Elastography For Characterization Research Articles

Value of elastography in characterization of solid renal masses

BackgroundSolid renal masses often come to light as incidental findings during abdominal ultrasound examinations. Once detected, determining whether a renal mass is benign or malignant becomes imperative for informed decision-making regarding management and treatment strategies. In this investigation, the aim was to explore the diagnostic efficacy of real-time strain sonoelastography in assessing solid renal masses.MethodsThis prospective research was steered on 26 individuals diagnosed with a solid renal mass, as endorsed by pathological analysis after surgical removal or biopsy. Elastography was performed on all patients. The measurement of strain index values for tissues was achieved by placing regions of interest of equal or near-equal size on both the tumor (A) and the adjacent normal renal cortex (B).ResultsStrain elastography showed no correlation with patient’s age, size of mass and probe to mass distance with p > 0.05 all. Sensitivity analysis showed that strain index can significantly predict malignant renal masses (P = 0.003) using a cut-off point 2, with 92.9% area under curve, 95.2% sensitivity, 80% specificity, 80% negative predictive value, 95.2% positive predictive value, and overall diagnostic accuracy 92.3%. Strain index > 2 was an independent predictor for malignant renal masses (P = 0.025), odds ratio 7.29 when adjusting for other risk factors. Malignant renal masses were significantly higher strain index compared to benign lesions with (P = 0.001).ConclusionsStrain elastography is a valuable technique for distinguishing between malignant and benign solid renal tumors. Benign lesions have lower strain index values compared to malignant ones, making the strain index a useful screening tool for distinguishing between benign and malignant renal masses using cut-off point 2.

Accuracy of shear wave elastography in characterization of thyroid nodules in children and adolescents

BackgroundThyroid nodules are an important health problem in children and adolescents. They possess a higher risk of malignancy in comparison to adults. This fact forms a great dilemma for clinicians. The aim of this study was to evaluate the reliability of shear wave elastography (SWE) as a non-invasive technique in the characterization of thyroid nodules in children and adolescents.MethodsThis prospective study included 56 patients with thyroid nodules. All the patients underwent clinical assessment, laboratory investigations, ultrasound, and Doppler examination, followed by an SWE assessment. Statistical analysis was performed and the best cut-off value to differentiate benign from malignant nodules was determined using the ROC curve and AUC.ResultsSeventy-two nodules were detected in the examined patients (ages ranged from 11 to 19 years, with mean age of 14.89 ± 2.3 years). Fifty-eight nodules (80.6%) were benign, and fourteen nodules (19.4%) were malignant (histopathologically proved). Highly suspicious criteria for prediction of malignancy by ultrasound and Doppler were hypoechoic echopattern, internal or internal and peripheral vascularity, microcalcifications, taller-than-wide dimensions, irregular outlines, and absence of halo (p < 0.05). The diagnostic performance for their summation was 70.69% sensitivity, 82.8% specificity, 80.45% accuracy, a 63.79% positive predictive value (PPV), and 87.9% negative predictive values (NPV). Regarding SWE, our results showed that 42.2 kPa was the best cut-off value, with AUC = 0.921 to differentiate malignant from benign nodules; the diagnostic performance was 85.71% sensitivity, 94.83% specificity, 93.06% accuracy, 76.9% PPV, and 93.2% NPV.ConclusionShear wave elastography is a non-invasive technique that can assist in the diagnosis of malignant thyroid nodules among children and adolescents.

556 Poster - Role of Ultrasound Elastography in characterization of breast lesions: Does it really count?

Background: To compare the diagnostic performance of Ultrasound Elastography, Ultrasonography (Greyscale & Colour Doppler) and Digital Mammography in the characterisation of breast lesions using Pathological diagnosis as Gold standard.

Role of shear wave elastography in characterization of hepatic focal lesions

BackgroundElastography is a recently developed diagnostic method that aims to evaluate tissue stiffness. Its utility is based on the fact that pathological tissues are generally stiffer than surrounding healthy tissues which often show up as a hard lesion. Shear wave elastography (SWE) is a new technique based on shear waves that has been implemented in diagnostic ultrasound (US) systems. The aim of this study is to study the role of shear wave elastography in differentiation between benign and malignant hepatic focal lesions.ResultsThe study was conducted on 110 patients (92 males, 18 females) with a mean age of 51.7 years. Age range was from 30 to 70 years; 28 patients were diagnosed with benign lesions, and 82 with malignant lesions. SWE shows that there is a significant difference in stiffness between malignant and benign lesions with p value = 0.002 and with mean ± SD of 10.3 ± 6.31 kPa for the benign lesions and 16.2 ± 9.32 kPa for the malignant group. A cutoff value of 13.24 was selected to differentiate between benign and malignant lesions using the SWE mean providing sensitivity 78.04%, specificity 71.42%, and accuracy 64.2%.ConclusionSWE is a good tool in the differentiation of benign and malignant hepatic focal lesions.

Ultrasound elastography in characterization of prostatic lesions: correlation with histopathological findings.

Ultrasound elastography is increasingly used in the diagnosis of prostate cancer, however results are heterogeneous. We correlate in a large sample-size prospective study the accuracy of elastography, aiming to settle an accurate cut-off point for diagnosis and possibility of use as a screening tool. Prospective study that included 120 patients with mean age 59.5 ± 9.8 years, showing enlarged prostate by clinical examination with prostate-specific antigen >4 ng ml-1.The study was done using high frequency high resolution endorectal probe with real time tissue elastography.Grayscale ultrasound examination was done first with Doppler followed by elastography color-coded map and strain ratio measurement. Then, transrectal ultrasound-guided core biopsy was done from suspicious areas detected by elastography (totally or partly stiff by color-coded map or with relative increased strain ratio), besides standard six-quadrant core biopsy samples. There was statistically significant difference (p < 0.001) regarding strain ratio in benign and malignant lesions. Strain ratio showed significant proportionate correlation with prostate-specific antigen level and Gleason pathological score, while no significant correlation noted with the age or the prostatic volume. A strain ratio with a cut-off value of 1.9 showed a sensitivity of 100%, specificity 93.8%, positive predictive value of 79.3%, negative predictive value 100 and 95% accuracy in differentiating between malignant and benign lesions. Strain ratio improves the detection of prostatic cancer with high sensitivity (100%) and high negative predictive value (100%). Different prostatic lesions are mostly similar in grayscale ultrasound.Imaging plays an important role in differentiation of prostatic nodules.Ultrasound elastography may play an important role in distinguishing benign from malignant nodules.

Role of elastography in characterization of solid breast masses

Objectives The aim of this study was to study the diagnostic performance of elastography in characterization of solid breast masses. Background Elastography is an imaging modality that can calculate the elasticity of tissues, based on the well-established principle that benign lesions are soft and malignant lesions are hard. It is an easy procedure with high diagnostic performance, which can be easily integrated with the B-mode ultrasound examination in the same session to improve its specificity. Patients and methods A total of 30 female patients were included in this prospective study in the period from February 2016 to February 2017 with a complaint of breast mass. We examined the patients using ultrasonography and strain elastography. Then, we compared the findings of ultrasonography and elastography with pathology findings to assess their diagnostic performance. Results Among the 30 breast masses, 14 were benign and 16 were malignant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography were 100, 43, 67, and 100%, respectively. Qualitative elastography (Tsukuba score) had a sensitivity of 69%, specificity of 86%, PPV of 85%, and NPV of 71%. Quantitative elastography, assessed using the strain ratio, was a good discriminant for malignancy (area under the receiver operating curve = 0.94, P = 0.001). Our results revealed a cutoff point for malignancy of more than2.7; by using this threshold, the diagnostic performance of the strain ratio was 94% sensitivity, 86% specificity, 88% PPV, and 92%NPV. Conclusion Elastography has great diagnostic performance in distinguishing between benign and malignant breast masses.

Role of Ultrasound Elastography in Characterization of Indeterminate Breast lesions (BIRADS 3&amp;4 lesions).

With the expanded role of screening breast ultrasonography and accumulating clinical experience, the American College of Radiology (ACR) has established the Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon to standardize terminology for description and management recommendations according to stratified risks. It has been established that probably benign (BI-RADS category 3) lesions having a malignancy rate of less than 2% require short-term imaging follow-up rather than immediate biopsy. The BI-RADS 4 category is assigned to suspicious lesions for which biopsy is recommended. Routine screening methods such as mammography and breast ultrasound are valuable methods for managing breast masses. Breast ultrasound is the preferable screening method as it provides high sensitivity for detecting breast cancer in women with dense breast tissue and can detect cancers not identified on mammography in asymptomatic women with dense breast tissue. In our study we included 46 patients with different breast lesions. All patients had a conventional B-mode ultrasound examination and were evaluated according to the BIRADS categories, then real time free-hand ultrasound elastography was performed in the same session and images were evaluated using both the Tsukuba elasticity score and the strain ratio method. Finally, the results were compared to the histopathologic results of those lesions. It was found that conventional B-mode ultrasound examination had a sensitivity of 72.73% and specificity of 83% While, elastography scoring alone turned out to have sensitivity of 65.5%, specificity of 83.4% using the Tsukuba score system. The additional of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity 98.4% and specificity 85.68% at a best cutoff point of 3.47. So we have found that elastography is an easy procedure with high diagnostic performance which can be easily integrated with the B-mode ultrasound examination in the same session and improves its specificity. That has proven benefit in minimizing the number of unnecessary biopsies especially in the assessment of BIRADS 3 and 4 lesions

Utility of point shear wave elastography in characterisation of focal liver lesions

ABSTRACTBackground: The present study aimed at evaluation of the usefulness of point shear wave elastography (pSWE) in characterization of FLL(s) by quantifying their stiffness.Methods: In total, 197 patients (mean age was 56.57 years) with FLL(s) on conventional ultrasound were included. Final diagnoses, confirmed by imaging and/or biopsy whenever possible, included hepatocellular carcinoma (HCC) (n = 143), metastasis (n = 36), hemangioma (n = 16), and focal nodular hyperplasia (n = 2). Stiffness evaluation was performed by pSWE. Stiffness ratio (lesion to background liver) was calculated. ROC analysis was performed to evaluate the diagnostic accuracy of the stiffness value and stiffness ratio and to extract the optimal cutoff values for characterisation of FLL(s).Results: HCC was significantly softer than its surrounding liver parenchyma [5.43 (3.03) vs. 17.05 (8.53) kPa, p <0.001]. However, the stiffness values for the other examined FLLs were comparable to their surrounding liver parenchyma. No significant difference was detected across different types of metastases or between metastases and surrounding liver (p>0.05). Stiffness ratio was superior to stiffness value in discrimination of HCC from metastasis (AUROC, 0.91 vs. 0.51 respectively).Conclusion: pSWE could provide a complementary information about FLLs especially in differentiation between HCCs from metastases.

Efficiency of Second Generation Ultrasound Elastography in Characterization of Thyroid Lesions

Efficiency of Second Generation Ultrasound Elastography in Characterization of Thyroid Lesions