Real-time Tissue Elastography Research Articles

1199: Analysis of Strain Patterns of Common Liver Tumors Using Real-Time Tissue Elastography

1199: Analysis of Strain Patterns of Common Liver Tumors Using Real-Time Tissue Elastography

Real-time tissue elastography in the diagnosis of autoimmune pancreatitis

Endoscopic ultrasound (EUS) elastography distinguishes tissues on the basis of their specific consistency. The preoperative diagnosis of autoimmune pancreatitis (AIP) is of the utmost importance in order to avoid surgery. The aim of this prospective evaluation of five patients was to investigate the role of this new technique in the characterization of mass lesions caused by AIP, with histology as the gold standard. All five patients with AIP presented with a characteristic stiff elastographic pattern not only of the mass lesion but also of the surrounding pancreatic parenchyma, which was not found in 17 patients with ductal adenocarcinoma and 10 healthy subjects. EUS elastography of the pancreas shows a typical and unique finding with homogenous stiffness of the whole organ, and this distinguishes AIP from the circumscribed mass lesion in ductal adenocarcinoma.

Real-Time Tissue Elastography Determines Optimal Treatment and Predicts the Prognosis of Ulcerative Colitis

Background/Aims: Ulcerative colitis (UC) is a chronic inflammatory disease with frequent remissions and relapses. Although colonoscopic examination is important in determining treatment for patients with UC, it is an invasive procedure and can lead to complications. Non-invasive methods to facilitate evaluation of the large bowel have therefore been sought. Real-time tissue elastography is a new technique that visualizes the differences in tissue strain produced by freehand compression during routine ultrasonography.

Real time elastography for noninvasive diagnosis of liver fibrosis

The accurate preoperative evaluation of liver fibrosis stage is important in determining surgical procedures. Although percutaneous liver biopsy is the gold standard, it may cause undesirable complications, such as bleeding. This study aimed to evaluate the usefulness of real-time tissue elastography for the preoperative assessment of liver fibrosis stage. We focused on a new mode of sonogram, real-time elastography, which can show tissue elasticity on images, and express the elasticity numerically. The elastic ratio of the liver for the intercostal muscle for each patient was calculated preoperatively, using the sonography device. The liver fibrosis stages were finally determined in the operative specimens from 41 patients. We examined the correlation between the elastic ratio and the histological fibrosis stage. The lower the elastic ratio, the more advanced was the liver fibrosis stage. There was a significant correlation between the elastic ratio and the histological fibrosis stage. The area under the receiver-operating characteristics curve for the diagnosis of significant liver fibrosis using this device was superior to those conventionally determined by blood parameters. Real-time elastography is a promising sonography-based noninvasive method for the preoperative assessment of liver fibrosis.

Diagnosis of mass forming lesions in combination with real-time tissue elastography.

Abstract Abstract #4013 [Purpose]
 Although “hardness” is a characteristic of invasive carcinomas, it was not given much importance until now because of its poor quantitative nature and reproducibility. However, due to the development of real-time tissue elastography (EG), the objective measurement of “hardness” is now possible. Moreover, we examined whether mammography (MMG) + B-mode ultrasound (US) in combination with EG improves diagnosability.
 [Subjects and methods]
 One hundred and seventy-seven patients with mass-image-forming lesions (135 benign, 42 malignant) whose tissues were diagnosed by core and mammotome biopsies from Oct 2007 to May 2008 were included in the study. Instruments used were Hitachi EUB-8500 and HV-900. The hardness is scored on a scale 1 to 5. Score 1: Distortion appears in the image of the entire low echo tumors, Score 2: Image of most of tumors are distorted but no distortion is seen in certain areas, Score 3: Distortion appears only in the peripheral areas, Score 4: No distortion appears in the entire tumors, and Score 5: No distortion appears even in the peripheral areas. The cases over score 4 are assumed to be malignant. US of category 4 or more, and MMG of category 3 or more were evaluated as malignant.
 [Results]
 In 57 patients with lesions of less than 1.1 cm (50 benign, 7 malignant), US + MMG showed sensitivity and specificity of 71.4% and 88.0%, respectively, whereas US + MMG + EG showed sensitivity and specificity of 100% and 80.8%. Moreover, when EG was combined with conventional methods, sensitivity increased from 71.4% to 100%. On the other hand, in 120 patients with lesions of 1.1 cm or more (85 benign, 35 malignant), US + MMG showed sensitivity and specificity of 100% and 55.3%, respectively, whereas US + MMG + EG showed sensitivity and specificity of 100% and 61.2%. There were no significant differences in sensitivity and specificity between the 2 methods, and no additional advantages were observed when EG was used.
 [Conclusions]
 Thus, in this study sensitivity could be increased by EG for tumors with a diameter of less than 1.1 cm. Therefore, it was suggested that biopsy may be omissible for low EG scores. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4013.

Feasibility of Tissue Elastography Using Transcutaneous Ultrasonography for the Diagnosis of Pancreatic Diseases

We investigated the feasibility of using real-time tissue elastography (EG) with transcutaneous ultrasonography (EG-US) for pancreatic diseases. A preliminary study (phase I) and a prospective (phase II) study were conducted. Phase I: subjects were 10 volunteers, 5 with cancer, 2 with endocrine tumor, 5 with chronic pancreatitis, 14 with intraductal papillary-mucinous neoplasm. To determine the characteristic EG images (diagnostic criteria for phase II), B-mode images were compared with EG images and histopathologic findings. Phase II: 53 consecutive patients were enrolled. The visualization rate by EG-US in lesions visualized by B mode was assessed, and the correct diagnosis rate by B mode alone (B diagnosis) or in combination with EG-US was evaluated. Phase I: normal parenchyma was a homogeneous color. In cancer, EG-US showed a markedly hard area with soft spots inside. Endocrine tumor was uniform and soft comparable to parenchyma. Chronic pancreatitis showed a mixture of various colors. Phase II: we identified 77.4% (41/53) of the lesions and observed 60.0% (15/25) of the cancers, 100% (3/3) of the endocrine tumor, 92.0% (23/25) of the cases of chronic pancreatitis cases on EG-US. The B-diagnosis rates ranged from about 70% to 80%. The diagnosis rates of the combination were more than 90% of lesions of each type. The EG-US is feasible in the diagnosis of pancreatic diseases.

Intra‐operative application of real‐time tissue elastography for the diagnosis of liver tumours

Real-time tissue elastography (RTE) has made it possible to visualize tissue elasticity. The aim of this study was to evaluate the usefulness of RTE for the differential diagnosis of liver tumours during surgical exploration. Fifty-five liver tumours in 44 patients were examined with RTE, concomitant with routine intra-operative ultrasonography. Elasticity images were classified into four types, from type A (even strain) to type D (no strain), according to the distribution and the degree of the strain contrasted with that of the surrounding liver [elasticity type of liver tumour (ETLT)]. We evaluated the consistency of the findings of RTE with the pathological diagnosis as a reference standard. All malignant lesions showed various degrees of strain reduction in the tumour tissue. Twenty-one of 22 hepatocellular carcinomas (HCCs) were classified as type B with a sensitivity of 95.5%, a specificity of 90.9% and an accuracy of 92.7%, while all 24 metastatic adenocarcinomas were classified as either type C or type D with a sensitivity of 100%, a specificity of 80.6% and an accuracy of 89.1%. Application of RTE in surgical exploration provided significant information about the elasticity of liver tumours. RTE, using a new criterion, ETLT, enabled us to distinguish rather accurately between two common malignancies: HCC and metastatic adenocarcinoma.

Real-time Tissue Elastography

Real-time tissue elastography is an emerging diagnostic tool that uses ultrasound to differentiate between hard and soft tissue. Typically, gentle freehand compression is used to apply 'stress' to tissue and the resulting 'strain' or displacement, is displayed as a colour overlay on a conventional B-mode ultrasound image. Elastography has the potential to increase examination specificity and thus reduce the need for diagnostic invasive procedures. Second generation technology, which quantifies strain characteristics, is bringing further improvements in diagnostic accuracy. Real-time tissue elastography has proven applications in breast, prostate, thyroid and pancreatic disease and where diagnostic biopsy is indicated, elastography allows more accurate localisation and targeting of lesions. This paper briefly reviews the underlying principles of the technique and outlines the current clinical applications.

VALIDATION OF SUBJECTIVE BENEFIT AFTER INTRAPROSTATIC BOTULINUS TOXIN A INJECTION IN PATIENTS WITH PROSTATIC HYPERTROPHY – AN EVIDENCE BY REAL-TIME TISSUE ELASTOGRAPHY

1964 VALIDATION OF SUBJECTIVE BENEFIT AFTER INTRAPROSTATIC BOTULINUS TOXIN A INJECTION IN PATIENTS WITH PROSTATIC HYPERTROPHY – AN EVIDENCE BY REAL-TIME TISSUE ELASTOGRAPHY Takeo Hiraoka*, Hiroaki Shiina, Shogo Inoue, Masahiro Sumura, Shinji Urakami, Satoshi Honda, Koji Wake, Mikio Igawa. Izumo, Japan. INTRODUCTION AND OBJECTIVE: Recent reports have indicated intraprostatic botulinus toxin A (BTX-A) injection as an attractive alternative to TUR-P. The purpose of this study is to validate the clinical usefulness of BTX-A injection into the prostate as a minimal invasive treatment for BPH. METHODS: Twenty-two BPH patients (average age 74 years old) were employed in this study. The eligible criteria for inclusion are

Noninvasive Evaluation of Hepatic Fibrosis Using Serum Fibrotic Markers, Transient Elastography (FibroScan) and Real-Time Tissue Elastography

Objective: The aim of this study was to investigate the accuracy of noninvasive tests, e.g. serum fibrotic markers, transient elastography and real-time tissue elastography, in the diagnosis of hepatic fibrosis, and to determine whether they can replace liver biopsy. Methods: 119 patients with chronic liver disease were included in this study. Serum fibrotic markers including hyaluronic acid, type IV collagen, type IV collagen 7S domain and type III procollagen-N-peptide were measured. Aspartate aminotransferase (AST) and platelet counts were also measured to calculate the AST to platelet ratio index (APRI). Liver stiffness was measured using FibroScan and real-time tissue elastography. Results: The fibrotic stage, determined by histopathological diagnosis of a liver biopsy sample, did not correlate as well with serum fibrotic markers although it was useful to diagnose liver cirrhosis. However, the stage of hepatic fibrosis correlated well with liver stiffness measured by FibroScan. FibroScan was also a much better predictor of liver cirrhosis than APRI. Furthermore, the levels of liver strain measured by real-time tissue elastography correlated well with liver stiffness (p < 0.05). Conclusion: Serum fibrotic markers and FibroScan are useful for distinguishing liver cirrhosis (F₄) from chronic hepatitis (F₁–F₃). In addition, real-time tissue elastography is a novel and promising method to determine the stage of hepatic fibrosis.

MP-14.04: Evaluation of prostate cancer with real-time tissue elastography based on step-section pathologic analysis after radical prostatectomy

MP-14.04: Evaluation of prostate cancer with real-time tissue elastography based on step-section pathologic analysis after radical prostatectomy

Poster 033: Clinical Significance of Real-Time Tissue Elastography in the Evaluation of Cervical Lymph Node Metastases in Patients With Oral Cancer

Poster 033: Clinical Significance of Real-Time Tissue Elastography in the Evaluation of Cervical Lymph Node Metastases in Patients With Oral Cancer

Clinical Application of Real-time Tissue Elastography to Head and Neck Cancer—Evaluation of Cervical Lymph Node Metastasis with Real-time Tissue Elastography

Real-time tissue elastography (elastography) is a new ultrasonography procedure that display tissue elasticity. We evaluated the usefulness of elastography in the diagnosis of cervical lymph node metastasis and its treatment results in patients with head and neck cancer. Metastatic lymph nodes tended to produce little distortion when displayed as hard tumors, and produced distortion, displayed as soft tumors, after radiation therapy and/or chemotherapy. Elastography thus is useful as a potential new diagnostic procedure in the diagnosis of neck lymph node metastasis in head and neck cancer.

Real-time Tissue Elastography 技術の開発

Real-time Tissue Elastography 技術の開発

Application of real-time tissue elastography in diagnosis of breast cancer

To investigate the clinical value of real-time tissue elastography (RTE) in the diagnosis of breast cancer. One hundred and twenty patients with breast lumps (135 lesions) were examined with B-mode imaging, color Doppler flowing imaging (CDFI) and RTE. The elastogram was graded using 5-score evaluating method. The postoperative pathological diagnosis was used as gold standard, and the sensitivity, specificity and accuracy of RTE and two-dimensional ultrasonography combined with RTE in diagnosis of breast cancer were calculated. When the score >4 was set for cut-off criteria of malignancy, the sensitivity, specificity and accuracy of RTE was 85.45%, 83.75% and 84.4%, respectively. While two-dimensional ultrasonography combined with RTE was used, the sensitivity, specificity and accuracy increased up to 100%, 95% and 97%, respectively. RTE combined with two-dimensional ultrasonography can improve the validity in the diagnosis of malignant breast lesions.

2045: Preoperative evaluation of lymph node metastasis of thyroid cancer using real-time tissue elastography

Objectives: The aim of this study was to investigate the clinical usefulness in detection of lymph node (LN) metastasis of thyroid cancer on real-time tissue elastography (RTE).Methods: Sixty cases were examined by RTE before surgery and those images were evaluated and classified into four patterns. Pattern 1: almost whole nodule displayed in light green. Pattern 2: light green base with blue in the periphery of the nodule. Pattern 3: blue zone base mixed with light green and red. Pattern 4: almost whole blue in the nodule. They were compared to pathological results.Results: Surgical LN dissections were performed in 78 lesions at lateral cervical areas and in 92 lesions at paratracheal areas. In 78 lateral cervical lesions, 58 (74%) lesions were detectable on B-mode and 64 (82%) lesions on RTE. In 92 paratracheal lesions, 35 (38%) lesions were detectable on B-mode and 30 (33%) lesions on RTE. Detection of LN metastasis at lateral cervical areas was improved by RTE.Conclusions: RTE demonstrated possibility of improvement in LN metastasis detection at lateral cervical areas. Though there are still some difficulties at paratracheal areas detection because of its anatomical features, RTE can provide useful information for surgical strategy. Objectives: The aim of this study was to investigate the clinical usefulness in detection of lymph node (LN) metastasis of thyroid cancer on real-time tissue elastography (RTE). Methods: Sixty cases were examined by RTE before surgery and those images were evaluated and classified into four patterns. Pattern 1: almost whole nodule displayed in light green. Pattern 2: light green base with blue in the periphery of the nodule. Pattern 3: blue zone base mixed with light green and red. Pattern 4: almost whole blue in the nodule. They were compared to pathological results. Results: Surgical LN dissections were performed in 78 lesions at lateral cervical areas and in 92 lesions at paratracheal areas. In 78 lateral cervical lesions, 58 (74%) lesions were detectable on B-mode and 64 (82%) lesions on RTE. In 92 paratracheal lesions, 35 (38%) lesions were detectable on B-mode and 30 (33%) lesions on RTE. Detection of LN metastasis at lateral cervical areas was improved by RTE. Conclusions: RTE demonstrated possibility of improvement in LN metastasis detection at lateral cervical areas. Though there are still some difficulties at paratracheal areas detection because of its anatomical features, RTE can provide useful information for surgical strategy.

3556: Application of elasticity imaging to evaluation of deep venous thrombosis: Preliminary study

We have developed a real-time tissue elastography for visualizing the tissue hardness/softness to detect lesions such as cancer. We have been investigating its clinical usefulness for several clinical abnormalities, e.g., breast cancer, prostate cancer, thyroid cancer and plaque hardness/softness. In this paper we applied our real-time tissue elastography to the diagnosis of deep venous thrombosis (DVT). DVT is known to cause pulmonary thromboembolism (PTE) and needs early detection and treatment especially when it is in acute stage.

2046: Evaluation of thyroid malignant tumor using real-time tissue elastography

2046: Evaluation of thyroid malignant tumor using real-time tissue elastography

2044: Clinical evaluation of real time tissue elastography for the thyroid follicular lesions

Objectives: The diagnosis and management of follicular carcinoma of the thyroid remains a controversial topic. The aim of this study was to evaluate the clinical usefulness of Real-time tissue elastography (RTE) for the differential diagnosis of thyroid follicular lesions.

CLINICAL EVALUATION OF REAL-TIME TISSUE ELASTOGRAPHY (RTE) FOR THE DIFFERENTIAL DIAGNOSIS OF THYROID FOLLICULAR LESIONS

Purpose: The diagnosis and management of follicular carcinoma of the thyroid gland remains a controversial topic. Fine needle aspiration, although very sensitive with other types of thyroid cancer, has limited accuracy with follicular lesions. Color-Doppler (CD) imaging has been expected for the differential diagnosis between follicular adenoma and follicular carcinoma, otherwise, the findings obtained by CD imaging could not easily confirmed by cytological and pathological methods. The aim of this study was to evaluate the clinical usefulness of Real-time tissue Elastography (RTE) imaging for the differential diagnosis of thyroid follicular lesions.