151
|
Caenen A, Knight AE, Rouze NC, Bottenus NB, Segers P, Nightingale KR. Analysis of multiple shear wave modes in a nonlinear soft solid: Experiments and finite element simulations with a tilted acoustic radiation force. J Mech Behav Biomed Mater 2020; 107:103754. [PMID: 32364950 DOI: 10.1016/j.jmbbm.2020.103754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022]
Abstract
Tissue nonlinearity is conventionally measured in shear wave elastography by studying the change in wave speed caused by the tissue deformation, generally known as the acoustoelastic effect. However, these measurements have mainly focused on the excitation and detection of one specific shear mode, while it is theoretically known that the analysis of multiple wave modes offers more information about tissue material properties that can potentially be used to refine disease diagnosis. This work demonstrated proof of concept using experiments and finite element simulations in a uniaxially stretched phantom by tilting the acoustic radiation force excitation axis with respect to the material's symmetry axis. Using this unique set-up, we were able to visualize two propagating shear wave modes across the stretch direction for stretches larger than 140%. Complementary simulations were performed using material parameters determined from mechanical testing, which enabled us to convert the observed shear wave behavior into a correct representative constitutive law for the phantom material, i.e. the Isihara model. This demonstrates the potential of measuring shear wave propagation in combination with shear wave modeling in complex materials as a non-invasive alternative for mechanical testing.
Collapse
Affiliation(s)
- Annette Caenen
- IBiTech-bioMMeda, Ghent University, Ghent, Belgium; Department of Cardiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.
| | - Anna E Knight
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Ned C Rouze
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Nick B Bottenus
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | | | | |
Collapse
|
152
|
Maier AM, Heil J, Harcos A, Sinn HP, Rauch G, Uhlmann L, Gomez C, Stieber A, Funk A, Barr RG, Hennigs A, Riedel F, Schäfgen B, Hug S, Marmé F, Sohn C, Golatta M. Prediction of pathological complete response in breast cancer patients during neoadjuvant chemotherapy: Is shear wave elastography a useful tool in clinical routine? Eur J Radiol 2020; 128:109025. [PMID: 32371182 DOI: 10.1016/j.ejrad.2020.109025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the validity of Shear Wave Elastography (SWE) for the preoperative assessment of pathological complete response (pCR) to standard clinical assessment in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS This prospective, consecutive clinical trial was conducted under routine clinical practice. Analysis included 134 patients. SWE served as index test, final pathology from surgical specimen as reference standard. PCR (ypT0) was defined as primary endpoint. Elasticity changes were compared for the pCR- vs. non-pCR group. To determine the validity of shear wave velocity (Vs), ROC analyses and diagnostic accuracy parameters were calculated and compared to the final standard clinical assessment by physical examination, mammography and B-mode ultrasound (ycT + vs. ycT0). RESULTS Vs was significantly reduced in pCR and non-pCR groups during NACT (pCR: ΔVs(abs) = 3.90 m/s, p < 0.001; non-pCR: ΔVs(abs) = 3.10 m/s, p < 0.001). The pCR-group showed significant lower Vs for all control visits (t1,2,END: p < 0.001). ROC analysis of Vs yielded moderate AUCs for the total population (t0: 0.613, t1: 0.745, t2: 0.685, tEND: 0.718). Compared to standard clinical assessment, Vs(tEND) (cut-off: ≤3.35 m/s) was superior in sensitivity (79.6 % vs. 54.5 %), NPV (86.4 % vs. 77.5 %), FNR (20.4 % vs. 45.5 %), inferior in specificity (58.6 % vs. 77.5 %), PPV (46.3 % vs. 54.5 %), FPR (41.4 % vs. 22.5 %). CONCLUSION SWE measures significant differences in tumour elasticity changes in pCR vs. non-pCR cases. SWE shows improved sensitivity compared to standard clinical assessment, high NPV and low FNR, but failed in specificity in order to predict pCR under routine conditions.
Collapse
Affiliation(s)
- Anna Marie Maier
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Aba Harcos
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, Heidelberg University, Heidelberg, Germany
| | - Geraldine Rauch
- Charité Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health Berlin, Berlin, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Christina Gomez
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University, Heidelberg, Germany
| | - Annika Funk
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA
| | - André Hennigs
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Sarah Hug
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Frederik Marmé
- Experimental & Translational Gynecological Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Christof Sohn
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany.
| |
Collapse
|
153
|
Knight AE, Lipman SL, Ketsiri T, Hobson-Webb LD, Nightingale KR. On the Challenges Associated with Obtaining Reproducible Measurements Using SWEI in the Median Nerve. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1092-1104. [PMID: 32057471 PMCID: PMC7419061 DOI: 10.1016/j.ultrasmedbio.2019.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/25/2019] [Accepted: 12/29/2019] [Indexed: 05/03/2023]
Abstract
This work discusses challenges we have encountered in acquiring reproducible measurements of shear wave speed (SWS) in the median nerve and suggests methods for improving reproducibility. First, procedural acquisition challenges are described, including nerve echogenicity, transducer pressure and transmit focal depth. Second, we present an iterative, radon sum-based algorithm that was developed specifically for measuring the SWS in median nerves. SWSs were measured using single track location shear wave elasticity imaging (SWEI) in the median nerves of six healthy volunteers and six patients diagnosed with carpal tunnel syndrome. Unsuccessful measurements were associated with several challenges including reverberation artifacts, low signal-to-noise ratio and temporal window limitations for tracking the velocity wave. To address these challenges, an iterative convergence algorithm was implemented to identify an appropriate temporal processing window that removed the reverberation artifacts while preserving shear wave signals. Algorithmically, it was important to consider the lateral regression kernel size and position and the temporal window. Procedurally, both nerve echogenicity and transducer compression were determined to impact the measured SWS. Shear waves were successfully measured in the median nerve proximal to the carpal tunnel, but SWEI measurements were significantly compromised within the carpal tunnel itself. The velocity-based SWSs were statistically significantly higher than the displacement SWSs (p < 0.0001), demonstrating for the first time dispersion in the median nerve in vivo using SWEI.
Collapse
Affiliation(s)
- Anna E Knight
- Duke Biomedical Engineering, Duke University, Durham, NC.
| | | | | | - Lisa D Hobson-Webb
- Duke Department of Neurology/Neuromuscular Division, Duke University, Durham, NC
| | | |
Collapse
|
154
|
Rus G, Faris IH, Torres J, Callejas A, Melchor J. Why Are Viscosity and Nonlinearity Bound to Make an Impact in Clinical Elastographic Diagnosis? SENSORS (BASEL, SWITZERLAND) 2020; 20:E2379. [PMID: 32331295 PMCID: PMC7219338 DOI: 10.3390/s20082379] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
The adoption of multiscale approaches by the biomechanical community has caused a major improvement in quality in the mechanical characterization of soft tissues. The recent developments in elastography techniques are enabling in vivo and non-invasive quantification of tissues' mechanical properties. Elastic changes in a tissue are associated with a broad spectrum of pathologies, which stems from the tissue microstructure, histology and biochemistry. This knowledge is combined with research evidence to provide a powerful diagnostic range of highly prevalent pathologies, from birth and labor disorders (prematurity, induction failures, etc.), to solid tumors (e.g., prostate, cervix, breast, melanoma) and liver fibrosis, just to name a few. This review aims to elucidate the potential of viscous and nonlinear elastic parameters as conceivable diagnostic mechanical biomarkers. First, by providing an insight into the classic role of soft tissue microstructure in linear elasticity; secondly, by understanding how viscosity and nonlinearity could enhance the current diagnosis in elastography; and finally, by compounding preliminary investigations of those elastography parameters within different technologies. In conclusion, evidence of the diagnostic capability of elastic parameters beyond linear stiffness is gaining momentum as a result of the technological and imaging developments in the field of biomechanics.
Collapse
Affiliation(s)
- Guillermo Rus
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
- Excellence Research Unit “ModelingNature” MNat UCE.PP2017.03, University of Granada, 18071 Granada, Spain
| | - Inas H. Faris
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Jorge Torres
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Antonio Callejas
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Juan Melchor
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
- Excellence Research Unit “ModelingNature” MNat UCE.PP2017.03, University of Granada, 18071 Granada, Spain
- Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain
| |
Collapse
|
155
|
Zhu Y, Jia XH, Zhou W, Zhan WW, Zhou JQ. Qualitative Evaluation of Virtual Touch Imaging Quantification: A Simple and Useful Method in the Diagnosis of Breast Lesions. Cancer Manag Res 2020; 12:2037-2045. [PMID: 32256111 PMCID: PMC7090171 DOI: 10.2147/cmar.s241815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/21/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To test the value of qualitative virtual touch imaging quantification (VTIQ) features in differentiating benign from malignant breast lesions. Methods From November 2016 to August 2017, 230 lesions were subjected to conventional US and virtual touch imaging quantification before biopsy. The maximum shear wave velocity (SWVmax) was measured using a standardized method. Qualitative VTIQ features, including the “stiff rim” sign and color pattern classification, were assessed according to a binary classification. The sensitivity, specificity and area under the receiver operating curve (AUC) of Breast Imaging Reporting and Data System (BI-RADS), SWVmax, qualitative VTIQ features, and combined data were compared. Results Among the 230 breast lesions, 150 were benign and 80 were malignant. Compared to the benign lesions, the malignant ones had higher SWVmax values and were more likely to show the “stiff rim” sign and VTIQ pattern 2 (P <0.001 for all). The AUC value was 0.885 for the qualitative VTIQ combination (the presence of the “stiff rim” sign and/or the display of VTIQ pattern 2), similar to that for SWVmax (P=0.472). BI-RADS combined with the qualitative VTIQ combination and with SWVmax yielded similar results, including significantly higher AUC values (P = 0.018 and 0.014, respectively), significantly higher specificities (P<0.001 for both), and nonsignificantly decreased sensitivities (P = 0.249 for both) compared to BI-RADS alone. Conclusion The dual-category classification of qualitative VTIQ features according to the presence of the “stiff rim” sign and/or the classification of VTIQ pattern 2 is a simple and useful method that may be representative of quantitative VTIQ parameters in the evaluation of breast masses.
Collapse
Affiliation(s)
- Ying Zhu
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Xiao-Hong Jia
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Wei Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Wei-Wei Zhan
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Jian-Qiao Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| |
Collapse
|
156
|
Cohen J, Riishede I, Carlsen JF, Lambine TL, Dam MS, Petersen MM, Nielsen MB, Ewertsen C. Can Strain Elastography Predict Malignancy of Soft Tissue Tumors in a Tertiary Sarcoma Center? Diagnostics (Basel) 2020; 10:diagnostics10030148. [PMID: 32156078 PMCID: PMC7151207 DOI: 10.3390/diagnostics10030148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
This study aims to investigate the ability of ultrasound strain elastography as an adjunct to predict malignancy in soft tissue tumors suspect of sarcoma or metastasis in a tertiary reference center for sarcoma. A total of 137 patients were included prospectively. Patients were referred on the basis of clinical or radiological suspicion of malignant soft tissue tumor. All patients had previously undergone diagnostic imaging (MRI, CT or PET-CT). After recording strain elastography cine loops, ultrasound guided biopsy was performed. Three investigators, who were blinded to final diagnosis, reviewed all elastograms retrospectively. For each elastogram, a qualitative, visual 5-point score was decided in consensus and a strain ratio was calculated. Final pathology obtained from biopsy or tumor resection served as gold standard. Eighty-one tumors were benign, and 56 were malignant. t-tests showed a significant difference in mean visual score between benign and malignant tumors. There was no significant difference in mean strain ratio between the two groups. Strain elastography may be a valuable adjunct to conventional B-mode ultrasound, perhaps primarily in primary care, when considering whether to refer to a sarcoma center or to biopsy, although biopsies cannot reliably be ruled out based on the current data.
Collapse
Affiliation(s)
- Jonathan Cohen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
- University of Copenhagen, Faculty of Health and Medical Sciences, Panum Institute, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Correspondence: ; Tel.: +45-61260782
| | - Iben Riishede
- Department of Obstetrics and Gynaecology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark;
| | - Jonathan Frederik Carlsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Trine-Lise Lambine
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Mikkel Seidelin Dam
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark;
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Caroline Ewertsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| |
Collapse
|
157
|
Wang X, Hu Y, Zhu J, Gao J, Chen S, Liu F, Li W, Liu Y, Ariun B. Effect of acquisition depth and precompression from probe and couplant on shear wave elastography in soft tissue: an in vitro and in vivo study. Quant Imaging Med Surg 2020; 10:754-765. [PMID: 32269934 DOI: 10.21037/qims.2020.01.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Shear wave elastography is a promising method to diagnose early musculoskeletal lesions. We aimed to explore the feasible depth and acceptable precompression applied by probe and couplant for soft tissues in the present system. Methods Ex-vivo muscles were evaluated at depths of 0.5-6 cm by 3 operators, using 1-5 mm couplant thickness and 0-3.0 kPa probe pressure. We compared the shear wave speed (SWS) and used intraclass correlation coefficients to assess reproducibility. In vivo skin and subcutaneous superficial fascia from volunteers were tested at depths ranging from 0.1-0.5 cm with 1-20 mm couplant thickness. Results The SWS of ex-vivo muscles varied and increased with depth, and could not be acquired at 6 cm because the shear wave failed to be detected. Furthermore, while the SWS of ex-vivo muscles were not affected by the couplant thickness, it was affected by probe pressure. Most cases demonstrated a satisfactory agreement degree of the intraoperator reproducibility (ICC, 0.81-0.95) and a substantial interoperator reproducibility (ICC >0.60). Inter- and intra-operator reproducibility was better at a depth of 0.5-4 cm than at 5 cm. In the in vivo study, when tissues within a 0.2 cm depth were evaluated, the SWS that was acquired using a couplant thickness of >10 mm was different from that acquired using other thicknesses. Conclusions The SWS acquired at a depth of ≤3 cm with a suitable amount of couplant is recommended.
Collapse
Affiliation(s)
- Xiuming Wang
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Yue Hu
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Jia'an Zhu
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Junxue Gao
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Si Chen
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Yiqun Liu
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Bilig Ariun
- Department of Ultrasound, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| |
Collapse
|
158
|
Relationship Between Shear Wave Elastography Findings and Histologic Prognostic Factors of Invasive Breast Cancer. Ultrasound Q 2020; 36:79-83. [DOI: 10.1097/ruq.0000000000000471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
159
|
Issaoui M, Balandraud X, Grédiac M, Blaysat B, Ouchchane L, Delabaere A, Sauvant-Rochat MP, Lemery D. Temperature Rise Caused by Shear Wave Elastography, Pulse Doppler and B-Mode in Biological Tissue: An Infrared Thermographic Approach. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:325-335. [PMID: 31735465 DOI: 10.1016/j.ultrasmedbio.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine the interest in and relevance of the use of infrared thermography, which is a non-invasive full-field surface temperature measurement technique, to characterize the heterogeneous heating caused by ultrasound in biological tissue. Thermal effects of shear wave elastography, pulse Doppler and B-mode were evidenced in porcine tissue. Experiments were performed using a high-frequency echography Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). For all three modes, ultrasound was applied continuously for 360 s while the temperature at the sample surface was recorded with a Cedip Jade III-MWIR infrared camera (Flir, Torcy, France). Temperature changes were detected for the three modes. In particular, "heat tunnels" crossing the sample were visualized from the early stages of the experiment. Heat conduction from the transducer was also involved in the global warming of the sample. The study widens the prospects for studies on tolerability, potentially in addition to classic approaches such as those using thermocouples.
Collapse
Affiliation(s)
- Maha Issaoui
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Xavier Balandraud
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Grédiac
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Benoit Blaysat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique, Unité de Biostatistique et Informatique Médicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amelie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Pierre Sauvant-Rochat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique et Environnement, Université Clermont-Auvergne, UFR Pharmacie, Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
160
|
Breast Cancer Assessment With Pulse-Echo Speed of Sound Ultrasound From Intrinsic Tissue Reflections: Proof-of-Concept. Invest Radiol 2020; 54:419-427. [PMID: 30913054 DOI: 10.1097/rli.0000000000000553] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to differentiate malignant and benign solid breast lesions with a novel ultrasound (US) technique, which measures speed of sound (SoS) using standard US transducers and intrinsic tissue reflections and scattering (speckles) as internal reference. MATERIALS AND METHODS This prospective, institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective comparison study was performed with prior written informed consent from 20 women. Ten women with histological proven breast cancer and 10 with fibroadenoma were measured. A conventional US system with a linear probe was used for SoS-US (SonixTouch; Ultrasonix, Richmond, British Columbia, Canada). Tissue speckle reflections served as a timing reference for the US signals transmitted through the breasts. Relative phase inconsistencies were detected using plane wave measurements from different angular directions, and SoS images with 0.5-mm resolution were generated using a spatial domain reconstruction algorithm. The SoS of tumors were compared with the breast density of a larger cohort of 106 healthy women. RESULTS Breast lesions show focal increments ΔSoS (meters per second) with respect to the tissue background. Peak ΔSoS values were evaluated. Breast carcinoma showed significantly higher ΔSoS than fibroadenomas ([INCREMENT]SoS > 41.64 m/s: sensitivity, 90%; specificity, 80%; area under curve, 0.910) and healthy breast tissue of different densities (area under curve, 0.938; sensitivity, 90%; specificity, 96.5%). The lesion localization in SoS-US images was consistent with B-mode imaging and repeated SoS-US measurements were reproducible. CONCLUSIONS Using SoS-US, based on conventional US and tissue speckles as timing reference, breast carcinoma showed significantly higher SoS values than fibroadenoma and healthy breast tissue of different densities. The SoS presents a promising technique for differentiating solid breast lesions.
Collapse
|
161
|
Marlevi D, Mulvagh SL, Huang R, DeMarco JK, Ota H, Huston J, Winter R, Macedo TA, Abdelmoneim SS, Larsson M, Pellikka PA, Urban MW. Combined spatiotemporal and frequency-dependent shear wave elastography enables detection of vulnerable carotid plaques as validated by MRI. Sci Rep 2020; 10:403. [PMID: 31942025 PMCID: PMC6962347 DOI: 10.1038/s41598-019-57317-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/25/2019] [Indexed: 12/29/2022] Open
Abstract
Fatal cerebrovascular events are often caused by rupture of atherosclerotic plaques. However, rupture-prone plaques are often distinguished by their internal composition rather than degree of luminal narrowing, and conventional imaging techniques might thus fail to detect such culprit lesions. In this feasibility study, we investigate the potential of ultrasound shear wave elastography (SWE) to detect vulnerable carotid plaques, evaluating group velocity and frequency-dependent phase velocities as novel biomarkers for plaque vulnerability. In total, 27 carotid plaques from 20 patients were scanned by ultrasound SWE and magnetic resonance imaging (MRI). SWE output was quantified as group velocity and frequency-dependent phase velocities, respectively, with results correlated to intraplaque constituents identified by MRI. Overall, vulnerable lesions graded as American Heart Association (AHA) type VI showed significantly higher group and phase velocity compared to any other AHA type. A selection of correlations with intraplaque components could also be identified with group and phase velocity (lipid-rich necrotic core content, fibrous cap structure, intraplaque hemorrhage), complementing the clinical lesion classification. In conclusion, we demonstrate the ability to detect vulnerable carotid plaques using combined SWE, with group velocity and frequency-dependent phase velocity providing potentially complementary information on plaque characteristics. With such, the method represents a promising non-invasive approach for refined atherosclerotic risk prediction.
Collapse
Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden. .,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Sharon L Mulvagh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America.,Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Runqing Huang
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, United States of America.,Department of Radiology, Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Reidar Winter
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Thanila A Macedo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Sahar S Abdelmoneim
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matthew W Urban
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| |
Collapse
|
162
|
Abd Ellah M, Taljanovic M, Klauser A. Musculoskeletal elastography. TISSUE ELASTICITY IMAGING 2020:197-224. [DOI: 10.1016/b978-0-12-809662-8.00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
163
|
Barr RG. Breast Elastography: How to Perform and Integrate Into a "Best-Practice" Patient Treatment Algorithm. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:7-17. [PMID: 31617225 DOI: 10.1002/jum.15137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively steep learning curve, and variability in methods between vendors. This article describes our protocol for performing breast elastography using both strain elastography and shear wave elastography, which produces high sensitivity and specificity. Additionally, we will describe the most commonly known false-positive and false-negative lesions as well as how to detect them.
Collapse
Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
- Southwoods Imaging, Youngstown, Ohio, USA
| |
Collapse
|
164
|
Inter- and intra-reader reproducibility of shear wave elastography measurements for musculoskeletal soft tissue masses. Skeletal Radiol 2020; 49:779-786. [PMID: 31832739 PMCID: PMC7083807 DOI: 10.1007/s00256-019-03300-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/01/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine inter- and intra-reader reproducibility of shear wave elastography measurements for musculoskeletal soft tissue masses. MATERIALS AND METHODS In all, 64 patients with musculoskeletal soft tissue masses were scanned by two readers prior to biopsy; each taking five measurements of shear wave velocity (m/s) and stiffness (kPa). A single lesion per patient was scanned in transverse and cranio-caudal planes. Depth measurements (cm) and volume (cm3) were recorded for each lesion, for each reader. Linear mixed modelling was performed to assess limits of agreement (LOA), inter- and intra-reader repeatability, including analyses for measured depth and volume. RESULTS Of the 64 lesions scanned, 24 (38%) were malignant. Bland-Altman plots demonstrated negligible bias with wide LOA for all measurements. Transverse velocity was the most reliable measure-intraclass correlation (95% CI) = 0.917 (0.886, 1)-though reader 1 measures could be between 38% lower and 57% higher than reader 2 [ratio-scale bias (95% LOA) = 0.99 (0.64, 1.55)]. Repeatability coefficients indicated most disagreement resulted from poor within-reader reproducibility. LOA between readers calculated from means of five repeated measurements were narrower-transverse velocity ratio-scale bias (95% LOA) = 1.00 (0.74, 1.35). Depth affected both estimated velocity and repeatability; volume also affected repeatability. CONCLUSION This study found poor repeatability of measurements with wide LOA due mostly to intra-reader variability. Transverse velocity was the most reliable measure; variability may be affected by lesion depth. At least five measurements should be reported with LOA to assist future comparability between shear wave elastography systems in evaluating soft tissue masses.
Collapse
|
165
|
Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters. Obstet Gynecol Sci 2019; 63:42-54. [PMID: 31970127 PMCID: PMC6962587 DOI: 10.5468/ogs.2020.63.1.42] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/29/2019] [Indexed: 01/18/2023] Open
Abstract
Objective To provide a standardized protocol for the measurement of cervical strain elastography, present its reproducibility, and analyze baseline clinical factors affecting the measurement of elastographic parameters. Methods This study was performed by the Korean Research Group of Cervical Elastography. We enrolled pregnant women according to our study protocol. After measuring the cervical length, elastography was performed using the E-Cervix™ quantification tool to measure the strain of the cervix using intrinsic compression. We evaluated 5 elastographic parameters, namely, the strain of the internal os of the cervix (IOS), strain of the external os of the cervix (EOS), ratio of the strain of IOS and EOS, elasticity contrast index, and hardness ratio. For baseline clinical factors, we examined the maternal body mass index, blood pressure, heart rate, uterine artery Doppler indices, and fetal presentation. Results We established a specific protocol for the measurement of cervical elastography using the E cervix program. For all elastographic parameters, the intra-observer intraclass correlation coefficient (ICC) ranged from 0.633 to 0.723 for single measures and from 0.838 to 0.887 for average measures, and the inter-observer ICC ranged from 0.814 to 0.977 for single measures and from 0.901 to 0.988 for average measures. Regression analysis showed that the measurement of the elastographic parameter was not affected by baseline clinical factors. Conclusion We present a standardized protocol for the measurement of cervical elastography using intrinsic compression. According to this protocol, reproducibility was acceptable and the measurement of elastographic parameters was not affected by the baseline clinical factors studied.
Collapse
|
166
|
Rosen D, Jiang J. Analyzing acoustoelastic effect of shear wave elastography data for perfused and hydrated soft tissues using a macromolecular network inspired model. J Biomech 2019; 97:109370. [PMID: 31606128 PMCID: PMC8011867 DOI: 10.1016/j.jbiomech.2019.109370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022]
Abstract
Shear wave elastography (SWE) has enhanced our ability to non-invasively make in vivo measurements of tissue elastic properties of animal and human tissues. Recently, researchers have taken advantages of acoustoelasticity in SWE to extract nonlinear elastic properties from soft biological tissues. However, most investigations of the acoustoelastic effects of SWE data (AE-SWE) rely on classic hyperelastic models for rubber-like (dry) materials. In this paper, we focus solely on understanding acoustoelasticity in soft hydrated tissues using SWE data and propose a straightforward approach to modeling the constitutive behavior of soft tissue that has a direct microstructural/macromolecular interpretation. Our approach incorporates two constitutive features relevant to biological tissues into AE-SWE: static dilation of the medium associated with nonstructural components (e.g. tissue hydration and perfusion) and finite extensibility derived from an ideal network of biological filaments. We evaluated the proposed method using data from an in-house tissue-mimicking phantom experiment, and ex vivo and in vivo AE-SWE data available in the SWE literature. In conclusion, predictions made by our approach agreed well with measurements obtained from phantom, ex vivo and in vivo tissue experiments.
Collapse
Affiliation(s)
- D Rosen
- Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA
| | - J Jiang
- Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA.
| |
Collapse
|
167
|
Chee C, Lombardo P, Schneider M, Danovani R. Comparison of the Fat-to-Lesion Strain Ratio and the Gland-to-Lesion Strain Ratio With Controlled Precompression in Characterizing Indeterminate and Suspicious Breast Lesions on Ultrasound Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3257-3266. [PMID: 31140631 DOI: 10.1002/jum.15037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the diagnostic performance of the fat-to-lesion strain ratio (FLR) and gland-to-lesion strain ratio (GLR) for patients with indeterminate or suspicious breast lesions on ultrasound (US) imaging under a controlled precompression technique and to see whether the technique improves the reproducibility of FLR and GLR measurement. METHODS Fifty-three lesions in 39 consecutive patients who had scheduled core biopsy or excision surgery based on US findings were examined by US elastography. Each lesion was acquired under controlled precompression by 2 sonographers independently. Both the FLR and GLR of the lesion were calculated. For diagnostic performance, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were obtained. Interobserver reliability between different sonographers was assessed by the intraclass correlation coefficient (ICC). RESULTS Forty lesions were benign, and 13 lesions were malignant. Both the FLR and GLR were significantly higher in malignant than benign lesions (P < .05). The FLR yielded higher accuracy and specificity compared to the GLR (accuracy, 79.2% versus 60.4%; and specificity, 87.5% versus 50.0%). With the controlled precompression applied at less than 25% during elastography, the interobserver agreement was excellent for FLR measurements (ICC, 0.853; 95% confidence interval, 0.738-0.920) and GLR measurements (ICC, 0.779; 95% confidence interval, 0.619-0.87). CONCLUSIONS The FLR performed better than the GLR in the detection of breast malignancy; thus, fatty tissue was a better reference tissue for calculating the strain ratio on malignant breast tumor elastography. Keeping precompression to less than 25% will enable different operators to acquire similar elastograms with reproducible FLR and GLR readings.
Collapse
Affiliation(s)
- Charlyn Chee
- Department of Radiology, Changi General Hospital, Singapore
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia
| | | |
Collapse
|
168
|
Wang Y, Bayer M, Jiang J, Hall TJ. Large-Strain 3-D in Vivo Breast Ultrasound Strain Elastography Using a Multi-compression Strategy and a Whole-Breast Scanning System. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3145-3159. [PMID: 31548103 PMCID: PMC6823158 DOI: 10.1016/j.ultrasmedbio.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/27/2019] [Accepted: 08/16/2019] [Indexed: 05/18/2023]
Abstract
Non-linear mechanical properties of breast tissue can be employed to diagnose and differentiate breast tumors. To obtain such non-linear mechanical properties, it is necessary to track tissue motion under large deformation. In this study, a multi-compression strategy was utilized to produce large tissue deformation, and a method to estimate 3-D motion of tissue under large deformation was introduced. Given multiple volumes of ultrasound data, the proposed method first estimates volume-to-volume incremental displacements using a 3-D region-growing motion-tracking method. Then, possible outliers among all incremental displacements are removed to avoid error accumulation. Once large displacement errors have been removed, all incremental displacements are registered together to obtain accumulated displacements under large tissue deformation (e.g., >10%). The proposed method was tested with one set of in vivo tumor-bearing ultrasound data acquired from a human subject. A total of 10 small-strain deformation steps were performed to obtain the final accumulated displacement field, in which the breast lesion and its surrounding were deformed by approximately 6% and 16%, respectively. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the elasticity images obtained with the proposed method were all higher than those obtained with a 2-D tracking method. Furthermore, in three orthogonal views of accumulated axial strain images, the breast lesion was clearly visible with good correspondence between the axial strain and B-mode images.
Collapse
Affiliation(s)
- Yuqi Wang
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.
| | - Matthew Bayer
- Ultrasound Division, GE Healthcare, Wauwatosa, Wisconsin, USA
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| |
Collapse
|
169
|
Gao Z, Wu S, Liu Z, Luo J, Zhang H, Gong M, Li S. Learning the implicit strain reconstruction in ultrasound elastography using privileged information. Med Image Anal 2019; 58:101534. [DOI: 10.1016/j.media.2019.101534] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022]
|
170
|
Wang Y, Liu Y, Zheng X, Huang Y, Han J, Li F, Mao R, Li Q, Cao L, Zhou J. Added Value of Different Types of Elastography in Evaluating Ultrasonography Detected Breast Lesions: A Compared Study With Mammography. Clin Breast Cancer 2019; 20:e366-e372. [PMID: 31983553 DOI: 10.1016/j.clbc.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study was to compare the diagnostic performance of ultrasonography (US) and mammography in the differential diagnosis of breast lesions after adding different types of elastography to US. PATIENTS AND METHODS This institutional review board-approved study included 316 breast lesions in 289 women between July 2016 and July 2018. All these lesions were evaluated with conventional US, elastography, and mammography before biopsy or surgery. Elastography, including elasticity imaging (EI), virtual touch tissue imaging (VTI), and virtual touch imaging quantification (VTIQ), were used to downgrade US Breast Imaging-Reporting and Data System category 4A lesions. Diagnostic performances were calculated for mammography, US elastography, and the combination of US and elastography. RESULTS The sensitivity of US (100%) was significantly higher than that of mammography (84.6%; P < .001), but the specificity of US (14.5%) was significantly lower than that of mammography (59.1%; P < .001). After adding EI, VTI, and VTIQ to US, the specificity was significantly increased from 14.5% to 69.4%, 72.6%, and 78.0%, respectively (P < .001), and were significantly higher than that of mammography (P = .043, P = .006, and P < .001, respectively). The sensitivity of US + EI (96.2%) and US + VTI (96.2%) was lower than that of US alone, although not significantly (100%; P = .063 and P = .063, respectively). CONCLUSION The addition of different types of elastography to US improved the diagnostic performance in the differential diagnosis of breast lesions when compared with mammography.
Collapse
Affiliation(s)
- Yun Wang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xueyi Zheng
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yini Huang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jing Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fei Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rushuang Mao
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qian Li
- Department of Ultrasound, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Longhui Cao
- Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| |
Collapse
|
171
|
Tanaka T, Kamata M, Fukaya S, Hayashi K, Fukuyasu A, Ishikawa T, Ohnishi T, Tada Y. Usefulness of real-time elastography for diagnosing lymph node metastasis of skin cancer: does elastography potentially eliminate the need for sentinel lymph node biopsy in squamous cell carcinoma? J Eur Acad Dermatol Venereol 2019; 34:754-761. [PMID: 31520558 DOI: 10.1111/jdv.15955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The metastatic involvement of regional lymph nodes is the most important prognostic factor for overall survival of skin cancer patients. The sonographic technique of freehand real-time tissue elastography (RTE), which displays tissue rigidity as a colour overlay of the tissue image, was developed. OBJECTIVE Our purpose was to evaluate the benefit of RTE for detecting lymph node metastases of skin cancer non-invasively before operation. METHODS We first selected lymph nodes of skin cancer patients which had already been diagnosed by biopsy as being reactive or metastatic, and then retrospectively collected images of RTE and B-mode and colour Doppler ultrasound on those lymph nodes performed preoperatively. Twenty-one lymph nodes from 12 patients with squamous cell carcinoma (SCC), 23 lymph nodes from 14 patients with malignant melanoma (MM) and 14 lymph nodes from six patients with extramammary Paget disease (Paget) were investigated. Elastographic images were assessed on a scale of one to four according to the percentage of high elasticity (hard) area (HEA) in the lymph node. RESULTS In all three skin cancers, lymph nodes evaluated as grade 3 or 4 by RTE were metastatic. All lymph nodes evaluated as grade 1 or 2 by RTE were reactive in SCC, whereas some lymph nodes evaluated as grade 1 or 2 were metastatic in MM and Paget. CONCLUSION Real-time tissue elastography may aid in distinguishing reactive lymph nodes from metastatic ones especially in SCC.
Collapse
Affiliation(s)
- T Tanaka
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - M Kamata
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - S Fukaya
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - K Hayashi
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - A Fukuyasu
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - T Ishikawa
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - T Ohnishi
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Y Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
172
|
Barr RG, Nikolov SI. Use of a Real-Time Stress Map for Assessment of Applied Stress for Strain Elastography: Utility in Training and Computation of Strain Ratios. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2999-3005. [PMID: 30945327 DOI: 10.1002/jum.15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES There is a significant learning curve in strain elastography. Uniform appropriate levels of stress must be applied for accurate elastograms. If the stress is not applied appropriately, inaccurate results will be obtained, particularly when strain ratios are being estimated. This paper describes a new technique which allows the real-time visualization of the applied stress with a color-coded stress map. The potential use of this map is discussed. METHODS Ten patients (5 breast, 5 thyroid) and phantoms were scanned using the stress map. The stress applied was varied and the resultant change in the strain image evaluated. RESULTS The stress map was able to document if appropriate stress was applied when performing strain elastography. When inappropriate stress was applied or physiological process effected the strain image the stress map demonstrated the areas of inaccurate measurements in the stress map. CONCLUSIONS The display of a stress map that depicts the degree and uniformity of applied stress would be helpful both for training of the appropriate technique, for confirming that the elastogram is appropriate for evaluation, and that strain ratio estimates are accurate.
Collapse
Affiliation(s)
- Richard G Barr
- The Northeast Ohio Medical University, Rootstown, Ohio, USA
- Radiology Consultants Inc., Youngstown, Ohio, USA
| | | |
Collapse
|
173
|
Miller DL, Dong Z, Dou C, Patterson B, Raghavendran K. Pulmonary Capillary Hemorrhage Induced by Acoustic Radiation Force Impulse Shear Wave Elastography in Ventilated Rats. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2575-2587. [PMID: 30702763 PMCID: PMC6771037 DOI: 10.1002/jum.14950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Diagnostic ultrasound (DUS) imaging can induce pulmonary capillary hemorrhage (PCH), possibly related to the ultrasonic radiation surface pressure arising from reflection at the lung blood-air interfaces. Acoustic radiation force impulse (ARFI) elastography is a relatively new DUS mode with high-energy "push pulses" used to move tissue and generate shear waves. The objective of this study was to characterize PCH induced by the ARFI elastographic mode for comparison with other previously tested DUS modes. METHODS Pulmonary capillary hemorrhage induction was examined for ARFI elastographic frames with 5.7-MHz push pulses (Acuson S3000; Siemens Medical Solutions, Mountain View, CA), which had a derated PRPA of 2.6 MPa. Groups of rats with tracheal tube placement had no ventilation (spontaneous breathing), intermittent positive pressure ventilation (IPPV), or IPPV plus 8 cm H2 O of positive end-expiratory pressure (PEEP). Exposure was to 1 or 20 manually triggered image frame acquisitions. The PCH area was measured on the lung surface. RESULTS All 20-frame exposure groups, and even the single-frame group, had significant PCH relative to shams. Single-frame exposures produced significantly less PCH (P = .002) than 20-frame exposures in rats with a tracheal tube only (spontaneous breathing). The PEEP inhibited the PCH and produced about half of the PCH area induced for IPPV without PEEP (P = .014). CONCLUSIONS The PCH results were comparable with those from a previous study using B-mode or color Doppler exposure for 5 minutes; however, these modes delivered many more pulses for continuous imaging frames, suggesting that the ARFI elastographic frames were individually much more effective.
Collapse
Affiliation(s)
- Douglas L. Miller
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | - Zhihong Dong
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | - Chunyan Dou
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | - Brandon Patterson
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | | |
Collapse
|
174
|
Akbas M, Koyuncu FM. Evaluation of maternal renal cortical elasticity in pregnancies with early- and late-onset preeclampsia. J Matern Fetal Neonatal Med 2019; 33:1434-1440. [PMID: 31550960 DOI: 10.1080/14767058.2019.1671347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The current study aimed to investigate renal cortical elasticity (RCE) in early- and late-onset preeclampsia patients and compare the results with healthy controls.Materials and methods: The study consisted of 136 pregnant women. Three groups were identified as; the late-onset preeclampsia (LOP) group (n = 40), the early-onset preeclampsia (EOP) group (n = 32) and the control group (n = 64). RCE values were measured by point shear wave elastography (pSWE). Nine measurements were taken for each kidney and the mean of nine measurements was accepted as the mean RCE value for each kidney. The arithmetic mean of left and right RCE values was accepted as the overall RCE value of a subject. Groups were compared in terms of clinical and biochemical parameters, ultrasonography findings and pSWE values.Results: There was a statistically significant difference between groups in terms of overall RCE values (F[2,133] = 17.96, p < .001). Post hoc comparisons indicated that both preeclampsia groups exhibited significantly higher RCE values than the control group. However, overall RCE values were not significantly different between the EOP and LOP groups. Overall RCE values were significantly and positively correlated with systolic blood pressure (r = 0.363, p < .001), diastolic blood pressure (r = 0.347, p < .001), proteinuria (r = 0.343, p < .001), serum creatinine level (r = 0.181, p = .035), serum uric acid level (r = 0.243, p = .004) and blood urea nitrogen (r = 0.27, p = .001).Conclusion: Our study demonstrated that maternal renal cortical stiffness increased in women with preeclampsia. The increased RCE values may be indicative for the severity of preeclampsia due to positive correlations between renal cortical stiffness and systolic - diastolic blood pressure and serum creatinine level.
Collapse
Affiliation(s)
- Murat Akbas
- Department of Obstetrics and Gynecology, Perinatology Division, Manisa Celal Bayar University, Manisa, Turkey
| | - Faik Mumtaz Koyuncu
- Department of Obstetrics and Gynecology, Perinatology Division, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
175
|
Bernabei M, Lee SSM, Perreault EJ, Sandercock TG. Shear wave velocity is sensitive to changes in muscle stiffness that occur independently from changes in force. J Appl Physiol (1985) 2019; 128:8-16. [PMID: 31556833 DOI: 10.1152/japplphysiol.00112.2019] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Clinical assessments for many musculoskeletal disorders involve evaluation of muscle stiffness, although it is not yet possible to obtain quantitative estimates from individual muscles. Ultrasound elastography can be used to estimate the material properties of unstressed, homogeneous, and isotropic materials by tracking the speed of shear wave propagation; these waves propagate faster in stiffer materials. Although elastography has been applied to skeletal muscle, there is little evidence that shear wave velocity (SWV) can directly estimate muscle stiffness since this tissue violates many of the assumptions required for there to be a direct relationship between SWV and stiffness. The objective of this study was to evaluate the relationship between SWV and direct measurements of muscle force and stiffness in contracting muscle. Data were collected from six isoflurane-anesthetized cats. We measured the short-range stiffness in the soleus via direct mechanical testing in situ and SWV via ultrasound imaging. Measurements were taken during supramaximal activation at optimum muscle length, with muscle temperature varying between 26°C and 38°C. An increase in temperature causes a decrease in muscle stiffness at a given force, thus decoupling the tension-stiffness relationship normally present in muscle. We found that increasing muscle temperature decreased active stiffness from 4.0 ± 0.3 MPa to 3.3 ± 0.3 MPa and SWV from 16.9 ± 1.5 m/s to 15.9 ± 1.6 m/s while force remained unchanged (mean ± SD). These results demonstrate that SWV is sensitive to changes in muscle stiffness during active contractions. Future work is needed to determine how this relationship is influenced by changes in muscle structure and tension.NEW & NOTEWORTHY Shear wave ultrasound elastography is a noninvasive tool for characterizing the material properties of muscle. This study is the first to compare direct measurements of stiffness with ultrasound measurements of shear wave velocity (SWV) in a contracting muscle. We found that SWV is sensitive to changes in muscle stiffness, even when controlling for muscle tension, another factor that influences SWV. These results are an important step toward developing noninvasive tools for characterizing muscle structure and function.
Collapse
Affiliation(s)
- Michel Bernabei
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.,Shirley Ryan AbilityLab, Chicago, Illinois
| | - Sabrina S M Lee
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois
| | - Eric J Perreault
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.,Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
| | | |
Collapse
|
176
|
Han J, Li F, Peng C, Huang Y, Lin Q, Liu Y, Cao L, Zhou J. Reducing Unnecessary Biopsy of Breast Lesions: Preliminary Results with Combination of Strain and Shear-Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2317-2327. [PMID: 31221510 DOI: 10.1016/j.ultrasmedbio.2019.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 05/03/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
The aim of our study was to compare strain elastography (SE), acoustic radiation force impulse-inducing Virtual Touch Imaging ([VTI] Siemens Medical Solutions, Mountain View, CA, USA), Virtual Touch Imaging Quantification ([VTIQ] Siemens Medical Solutions) and combined methods in the evaluation of ultrasound (US) Breast Imaging-Reporting and Data System (BI-RADS) category 4 lesions to explore an applicable way to reduce unnecessary biopsy by reducing false positives of conventional US without yielding false-negative cases. A total of 267 patients with 278 BI-RADS category 4 lesions (151 benign and 127 malignant) were evaluated with conventional B-mode US, SE, VTI and VTIQ implemented on a Siemens Acuson S2000 US system. Diagnostic performance, including area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were evaluated. Overall, VTI alone exhibited the highest NPV (91.74%), although combined elastic methods exhibited higher NPV than single methods, with the highest NPV at 100% when the VTI, SE and VTIQ methods were combined. Compared with conventional US, PPV increased from 45.7% (127 of 278) to 63.18% (127 of 201) when adding combined elastography (VTI + SE +VTIQ). In addition, 52.5% (63/120) and 50.8% (61/120) of BI-RADS 4 A lesions were downgraded when using combined methods (VTI + SE and VTI + SE + VTIQ, respectively) without missing any cancer. However, 2 intraductal papillomas and 1 phyllodes tumor were not identified. In conclusion, the combination of different elastic methods have the potential to downgrade BI-RADS 4A lesions to reduce false-positive biopsies without increasing the risk of missing cancers.
Collapse
Affiliation(s)
- Jing Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Fei Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Chuan Peng
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Yini Huang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Qingguang Lin
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Longhui Cao
- Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
| |
Collapse
|
177
|
Dietrich CF, Jenssen C. Modern ultrasound imaging of pancreatic tumors. Ultrasonography 2019; 39:105-113. [PMID: 31962384 PMCID: PMC7065990 DOI: 10.14366/usg.19039] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
In patients with solid pancreatic lesions (SPLs), the differential diagnosis must be evaluated to determine whether radical surgery, pancreatic parenchyma-saving strategies, or follow-up is indicated. Contrast-enhanced (endoscopic) ultrasonography and elastography facilitate the further characterization of SPLs. The majority of cases of pancreatic ductal adenocarcinoma exhibit hypoenhancement with contrast-enhanced ultrasonography. Elastographically soft SPLs are benign with very few exceptions, whereas stiffer SPLs can be malignant or benign. This article reviews the current use of modern ultrasound imaging techniques, including contrast-enhanced ultrasonography and elastography, for the detection and characterization of SPLs. In particular, the unexcelled diagnostic potential of multiparametric endoscopic ultrasonography to detect and characterize small SPLs is highlighted.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany.,Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
| |
Collapse
|
178
|
Abstract
Ultrasound (US) is an important imaging tool and the most commonly used imaging modality worldwide. Although US requires expertise to be performed at the highest quality levels, basic US exams can be learned by most physicians and medical technologists with knowledge of human anatomy and with physical examination skills. The full potential of US is achieved when it is more than a pure “imaging modality”, but instead an integrated clinical, physical, and imaging assessment in which the examiner interacts directly and personally with the patient. Specific diagnostic US knowledge is strongly encouraged for specialist training in clinical disciplines.
Collapse
|
179
|
Patterson B, Miller DL. Acoustic Fountains and Atomization at Liquid Surfaces Excited by Diagnostic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2162-2173. [PMID: 31101447 PMCID: PMC6591062 DOI: 10.1016/j.ultrasmedbio.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/01/2019] [Accepted: 04/07/2019] [Indexed: 05/11/2023]
Abstract
Pulmonary capillary hemorrhage (PCH) has been found in mammalian lungs exposed to diagnostic ultrasound (DUS), although the mechanism is poorly understood. This work investigates acoustic atomization and fountains at liquid-air interfaces subjected to DUS, which has been suggested as a possible PCH damage mechanism. Primarily using a SuperSonic Imagine Aixplorer DUS machine (SuperSonic Imagine, Aix-en-Provence, France), blood and water surfaces were excited in vitro by DUS and recorded with a high-speed camera. The surface was driven by B-mode, color Doppler, pulsed Doppler, and shear wave elastography imaging modes with center frequencies from 5.0-7.2 MHz and mechanical indexes (MI) up to 1.7. Fountains and atomization were only observed for SWE, for MI as low as 1.0. A comparison of the SWE waveforms with the surface dynamics suggests that fountains and atomization were driven by push-pulses and depended on pulse duration and intensity. However, we conclude that atomization and fountaining are unlikely primary mechanisms behind all DUS-induced PCH because neither phenomenon occurred for traditional diagnostic imaging modes.
Collapse
Affiliation(s)
- Brandon Patterson
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Douglas L Miller
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
180
|
Abstract
Ultrasound elastography (USE) of the pancreas allows pancreatic tissue stiffness assessment by virtual palpation. Two main types of USE are used. For the pancreas strain elastography applying by endoscopic ultrasound has been established for the characterisation of small solid pancreatic lesions (SPL). In larger SPL >30 mm the results are less convincing mainly due to the heterogenicity of the lesions but also by concomitant changes of the surrounding pancreatic parenchyma. The current role of shear wave elastography has to be determined. This article reviews the current use of elastography of the pancreas.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Ultrasound Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Internal Medicine, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Michael Hocke
- Department of Internal Medicine, HELIOS Klinikum Meiningen, Meiningen, Germany
| |
Collapse
|
181
|
Ormachea J, Parker KJ, Barr RG. An initial study of complete 2D shear wave dispersion images using a reverberant shear wave field. ACTA ACUST UNITED AC 2019; 64:145009. [DOI: 10.1088/1361-6560/ab2778] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
182
|
Ahmed R, Doyley MM. Distributing Synthetic Focusing Over Multiple Push-Detect Events Enhances Shear Wave Elasticity Imaging Performance. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:1170-1184. [PMID: 30990427 PMCID: PMC6701192 DOI: 10.1109/tuffc.2019.2911036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Plane wave (PW) imaging is a commonly used method for tracking waves during shear wave elasticity imaging (SWEI), but its unfocused transmission beam reduces tracking accuracy and precision. Coherent compounding minimizes this problem, but SWEI's stringent frame rate requirement and the coarse pitch of most clinical transducers limit its effectiveness. Synthetic aperture imaging (SAI) is an alternate ultrasound imaging approach with a much tighter focus than PW imaging, but its lower transmission power has deterred researchers from using SAI in SWEI. Hadamard-encoded multielement SAI can overcome this limitation. However, only a limited number of subapertures (3-5) can be transmitted in a single push-detect event. We have developed methods to distribute more subapertures or more compounding angles over multiple push-detect events. In this paper, we report the results of experiments conducted on phantoms to assess SWEI's performance when using Hadamard-encoded distributed-multielement synthetic aperture (HDMSA) imaging or distributed plane wave compounding (DPWC) to track shear waves. Tracking shear waves with HDMSA improved the elastographic signal-to-noise ratio (SNRe) by 61.6%-89.5% depending on the phantom employed. Similarly, DPWC tracking improved SNRe by 56.2%-93.3% for the same group of phantoms. Compared to focused ultrasound tracking (at the focus), SNRe improved by 28.6% and 32.5% when tracking shear waves with HDMSA and DPWC, respectively. Long acquisitions could introduce decoding errors that decrease the performance when performing HDMSA tracking within the clinical setting. Nevertheless, the results of studies performed on the bicep muscle of three healthy volunteers demonstrate that for stationary organs, tracking shear waves with HDMSA yielded repeatable elastograms that offer better elastographic performance than those produced with current tracking methods.
Collapse
|
183
|
Liu G, Zhang MK, He Y, Liu Y, Li XR, Wang ZL. BI-RADS 4 breast lesions: could multi-mode ultrasound be helpful for their diagnosis? Gland Surg 2019; 8:258-270. [PMID: 31328105 DOI: 10.21037/gs.2019.05.01] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The malignant probability of Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions is 3-94%, which is a very large span, and thus leads to a high rate of unnecessary biopsy. Therefore, the differential diagnosis of benign and malignant BI-RADS 4 breast lesions has become extremely important. Thus, in this paper, we investigated the diagnostic value of conventional ultrasonography (US), contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) for BI-RADS 4 breast lesions, and tried to figure out a multi-mode ultrasonic method for them. Methods From March 2016 to May 2017, 118 breast lesions that were categorized as BI-RADS 4 lesions by US were studied with CEUS and SWE. All the lesions were confirmed by pathology via surgery or vacuum-assisted biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US, CEUS and SWE were analyzed. Then the diagnostic efficacies of US, CEUS, SWE and the combination of these modalities were compared. Logistic regression analysis was performed to identify the independent risk factors. A multi-mode method to evaluate BI-RADS 4 lesions based on the logistic regression was developed. Results Of the 118 BI-RADS 4 lesions, 74 lesions (62.7%) were benign and 44 lesions (37.3%) were malignant. The diagnostic sensitivity and specificity for US, US + CEUS, US + SWE, US + CEUS + SWE were 88.6% and 75.7%, 86.4% and 94.6%, 88.6% and 90.5%, 97.7% and 93.2%, respectively. The area under the ROC curve (AUC) of US + SWE + CEUS was significantly higher than that of US (P<0.0001), US + CEUS (P=0.020), but there was no significant difference between the AUC of US + SWE + CEUS and the AUC of US + SWE. Conclusions US + CEUS + SWE and US + SWE could significantly improve the diagnostic efficiency and accuracy of US in the diagnosis of BI-RADS 4 breast lesions.
Collapse
Affiliation(s)
- Gang Liu
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Meng-Ke Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yan He
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yuan Liu
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xi-Ru Li
- General Surgery Department, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Zhi-Li Wang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| |
Collapse
|
184
|
Barr RG, De Silvestri A, Scotti V, Manzoni F, Rebuffi C, Capittini C, Tinelli C. Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1397-1404. [PMID: 30411806 DOI: 10.1002/jum.14849] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
There are 3 methods of interpreting breast strain elastography: the elastographic-to-B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy.
Collapse
Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio USA
- Southwoods Imaging, Youngstown, Ohio USA
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometeric Unit, Pavia, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Valeria Scotti
- Center for Scientific Documentation, Pavia, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Federica Manzoni
- Clinical Epidemiology and Biometeric Unit, Pavia, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Chiara Rebuffi
- Center for Scientific Documentation, Pavia, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Cristina Capittini
- Clinical Epidemiology and Biometeric Unit, Pavia, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometeric Unit, Pavia, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Clinical Epidemiology and Biometeric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Center for Scientific Documentation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
185
|
Kishimoto R, Kikuchi K, Koyama A, Kershaw J, Omatsu T, Tachibana Y, Suga M, Obata T. Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers. Eur Radiol 2019; 29:5999-6008. [PMID: 31089847 PMCID: PMC6795636 DOI: 10.1007/s00330-019-06195-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was conducted in order to assess the intra- and interoperator reproducibility of shear-wave speed (SWS) measurement on elasticity phantoms and healthy volunteers using ultrasound-based point shear-wave elastography. MATERIALS AND METHODS This study was approved by the institutional review board. Two operators measured the SWS of five elasticity phantoms and seven organs (thyroid, lymph node, muscle, spleen, kidney, pancreas, and liver) of 30 healthy volunteers with 1.0-4.5 MHz convex (4C1) and 4.0-9.0 MHz linear (9L4) transducers. The phantom measurements were repeated ten times, while the volunteer measurements were performed five times each. Intra- and interoperator reproducibility was assessed. Interoperator reproducibility was also evaluated with the 95% Bland-Altman limits of agreement (LOA). RESULTS In phantoms, all intraclass correlation coefficients (ICCs) were above 0.90 and the 95% LOA between the two operators were less than ± 18%. In volunteers, intraoperator ICCs were > 0.75 for all regions except the pancreas. Interoperator ICC was above 0.75 for the right lobe of the liver (depth 4 cm) and the kidney, but the 95% LOA was less than ± 25% only for the liver. CONCLUSION Although excellent in phantoms, interoperator reproducibility was insufficient for all regions in the volunteers other than the right hepatic lobe at a depth of 4 cm. Clinicians should be aware of the 95% LOA when using SWS in patients. KEY POINTS • Our phantom study indicated a high reproducibility for shear-wave speed (SWS) measurements with point shear-wave elastography (pSWE). • In volunteers, intraoperator reproducibility was generally high, but the interoperator reproducibility was not high enough except for the right hepatic lobe at 4 cm depth. • To evaluate interoperator reproducibility, the 95% limits of agreement (LOA) between operators should be considered in addition to the intraclass correlation coefficient (ICC).
Collapse
Affiliation(s)
- Riwa Kishimoto
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Chiba, 263-8555, Japan.
| | - Katsuhiko Kikuchi
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Chiba, 263-8555, Japan.,Tokyo-Kita Medical Center, 4-17-56, Akabanedai, Tokyo, 115-0053, Japan
| | - Atsuhisa Koyama
- Center for Frontier Medical Engineering, Chiba University, 1-33, Yayoi-chou, Chiba, 263-8522, Japan
| | - Jeff Kershaw
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Chiba, 263-8555, Japan
| | - Tokuhiko Omatsu
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Chiba, 263-8555, Japan
| | - Yasuhiko Tachibana
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Chiba, 263-8555, Japan
| | - Mikio Suga
- Center for Frontier Medical Engineering, Chiba University, 1-33, Yayoi-chou, Chiba, 263-8522, Japan
| | - Takayuki Obata
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Chiba, 263-8555, Japan
| |
Collapse
|
186
|
Filip I, Ferré R, AlSharif S, Aldis A, Theriault M, Mesurolle B. Can strain elastography improve the characterization of breast lesions identified during second-look MRI-directed sonographic examination? JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:187-194. [PMID: 30735242 DOI: 10.1002/jcu.22704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate strain elastography as a complementary tool for characterization of lesions identified during second-look MRI-directed sonographic examination. METHODS We reviewed 83 breast lesions evaluated with MRI, secondlook ultrasound (US) and strain elastography in 75 consecutive patients (median age, 56 years). US-guided biopsies were performed in all cases. RESULTS After histopathological examination, 44 lesions were benign, 38 were malignant and 1 was high-risk. At MRI, the mean size of the lesions was 12 mm. Forty lesions (48.2%) appeared as masses, 30 (36.1%) as "non-masses" and 13 (15.7%) as "foci." At second-look US examination, 56 (67.5%) appeared as masses (mean size, 7 mm) and 27 (32.5%) as non-masses (mean size, 14 mm). At strain elastography, among the 39 malignant/high risk lesions, 5 (12.8%) had a score of 4 or 5, whereas 16 (41%) had a score of 1 and 2 (false negative). Among the 44 benign lesions, 36 (82%) had a score of 1 or 2, whereas none had a score of 5. Sensitivity and specificity of strain elastography in the diagnosis of breast cancer were 58% and 81%, respectively. CONCLUSION The addition of strain elastography offers no benefit in the characterization of lesions identified on second-look US after breast MRI.(E1, 3).
Collapse
Affiliation(s)
- Iulia Filip
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Québec, Canada
| | - Romuald Ferré
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Québec, Canada
| | - Shaza AlSharif
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Québec, Canada
| | - Ann Aldis
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Québec, Canada
| | - Mélanie Theriault
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Québec, Canada
| | - Benoît Mesurolle
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Québec, Canada
| |
Collapse
|
187
|
Ohno E, Hirooka Y, Kawashima H, Ishikawa T, Tanaka H, Sakai D, Ishizu Y, Kuzuya T, Nakamura M, Honda T. Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study. J Med Ultrason (2001) 2019; 46:425-433. [PMID: 30993580 PMCID: PMC6765472 DOI: 10.1007/s10396-019-00944-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/18/2019] [Indexed: 12/17/2022]
Abstract
Purpose To assess the feasibility and the clinical usefulness of a newly developed endoscopic ultrasonography (EUS) shear-wave elastography technique (EUS shear-wave measurement: EUS-SWM) in the diagnosis and treatment of autoimmune pancreatitis (AIP). Methods Tissue elasticity was measured in the pancreas in 160 patients. The success rate of EUS-SWMs, the velocity of the shear wave (Vs, m/s), and the reliability index of the Vs measurement (VsN) were evaluated, and the elasticity (median Vs) was compared between AIP patients (n = 14) and normal controls. Results A total of 3837 EUS-SWMs were performed without adverse events. Overall, 97.6% (3743/3837) were successful. The median VsN was 74%. The median Vs values of the pancreas were as follows: 2.22 m/s in the pancreatic head (push position), 2.36 m/s in the head (pull position), 1.99 m/s in the body, and 2.25 m/s in the tail. The median Vs of the AIP group (2.57 m/s) was significantly higher than that of the normal controls (1.89 m/s) (P = 0.0185). The mean Vs significantly decreased from 3.32 m/s to 2.46 m/s after steroid therapy (n = 6) (P = 0.0234). Conclusion EUS-SWM is feasible and generates credible results. EUS-SWM was a useful method for assessment of the effect of steroid therapy in AIP patients. Electronic supplementary material The online version of this article (10.1007/s10396-019-00944-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eizaburo Ohno
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hiroki Kawashima
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuya Ishikawa
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Tanaka
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daisuke Sakai
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoji Ishizu
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Teiji Kuzuya
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masanao Nakamura
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
188
|
Georgieva M, Prantl L, Utpatel K, Wiesinger I, Stroszczynski C, Jung F, Jung E. Diagnostic performance of ultrasound strain elastography for differentiation of malignant breast lesions. Clin Hemorheol Microcirc 2019; 71:237-247. [DOI: 10.3233/ch-189415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M. Georgieva
- Department of Radiology, University Hospital Regensburg, Germany
| | - L. Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - K. Utpatel
- Department of Pathology, University Regensburg, Germany
| | - I. Wiesinger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Germany
| | - F. Jung
- Institute of Clinical Haemostasiology and Transfusion Medicine, University of Saarland, Homburg, Germany
| | - E.M. Jung
- Department of Radiology, University Hospital Regensburg, Germany
| |
Collapse
|
189
|
Dória MT, Jales RM, Conz L, Derchain SFM, Sarian LOZ. Diagnostic accuracy of shear wave elastography – Virtual touch™ imaging quantification in the evaluation of breast masses: Impact on ultrasonography’s specificity and its ultimate clinical benefit. Eur J Radiol 2019; 113:74-80. [DOI: 10.1016/j.ejrad.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 12/18/2022]
|
190
|
Koh J, Kim EK, Kim MJ, Yoon JH, Park VY, Moon HJ. Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors. Acta Radiol 2019; 60:278-285. [PMID: 29890844 DOI: 10.1177/0284185118780901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions. PURPOSE To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women. MATERIAL AND METHODS Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors. RESULTS Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography ( P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography ( P = 0.390). CONCLUSION In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.
Collapse
Affiliation(s)
- Jieun Koh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
191
|
Gonzalez EA, Romero SE, Castaneda B. Real-Time Crawling Wave Sonoelastography for Human Muscle Characterization: Initial Results. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:563-571. [PMID: 30040637 DOI: 10.1109/tuffc.2018.2858658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Imaging of musculoskeletal tissue dynamics is currently an exploratory field with the goal of aiding rehabilitation and performance evaluation of pathological or asymptomatic patients. In this pilot study, initial elasticity assessments of the biceps brachii were conducted in a novel crawling wave sonoelastography (CWS) system implemented on a research ultrasound instrument with graphical processing unit capabilities, displaying quantitative elasticity values at 4 frames per second. The CWS system computes the tissue stiffness with the generation of an interference pattern from external vibrators, which can overcome depth limitations of imaging systems with internal excitation sources. Validation on gelatin-based phantoms reported low bias of elasticity values (4.7%) at low excitation frequencies. Preliminary results on in vivo muscle characterization are in accordance with average elasticity values for relaxed and contracted tissues found in the literature, as well as for a range of weight loads.
Collapse
|
192
|
Pu H, Zhang XL, Xiang LH, Zhang JL, Xu G, Liu H, Tang GY, Zhao BH, Wu R. The efficacy of added shear wave elastography (SWE) in breast screening for women with inconsistent mammography and conventional ultrasounds (US). Clin Hemorheol Microcirc 2019; 71:83-94. [PMID: 29843228 DOI: 10.3233/ch-180398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xue-Li Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Jiu-Long Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang-Yu Tang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bing-Hui Zhao
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
193
|
Shang J, Ruan LT, Wang YY, Zhang XJ, Dang Y, Liu B, Wang WL, Song Y, Chang SJ. Utilizing size-based thresholds of stiffness gradient to reclassify BI-RADS category 3-4b lesions increases diagnostic performance. Clin Radiol 2019; 74:306-313. [PMID: 30755314 DOI: 10.1016/j.crad.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/08/2019] [Indexed: 01/16/2023]
Abstract
AIM To investigate the role of utilizing size-based thresholds of stiffness gradient in diagnosing solid breast lesions and optimizing original Breast Imaging-Reporting And Data System (BI-RADS) classifications. MATERIALS AND METHODS Two-hundred and twenty-seven consecutive women underwent shear-wave elastography (SWE) before ultrasound-guided biopsy, and 234 solid breast lesions categorized as BI-RADS 3-5 were analysed. Receiver operating characteristic curve analysis was performed based on histopathology. Diagnostic performance among SWE, BI-RADS, and their combination were compared. RESULTS The stiffness gradient correlated with the standard deviation of elasticity (SD, r=0.90), and with Tozaki's pattern classification (r=0.64). The area under the receiver operating characteristic curves (AUC) for stiffness gradient (0.939) outperformed SD (0.897) or colour pattern (0.852). Due to significant association with lesion size (r=0.394, p<0.001), stiffness gradient's size-based thresholds (lesions >15 mm: 82.5 kPa; lesions ≤15 mm: 51.1 kPa) were established to reclassify BI-RADS 3-4b lesions. Upgrading category 3 lesions (over the corresponding cut-off value, 3 to 4a) and downgrading categories 4a-4b lesions (less than or equal to the corresponding cut-off value, 4b to 4a, 4a to 3), yielded significant improvement in specificity (90.28% versus 77.78%, p<0.001) and AUC (0.948 versus 0.926, p=0.035) than BI-RADS alone. No significant loss emerged in the sensitivity (88.89% versus 91.11%, p=0.500). CONCLUSION Stiffness gradient exhibited better discriminatory ability than SD or four-colour pattern classification in determining solid breast lesions and applying its size-specific thresholds to categorize BI-RADS 3-4b lesions could improve diagnostic performance.
Collapse
Affiliation(s)
- J Shang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - L-T Ruan
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China.
| | - Y-Y Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - X-J Zhang
- Department of Pathology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - Y Dang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - B Liu
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China; Department of Ultrasound Diagnosis, Shaanxi Province People's Hospital, Xi'an 710068, China
| | - W-L Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China; Department of Ultrasound Diagnosis, Xi'an NO.3 Hospital, Xi'an 710018, China
| | - Y Song
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - S-J Chang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| |
Collapse
|
194
|
Racedo J, Urban MW. Evaluation of Reconstruction Parameters for 2-D Comb-Push Ultrasound Shear Wave Elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:254-263. [PMID: 30507530 PMCID: PMC6375804 DOI: 10.1109/tuffc.2018.2884348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Shear wave elastography (SWE) is a noninvasive ultrasound imaging modality used in the assessment of the mechanical properties of tissues such as the liver, kidney, skeletal muscle, thyroid, and the breast. Among the methods used to perform SWE is the comb-push ultrasound shear elastography method. This method uses multiple focused ultrasound beams to generate push beams with acoustic radiation force. Applying these push beams generates propagating shear waves. The propagation motion is measured with ultrafast ultrasound imaging. The shear wave motion data are directionally filtered, and a 2-D shear wave velocity (SWV) algorithm is applied to create group velocity maps. This algorithm uses a moving window and a specified patch for performing cross-correlations of time-domain signals. We performed a parametric study of how the choice of the patch and window size affected the reconstruction of the SWV in homogeneous and inclusion phantoms. We quantified the mean velocity and coefficient of variation in the homogeneous phantoms. We measured the contrast-to-noise ratio and bias in the inclusion phantoms. In each of these cases, we found that particular combinations of the patch and window provided optimal values of these evaluation metrics for the phantoms tested. This study provides a basis to construct algorithms to produce optimal SWV reconstructions for various clinical applications.
Collapse
Affiliation(s)
- Jorge Racedo
- Department of Biomedical Engineering and Department of Physics, Universidad de los Andes, Bogota D.C., 111711 Colombia ( )
| | - Matthew W. Urban
- Department of Radiology, Mayo Clinic, Rochester, MN 55905 USA and also with the Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905 USA
| |
Collapse
|
195
|
Dobruch-Sobczak K, Piotrzkowska-Wróblewska H, Klimonda Z, Roszkowska-Purska K, Litniewski J. Ultrasound echogenicity reveals the response of breast cancer to chemotherapy. Clin Imaging 2019; 55:41-46. [PMID: 30739033 DOI: 10.1016/j.clinimag.2019.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/16/2018] [Accepted: 01/25/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the ultrasound (US) response in patients with breast cancer (BC) during neoadjuvant chemotherapy (NAC). METHODS Prospective US analysis was performed on 19 malignant tumors prior to NAC treatment and 7 days after each first four courses of NAC in 13 patients (median age = 57 years). Echogenicity, size, vascularity, and sonoelastography were measured and compared with posttreatment scores of residual cancers burden. RESULTS Changes in the echogenicity of tumors after 3 courses of NAC had the most statistically strong correlation with the percentage of residual malignant cells used in histopathology to assess the response to treatment (odds ratio = 60, p < 0.05). Changes in lesion size and elasticity were also significant (p < 0.05). CONCLUSIONS There is a statistically significant relationship between breast tumors' echogenicity in US, neoplasm size, and stiffness and the response to NAC. In particular, our results show that the change in tumor echogenicity could predict a pathological response with satisfactory accuracy and may be considered in NAC monitoring.
Collapse
Affiliation(s)
- Katarzyna Dobruch-Sobczak
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland; Department of Ultrasound, Cancer Center and Institute of Oncology, M. Skłodowska-Curie Memorial, Wawelska 15, 02-034 Warsaw, Poland.
| | - Hanna Piotrzkowska-Wróblewska
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland
| | - Ziemowit Klimonda
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland
| | - Katarzyna Roszkowska-Purska
- Department of Pathology, Cancer Center and Institute of Oncology, M. Skłodowska-Curie Memorial, Warsaw, Poland
| | - Jerzy Litniewski
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland
| |
Collapse
|
196
|
Abstract
Both strain elastography and shear wave elastography have been shown to have high sensitivity and specificity for characterizing breast lesions as benign or malignant. Training is important for both strain and shear wave elastography. The unique feature of benign lesions measuring smaller on elastography than B-mode imaging and malignant lesions appearing larger on elastography is an important feature for characterization of breast masses. There are several artifacts which can contain diagnostic information or alert to technique problems. Both strain and shear wave elastography continue to have improvements and new techniques will soon be available for clinical use that may provide additional diagnostic information. This paper reviews the present state of breast elastography and discusses future techniques that are not yet in clinical practice.
Collapse
Affiliation(s)
- Richard Gary Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH, USA.,Southwoods Imaging, Youngstown, OH, USA
| |
Collapse
|
197
|
Wu T, Li J, Wang D, Leng X, Zhang L, Li Z, Jing H, Kang J, Tian J. Identification of a correlation between the sonographic appearance and molecular subtype of invasive breast cancer: A review of 311 cases. Clin Imaging 2019; 53:179-185. [DOI: 10.1016/j.clinimag.2018.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 10/13/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
|
198
|
Yang T, Niu J, Dang Y, Zhou Y, Cao Y, Zeng M, Lv M. An Innovative Ultrasound Strain Elastographic Method for the Differential Diagnosis of Breast Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:56-67. [PMID: 30301575 DOI: 10.1016/j.ultrasmedbio.2018.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 06/08/2023]
Abstract
In this monocentric perspective study examining 64 lesions (19 benign and 45 malignant), we tested an innovative ultrasound elastographic method for diagnosing breast tumors. A new region of control and a new index designating the strain ratio (SR) were used. A traditional ultrasound elastographic method was used as the control. The results indicated that the SR ratios of the benign and malignant groups were 0.25 ± 0.22 and 1.10 ± 1.53, respectively, and this difference was statistically significant. The area under the receiver operating characteristic curve of the SR ratio method was 0.95, the cutoff point was 0.37 and the sensitivity and specificity were 95.56% and 94.74%, respectively. The two receiver operating characteristic curves of the traditional method and the SR of the proposed method were significantly different, at a p value of 0.02. Compared with that of the traditional method, the SR obtained with the new method had a larger area under the receiver operating characteristic curve, sensitivity, specificity and objectivity.
Collapse
Affiliation(s)
- Tian Yang
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Jianmei Niu
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yuanyuan Dang
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yun Zhou
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yunyun Cao
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Min Zeng
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Mingli Lv
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China.
| |
Collapse
|
199
|
Zhang Q, Song S, Xiao Y, Chen S, Shi J, Zheng H. Dual-mode artificially-intelligent diagnosis of breast tumours in shear-wave elastography and B-mode ultrasound using deep polynomial networks. Med Eng Phys 2018; 64:1-6. [PMID: 30578163 DOI: 10.1016/j.medengphy.2018.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/21/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022]
Abstract
The main goal of this study is to build an artificial intelligence (AI) architecture for automated extraction of dual-modal image features from both shear-wave elastography (SWE) and B-mode ultrasound, and to evaluate the AI architecture for classification between benign and malignant breast tumors. In this AI architecture, ultrasound images were segmented by the reaction diffusion level set model combined with the Gabor-based anisotropic diffusion algorithm. Then morphological features and texture features were extracted from SWE and B-mode ultrasound images at the contourlet domain. Finally, we employed a framework for feature learning and classification with the deep polynomial network (DPN) on dual-modal features to distinguish between malignant and benign breast tumors. With the leave-one-out cross validation, the DPN method on dual-modal features achieved a sensitivity of 97.8%, a specificity of 94.1%, an accuracy of 95.6%, a Youden's index of 91.9% and an area under the receiver operating characteristic curve of 0.961, which was superior to the classic single-modal methods, and the dual-modal methods using the principal component analysis and multiple kernel learning. These results have demonstrated that the dual-modal AI-based technique with DPN has the potential for breast tumor classification in future clinical practice.
Collapse
Affiliation(s)
- Qi Zhang
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Room 803, Xiangying Building, No. 333, Nanchen Road, Shanghai 200444, China; The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Institute of Biomedical Engineering, Shanghai University, Shanghai 200444, China.
| | - Shuang Song
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Room 803, Xiangying Building, No. 333, Nanchen Road, Shanghai 200444, China; The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Institute of Biomedical Engineering, Shanghai University, Shanghai 200444, China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave., SZ University Town, Shenzhen 518055, China.
| | - Shuai Chen
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Room 803, Xiangying Building, No. 333, Nanchen Road, Shanghai 200444, China; The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Institute of Biomedical Engineering, Shanghai University, Shanghai 200444, China
| | - Jun Shi
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Room 803, Xiangying Building, No. 333, Nanchen Road, Shanghai 200444, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave., SZ University Town, Shenzhen 518055, China
| |
Collapse
|
200
|
Barr RG, Managuli RA. A Clinical Study Comparing the Diagnostic Performance of Assist Strain Ratio Against Manual Strain Ratio in Ultrasound Breast Elastography. Ultrasound Q 2018; 35:82-87. [PMID: 30516731 DOI: 10.1097/ruq.0000000000000398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Strain ratio (SR) is a semiquantitative parameter in differentiating benign from malignant tumors in breast ultrasound elastography. Currently, SR is computed manually and, thus, user dependent. The objective of this study was to evaluate the performance of a new tool assist strain ratio (ASR) and determine how it performs compared with an expert sonologist. METHODS Ninety-one patients scheduled for breast biopsy were included in this institutional review board-approved/Health Insurance Portability and Accountability Act-compliant study. For manual strain ratio (MSR), fat and lesion were manually outlined, whereas for ASR, the clinician indicated the lesion center and the fat-to-lesion ratio is computed automatically. Three measurements were obtained for each lesion. The same raw data were used to calculate the MSR and ASR. RESULTS The SR thresholds to differentiate benign from malignant tumors were determined using the Youden index. For MSR, the cutoff was 2.7, and for ASR was 2.8. The MSR showed a sensitivity of 88%, specificity of 64%, accuracy of 77%, positive predictive value of 72%, and negative predictive value of 92.1%. Corresponding ASR showed a sensitivity of 86%, specificity of 76%, accuracy of 81%, positive predictive value of 79%, and negative predictive value of 84%. The areas under the curve for the MSR and ASR were 0.83 and 0.85, respectively. The average coefficients of variation for the MSR and ASR measurements were 43% and 30%, respectively. CONCLUSION Assist strain ratio demonstrated similar diagnostic performance compared with MSR. In addition, the coefficient of variation of ASR is lower, implying lower intraoperator dependency. Thus, ASR may aid less-experienced scanners in obtaining improved results.
Collapse
|