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Zaniker EJ, Zhang M, Hughes L, La Follette L, Atazhanova T, Trofimchuk A, Babayev E, Duncan FE. Shear wave elastography to assess stiffness of the human ovary and other reproductive tissues across the reproductive lifespan in health and disease†. Biol Reprod 2024; 110:1100-1114. [PMID: 38609185 PMCID: PMC11180622 DOI: 10.1093/biolre/ioae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
The ovary is one of the first organs to show overt signs of aging in the human body, and ovarian aging is associated with a loss of gamete quality and quantity. The age-dependent decline in ovarian function contributes to infertility and an altered endocrine milieu, which has ramifications for overall health. The aging ovarian microenvironment becomes fibro-inflammatory and stiff with age, and this has implications for ovarian physiology and pathology, including follicle growth, gamete quality, ovulation dynamics, and ovarian cancer. Thus, developing a non-invasive tool to measure and monitor the stiffness of the human ovary would represent a major advance for female reproductive health and longevity. Shear wave elastography is a quantitative ultrasound imaging method for evaluation of soft tissue stiffness. Shear wave elastography has been used clinically in assessment of liver fibrosis and characterization of tendinopathies and various neoplasms in thyroid, breast, prostate, and lymph nodes as a non-invasive diagnostic and prognostic tool. In this study, we review the underlying principles of shear wave elastography and its current clinical uses outside the reproductive tract as well as its successful application of shear wave elastography to reproductive tissues, including the uterus and cervix. We also describe an emerging use of this technology in evaluation of human ovarian stiffness via transvaginal ultrasound. Establishing ovarian stiffness as a clinical biomarker of ovarian aging may have implications for predicting the ovarian reserve and outcomes of Assisted Reproductive Technologies as well as for the assessment of the efficacy of emerging therapeutics to extend reproductive longevity. This parameter may also have broad relevance in other conditions where ovarian stiffness and fibrosis may be implicated, such as polycystic ovarian syndrome, late off target effects of chemotherapy and radiation, premature ovarian insufficiency, conditions of differences of sexual development, and ovarian cancer. Summary sentence: Shear Wave Elastography is a non-invasive technique to study human tissue stiffness, and here we review its clinical applications and implications for reproductive health and disease.
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Affiliation(s)
- Emily J Zaniker
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Man Zhang
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lydia Hughes
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Tomiris Atazhanova
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alexis Trofimchuk
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elnur Babayev
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Reproductive Longevity and Equality, Buck Institute for Research on Aging, Novato, CA, USA
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Statsenko Y, Smetanina D, Arora T, Östlundh L, Habuza T, Simiyu GL, Meribout S, Talako T, King FC, Makhnevych I, Gelovani JG, Das KM, Gorkom KNV, Almansoori TM, Al Zahmi F, Szólics M, Ismail F, Ljubisavljevic M. Multimodal diagnostics in multiple sclerosis: predicting disability and conversion from relapsing-remitting to secondary progressive disease course - protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e068608. [PMID: 37451729 PMCID: PMC10351237 DOI: 10.1136/bmjopen-2022-068608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The number of patients diagnosed with multiple sclerosis (MS) has increased significantly over the last decade. The challenge is to identify the transition from relapsing-remitting to secondary progressive MS. Since available methods to examine patients with MS are limited, both the diagnostics and prognostication of disease progression would benefit from the multimodal approach. The latter combines the evidence obtained from disparate radiologic modalities, neurophysiological evaluation, cognitive assessment and molecular diagnostics. In this systematic review we will analyse the advantages of multimodal studies in predicting the risk of conversion to secondary progressive MS. METHODS AND ANALYSIS We will use peer-reviewed publications available in Web of Science, Medline/PubMed, Scopus, Embase and CINAHL databases. In vivo studies reporting the predictive value of diagnostic methods will be considered. Selected publications will be processed through Covidence software for automatic deduplication and blind screening. Two reviewers will use a predefined template to extract the data from eligible studies. We will analyse the performance metrics (1) for the classification models reflecting the risk of secondary progression: sensitivity, specificity, accuracy, area under the receiver operating characteristic curve, positive and negative predictive values; (2) for the regression models forecasting disability scores: the ratio of mean absolute error to the range of values. Then, we will create ranking charts representing performance of the algorithms for calculating disability level and MS progression. Finally, we will compare the predictive power of radiological and radiomical correlates of clinical disability and cognitive impairment in patients with MS. ETHICS AND DISSEMINATION The study does not require ethical approval because we will analyse publicly available literature. The project results will be published in a peer-review journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42022354179.
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Affiliation(s)
- Yauhen Statsenko
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
- Big Data Analytics Center, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
| | - Darya Smetanina
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Teresa Arora
- Psychology Department, College of Natural and Health Sciences, Zayed University, Abu Dhabi, Abu Dhabi Emirate, UAE
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
- Library, Örebro University, Örebro, Sweden
| | - Tetiana Habuza
- Big Data Analytics Center, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
- Department of Computer Science, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
| | - Gillian Lylian Simiyu
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Sarah Meribout
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
- Internal Medicine Department, Maimonides Medical Center, New York, New York, USA
| | - Tatsiana Talako
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Department of Oncohematology, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
| | - Fransina Christina King
- Physiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Neuroscience Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Iryna Makhnevych
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Juri George Gelovani
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Biomedical Engineering Department, Wayne State University, College of Engineering, Detroit, Michigan, USA
- Radiology Department, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
- Provost Office, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
| | - Karuna M Das
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Klaus Neidl-Van Gorkom
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Taleb M Almansoori
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Fatmah Al Zahmi
- Neurology Department, Mediclinic Parkview Hospital, Dubai, Dubai Emirate, UAE
- Neurology Department, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, Dubai Emirate, UAE
| | - Miklós Szólics
- Internal Medicine Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Division of Neurology, Department of Medicine, Tawam Hospital, Al Ain, Abu Dhabi Emirate, UAE
| | - Fatima Ismail
- Pediatrics Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Milos Ljubisavljevic
- Physiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Neuroscience Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
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Chen SH, Xiang XZ, Che PF, Hu B, Shui DY, Zhao Y, Wang L. Superb Microvascular Imaging for the Differentiation of Benign and Malignant Breast Lesions: A System Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1385-1399. [PMID: 36579829 DOI: 10.1002/jum.16159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. METHODS A systematic search of PubMed, EMBASE, Cochrane, OVID, SCI, and SCOPUS was performed to find relevant studies which applied SMI to differentiate benign and malignant breast lesions. All the studies were published before October 10, 2022. Only studies published in English were collected. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was also performed to the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. Subgroup analyses and meta-regression were performed to find out the heterogeneity. RESULTS Twenty studies which include a total of 2873 lesions (1748 benign and 1125 malignant) in 2740 patients were evaluated in this meta-analysis. The summary sensitivity and specificity were 0.82 (95% confidence interval [CI]: 0.76-0.86), 0.70 (95% CI: 0.64-0.76) for SMI vascular degree, 0.77 (95% CI: 0.67-0.84), 0.79 (95% CI: 0.75-0.83) for SMI vascular distribution, 0.78 (95% CI: 0.70-0.84), 0.75 (95% CI: 0.69-0.80) for SMI vascular morphology, 0.81 (95% CI: 0.72-0.87), 0.80 (95% CI: 0.75-0.85) SMI penetration vessel. For SMI overall vascular features, the summary sensitivity and summary specificity were 0.74 (95% CI: 0.61-0.84) and 0.80 (95% CI: 0.76-0.84). The result of subgroup analysis and meta-analysis showed malignant rate and country might be the cause of heterogeneity of diagnostic accuracy of vascular grade and morphology. CONCLUSION SMI vascular features have high sensitivity and specificity in the differentiation of benign and malignant lesions. Future international multicenter studies in various regions with large sample size are required to confirm these findings.
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Affiliation(s)
- Si-Han Chen
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Xiao-Zhen Xiang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Peng-Fei Che
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Bing Hu
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Dian-Ya Shui
- Department of Ultrasonic Imaging, Yichang Second People's Hospital, Yichang, Hubei, China
| | - Yun Zhao
- Medical School of China, Three Gorges University, Yichang, Hubei, China
| | - Li Wang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
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Fukuda T, Tsunoda H, Yagishita K, Naganawa S, Hayashi K, Kurihara Y. Deep Learning for Differentiation of Breast Masses Detected by Screening Ultrasound Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:989-995. [PMID: 36681608 DOI: 10.1016/j.ultrasmedbio.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 11/01/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Recently, deep learning using convolutional neural networks (CNNs) has yielded consistent results in image-pattern recognition. This study was aimed at investigating the effectiveness of deep learning using CNNs to differentiate benign and malignant breast masses identified by elastography on ultrasound screening. A data set of the elastography images of 245 breast masses (146 benign, 99 malignant) in 239 consecutive patients was retrospectively obtained. The data set was randomly split into training (55%), validation (25%) and test (20%) cohorts. A deep learning model predicting the probability of malignancy was constructed using GoogLeNet architectures (pre-trained by ImageNet) with 50 epochs. The model was then applied to the test data, and the results were compared with those obtained by evaluating the fat-to-lesion ratio (FLR) and by a 5-point visual color assessment (elasticity score). The receiver operating characteristic (ROC) curve was calculated to evaluate the performance of the model. The DeLong test was used to compare the areas under the ROC curve (AUCs). The CNN, FLR and elasticity score had a sensitivity of 0.800, 0.800 and 0.350; specificity of 0.966, 0.586 and 0.931; accuracy of 0.898, 0.673 and 0.694; positive predictive value of 0.941, 0.571 and 0.778; negative predictive value of 0.875, 0.810 and 0.675; and AUC of 0.895, 0.693 and 0.641, respectively. The AUC of the CNN was significantly higher than that of the FLR or elasticity score (p < 0.001). A CNN-based deep learning model for predicting benign or malignant breast masses revealed better diagnostic performance than did FLR or elasticity score-based estimations on ultrasound elastography. The CNN-based model also increased the positive predictive value from 57%-78% to 94%. Therefore, this model may reduce unnecessary biopsy recommendations for masses detected on breast ultrasound screening.
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Affiliation(s)
- Toshinori Fukuda
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan.
| | - Hiroko Tsunoda
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuyo Yagishita
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Shotaro Naganawa
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke's International University, OMURA Susumu and Mieko Memorial St. Luke's Center for Clinical Academia, Tokyo, Japan
| | - Yasuyuki Kurihara
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
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Seppecher L, Bretin E, Millien P, Petrusca L, Brusseau E. Reconstructing the Spatial Distribution of the Relative Shear Modulus in Quasi-static Ultrasound Elastography: Plane Stress Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:710-722. [PMID: 36639283 DOI: 10.1016/j.ultrasmedbio.2022.09.023] [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: 12/23/2021] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Quasi-static ultrasound elastography (QSUE) is an imaging technique that mainly provides axial strain maps of tissues when the latter are subjected to compression. In this article, a method for reconstructing the relative shear modulus distribution within a linear elastic and isotropic medium, in QSUE, is introduced. More specifically, the plane stress inverse problem is considered. The proposed method is based on the variational formulation of the equilibrium equations and on the choice of adapted discretization spaces, and only requires displacement fields in the analyzed media to be determined. Results from plane stress and 3-D numerical simulations, as well as from phantom experiments, showed that the method is able to reconstruct the different regions within a medium, with shear modulus contrasts that unambiguously reveal whether inclusions are stiffer or softer than the surrounding material. More specifically, for the plane stress simulations, inclusion-to-background modulus ratios were found to be very accurately estimated, with an error lower than 3%. For the 3-D simulations, for which the plane stress conditions are no longer satisfied, these ratios were, as expected, less accurate, with an error that remained lower than 10% for two of the three cases analyzed but was around 34% for the last case. Concerning the phantom experiments, a comparison with a shear wave elastography technique from a clinical ultrasound scanner was also made. Overall, the inclusion-to-background shear modulus ratios obtained with our approach were found to be closer to those given by the phantom manufacturer than the ratios provided by the clinical system.
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Affiliation(s)
- Laurent Seppecher
- Institut Camille Jordan, Ecole Centrale de Lyon & UCBL, Lyon, France
| | - Elie Bretin
- Institut Camille Jordan, INSA de Lyon & UCBL, Lyon, France
| | - Pierre Millien
- Institut Langevin, CNRS UMR 7587, ESPCI Paris, PSL Research University, Paris, France
| | - Lorena Petrusca
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM Saint-Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
| | - Elisabeth Brusseau
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM Saint-Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France.
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Brunelli AC, Brito LGO, Moro FAS, Jales RM, Yela DA, Benetti-Pinto CL. Ultrasound Elastography for the Diagnosis of Endometriosis and Adenomyosis: A Systematic Review with Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:699-709. [PMID: 36528440 DOI: 10.1016/j.ultrasmedbio.2022.11.006] [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: 05/13/2022] [Revised: 10/05/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
Elastography is capable of measuring tissue mechanical properties and elasticity. It is used to help diagnose various diseases, although its use in pelvic endometriosis remains to be established. A systematic review and meta-analysis were conducted to assess transvaginal ultrasound elastography for the diagnosis of different manifestations of endometriosis and adenomyosis. PRISMA guidelines were used for a Medline, PubMed, Embase, BVS/Bireme, Scopus, Cochrane Library and Escudos database search. Studies indexed until March 2021 that evaluated elastography compared with histopathological results (gold standard), ultrasound or magnetic resonance imaging for diagnosis of pelvic endometriosis and adenomyosis were eligible. The Rayyan platform was used to select studies. Sensitivity (S), specificity (Ps), positive and negative predictive values and receiver operating characteristic curves were calculated for elastographic diagnosis of endometriosis. A meta-analysis using Review Manager 5 and Open Meta Analyst was performed. Bias risk in the studies was analyzed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. This systematic review was prospectively registered in the PROSPERO database: CRD42021244555. Among the 163 identified citations, 10 studies were eligible for review (5 for diagnosis of adenomyosis, 2 for endometrioma, 3 for deep intestinal endometriosis and rectovaginal septum [deep pelvic endometriosis], N = 744 women). In deep pelvic endometriosis, lesions diagnosed by elastography were found to correlate with histopathology results. Increased "stiffness" (elastography) was associated with a higher fibrotic component, with S = 78%-100% and Ps = 100%, according to the authors. On elastography, endometriomas were stiffer than hemorrhagic cysts (S = 82%, Ps = 79%) and malignant tumors (S = 86%, Ps = 100%). For these lesions, a meta-analysis could not be performed because the small number of studies and insufficient data. In adenomyosis, meta-analysis and receiver operating characteristic curve analysis revealed that elastography had good sensitivity and specificity. Studies indicated a low bias risk by QUADAS-2. Elastography had high sensitivity and specificity for deep pelvic endometriosis diagnosis, and its findings correlated with histopathology results. For adenomyosis, the meta-analysis confirmed the sensitivity and specificity results of the studies. Given these results, elastography may be a promising imaging test, contributing to non-invasive diagnosis of endometriosis and adenomyosis.
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Affiliation(s)
- Ana Claudia Brunelli
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Flavia Assad Salum Moro
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Daniela Angerame Yela
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Value of shear wave elasticity in predicting the efficacy of neoadjuvant chemotherapy in different molecular types. Clin Imaging 2022; 89:97-103. [DOI: 10.1016/j.clinimag.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
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Dickson DM, Smith SL, Hendry GJ. Strain sonoelastography in asymptomatic individuals and individuals with knee osteoarthritis: an evaluation of quadriceps and patellar tendon. Rheumatol Int 2022; 42:2241-2251. [PMID: 35974116 PMCID: PMC9548467 DOI: 10.1007/s00296-022-05184-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.,Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recover and Inflammation Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham, NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
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Gubarkova EV, Sovetsky AA, Vorontsov DA, Buday PA, Sirotkina MA, Plekhanov AA, Kuznetsov SS, Matveyev AL, Matveev LA, Gamayunov SV, Vorontsov AY, Zaitsev VY, Gladkova ND. Compression optical coherence elastography versus strain ultrasound elastography for breast cancer detection and differentiation: pilot study. BIOMEDICAL OPTICS EXPRESS 2022; 13:2859-2881. [PMID: 35774307 PMCID: PMC9203088 DOI: 10.1364/boe.451059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 05/20/2023]
Abstract
The aims of this study are (i) to compare ultrasound strain elastography (US-SE) and compression optical coherence elastography (C-OCE) in characterization of elastically linear phantoms, (ii) to evaluate factors that can cause discrepancy between the results of the two elastographic techniques in application to real tissues, and (iii) to compare the results of US-SE and C-OCE in the differentiation of benign and malignant breast lesions. On 22 patients, we first used standard US-SE for in vivo assessment of breast cancer before and then after the lesion excision C-OCE was applied for intraoperative visualization of margins of the tumors and assessment of their type/grade using fresh lumpectomy specimens. For verification, the tumor grades and subtypes were determined histologically. We show that in comparison to US-SE, quantitative C-OCE has novel capabilities due to its ability to locally control stress applied to the tissue and obtain local stress-strain curves. For US-SE, we demonstrate examples of malignant tumors that were erroneously classified as benign and vice versa. For C-OCE, all lesions are correctly classified in agreement with the histology. The revealed discrepancies between the strain ratio given by US-SE and ratio of tangent Young's moduli obtained for the same samples by C-OCE are explained. Overall, C-OCE enables significantly improved specificity in breast lesion differentiation and ability to precisely visualize margins of malignant tumors compared. Such results confirm high potential of C-OCE as a high-speed and accurate method for intraoperative assessment of breast tumors and detection of their margins.
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Affiliation(s)
| | | | | | - Pavel A. Buday
- Nizhny Novgorod Regional Oncologic Hospital, Nizhny Novgorod, Russia
| | | | | | | | | | - Lev A. Matveev
- Institute of Applied Physics RAS, Nizhny Novgorod, Russia
| | | | | | - Vladimir Y. Zaitsev
- Institute of Applied Physics RAS, Nizhny Novgorod, Russia
- Equally contributed
| | - Natalia D. Gladkova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Equally contributed
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Xie Y, Zhu Y, Chai W, Zong S, Xu S, Zhan W, Zhang X. Downgrade BI-RADS 4A Patients Using Nomogram Based on Breast Magnetic Resonance Imaging, Ultrasound, and Mammography. Front Oncol 2022; 12:807402. [PMID: 35155244 PMCID: PMC8828585 DOI: 10.3389/fonc.2022.807402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/03/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives To downgrade BI-RADS 4A patients by constructing a nomogram using R software. Materials and Methods A total of 1,717 patients were retrospectively analyzed who underwent preoperative ultrasound, mammography, and magnetic resonance examinations in our hospital from August 2019 to September 2020, and a total of 458 patients of category BI-RADS 4A (mean age, 47 years; range 18–84 years; all women) were included. Multivariable logistic regression was used to screen out the independent influencing parameters that affect the benign and malignant tumors, and the nomogram was constructed by R language to downgrade BI-RADS 4A patients to eligible category. Results Of 458 BI-RADS 4A patients, 273 (59.6%) were degraded to category 3. The malignancy rate of these 273 lesions is 1.5% (4/273) (<2%), and the sensitivity reduced to 99.6%, the specificity increased from 4.41% to 45.3%, and the accuracy increased from 63.4% to 78.8%. Conclusion By constructing a nomogram, some patients can be downgraded to avoid unnecessary biopsy.
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Affiliation(s)
- Yamie Xie
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Medicine, Kunming University of Science and Technology, Department of Ultrasound, The First People's Hospital of Yunnan Province, Kunming, China
| | - Ying Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weimin Chai
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoyun Zong
- College of Medicine, Kunming University of Science and Technology, Department of Ultrasound, The First People's Hospital of Yunnan Province, Kunming, China
| | - Shangyan Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxiao Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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The Utility of the Fifth Edition of the BI-RADS Ultrasound Lexicon in Category 4 Breast Lesions: A Prospective Multicenter Study in China. Acad Radiol 2022; 29 Suppl 1:S26-S34. [PMID: 32768352 DOI: 10.1016/j.acra.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to evaluate the utility of the fifth edition of the Breast Imaging-Reporting and Data System (BI-RADS) in clinical breast radiology by using prospective multicenter real-time analyses of ultrasound (US) images. MATERIALS AND METHODS We prospectively studied 2049 female patients (age range, 19-86 years; mean age 46.88 years) with BI-RADS category 4 breast masses in 32 tertiary hospitals. All the patients underwent B-mode, color Doppler US, and US elastography examination. US features of the mass and associated features were described and categorized according to the fifth edition of the BI-RADS US lexicon. The pathological results were used as the reference standard. The positive predictive values (PPVs) of subcategories 4a-4c were calculated. RESULTS A total of 2094 masses were obtained, including 1124 benign masses (54.9%) and 925 malignant masses (45.1%). For BI-RADS US features of mass shape, orientation, margin, posterior features, calcifications, architectural distortion, edema, skin changes, vascularity, and elasticity assessment were significantly different for benign and malignant masses (p< 0.05). Typical signs of malignancy were irregular shape (PPV, 57.2%), spiculated margin (PPV, 83.7%), nonparallel orientation (PPV, 63.9%), and combined pattern of posterior features (PPV, 60.6%). For the changed or newly added US features, the PPVs for intraductal calcifications were 80%, 56.4% for internal vascularity, and 80% for a hard pattern on elastography. The associated features such as architectural distortion (PPV, 89.3%), edema (PPV, 69.2%), and skin changes (PPV, 76.2%) displayed high predictive value for malignancy. The rate of malignant was 7.4% (72/975) in category 4a, 61.4% (283/461) in category 4b, and 93.0% (570/613) in category 4c. The PPV for category 4b was higher than the likelihood ranges specified in BI-RADS and the PPVs for categories 4a and 4c were within the acceptable performance ranges specified in the fifth edition of BI-RADS in our study. CONCLUSION Not only the US features of the breast mass, but also associated features, including vascularity and elasticity assessment, have become an indispensable part of the fifth edition of BI-RADS US lexicon to distinguish benign and malignant breast lesions. The subdivision of category 4 lesions into categories 4a, 4b, and 4c for US findings is helpful for further assessment of the likelihood of malignancy of breast lesions.
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Hossain MM, Gallippi CM. Electronic Point Spread Function Rotation Using a Three-Row Transducer for ARFI-Based Elastic Anisotropy Assessment: In Silico and Experimental Demonstration. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:632-646. [PMID: 32833634 PMCID: PMC7987224 DOI: 10.1109/tuffc.2020.3019002] [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] [Indexed: 05/04/2023]
Abstract
Degree of anisotropy (DoA) of mechanical properties has been assessed as the ratio of acoustic radiation force impulse (ARFI)-induced peak displacements (PDs) achieved using spatially asymmetric point spread functions (PSFs) that are rotated 90° to each other. Such PSF rotation has been achieved by manually rotating a linear array transducer, but manual rotation is cumbersome and prone to misalignment errors and higher variability in measurements. The purpose of this work is to evaluate the feasibility of electronic PSF rotation using a three-row transducer, which will reduce variability in DoA assessment. A Siemens 9L4, with 3×192 elements, was simulated in Field II to generate spatially asymmetric ARFI PSFs that were electronically rotated 63° from each other. Then, using the finite element method (FEM), PD due to the ARFI excitation PSFs in 42 elastic, incompressible, transversely isotropic (TI) materials with shear moduli ratios of 1.0-6.0 were modeled. Finally, the ratio of PDs achieved using the two rotated PSFs was evaluated to assess elastic DoA. DoA increased with increasing shear moduli ratios and distinguished materials with 17% or greater difference in shear moduli ratios (Wilcoxon, ). Experimentally, the ratio of PDs achieved using ARFI PSF rotated 63° from each other distinguished the biceps femoris muscle from two pigs, which had median shear moduli ratios of 4.25 and 3.15 as assessed by shear wave elasticity imaging (SWEI). These results suggest that ARFI-based DoA assessment can be achieved without manual transducer rotation using a three-row transducer capable of electronically rotating PSFs by 63°. It is expected that electronic PSF rotation will facilitate data acquisitions and improve the reproducibility of elastic anisotropy assessments.
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Galaz B, Donoso E, Trejo M. Importance of the Ultrasound Probe Angle on the Rotation Fill-in Signature in Ultrasound Axial-Shear Strain Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:345-354. [PMID: 33162253 DOI: 10.1016/j.ultrasmedbio.2020.10.002] [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: 02/06/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 06/11/2023]
Abstract
The rotation fill-in is a signature of tumor benignity in rotation elastograms and has been used for breast tumor classification. It is a consequence of the bonding condition at the tumor-tissue interface. In vivo studies have revealed the presence of fluctuations when inclined uniaxial external compression is applied. However, the physical meaning of these fluctuations is not yet fully understood. In this article we present an experimental and numerical study of the rotation fill-in signature as a function of the probe's tilt angle. This angle introduces asymmetries in the stress field, modifying the bonding condition. We numerically consider this asymmetry by using a model of friction with a simple angular dependence, which allows us to capture the experimental trends. We argue that the formulation of a tumor model with a bonding condition dependence may have potential implications in correct tumor classification.
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Affiliation(s)
- Belfor Galaz
- Departamento de Fisica, Universidad de Santiago de Chile, Santiago, Chile.
| | - Esteban Donoso
- Departamento de Fisica, Universidad de Santiago de Chile, Santiago, Chile
| | - Miguel Trejo
- Instituto de Fisica de Buenos Aires (IFIBA-CONICET), Departamento de Fisica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires, Argentina
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Yang H, Xu Y, Zhao Y, Yin J, Chen Z, Huang P. The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography. BMC Cancer 2020; 20:930. [PMID: 32993571 PMCID: PMC7526131 DOI: 10.1186/s12885-020-07423-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 09/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background Elastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE. Methods Between September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (Emean), elasticity maximum (Emax), and elasticity minimum (Emin), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models. Results This prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of Emax-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the Emax-3shell and the Emin-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86. Conclusions SWE features, particularly the combination of Emax-3shell and Emin-3shell can improve the diagnosis of breast lesions.
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Affiliation(s)
- Hui Yang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yongyuan Xu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yanan Zhao
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jing Yin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, The Third Affiliated Hospital of Guangzhou Medical University, The Liwan Hospital of the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, Guangdong, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Park HJ, Kim SM, Yun BL, Jang M, Kim B, Lee SH, Ahn HS. Comparison of One- and Two-Region of Interest Strain Elastography Measurements in the Differential Diagnosis of Breast Masses. Korean J Radiol 2020; 21:431-441. [PMID: 32193891 PMCID: PMC7082658 DOI: 10.3348/kjr.2019.0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/09/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Hee Jeong Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Soo Hyun Lee
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Kanagaraju V, Dhivya B, Devanand B, Maheswaran V. Utility of Ultrasound Strain Elastography to Differentiate Benign from Malignant Lesions of the Breast. J Med Ultrasound 2020; 29:89-93. [PMID: 34377638 PMCID: PMC8330691 DOI: 10.4103/jmu.jmu_32_20] [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: 03/04/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to determine the utility and diagnostic performance of strain elastography (SE) in differentiating benign from malignant lesions of the breast. Methods In this prospective study, 50 palpable breast masses in 50 patients were examined by mammography, B-mode ultrasound (US) and SE. Lesions were categorized using Breast Imaging Reporting and Data System (BIRADS) scoring based on mammographic and sonographic features. Elasticity scores were assessed on a five-point scale based on the distribution of strain, and the lesion size on SE imaging and B-mode (elasticity imaging/B mode [EI/B] ratio) was compared. Findings were correlated with the BIRADS assessment and diagnostic performance of sonoelastography was evaluated taking histopathology as reference standard. Results Histopathology revealed 29 (58%) malignant and 21 (42%) benign lesions. Infiltrative ductal carcinoma and fibroadenoma were the most common malignant and benign lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE was 100%, 76.1%, 85.2%, 100%, and 90%, respectively. Higher elasticity score was significantly associated with malignant histopathology (P < 0.00001). The mean EI/B ratio for malignant lesions was 1.36 ± 0.24 while that of benign lesions was 1.03 ± 0.30 (P = 0.000). Conclusion Real-time SE of the breast, with its superior sensitivity and specificity, could provide improved characterization of benign and malignant breast masses compared with mammography and conventional US. Due to greater diagnostic accuracy, SE can be an effective adjunctive tool to B-mode US in predicting malignancy of breast, as well as in reducing the need for biopsies in benign breast lesions.
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Affiliation(s)
- Vikrant Kanagaraju
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Dhivya
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Devanand
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - V Maheswaran
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Shear wave elastography of the uterine cervix under different conditions with inter-operator agreement analysis. Pol J Radiol 2020; 85:e245-e249. [PMID: 32612722 PMCID: PMC7315054 DOI: 10.5114/pjr.2020.95527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/19/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Shear wave elastography (SWE) is a relatively new technique for measuring tissue elasticity. Its implementation for assessing the tissue of the cervix is evolving, and SWE analyses of healthy, nonpregnant cervixes is the first step in understanding other SWE changes related to cervical pathologies; nevertheless, some challenges in the use of the technique still require investigation. We aimed to target the consistency of healthy cervix shear wave elastography measurements and examine the changes induced by patient-related factors. Material and methods Elastograms were obtained at the internal and external os in the anterior (IA, EA) and posterior (IP, EP) portions of the cervix using a transvaginal approach in eight postmenopausal and 25 premenopausal women. Measurements with a standard deviation of over 20% and patients who presented with colour loss or heterogeneity were excluded from the study. Shear wave elastography assessments were performed using a Toshiba Aplio 500 version 6. Statistical significance was defined as a p value less than 0.10, due to the small number of patients. Results The mean speeds obtained at the external os on the anterior and posterior aspects was 3.17 ± 0.85 m/s and 3.18 ± 0.84 m/s, respectively, and at the internal os, the results on the anterior and posterior aspects were 3.38 ± 0.73 m/s and 3.53 ± 0.81 m/s, respectively. The difference in speed among all regions was statistically significant (p < 0.05). Fifteen patients were also analysed by a second radiologist with a similar experience level as that of the first. Nine measurements for IP, 13 measurements for IA, 11 measurements for EP, and 15 measurements for EA were performed. The correlation coefficients between the two sets of measurements were 0.46, 0.30, 0.67, and 0.51, respectively. There was no difference in the SWE values with respect to age, parity, and gravidity for any of the regions. The SWE values at the IA, IP, and EA regions between the postmenopausal and premenopausal women were significantly different (p = 0.038, p = 0.059, p = 0.065). Conclusions The posterior portion of the internal os is most likely to undergo inaccurate SWE measurement among the different anatomical positions. The correlation between radiologists was found to be different for different locations in the cervix. More studies are needed to determine the SWE values of the healthy cervix and the agreement levels between radiologists.
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Zhang S, Wan J, Liu H, Yao M, Xiang L, Fang Y, Jia L, Wu R. Value of conventional ultrasound, ultrasound elasticity imaging, and acoustic radiation force impulse elastography for prediction of malignancy in breast lesions. Clin Hemorheol Microcirc 2020; 74:241-253. [PMID: 31683464 DOI: 10.3233/ch-180527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Shupin Zhang
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Department of Medical Ultrasound, Shanghai First People’s Hospital Baoshan Branch, Shanghai, China
| | - Jing Wan
- Department of Ultrasound in Medical, 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 Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Minghua Yao
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Lihua Xiang
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Yan Fang
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Liqiong Jia
- Department of Medical Ultrasound, Shanghai First People’s Hospital Baoshan Branch, Shanghai, China
| | - Rong Wu
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ultrasound in Medical, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Rosen D, Jiang J. Modeling Uncertainty of Strain Ratio Measurements in Ultrasound Breast Strain Elastography: A Factorial Experiment. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:258-268. [PMID: 31545719 PMCID: PMC8011866 DOI: 10.1109/tuffc.2019.2942821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Strain elastography (SE) is a technique in which images of localized tissue strains are used to detect the relative stiffness of tissues. The application of SE in differentiating malignant breast lesions from benign ones has been broadly investigated. The strain ratio (SR) between the background and the breast tumor has been used and its results have been mixed. Due to the complex nature of tissue elasticity and how it relates to the strain fields measured in SE, the exact reason is not known. In this study, we apply a novel design-of-experiments-based metamodeling approach to mechanical simulation of SE in the human breast. To our knowledge, such a study has not been reported in the ultrasound SE literature. More specifically, we first conduct a screening study to identify the biomechanical factors/simulation inputs that most strongly determine SR. We then apply a response surface experimental design to these factors to produce a metamodel of SR as a function of said factors. Results from the screening study suggest that the SR measurements are primarily influenced by three factors: the initial shear modulus of the lesion, the elastic nonlinearity of the lesion, and the precompression applied during acquisition. In order to investigate the implications of these results, stochastic inputs for these three factors associated with the malignant and benign cases were applied to the resulting response surface. The resulting optimal cutoffs, sensitivity, and specificity were generally in line with a majority (>60%) of 19 clinical trials in the literature.
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The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast Cancer 2019; 27:17-24. [PMID: 31734900 PMCID: PMC8134289 DOI: 10.1007/s12282-019-01025-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.
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Wang Q, Li XL, He YP, Alizad A, Chen S, Zhao CK, Guo LH, Bo XW, Ren WW, Zhou BG, Xu HX. Three-dimensional shear wave elastography for differentiation of breast lesions: An initial study with quantitative analysis using three orthogonal planes. Clin Hemorheol Microcirc 2019; 71:311-324. [PMID: 29865044 DOI: 10.3233/ch-180388] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Azra Alizad
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bang-Guo Zhou
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Verhoeven RLJ, de Korte CL, van der Heijden EHFM. Optimal Endobronchial Ultrasound Strain Elastography Assessment Strategy: An Explorative Study. Respiration 2018; 97:337-347. [PMID: 30554224 PMCID: PMC6492606 DOI: 10.1159/000494143] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/01/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In lung cancer staging, mediastinal lymph nodes are currently aspirated using endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) based on size and FDG-PET avidity. EBUS strain elastography (SE) is a new technique that may help predict the presence of malignancy. However, a standardized assessment strategy for EBUS-SE measurement is lacking. OBJECTIVES The aim of this study was to determine the optimal assessment strategy for investigating the predictive value of EBUS-SE in mediastinal lymph nodes. METHODS Two qualitative visual analogue scale strain scores and two semiquantitative strain elastography measurements (a strain histogram and strain ratio) were acquired in 120 lymph nodes of 63 patients with (suspected) lung cancer. The dataset was randomized into an 80% training dataset to determine cut-off values. Performance was consecutively tested on the remaining 20% and the overall dataset. RESULTS The semiquantitative mean histogram scoring strategy with a cut-off value of 78 (range 0-255) showed the best and most reproducible performance in prediction of malignancy with 93% overall sensitivity, 75% specificity, 69% positive predictive value, 95% negative predictive value, and 82% accuracy. Combining the EBUS-SE mean histogram scoring outcome with PET-CT information increased the post-test probability of disease in relevant clinical scenarios, having a positive test likelihood ratio of 4.16 (95% CI 2.98-8.13) and a negative test likelihood ratio of 0.14 (95% CI 0.04-2.81) in suspicious lymph nodes based on FDG-PET or CT imaging. CONCLUSIONS EBUS-SE can potentially help predict lymph node malignancy in patients with lung cancer. The best semiquantitative assessment method is the mean strain histogram technique.
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Affiliation(s)
- Roel L J Verhoeven
- Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Science and Technology, Twente University, Enschede, The Netherlands
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Science and Technology, Twente University, Enschede, The Netherlands
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Ferre R, Mesurolle B. Sonoelastography of retroareolar carcinomas. J Gynecol Obstet Hum Reprod 2018; 48:165-170. [PMID: 30355505 DOI: 10.1016/j.jogoh.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the sonographic and elastographic features of retroareolar carcinomas. MATERIALS Institutional review board approval was obtained. Among 967 sonographically guided biopsies (2013-2014) (14-gauge cores), 53 yielded the diagnosis of retroareolar carcinoma (located less than 2cm from the nipple on mammograms). Out of these 53 lesions, 30 were assessed additionally with strain elastography prior to the biopsy in addition to conventional sonographic analysis. Imaging features were analyzed in consensus by two radiologists. Elasticity score was evaluated by the score defined by Itoh (Tsukuba score). Descriptive analysis was performed. RESULTS A total of 30 lesions were included (30 patients; mean age, 66.03 (±12.88)). The mean size of the lesions at diagnosis was 23.97mm (±13.64). Sonographically, most of lesions appeared as hypoechoic masses (96.5%, 28/29) displaying an irregular shape (75.9%, 22/29), non parallel orientation (58.6%, 17/29), non circumscribed margins (86.2%, 25/29), posterior attenuation (93.3%, 28/29). Among the 30 lesions, 3.3% (1/30) of lesions appeared as an attenuation and distortion without discrete mass. Most of the lesions were categorized as BI-RADS category 5 (76.7%, 23/30). Approximately half of lesions (53.3%, 16/30) appeared as firm and larger than 2D mode with strain elastography according to the Tsukuba score. CONCLUSION Retroareolar carcinoma displayed malignant features at US and elastographic examination. In our study population, the addition of elastography to breast US in this location did not improve diagnostic accuracy.
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Affiliation(s)
- Romuald Ferre
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave West, Montreal, PQ H3H 1A1, Canada.
| | - Benoit Mesurolle
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave West, Montreal, PQ H3H 1A1, Canada
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Chen YF, Mao XW, Zhang YJ, Zhang CY, Yu YF, Qin E, Chen X, Shen JX. Endobronchial Ultrasound Elastography Differentiates Intrathoracic Lymph Nodes: A Meta-Analysis. Ann Thorac Surg 2018; 106:1251-1257. [DOI: 10.1016/j.athoracsur.2018.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/27/2022]
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Abstract
Ultrasound-based strain imaging is available in several ultrasound (US) scanners. Strain ratio (SR) can be used to quantify the strain recorded simultaneously in two different user-selected areas, ideally exposed to the same amount of stress. The aim of this study was to evaluate SR variability when assessed in an in-vitro setup with a tissue-mimicking phantom on resected tissue samples and in live tissue scanning with endoscopic applications. We performed an in vivo retrospective analysis of SR variability used for quantification of elastic contrasts in a tissue-mimicking phantom containing four homogenous inclusion in 38 resected bowel wall lesions and 48 focal pancreatic lesions. Median SR and the inter-quartile range (IQR) were calculated for all external and endoscopic ultrasound (EUS) applications. The IQR and median provide a measure of SR variability focusing on the two percentiles of the data closest to the median value. The overall SR variability was lowest in a tissue-mimicking phantom (mean QR/median SR: 0.07). In resected bowel wall lesions representing adenomas, adenocarcinomas, or Crohn lesions, the variability increased (mean IQR/Median: 0.62). During an in vivo endoscopic examination of focal pancreatic lesions, the variability increased further (mean IQR/Median: 2.04). SR variability increased when assessed for different targets with growing heterogeneity and biological variability from homogeneous media to live tissues and endoscopic application. This may indicate a limitation for the accuracy of SR evaluation in some clinical applications.
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Downgrading and Upgrading Gray-Scale Ultrasound BI-RADS Categories of Benign and Malignant Masses With Optoacoustics: A Pilot Study. AJR Am J Roentgenol 2018; 211:689-700. [PMID: 29975115 DOI: 10.2214/ajr.17.18436] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE False-positive findings remain challenging in breast imaging. This study investigates the incremental value of optoacoustic imaging in improving BI-RADS categorization of breast masses at ultrasound. SUBJECTS AND METHODS The study device is an optoacoustic breast imaging device with a handheld duplex laser and internal gray-scale ultrasound probe, fusing functional and morphologic information (optoacoustic ultrasound). In this prospective multisite study, breast masses assessed as BI-RADS category 3, 4A, 4B, 4C, or 5 by site radiologists underwent both gray-scale ultrasound and optoacoustic imaging with the study device. Independent reader radiologists assessed internal gray-scale ultrasound and optoacoustic ultrasound features for each mass and assigned a BI-RADS category. The percentage of mass reads for which optoacoustic ultrasound resulted in a downgrade or upgrade of BI-RADS category relative to internal gray-scale ultrasound was determined. RESULTS Of 94 total masses, 39 were biopsy-proven malignant, 44 were biopsy-proven benign, and 11 BI-RADS category 3 masses were stable at 12-month follow-up. The sensitivity of both optoacoustic ultrasound and internal gray-scale ultrasound was 97.1%. The specificity was 44.3% for optoacoustic ultrasound and 36.4% for internal gray-scale ultrasound. Using optoacoustic ultrasound, 41.7% of benign masses or BI-RADS category 3 masses that were stable at 12-month follow-up were downgraded to BI-RADS category 2 by independent readers; 36.6% of masses assigned BI-RADS category 4A were downgraded to BI-RADS category 3 or 2, and 10.1% assigned BI-RADS category 4B were downgraded to BI-RADS category 3 or 2. Using optoacoustic ultrasound, independent readers upgraded 75.0% of the malignant masses classified as category 4A, 4B, 4C, or 5, and 49.4% of the malignant masses were classified as category 4B, 4C, or 5. CONCLUSION Optoacoustic ultrasound resulted in BI-RADS category downgrading of benign masses and upgrading of malignant masses compared with gray-scale ultrasound.
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Liu H, Zhu Y, Jiao J, Yuan J, Pu T, Yong Q. ShearWave™ elastography for evaluation of the elasticity of Hashimoto’s thyroiditis. Clin Hemorheol Microcirc 2018; 80:9-16. [PMID: 29660914 DOI: 10.3233/ch-170347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Haifang Liu
- Department of Ultrasound Diagnosis, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, P.R. China
| | - Yuping Zhu
- Department of Ultrasound Diagnosis, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, P.R. China
| | - Jie Jiao
- Department of Endocrinology Diagnosis, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, P.R. China
| | - Jia Yuan
- Department of Ultrasound Diagnosis, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, P.R. China
| | - Tianning Pu
- Department of Ultrasound Diagnosis, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, P.R. China
| | - Qiang Yong
- Department of Ultrasound Diagnosis, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, P.R. China
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Abstract
Tissue stiffness has long been known to be a biomarker of tissue pathology. Ultrasound elastography measures tissue mechanical properties by monitoring the response of tissue to acoustic energy. Different elastographic techniques have been applied to many different tissues and diseases. Depending on the pathology, patient-based factors, and ultrasound operator-based factors, these techniques vary in accuracy and reliability. In this review, we discuss the physical principles of ultrasound elastography, discuss differences between different ultrasound elastographic techniques, and review the advantages and disadvantages of these techniques in clinical practice.
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Affiliation(s)
- Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL, USA
| | - Manish Dhyani
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Brian W Anthony
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Dong Y, Zhou C, Zhou J, Yang Z, Zhang J, Zhan W. Breast strain elastography: Observer variability in data acquisition and interpretation. Eur J Radiol 2018; 101:157-161. [DOI: 10.1016/j.ejrad.2018.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 12/21/2022]
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Real-time elastography evaluation of differential penetrating liver trauma in a rabbit model. Am J Emerg Med 2018; 36:1627-1630. [PMID: 29502976 DOI: 10.1016/j.ajem.2018.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Real-time ultrasound elastography (RTE) is used to examine liver fibrosis and benign and malignant lesions, but its use for the diagnosis of liver trauma has not been examined. The purpose of this study was to examine the use of RTE for the evaluation of differential penetrating liver trauma in a rabbit model. MATERIAL AND METHODS Eighty New Zealand rabbits were divided into 2 groups. In one group, a single incision (type "-" lesion) was made, and in the other group a hash mark incision (type "#" lesion) was made (about 0.5cm in depth; 1.0-2.0cm in length). RTE was performed at 10, 30, and 60min after injury. RESULTS There were no differences in mean RTE scores between the 2 types of lesions at 10 and 30min. However, the mean values for the 2 types of lesions increased from 10min to 60min (type '-' lesion: 0.88±0.32 to 2.06±0.88; type '#' lesion: 0.89±0.34 to 2.63±1.16). At 60min, the mean elasticity score in the type '#' lesion group was significantly higher than in the type '-' lesion group (P<.001). Strain ratios were not different between the groups at each time point, but in each group the values decreased from the 10min time point to the 60min time point (P-value for the trends, <.001). CONCLUSIONS RTE may be able to distinguish mild or severe penetrating liver trauma at 60min or more after injury.
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A Normalized Shear Deformation Indicator for Ultrasound Strain Elastography in Breast Tissues: An In Vivo Feasibility Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2053612. [PMID: 29789777 PMCID: PMC5896347 DOI: 10.1155/2018/2053612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/09/2017] [Accepted: 01/09/2018] [Indexed: 12/21/2022]
Abstract
The shear deformation under loads contains useful information for distinguishing benign breast lesions from malignant ones. In this study, we proposed a normalized shear deformation indicator (NSDI) that was derived from the concept of principal strains. Since the NSDI requires both high-quality axial and lateral (parallel and perpendicular to the beam, resp.) displacement estimates, a strategy combining high-quality speckle tracking with signal “denoising” was employed. Both techniques were previously published by our group. Finite element (FE) models were used to identify possible causes for elevated NSDI values in and around breast lesions, followed by an analysis of ultrasound data acquired from 26 biopsy-confirmed in vivo breast lesions. We found that, theoretically, the elevated NSDI values could be attributed to two factors: significantly hardened tissue stiffness and increasing heterogeneity. The analysis of in vivo data showed that the proposed NSDI values were higher (p < 0.05) among malignant cancers as compared to those measured from benign ones. In conclusion, our preliminary results demonstrated that the calculation of NSDI value is feasible and NSDI could add value to breast lesion differentiation with current clinical equipment as a postprocessing tool.
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Exploring the Negative Likelihood Ratio and How It Can Be Used to Minimize False-Positives in Breast Imaging. AJR Am J Roentgenol 2018; 210:301-306. [DOI: 10.2214/ajr.17.18774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Brusseau E, Bernard A, Meynier C, Chaudet P, Detti V, Férin G, Basset O, Nguyen-Dinh A. Specific Ultrasound Data Acquisition for Tissue Motion and Strain Estimation: Initial Results. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2904-2913. [PMID: 29031983 DOI: 10.1016/j.ultrasmedbio.2017.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
Ultrasound applications such as elastography can benefit from 3-D data acquisition and processing. In this article, we describe a specific ultrasound probe, designed to acquire series of three adjacent imaging planes over time. This data acquisition makes it possible to consider the out-of-plane motion that can occur at the central plane during medium scanning, and is proposed with the aim of improving the results of strain imaging. In this first study, experiments were conducted on phantoms, and controlled axial and elevational displacements were applied to the probe using a motorized system. Radiofrequency ultrasound data were acquired at a 40-MHz sampling frequency with an Ultrasonix ultrasound scanner, and processed using a 3-D motion estimation method. For each of the 2-D regions of interest of the central plane in pre-compression data, a 3-D search was run to determine its corresponding version in post-compression data, with this search taking into account the region-of-interest deformation model chosen. The results obtained with the proposed ultrasound data acquisition and strain estimation were compared with results from a classic approach and illustrate the improvement produced by considering the medium's local displacements in elevation, with notably an increase in the mean correlation coefficients achieved.
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Affiliation(s)
- Elisabeth Brusseau
- Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France.
| | - Adeline Bernard
- Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | | | - Philippe Chaudet
- Université de Lyon, LaMCoS, CNRS UMR5259, INSA-Lyon, Lyon, France
| | - Valérie Detti
- Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | | | - Olivier Basset
- Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
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Neuschler EI, Butler R, Young CA, Barke LD, Bertrand ML, Böhm-Vélez M, Destounis S, Donlan P, Grobmyer SR, Katzen J, Kist KA, Lavin PT, Makariou EV, Parris TM, Schilling KJ, Tucker FL, Dogan BE. A Pivotal Study of Optoacoustic Imaging to Diagnose Benign and Malignant Breast Masses: A New Evaluation Tool for Radiologists. Radiology 2017; 287:398-412. [PMID: 29178816 DOI: 10.1148/radiol.2017172228] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the diagnostic utility of an investigational optoacoustic imaging device that fuses laser optical imaging (OA) with grayscale ultrasonography (US) to grayscale US alone in differentiating benign and malignant breast masses. Materials and Methods This prospective, 16-site study of 2105 women (study period: 12/21/2012 to 9/9/2015) compared Breast Imaging Reporting and Data System (BI-RADS) categories assigned by seven blinded independent readers to benign and malignant breast masses using OA/US versus US alone. BI-RADS 3, 4, or 5 masses assessed at diagnostic US with biopsy-proven histologic findings and BI-RADS 3 masses stable at 12 months were eligible. Independent readers reviewed US images obtained with the OA/US device, assigned a probability of malignancy (POM) and BI-RADS category, and locked results. The same independent readers then reviewed OA/US images, scored OA features, and assigned OA/US POM and a BI-RADS category. Specificity and sensitivity were calculated for US and OA/US. Benign and malignant mass upgrade and downgrade rates, positive and negative predictive values, and positive and negative likelihood ratios were compared. Results Of 2105 consented subjects with 2191 masses, 100 subjects (103 masses) were analyzed separately as a training population and excluded. An additional 202 subjects (210 masses) were excluded due to technical failures or incomplete imaging, 72 subjects (78 masses) due to protocol deviations, and 41 subjects (43 masses) due to high-risk histologic results. Of 1690 subjects with 1757 masses (1079 [61.4%] benign and 678 [38.6%] malignant masses), OA/US downgraded 40.8% (3078/7535) of benign mass reads, with a specificity of 43.0% (3242/7538, 99% confidence interval [CI]: 40.4%, 45.7%) for OA/US versus 28.1% (2120/7543, 99% CI: 25.8%, 30.5%) for the internal US of the OA/US device. OA/US exceeded US in specificity by 14.9% (P < .0001; 99% CI: 12.9, 16.9%). Sensitivity for biopsied malignant masses was 96.0% (4553/4745, 99% CI: 94.5%, 97.0%) for OA/US and 98.6% (4680/4746, 99% CI: 97.8%, 99.1%) for US (P < .0001). The negative likelihood ratio of 0.094 for OA/US indicates a negative examination can reduce a maximum US-assigned pretest probability of 17.8% (low BI-RADS 4B) to a posttest probability of 2% (BI-RADS 3). Conclusion OA/US increases the specificity of breast mass assessment compared with the device internal grayscale US alone. Online supplemental material is available for this article. © RSNA, 2017.
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Affiliation(s)
- Erin I Neuschler
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Reni Butler
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Catherine A Young
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Lora D Barke
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Margaret L Bertrand
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Marcela Böhm-Vélez
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Stamatia Destounis
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Pamela Donlan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Stephen R Grobmyer
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Janine Katzen
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Kenneth A Kist
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Philip T Lavin
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Erini V Makariou
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Tchaiko M Parris
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Kathy J Schilling
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - F Lee Tucker
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
| | - Basak E Dogan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (E.I.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042 (R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.Y.); Radiology Imaging Associates/Invision Sally Jobe, Englewood, Colo (L.D.B.); Solis Mammography Greensboro, Greensboro, NC (M.L.B.); Weinstein Imaging Associates, Pittsburgh, Pa (M.B.V.); Elizabeth Wende Breast Care, Rochester, NY (S.D.); Breast Care Atlanta, Atlanta, Ga (P.D.); Cleveland Clinic, Cleveland, Ohio (S.R.G.); Weill Cornell Medicine, New York, NY (J.K.); UT Health San Antonio, San Antonio, Tex (K.A.K.); Boston Biostatistics Research Foundation, Framingham, Mass (P.T.L.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (E.V.M.); Breastlink Temecula Valley, Murrieta, Calif (T.M.P.); Boca Raton Regional Hospital, Boca Raton, Fla (K.J.S.); Virginia Biomedical Laboratories, LLC, Wirtz, Va (F.L.T.); and Department of Radiology, The UT Southwestern Medical Center, Dallas, Tex (B.E.D.)
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Herman J, Sedlackova Z, Vachutka J, Furst T, Salzman R, Vomacka J. Shear wave elastography parameters of normal soft tissues of the neck. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:320-325. [DOI: 10.5507/bp.2017.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/04/2017] [Indexed: 11/23/2022] Open
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Ultrasound positive predictive values by BI-RADS categories 3–5 for solid masses: An independent reader study. Eur Radiol 2017; 27:4307-4315. [DOI: 10.1007/s00330-017-4835-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 12/21/2022]
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Sigrist RM, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017; 7:1303-1329. [PMID: 28435467 PMCID: PMC5399595 DOI: 10.7150/thno.18650] [Citation(s) in RCA: 895] [Impact Index Per Article: 127.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 12/15/2022] Open
Abstract
Elastography-based imaging techniques have received substantial attention in recent years for non-invasive assessment of tissue mechanical properties. These techniques take advantage of changed soft tissue elasticity in various pathologies to yield qualitative and quantitative information that can be used for diagnostic purposes. Measurements are acquired in specialized imaging modes that can detect tissue stiffness in response to an applied mechanical force (compression or shear wave). Ultrasound-based methods are of particular interest due to its many inherent advantages, such as wide availability including at the bedside and relatively low cost. Several ultrasound elastography techniques using different excitation methods have been developed. In general, these can be classified into strain imaging methods that use internal or external compression stimuli, and shear wave imaging that use ultrasound-generated traveling shear wave stimuli. While ultrasound elastography has shown promising results for non-invasive assessment of liver fibrosis, new applications in breast, thyroid, prostate, kidney and lymph node imaging are emerging. Here, we review the basic principles, foundation physics, and limitations of ultrasound elastography and summarize its current clinical use and ongoing developments in various clinical applications.
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Affiliation(s)
- Rosa M.S. Sigrist
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Joy Liau
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Maria Cristina Chammas
- Department of Ultrasound, Institute of Radiology, Hospital das Clínicas, Medical School of University of São Paulo
| | - Juergen K. Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
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Afshari E, Rostami M, Farahmand F. Review on different experimental techniques developed for recording force-deformation behaviour of soft tissues; with a view to surgery simulation applications. J Med Eng Technol 2017; 41:257-274. [DOI: 10.1080/03091902.2016.1264492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Elnaz Afshari
- Biomechanics Department, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Mostafa Rostami
- Biomechanics Department, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
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Tian J, Liu Q, Wang X, Xing P, Yang Z, Wu C. Application of 3D and 2D quantitative shear wave elastography (SWE) to differentiate between benign and malignant breast masses. Sci Rep 2017; 7:41216. [PMID: 28106134 PMCID: PMC5247720 DOI: 10.1038/srep41216] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/16/2016] [Indexed: 01/03/2023] Open
Abstract
As breast cancer tissues are stiffer than normal tissues, shear wave elastography (SWE) can locally quantify tissue stiffness and provide histological information. Moreover, tissue stiffness can be observed on three-dimensional (3D) colour-coded elasticity maps. Our objective was to evaluate the diagnostic performances of quantitative features in differentiating breast masses by two-dimensional (2D) and 3D SWE. Two hundred ten consecutive women with 210 breast masses were examined with B-mode ultrasound (US) and SWE. Quantitative features of 3D and 2D SWE were assessed, including elastic modulus standard deviation (ESDE) measured on SWE mode images and ESDU measured on B-mode images, as well as maximum elasticity (Emax). Adding quantitative features to B-mode US improved the diagnostic performance (p < 0.05) and reduced false-positive biopsies (p < 0.0001). The area under the receiver operating characteristic curve (AUC) of 3D SWE was similar to that of 2D SWE for ESDE (p = 0.026) and ESDU (p = 0.159) but inferior to that of 2D SWE for Emax (p = 0.002). Compared with ESDU, ESDE showed a higher AUC on 2D (p = 0.0038) and 3D SWE (p = 0.0057). Our study indicates that quantitative features of 3D and 2D SWE can significantly improve the diagnostic performance of B-mode US, especially 3D SWE ESDE, which shows considerable clinical value.
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Affiliation(s)
- Jie Tian
- Ultrasound Department, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qianqi Liu
- Ultrasound Department, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi Wang
- Ultrasound Department, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ping Xing
- Ultrasound Department, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhuowen Yang
- Endocrinology Department, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Changjun Wu
- Ultrasound Department, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Lee SE, Moon JE, Rho YH, Kim EK, Yoon JH. Which supplementary imaging modality should be used for breast ultrasonography? Comparison of the diagnostic performance of elastography and computer-aided diagnosis. Ultrasonography 2016; 36:153-159. [PMID: 27764908 PMCID: PMC5381849 DOI: 10.14366/usg.16033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/24/2016] [Accepted: 09/24/2016] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study was to evaluate and compare the diagnostic performance of grayscale ultrasonography (US), US elastography, and US computer-aided diagnosis (US-CAD) in the differential diagnosis of breast masses. Methods A total of 193 breast masses in 175 consecutive women (mean age, 46.4 years) from June to August 2015 were included. US and elastography images were obtained and recorded. A US-CAD system was applied to the grayscale sonograms, which were automatically analyzed and visualized in order to generate a final assessment. The final assessments of breast masses were based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, while elasticity scores were assigned using a 5-point scoring system. The diagnostic performance of grayscale US, elastography, and US-CAD was calculated and compared. Results Of the 193 breast masses, 120 (62.2%) were benign and 73 (37.8%) were malignant. Breast masses had significantly higher rates of malignancy in BI-RADS categories 4c and 5, elastography patterns 4 and 5, and when the US-CAD assessment was possibly malignant (all P<0.001). Elastography had higher specificity (40.8%, P=0.042) than grayscale US. US-CAD showed the highest specificity (67.5%), positive predictive value (PPV) (61.4%), accuracy (74.1%), and area under the curve (AUC) (0.762, all P<0.05) among the three diagnostic tools. Conclusion US-CAD had higher values for specificity, PPV, accuracy, and AUC than grayscale US or elastography. Computer-based analysis based on the morphologic features of US may be very useful in improving the diagnostic performance of breast US.
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Affiliation(s)
- Si Eun Lee
- Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Eun Moon
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Rho
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Chen YL, Chang C, Zeng W, Wang F, Chen JJ, Qu N. 3-Dimensional shear wave elastography of breast lesions: Added value of color patterns with emphasis on crater sign of coronal plane. Medicine (Baltimore) 2016; 95:e4877. [PMID: 27684820 PMCID: PMC5265913 DOI: 10.1097/md.0000000000004877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Color patterns of 3-dimensional (3D) shear wave elastography (SWE) is a promising method in differentiating tumoral nodules recently. This study was to evaluate the diagnostic accuracy of color patterns of 3D SWE in breast lesions, with special emphasis on coronal planes.A total of 198 consecutive women with 198 breast lesions (125 malignant and 73 benign) were included, who underwent conventional ultrasound (US), 3D B-mode, and 3D SWE before surgical excision. SWE color patterns of Views A (transverse), T (sagittal), and C (coronal) were determined. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were calculated.Distribution of SWE color patterns was significantly different between malignant and benign lesions (P = 0.001). In malignant lesions, "Stiff Rim" was significantly more frequent in View C (crater sign, 60.8%) than in View A (51.2%, P = 0.013) and View T (54.1%, P = 0.035). AUC for combination of "Crater Sign" and conventional US was significantly higher than View A (0.929 vs 0.902, P = 0.004) and View T (0.929 vs 0.907, P = 0.009), and specificity significantly increased (90.4% vs 78.1%, P = 0.013) without significant change in sensitivity (85.6% vs 88.0%, P = 0.664) as compared with conventional US.In conclusion, combination of conventional US with 3D SWE color patterns significantly increased diagnostic accuracy, with "Crater Sign" in coronal plane of the highest value.
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Affiliation(s)
- Ya-ling Chen
- Department of Ultrasound, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Cai Chang
- Department of Ultrasound, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
- Correspondence: Prof Cai Chang, Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (e-mail: )
| | - Wei Zeng
- Department of Ultrasound, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Fen Wang
- Department of Ultrasound, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jia-jian Chen
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Breast Surgery
| | - Ning Qu
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Wang Y, Helminen E, Jiang J. Building a virtual simulation platform for quasistatic breast ultrasound elastography using open source software: A preliminary investigation. Med Phys 2016; 42:5453-66. [PMID: 26328994 DOI: 10.1118/1.4928707] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Quasistatic ultrasound elastography (QUE) is being used to augment in vivo characterization of breast lesions. Results from early clinical trials indicated that there was a lack of confidence in image interpretation. Such confidence can only be gained through rigorous imaging tests using complex, heterogeneous but known media. The objective of this study is to build a virtual breast QUE simulation platform in the public domain that can be used not only for innovative QUE research but also for rigorous imaging tests. METHODS The main thrust of this work is to streamline biomedical ultrasound simulations by leveraging existing open source software packages including Field II (ultrasound simulator), VTK (geometrical visualization and processing), FEBio [finite element (FE) analysis], and Tetgen (mesh generator). However, integration of these open source packages is nontrivial and requires interdisciplinary knowledge. In the first step, a virtual breast model containing complex anatomical geometries was created through a novel combination of image-based landmark structures and randomly distributed (small) structures. Image-based landmark structures were based on data from the NIH Visible Human Project. Subsequently, an unstructured FE-mesh was created by Tetgen. In the second step, randomly positioned point scatterers were placed within the meshed breast model through an octree-based algorithm to make a virtual breast ultrasound phantom. In the third step, an ultrasound simulator (Field II) was used to interrogate the virtual breast phantom to obtain simulated ultrasound echo data. Of note, tissue deformation generated using a FE-simulator (FEBio) was the basis of deforming the original virtual breast phantom in order to obtain the postdeformation breast phantom for subsequent ultrasound simulations. Using the procedures described above, a full cycle of QUE simulations involving complex and highly heterogeneous virtual breast phantoms can be accomplished for the first time. RESULTS Representative examples were used to demonstrate capabilities of this virtual simulation platform. In the first set of three ultrasound simulation examples, three heterogeneous volumes of interest were selected from a virtual breast ultrasound phantom to perform sophisticated ultrasound simulations. These resultant B-mode images realistically represented the underlying complex but known media. In the second set of three QUE examples, advanced applications in QUE were simulated. The first QUE example was to show breast tumors with complex shapes and/or compositions. The resultant strain images showed complex patterns that were normally seen in freehand clinical ultrasound data. The second and third QUE examples demonstrated (deformation-dependent) nonlinear strain imaging and time-dependent strain imaging, respectively. CONCLUSIONS The proposed virtual QUE platform was implemented and successfully tested in this study. Through show-case examples, the proposed work has demonstrated its capabilities of creating sophisticated QUE data in a way that cannot be done through the manufacture of physical tissue-mimicking phantoms and other software. This open software architecture will soon be made available in the public domain and can be readily adapted to meet specific needs of different research groups to drive innovations in QUE.
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Affiliation(s)
- Yu Wang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931
| | - Emily Helminen
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931
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Li C, Zhang C, Li N, Li J. Compression Real-time Elastography for Evaluation of Salivary Gland Lesions: A Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:999-1007. [PMID: 27072157 DOI: 10.7863/ultra.15.08043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/03/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the performance of compression real-time elastography for differentiation between benign and malignant salivary gland lesions. METHODS A systematic literature database search was conducted. Pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) values for real-time elastography were analyzed. Summary receiver operating characteristic (ROC) curves were also constructed. Heterogeneity was evaluated by χ(2) and I(2) tests. I(2) > 50% or P < .05 indicated heterogeneity, and then a random-effects model was applied. A Deek funnel plot was used to assess publication bias. Fagan plot analysis was performed to evaluate the clinical utility of real-time elastography. When heterogeneity was found, subgroup analyses were used to explore the sources of heterogeneity. A sensitivity analysis was conducted by omitting 1 study at a time and examining the influence of each individual study on the overall results. RESULTS Nine articles with 581 lesions were included. The pooled sensitivity and specificity of real-time elastography for differentiation between benign and malignant lesions were 76% (95% confidence interval [CI], 65%-85%; 95% prediction interval [PI], 29%-95%) and 73% (95% CI, 62%-81%; 95% PI, 24%-96%), respectively. The LR+ and LR- were 2.81 (95% CI, 1.79-4.39; 95% PI, 0.65-12.16) and 0.33 (95% CI, 0.20-0.55; 95% PI, 0.07-1.69). The area under the ROC curve was 0.81 (95% CI, 0.77-0.84). No publication bias was detected, according to the Deek funnel plot (P = .51). The Fagan plot showed that when pretest probabilities were 25%, 50%, and 75%, positive posttest probabilities were 48%, 74%, and 89%, and negative probabilities were 10%, 25%, and 50%. CONCLUSIONS Real-time elastography is a novel supplementary adjunct to conventional sonography for evaluation of salivary gland lesions. However, its overall accuracy is less promising, and biopsy may still be necessary in routine clinical practice.
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Affiliation(s)
- Changtian Li
- Department of Ultrasound, Southern Building, Chinese PLA General Hospital, Beijing, China
| | - Changsheng Zhang
- Department of Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, Southern Building, Chinese PLA General Hospital, Beijing, China
| | - Junlai Li
- Department of Ultrasound, Southern Building, Chinese PLA General Hospital, Beijing, China
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Liu B, Zheng Y, Huang G, Lin M, Shan Q, Lu Y, Tian W, Xie X. Breast Lesions: Quantitative Diagnosis Using Ultrasound Shear Wave Elastography-A Systematic Review and Meta--Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:835-47. [PMID: 26778289 DOI: 10.1016/j.ultrasmedbio.2015.10.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 05/08/2023]
Abstract
The aim of this meta-analysis was to estimate the diagnostic performance of shear wave elastography (SWE) in differentiating malignant from benign breast lesions. A literature search of PubMed, Web of Science and Scopus up to November 2014 was conducted. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated using a bivariate mixed-effects regression model. Thirty-three studies, which included a total of 5838 lesions (2093 malignant, 3745 benign) from 5397 patients, were finally analyzed. Summary sensitivity and specificity were 0.886 (95% confidence interval [CI], 0.858-0.909) and 0.866 (95% CI, 0.833-0.894), respectively. The pooled diagnostic odds ratio was 50.410 (95% CI, 34.972-72.664). And the area under the receiver operating characteristic curve of SWE was 0.94 (95% CI, 0.91-0.96). No publication bias existed among these studies (p = 0.245). In the subgroup analysis, sensitivity and specificity were 0.862 (95% CI, 0.811-0.901) and 0.875 (95% CI, 0.793-0.928) among 1552 lesions from 1429 patients in the 12 studies using acoustic radiation force impulse imaging and 0.897 (95% CI, 0.863-0.923) and 0.863 (95% CI, 0.831-0.889) among another 4436 lesions from 4097 patients in the 21 studies using supersonic shear imaging. When analysis confined to 9 studies evaluated the diagnostic performance of combination SWE and conventional ultrasound, the area under the curve was 0.96 (95% CI, 0.94-0.97), yielding a sensitivity of 0.971 (95% CI, 0.941-0.986) and specificity of 0.801 (95% CI, 0.733-0.856). SWE seems to be a good quantitative method for differentiating breast lesions, with promise for integration into routine imaging protocols.
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Affiliation(s)
- Baoxian Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Yanling Zheng
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Guangliang Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Manxia Lin
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Quanyuan Shan
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Ying Lu
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Wenshuo Tian
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China.
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Guo X, Liu Y, Li W. Diagnostic accuracy of shear wave elastography for prediction of breast malignancy in patients with pathological nipple discharge. BMJ Open 2016; 6:e008848. [PMID: 26801462 PMCID: PMC4735172 DOI: 10.1136/bmjopen-2015-008848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Pathological nipple discharge (PND) may indicate malignant breast lesions. As the role of shear wave elastography (SWE) in predicting these malignant lesions has not yet been evaluated, we aim to evaluate the diagnostic value of SWE for this condition. DESIGN Prospective diagnostic accuracy study comparing a combination of qualitative and quantitative measurements of SWE (index test) to a ductoscopy and microdochectomy for histological diagnosis (reference test). SETTING Fuzhou General Hospital of Nanjing military command. PARTICIPANTS A total of 379 patients with PND were finally included from January, 2011 to March 2014, after we screened 1084 possible candidates. All participants were evaluated through SWE, with qualitative parameters generated by Virtual Touch tissue imaging (VTI) and quantitative parameters generated by Virtual Touch tissue quantification (VTQ). All the patients were consented to receive a ductoscopy and microdochectomy for histological diagnosis, and the results were set as a reference test. OUTCOME MEASURES Sensitivity and specificity of the combined VTI and VTQ of the SWE for detection of malignancy in patients with PND. RESULTS The 379 participants presented with 404 lesions. The results of pathological examination showed that 326 (80.7%) of the 404 lesions were benign and the other 78 (19.3%) were malignant. An area under the curve of elasticity score, VTQm and VTQc, were 0.872, 0.825 and 0.857, respectively, with the corresponding cut-off point as 2.50, 2.860 m/s and 3.015 m/s, respectively. After a combination of these measurements, the sensitivity, specificity, and positive and negative predictive value (PPV and NPV), were 89.7%, 72.1%, 43.5% and 96.7%, respectively. The sensitivity analysis showed 82% of the sensitivity and 96.8% of the specificity, in which patients with no pathological findings in ductoscopy were excluded. CONCLUSIONS Ultrasonographic elastography is sensitive for patients with PND and could be used as a triage test before ductoscopy examination. Studies for further improvement of diagnostic sensitivity are warranted.
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Affiliation(s)
- Xiaobo Guo
- Department of Ultrasonography, 476 Clinical Department, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, China
| | - Ying Liu
- Department of Ultrasonography, 476 Clinical Department, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, China
| | - Wanhu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, China
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Legendre G, Guilhen N, Nadeau C, Brossard A, Fauvet R. [Exploring a non-inflammatory clinical breast mass: Clinical practice guidelines]. ACTA ACUST UNITED AC 2015; 44:904-12. [PMID: 26541562 DOI: 10.1016/j.jgyn.2015.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to assess the diagnostic value of physical examination, radiologic explorations and percutaneous procedures of the breast in the exploration of a non-inflammatory palpable mass, in order to propose guidelines. METHOD A systematic literature review was conducted in the Medline and Cochrane library databases. International guidelines in French and English language were also consulted until April 30th 2015. RESULTS Physical examination of a non-inflammatory palpable breast mass is not sufficient to eliminate a breast cancer (LE2). Mammography alone has a sensitivity between 70 and 95% for the diagnosis of breast cancer (LE3). Echography alone has a sensitivity of 98 to 100% for the diagnosis of breast cancer (LE2). The core needle biopsy has a better sensitivity and specificity than the fine-needle aspiration for breast cancer diagnosis (LE2). The association of mammography and 2D echography presents excellent sensitivity and negative predictive value (close to 100 %) to exclude a breast cancer (LE3). A double evaluation using mammography and echography is recommended in the exploration of a non-inflammatory palpable breast mass (grade B).
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Affiliation(s)
- G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre, France.
| | - N Guilhen
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - C Nadeau
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - A Brossard
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - R Fauvet
- Service de gynécologie-obstétrique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 09, France; Inserm U1199, unité « Biologie et thérapies innovantes des cancers localement agressifs » (BioTICLA), université de Caen Basse-Normandie, centre de lutte contre le cancer François-Baclesse, 14076 Caen cedex 05, France
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Evranos B, Idilman I, Ipek A, Polat SB, Cakir B, Ersoy R. Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study. J Diabetes Complications 2015; 29:1124-9. [PMID: 26382616 DOI: 10.1016/j.jdiacomp.2015.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/04/2015] [Accepted: 08/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is an endocrine disease characterized by metabolic abnormalities and long-term complications. The Achilles tendon (AT) plays an important role in foot biomechanics. We aimed to investigate the effect of DM on the Achilles tendon, which may contribute to long-term complications in the foot-ankle complex. METHODS Seventy-eight patients with diabetes, with (35 patients, group I) or without (43 patients, group II) foot ulcers were recruited from the endocrinology clinic. Thirty-three age-, gender-, and BMI-matched healthy individuals were selected as controls. All participants underwent ultrasonography and sonoelastography of their AT in order to evaluate Achilles tendon thickness (ATT) and stiffness (ATS). Each patient was also tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C) as a measure of diabetes control. Other chronic complications were also evaluated in all patients with diabetes. RESULTS The AT was significantly thicker in group I compared to group II and the controls. HbA1C, FPG, and duration of diabetes were higher in group I. We observed that ATT was positively correlated with neuropathy, retinopathy, nephropathy, peripheral arterial disease and coronary arterial disease in group II while this correlation was not detected in group I. ATS was reduced in group I more than group II and control groups. CONCLUSION Changes in the structure of the AT may precede foot ankle disorders in patients with diabetes. This is the first study that reported the results of sonoelastosonography of AT in patients with diabetes and revealed the correlation between ATT and other chronic complications of diabetes.
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Affiliation(s)
- Berna Evranos
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
| | - Ilkay Idilman
- Ataturk Education and Research Hospital, Radiology Department, Ankara, Turkey
| | - Ali Ipek
- Ataturk Education and Research Hospital, Radiology Department, Ankara, Turkey
| | - Sefika Burcak Polat
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Bekir Cakir
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
| | - Reyhan Ersoy
- Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey
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Elastography by acoustic radiation force impulse technology for differentiation of benign and malignant breast lesions: a meta-analysis. J Med Ultrason (2001) 2015; 43:47-55. [PMID: 26703166 DOI: 10.1007/s10396-015-0658-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/16/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To perform a meta-analysis assessing the ability of elastography by acoustic radiation force impulse (ARFI) technology to differentiate benign and malignant breast lesions. METHODS PubMed, the Cochrane Library, and the Web of Knowledge before September 24, 2014 were searched. Published studies that evaluated the diagnostic performance of ARFI for characterization of focal breast lesions were included. RESULTS A total of fifteen studies, including 1720 patients with 1873 breast lesions (743 cancers, 1130 benign lesions), was analyzed. Among the included studies, virtual touch tissue imaging (VTI) was used in six studies, virtual touch tissue quantification (VTQ) in eight, combined VTI and VTQ in four, and virtual touch tissue imaging quantification (VTIQ) in three. Summary sensitivity and summary specificity for distinguishing malignant from benign breast lesions were 0.913 [95% confidence interval (CI), 0.779-0.969] and 0.871 (95% CI 0.773-0.930) for VTI, 0.849 (95% CI 0.805-0.884) and 0.889 (95% CI 0.771-0.950) for VTQ, and 0.935 (95% CI 0.892-0.961) and 0.881 (95% CI 0.818-0.924) for combined VTI and VTQ, respectively. The area under summary receiver operating characteristic (sROC) curve of VTI, VTQ, and combined VTI and VTQ were 0.95, 0.88, and 0.96, respectively. Significant publication bias was found only in the VTQ assessment (p = 0.025). The obtained sensitivity of VTIQ ranged from 80.4 to 90.3%, while the specificity ranged from 73.0 to 93.0%. The summary diagnostic value of VTIQ could not be evaluated due to insufficient data. CONCLUSION Elastography by ARFI technology could be used as a good identification tool for differentiating benign and malignant breast lesions.
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The Journey of Elastography: Background, Current Status, and Future Possibilities in Breast Cancer Diagnosis. Clin Breast Cancer 2015; 15:313-24. [DOI: 10.1016/j.clbc.2015.01.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/14/2015] [Indexed: 12/21/2022]
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Liu D, Huang Y, Tian D, Yin J, Deng LJ. Value of sonographic bidirectional arterial flow combined with elastography for diagnosis of breast imaging reporting and data system category 4 breast masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:759-766. [PMID: 25911707 DOI: 10.7863/ultra.35.5.759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the role of bidirectional arterial flow combined with ultrasound elastography for differentiation of American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4 masses. METHODS A total of 116 BI-RADS category 4 breast masses were evaluated with color Doppler sonography, spectral analysis, and elastography. The sensitivity, specificity, accuracy, positive and negative predictive values, and receiver operator characteristic curve were used to estimate the diagnostic performance for each modality and the combination method. RESULTS The combination method had the best sensitivity (81.1%) but less specificity (94.9%) and the best accuracy (90.5%). The discriminating power of the combined method (area under the curve [AUC], 0.880; 95% confidence interval [CI], 80.0%-96.0%) was significantly higher than that of bidirectional arterial flow (AUC, 0.818; 95% CI, 72.0%-91.6%; P< .01) and elastography (AUC, 0.765; 95% CI, 65.9%-87.0%; P< .01). CONCLUSIONS Bidirectional arterial flow evaluation, when combined with elastography, could potentially improve diagnostic accuracy for BI-RADS category 4 breast masses.
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Affiliation(s)
- Da Liu
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Huang
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Dan Tian
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Yin
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Li-Jun Deng
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
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