Жесткость мозга по данным магнито-резонанасной эластографии

Оценка сдвиговой упругости и других механических свойств может предоставлять новые полезные параметры для характеристики тканей при нейровизуализации. По данным МРЭ (магнито-резонансной эластографии) белое мозговое вещество существенно жестче, чем серое in vivo. Средний модуль сдвига жесткости белого вещества составляет 14,6 кПа, а серого - ниже чем 6,43 кПа. Разница является статистически значимой. При этом не существует никакой видимой связи между возрастом и модулем сдвига. (Дреснер М. А. с соавт, клиника Мейо, Рочестер).

Эластография сдвиговой волны опухолей молочной железы

Эластография сдвиговой волны опухолей молочной железы

Жесткость нормальной паренхимы молочной железы
Жесткость доброкачественных опухолей	от 4 до 45 кПа
Соотношение жесткости доброкачественной опухоли и нормальной паренхимы	от 0,7 до 4,6
Жесткость злокачественных опухолей	от 22 до 300 кПа
Соотношение жесткости злокачественной опухоли и нормальной паренхимы	от 3,3 до 26,4
Критерий добро/зло

 

 

SHEAR WAVE ELASTOGRAPHY of BREAST TUMORS - Presentation Transcript

 

Shear Wave Elastography (SWE) of 724 cases of BREAST TUMORS

Dr THU DUY NGUYEN

Dr HUNG THIEN NGUYEN

Dr HAI THANH PHAN

MEDIC MEDICAL CENTER, HCMC,VIETNAM

OBJECTIVES: To evaluate shear wave elastography of breast tumors in comparison to conventional ultrasound and BIRADS classification.

MATERIAL and METHODS A descriptive, cross-sectional, prospective study. In comparison the SWE to conventional ultrasonography, mammography and biopsy (FNA and core biopsy) from November 2009 to November 2010 at Medic Medical Center. Conventional ultrasound MEDISON with linear probe 10MHz, and Supersonic Imagine system, linear probe 15MHz . 724 breast tumors with 568 benign tumors and 156 malignant tumors .

Fig.1: A breast tumor with regular contour ( BIRADS III) on conventional US. On SWE system this tumor becomes BIRADS IV on B-Mode and the stiffness (hard).

 

Shear Wave Elastography technique

Shear Wave Elastography technique : interactions between acoustic waves and shear waves. - SW # 10m/sec are generated in tissue and are caught by ultrafast imaging. - Process less than 20 sec. - Tissue elasticity (stiffness) presented as elastogram with quantitative values in kilopascals (kPa) units. Tissue stiffness in color range from red (very hard), orange, yellow, green and blue (soft). - Elastic ratio (ER) = proportion of stiffness of lesion and surrounding (fatty tissue).

Fig.3: Mecanism of shear wave elastography (SWE).

With 724 cases: 568 benign tumors (fibrocystic changes, fibroadenona, phyllodes tumors) # 78 % (4 to 45 kPa), with elastic ratio ER from 0.7 to 4.6. 156 malignant tumors # 22 % (from 22 to 300 kPa), with ER from 3.3 to 26.4. Nota: *kPa :stiffness with kiloPascal units *ER (elastic ratio): proportion of stiffness of tumor and surrounding tissue. Results: Table 1: Distribution of elastic values of benign and malignant breast tumors. kPa Benign tumors Malignant tumors < 20 527 20  <30 27 4 30  <40 9 10 40  <50 5 32 50  <60 19 60  <70 12 > 70 79

Discussions: Diagnostic criteria= elastogram, dimension, homogeneity, elastic value, and elastic ratio. 1/156 cases of malignant tumor: most of cases with elastic value from 40kPa to 70kPa or more. 14 cases with elastic value less than 40kPa, but ER higher than 4 times. 2/ Benign tumors with elastic value of 20kPa. 41 cases (#7%) more than 20kPa but lower than 45kPa: fibroadenoma with great dimension, huge phyllodes tumors (inhomogenous elastogram with blue color dominant).

3. Proposal management : Breast tumors with BIRADS II-III, low stiffness, low ER : follow up. Breast tumors with BIRADS III and high stiffness: reclassified to BIRADS IV and biopsy. Breast tumors with BIRADS IV and low stiffness:reclassified to BIRADS III and follow up. With a benign of biopsy result their results are not false negative. Elastogram analysis: very high kPa value, no need to check In case of low kPa, must refer elastic ratio (ER). The higher ER the higher possibility of malignancy.

4. Elastogram analysis : Benign tumor = between blue and yellow code (from soft to hard) and homogenous. Malignant tumor: elastogram changes from yellow to red (hard) and homogenous. Because of central necrosis the center of tumor is always softer than (blue). So need to evaluate altogether elastic value (stiffness), elastic ratio and elastogram to gain an exact diagnosis. Elastogram may help choosing the area of biopsy.

Fig.4: Fibroadenoma (BIRADS III) on B-mode and Elastogram (blue)

Fig.5: B-mode (BIRADS III) but so hard with elastogram, a ductal carcinoma (biopsy).

Fig.6: Microcalcification of ductal carcinoma on high resolution B-mode and Elastogram (hard) .

CONCLUSIONS: Malignant tumor has elastic value of 40-70kPa and more. Benign tumor, under 20kPa. SWE improves sensibility and speficity of ultrasound in diagnosing breast tumor and decreases the rate of breast biopsy.

 

Жесткость жира в молочной железе в зависимости от возраста

Жесткость жира в молочной железе в зависимости от возраста

 

20-30 лет 11.6 кПа

 

30-40 лет 12.1 кПа

 

40-50 лет 14 кПа

 

60-70 лет 15.5 кПа

 

70-80 лет 14.2 кПа

 

Более 80 лет 17 кПа

 

Shearwave Elasticity Measurements of Breast Fat

D. Cosgrove,1 C Dore,2 R. Hooley,3 E. B. Mendelson,4 L. Barke,5 A. Cossi, B. Cavanaugh, L Larsen

1Imaging Sciences, Hammersmith Hospital, London/UK, 2MRC Clinical Trials Unit, London/UK, Yale Medical Center, Yale/US, Lynn Sage

Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago/US, 5Sally Jobe Breast Center, Denver/US, 6Boston Medical Center, Boston/US, 7Thomas Jefferson University, Philadelphia/US, 8University of Southern California, Los Angeles/US

Purpose: Background: The fatty tissue of the breast is commonly used as a reference for assessing relative strain, but its normal variation has not been documented. The aim of this study was to measure the elasticity of breast fat in kilo Pascals using shearwave elastography (SWE) in women of different ages.

Material & Methods: SWE was performed on 1000 women in the multicenter BE1 study of breast masses; measurements of the subcuta¬neous fat adjacent to the lesion in kPa were made using SWE on a proto¬type of the Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). The values were compared with the patients age and with the type of pathology (benign or malignant).

Results: The mean age of the patients was 52.1 years (SD + /-;14.8, range 21.2 to; 95.3). The mean elasticity value was 14.1 kPa (SD +/-10.92, range 0.03 to 130.8).

The mean values ranked against the patients age by decade were: 20-30: 11.6; 30-40: 12.1; 40-50: 14; 60-70: 15.5; 70-80: 14.2; over 80: 17 kPa. The slight trend to a higher value with age was significant (p 0.001). Fat in the patients with benign masses had a mean elasticity of 13.1 kPa while in the malignant group the mean value was 15.9kPa.

Conclusion: This is the first quantitative assessment of the stiffness of breast fatty tissue. The elasticity varied little with age or pathology, sup¬porting the use of fat stiffness as a comparator. The BE1 study was sup¬ported by SuperSonic Imagine, Aix-en-Provence, France.

Shear wave speed recovery in transient elastography and supersonic imaging using propagating fronts

Shear wave speed recovery in transient elastography and supersonic imaging using propagating fronts

Эластография сдвиговой волны узлов щитовидной железы

Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P, Oliver C.

Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules.

J Clin Endocrinol Metab 2010;95:5281-8.

www.thyroid.org

Эластография сдвиговой волны узлов щитовидной железы.

Жесткость нормальной паренхимы щитовидной железы	15,9 ± 7,6 кПа
Жесткость доброкачественных узлов	36 ± 30 кПа
Жесткость злокачественных узлов	150 ± 95 кПа
Критерий добро/зло	65 кПа