ultrasound, sonoelastography and magnetic resonance imaging. Compression sonoelastography was found to have high inter-observer and inter-method agreement for the measurement of uterine and fibroid volumes. The addition of sonoelastography to gray-scale ultrasound seems to be useful in the differentiation between fibroids, adenomyosis and normal uteri as reflected by an increase in accuracy and diagnostic agreement.

Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications.

In the past 2 decades, sonoelastography has been progressively used as a tool to help evaluate soft-tissue elasticity and add to information obtained with conventional gray-scale and Doppler ultrasonographic techniques. Recently introduced on clinical scanners, shear-wave elastography (SWE) is considered to be more objective, quantitative, and reproducible than compression sonoelastography with increasing applications to the musculoskeletal system. SWE uses an acoustic radiation force pulse sequence to generate shear waves, which propagate perpendicular to the ultrasound beam, causing transient displacements. The distribution of shear-wave velocities at each pixel is directly related to the shear modulus, an absolute measure of the tissue's elastic properties. Shear-wave images are automatically coregistered with standard B-mode images to provide quantitative color elastograms with anatomic specificity. Shear waves propagate faster through stiffer contracted tissue, as well as along the long axis of tendon and muscle. SWE has a promising role in determining the severity of disease and treatment follow-up of various musculoskeletal tissues including tendons, muscles, nerves, and ligaments. This article describes the basic ultrasound physics of SWE and its applications in the evaluation of various traumatic and pathologic conditions of the musculoskeletal system. ©RSNA, 2017.

Endofalloprosthesis with a one-component semirigid prosthesis in a patient with an arteriovenous fistula of the cavernous artery and the development of priapism

Phalloprosthesis in patients with various durations and different hemodynamic types of priapism is a disputable problem. Rigid penile prosthesis placement may be deemed to be a possible method for the torpid treatment of ischemic priapism, particularly if other medical and surgical procedures have been ineffective and the time of pathological erection is over 36–72 hours. The paper gives an example of how such a patient was treated. Imaging techniques, such as color Doppler mapping of the penile vessels, selective iliacography, and compression sono elastography, were used for diagnosis. These techniques could make a correct diagnosis and provide a rationale for endofalloprosthesis.

Тенденции развития компрессионной соноэластографии поверхностных органов и эндосонографии в рамках стандартизации методики

The purpose of this research is the use 5 stages of standardized methodology of compression elastography based on a preliminary assessment of gray-scale images, qualitative and semi-quantitative elastography. The authors give comparative characteristics of diagnostic efficiency and reproducibility standard data and propose the elastography in 3419 people with focal lesions of the breast, thyroid, regional lymph nodes, pancreas. The article presents the ways of nationwide discussion of standardized recommendations for compression elastography. Analysis of the data shows the advantage of the proposed standardized methodology of compression elastography. The evaluation of diagnostic and prognostic values of routine and standardized methods sonoelastography was carried out. Statistics are distributed as follows: in a routine method, the specificity is 90.3%, the sensitivity is estimated at 82.4%, the accuracy - 86,7%, AUC is equal 0,892 with 95% confidence interval [0,872 – 0,974]. In a standardized method, the specificity is 93.8%, the sensitivity is 84.7%, the accuracy – 88.5%, AUC is 0,938 with 95% confidence interval [0,889 – 0,981]. The non-specificity of the standardized compression sonoelastography method allows its use in any pathology of internal organs and tissues. Strict adherence to the stages of the standardized elastography contributes to the formation of a precise protocol elastographic examination.