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Yang FY, Wang X, Lu SY, Zhao YJ, Ren WW. Initial experience using ultrasound, automated breast volume scanner, and elastography for primary leiomyosarcoma of the breast: A rare case report. Heliyon 2024; 10:e33475. [PMID: 39050457 PMCID: PMC11266987 DOI: 10.1016/j.heliyon.2024.e33475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Background Primary leiomyosarcoma of the breast was a rare malignant tumor. Due to the extremely low morbidity and insufficient understanding of its imageological characteristics, there was a risk of misdiagnosis. In this case report, we presented the features of conventional US, elastography, automated breast volume scanner (ABVS), computed tomography (CT), and pathological findings of a case of primary leiomyosarcoma of the breast. Case presentation A 74-year-old woman detected a mass of the left breast by palpation. Both ultrasound and CT revealed a solid mass in the outer quadrant of the left breast. After admission, she underwent a modified radical unilateral mastectomy under general anesthesia (resection of the lesion with left breast reserved). Furthermore, the intraoperative frozen section revealed malignant spindle cells, and the postoperative histopathology revealed primary leiomyosarcoma of the breast. After discharge, the patient was generally in good condition after the procedure and was asked to seek medical treatment in the oncology department. Findings on various imaging examinations and clinical data were carefully evaluated. Additionally, we also reviewed the associated kinds of literature. Conclusion We reported the features of conventional US, elastography, ABVS, CT, and pathological findings of a rare case of primary leiomyosarcoma of the breast. Overall, our findings indicated that the above-mentioned features generally predict malignancy. However, compared to other malignant breast lesions, the features of this case were not specific enough.
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Affiliation(s)
- Fei-Yue Yang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Xiu Wang
- Department of Pathology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Shao-Yi Lu
- Department of Breast and Thyroid Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Yu-Jing Zhao
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, 200443, China
- Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, 200443, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, 200443, China
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Xu J, Zhang L, Wen W, He Y, Wei T, Zheng Y, Pan X, Li Y, Wu Y, Dong F, Zhang H, Cheng W, Xu H, Zhang Y, Bao L, Zhang X, Tang S, Liao J, Luo H, Zhao H, Tian J, Peng Y. Evaluation of standard breast ultrasonography by adding two-dimensional and three-dimensional shear wave elastography: a prospective, multicenter trial. Eur Radiol 2024; 34:945-956. [PMID: 37644151 PMCID: PMC11322273 DOI: 10.1007/s00330-023-10057-9] [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: 03/03/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4-5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions. METHODS A total of 897 breast lesions, categorized as BI-RADS 3-5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment. RESULTS After standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4-5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268). CONCLUSION Combining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4-5 lesions without sacrificing sensitivity unacceptably. CLINICAL RELEVANCE STATEMENT Combining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4-5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions. TRIAL REGISTRATION ChiCTR1900026556 KEY POINTS: • Reduce benign biopsy is necessary in breast lesions with BI-RADS 4-5 category. • A reduction of 54.1% on benign biopsies in BI-RADS 4-5 lesions was achieved using 2D + 3D SWE reclassification. • Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).
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Affiliation(s)
- Jinshun Xu
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Ultrasound Medicine & Laboratory of Translational Research in Ultrasound Theranostics, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wen Wen
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yushuang He
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Tianci Wei
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofang Pan
- Health Medical Department, Dalian Municipal Central Hospital, Dalian, China
| | - Yuhong Li
- Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yiyun Wu
- Department of Ultrasound, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Fenglin Dong
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Heqing Zhang
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hongchun Xu
- Department of Ultrasound, Shengjing-Dalian Hospital, Chinese Medical Sciences University, Dalian, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingyun Bao
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinguo Zhang
- Department of Ultrasound, Shaoyang Central Hospital, Shaoyang, China
| | - Shichu Tang
- Department of Ultrasound, Hunan Provincial Tumor Hospital, Changsha, China
| | - Jintang Liao
- Department of Ultrasound, Xiangya Hospital of Central South University, Changsha, China
| | - Honghao Luo
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Haina Zhao
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yulan Peng
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China.
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Chen Y, Lu J, Li J, Liao J, Huang X, Zhang B. Evaluation of diagnostic efficacy of multimode ultrasound in BI-RADS 4 breast neoplasms and establishment of a predictive model. Front Oncol 2022; 12:1053280. [PMID: 36505867 PMCID: PMC9730703 DOI: 10.3389/fonc.2022.1053280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore the diagnostic efficacy of ultrasound (US), two-dimensional and three-dimensional shear-wave elastography (2D-SWE and 3D-SWE), and contrast-enhanced ultrasound (CEUS) in breast neoplasms in category 4 based on the Breast Imaging Reporting and Data System (BI-RADS) from the American College of Radiology (ACR) and to develop a risk-prediction nomogram based on the optimal combination to provide a reference for the clinical management of BI-RADS 4 breast neoplasms. Methods From September 2021 to April 2022, a total of 104 breast neoplasms categorized as BI-RADS 4 by US were included in this prospective study. There were 78 breast neoplasms randomly assigned to the training cohort; the area under the receiver-operating characteristic curve (AUC), 95% confidence interval (95% CI), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2D-SWE, 3D-SWE, CEUS, and their combination were analyzed and compared. The optimal combination was selected to develop a risk-prediction nomogram. The performance of the nomogram was assessed by a validation cohort of 26 neoplasms. Results Of the 78 neoplasms in the training cohort, 16 were malignant and 62 were benign. Among the 26 neoplasms in the validation cohort, 6 were malignant and 20 were benign. The AUC values of 2D-SWE, 3D-SWE, and CEUS were not significantly different. After a comparison of the different combinations, 2D-SWE+CEUS showed the optimal performance. Least absolute shrinkage and selection operator (LASSO) regression was used to filter the variables in this combination, and the variables included Emax, Eratio, enhancement mode, perfusion defect, and area ratio. Then, a risk-prediction nomogram with BI-RADS was built. The performance of the nomogram was better than that of the radiologists in the training cohort (AUC: 0.974 vs. 0.863). In the validation cohort, there was no significant difference in diagnostic accuracy between the nomogram and the experienced radiologists (AUC: 0.946 vs. 0.842). Conclusions US, 2D-SWE, 3D-SWE, CEUS, and their combination could improve the diagnostic efficiency of BI-RADS 4 breast neoplasms. The diagnostic efficacy of US+3D-SWE was not better than US+2D-SWE. US+2D-SWE+CEUS showed the optimal diagnostic performance. The nomogram based on US+2D-SWE+CEUS performs well.
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Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters. Sci Rep 2022; 12:16205. [PMID: 36171328 PMCID: PMC9519555 DOI: 10.1038/s41598-022-19971-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
To investigate the diagnostic value of combined SWE, SMI, and B-mode US scores for distinguishing between benign and malignant masses. A total of 450 breast masses that underwent US-guided core needle biopsies were prospectively enrolled. The breast masses were assessed based on the BI-RADS and quantitative SWE and SMI parameters. The SWEmax, SWEratio, and SMIVI cutoff value were determined using Youden’s index by comparison to the pathological results. The BI-RADS categories were scored on a scale from 1 to 5, and SWEmax, SWEratio, and SMIVI were dichotomized based on each cutoff values (0 or 1). The combined scores (1 to 8) were calculated as the sum of the BI-RADS score and the quantitative scores and compared to the pathologic results using AUROC analysis. The cutoff values were 52.25 kPa for SWEmax, 5.03 for SWEratio, and 2.15% for SMIVI. In AUROC, the combined scores showed significantly better diagnostic performance compared to BI-RADS alone (p < 0.001). The combined score showed significantly increased than BI-RADS alone in specificity (p < 0.001) and accuracy (p < 0.001), but a sensitivity decreased without significance (p = 0.082). When a combined score cutoff value of 4 was used, the false negative rate was 2.7%. Using the combined score, 76.4% of the C4a lesions were considered benign also pathologically diagnosed as benign. The combined scores showed improved diagnostic performance in differentiating between benign and malignant breast masses, which could be helpful for determining a breast biopsy eligibility.
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Hu Z, Lu M, Wang X, Yang W, Fan Y, Li T, Wang L, Wei T. Diagnostic Value of Different 3-D Shear Wave Elastography Sections in the Diagnosis of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1957-1965. [PMID: 35853762 DOI: 10.1016/j.ultrasmedbio.2022.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study was to explore the value of 3-D shear wave elastography (SWE) in differentiating malignant from benign thyroid nodules. A total of 188 patients with 216 nodules who underwent conventional ultrasound, 2-D SWE and 3-D SWE were included in this study. All patients underwent surgical excision, and the pathological results were the gold standard. Receiver operating characteristic (ROC) curves of the American College of Radiology's Thyroid Imaging Reporting and Data System (ACR TI-RADS), 2-D SWE and 3-D SWE were plotted, and the areas under the curves (AUCs) were compared using a Z-test. There were 62 benign thyroid nodules and 154 malignant thyroid nodules in this study. Young's modulus (Emin, Emean, Emax, Esd) values of thyroid malignant nodules in different sections of 2-D SWE and 3-D SWE were significantly higher than those of thyroid benign nodules (p < 0.001). The AUC of Emax in 2-D SWE transverse sections was significantly lower than that in 3-D SWE transverse sections and 3-D SWE sagittal sections (0.768 vs. 0.831 and 0.844, p < 0.05). The AUC of 3-D S-Emax combined with ACR TI-RADS was 0.859; the specificity increased from 54.84% to 85.71%, and the diagnostic accuracy increased from 74.54% to 85.19%, compared with ACR TI-RADS. The difference was statistically significant (p < 0.05). Three-dimensional SWE combined with ACR TI-RADS for the diagnosis of thyroid nodules significantly improved the diagnostic ability of ACR TI-RADS, and was significantly better than 2-D SWE combined with ACR TI-RADS.
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Affiliation(s)
- Ziyue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Yang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuting Fan
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Wang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Wei
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Huang S, Ye X, Yang K, Tian H, Ding Z, Chen J, Xu J, Dong F. The significance of dual-mode elastography in the diagnosis of breast lesions by physicians with different levels of experience. Quant Imaging Med Surg 2022; 12:1438-1449. [PMID: 35111637 PMCID: PMC8739147 DOI: 10.21037/qims-21-636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to assess the diagnostic value of dual-mode elastography for benign and malignant breast lesions and determine whether this technique can improve the diagnostic ability of physicians with different levels of experience. METHODS One hundred and eighty-three breast lesions were analyzed retrospectively, and the following values were calculated for the lesions with various shells: shear modulus (G), Young's modulus (E), shear wave velocity (Cs), and strain ratio (SR). A random forest algorithm was used to select the optimal modes for elastography. A receiver operating characteristic curve was used to assess the diagnostic efficacy for benign and malignant breast lesions. Sensitivity and specificity values were calculated to evaluate any improvements in the diagnostic efficacy of physicians with different levels of experience (junior, intermediate-level, and senior) in the evaluation of malignant breast lesions using dual-mode elastography. RESULTS The best-performing mode of shear wave elastography (SWE) in the diagnosis of breast lesions was the A'min 1.0 (Cs) mode (minimum shear wave velocity of the area of interest and 1.0 mm around the area of interest), and the best-performing mode of strain elastography (SE) was the B/A' 0.5 (ratio of fat to the elasticity of the area of interest and 0.5 mm around the area of interest). When the two methods were used in series, results showed high specificity (98%), positive likelihood ratio (PLR) (21.2), and positive predictive value (PPV) (95%). Series means that if SE and SWE were malignant, the result in series was malignant, and that if either SE or SWE was benign, the result in series was benign. When the methods were used in parallel, the results showed high sensitivity (91%), negative likelihood ratio (NLR) (0.15), and negative predictive value (NPV) (89%). Parallel means that if SE and SWE were benign, the result in parallel was benign, and that if either SE or SWE was malignant, the result in parallel was malignant. When conventional ultrasound was combined with dual-mode elastography, the intermediate-level and junior physicians' diagnoses of breast lesions showed a higher sensitivity, specificity, and area under the curve than conventional ultrasound diagnosis alone. CONCLUSIONS Dual-mode elastography is effective in the diagnosis of breast lesions. The sensitivity and specificity values in this study show that diagnoses made by junior and intermediate-level physicians improve when dual-mode elastography is used, although diagnoses made by senior physicians do not improve significantly.
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Affiliation(s)
| | | | - Keen Yang
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | | | | | - Jing Chen
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Brasier-Lutz P, Jäggi-Wickes C, Schaedelin S, Burian R, Schoenenberger CA, Zanetti-Dällenbach R. Agreement in breast lesion assessment and final BI-RADS classification between radial and meander-like breast ultrasound. BMC Med Imaging 2021; 21:104. [PMID: 34157997 PMCID: PMC8220682 DOI: 10.1186/s12880-021-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study prospectively investigates the agreement between radial (r-US) and meander-like (m-US) breast ultrasound with regard to lesion location, lesion size, morphological characteristics and final BI-RADS classification of individual breast lesions. METHODS Each patient of a consecutive, unselected, mixed collective received a dual ultrasound examination. RESULTS The agreement between r-US and m-US for lesion location ranged from good (lesion to mammilla distance ICC 0.64; lesion to skin distance ICC 0.72) to substantial (clock-face localization κ 0.70). For lesion size the agreement was good (diameter ICC 0.72; volume ICC 0.69), for lesion margin and architectural distortion it was substantial (κ 0.68 and 0.70, respectively). Most importantly, there was a substantial agreement (κ 0.76) in the final BI-RADS classification between r-US and m-US. CONCLUSIONS Our recent comparison of radial and meander-like breast US revealed that the diagnostic accuracy of the two scanning methods was comparable. In this study, we observe a high degree of agreement between m-US and r-US for the lesion description (location, size, morphology) and final BI-RADS classification. These findings corroborate that r-US is a suitable alternative to m-US in daily clinical practice. Trial registration NCT02358837. Registered January 2015, retrospectively registered https://clinicaltrials.gov/ct2/results?cond=&term=NCT02358837&cntry=&state=&city=&dist =.
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Affiliation(s)
- Pascale Brasier-Lutz
- Department of Obstetrics and Gynecology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Claudia Jäggi-Wickes
- Department of Obstetrics and Gynecology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Clinical Research, Statistics and Data Management, University Basel, Schanzenstrasse 55, 4031, Basel, Switzerland
| | - Rosemarie Burian
- Department of Obstetrics and Gynecology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Cora-Ann Schoenenberger
- Department of Chemistry, University Basel, BioPark 1096, Mattenstrasse 24a, 4058, Basel, Switzerland.,Gynecology/Gynecologic Oncology, St. Claraspital Basel, Kleinriehenstrasse 30, 4085, Basel, Switzerland
| | - Rosanna Zanetti-Dällenbach
- Gynecology/Gynecologic Oncology, St. Claraspital Basel, Kleinriehenstrasse 30, 4085, Basel, Switzerland.
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Uysal E, Öztürk M, Kilinçer A, Koplay M. Comparison of the Effectiveness of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Breast Masses. Ultrasound Q 2021; 37:191-197. [PMID: 34057918 DOI: 10.1097/ruq.0000000000000562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study aims to determine the diagnostic performance of superb microvascular imaging (SMI) and shear wave elastography methods in evaluating breast lesions. We will also compare the effectiveness of the stiffness, velocity, and vascular index (VI) parameters in distinguishing malignancy.From January to June 2019, 121 patients with 121 solid breast masses (category 4 and 5 lesions according to the Breast Imaging-Reporting and Data System) detected during the routine grayscale sonographic examination were included in the study. Stiffness and velocity values were obtained using shear wave elastography for all lesions, and VI was obtained using SMI. The receiver operating characteristic curves were obtained to set the best cutoff values for the stiffness, velocity, and VI to differentiate patients with malignant breast lesions.All 121 lesions were pathologically verified by US-guided core needle biopsy. Forty-seven (38.9%) of the lesions were malignant, and 74 (61.1%) were benign. Median stiffness, velocity, and VI values were significantly lower in benign masses compared with malignant masses (P < 0.001). The optimum cutoff values for the stiffness, velocity, and VI were determined to be 58.3 kPa, 4.5 m/s, and 1.1%, respectively. The areas under the curves were 0.897 for stiffness, 0.884 for velocity, and 0.687 for VI.Shear wave elastography and SMI are noninvasive methods that may be used to evaluate breast masses. Although both methods' quantitative data are beneficial in differentiating malignant from benign masses, stiffness is the best parameter to be used.
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Affiliation(s)
- Emine Uysal
- Department of Radiology, Selçuk University Faculty of Medicine, Konya, Turkey
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Park SY, Kang BJ. Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis. Ultrasonography 2020; 40:318-332. [PMID: 33652513 PMCID: PMC8217803 DOI: 10.14366/usg.20058] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose This study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE. Methods A systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool. Results Twenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively. Conclusion Adding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies.
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Affiliation(s)
- Sun-Young Park
- Devision of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee EJ, Chang YW. Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses. Korean J Radiol 2020; 21:1045-1054. [PMID: 32691540 PMCID: PMC7371619 DOI: 10.3348/kjr.2019.0765] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear wave elastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign and malignant breast masses. Materials and Methods A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewed using breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting and data system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and the vascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US with SWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively. Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 and downgrading of category 4a (set 2) were calculated. Results Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. In set 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively) than B-mode alone (0.719) (p < 0.001 and p = 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVI had the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0% to 84.0% (p < 0.001) and from 46.1% to 79.1% (p < 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6% without statistical loss (p = 0.199). Conclusion Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance in differentiating between benign and malignant breast lesions.
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Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Yun Woo Chang
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Korea.
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Goswami S, Ahmed R, Khan S, Doyley MM, McAleavey SA. Shear Induced Non-Linear Elasticity Imaging: Elastography for Compound Deformations. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3559-3570. [PMID: 32746104 PMCID: PMC8527856 DOI: 10.1109/tmi.2020.2999439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The goal of non-linear ultrasound elastography is to characterize tissue mechanical properties under finite deformations. Existing methods produce high contrast non-linear elastograms under conditions of pure uni-axial compression, but exhibit bias errors of 10-50% when the applied deformation deviates from the uni-axial condition. Since freehand transducer motion generally does not produce pure uniaxial compression, a motion-agnostic non-linearity estimator is desirable for clinical translation. Here we derive an expression for measurement of the Non-Linear Shear Modulus (NLSM) of tissue subject to combined shear and axial deformations. This method gives consistent nonlinear elasticity estimates irrespective of the type of applied deformation, with a reduced bias in NLSM values to 6-13%. The method combines quasi-static strain imaging with Single-Track Location-Shear Wave Elastography (STL-SWEI) to generate local estimates of axial strain, shear strain, and Shear Wave Speed (SWS). These local values were registered and non-linear elastograms reconstructed with a novel nonlinear shear modulus estimation scheme for general deformations. Results on tissue mimicking phantoms were validated with mechanical measurements and multiphysics simulations for all deformation types with an error in NLSM of 6-13%. Quantitative performance metrics with the new compound-motion tracking strategy reveal a 10-15 dB improvement in Signal-to-Noise Ratio (SNR) for simple shear versus pure compressive deformation for NLSM elastograms of homogeneous phantoms. Similarly, the Contrast-to-Noise Ratio (CNR) of NLSM elastograms of inclusion phantoms improved by 25-30% for simple shear over pure uni-axial compression. Our results show that high fidelity NLSM estimates may be obtained at ~30% lower strain under conditions of shear deformation as opposed axial compression. The reduction in strain required could reduce sonographer effort and improve scan safety.
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Farghadani M, Barikbin R, Rezaei MH, Hekmatnia A, Aalinezhad M, Zare H. Differentiating solid breast masses: comparison of the diagnostic efficacy of shear wave elastography and magnetic resonance imaging. Diagnosis (Berl) 2020; 8:382-387. [PMID: 33006950 DOI: 10.1515/dx-2020-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Shear wave elastography (SWE) quantitatively determines the nature of the breast lesions. Few previous studies have compared the diagnostic value of this modality with other imaging techniques. The present study aimed to compare the diagnostic value of SWE with that of magnetic resonance imaging (MRI) in detecting the nature of the breast masses. METHODS In this cross-sectional study, 80 patients with breast lumps who had Breast Imaging Reporting and Data System (BI-RADS) score of three or higher based on mammography and/or screening ultrasonography, underwent 3D SWE and MRI. The lesions were classified according to MRI BI-RADS scoring; Mean elasticity (Emean) and elasticity ratio (Eratio) for each lesion were also determined by SWE. The results of these two modalities were compared with histopathologic diagnosis as the gold standard method; diagnostic value and diagnostic agreement were then calculated. RESULTS Of the masses, 46.2% were histopathologically proven to be malignant. The Emean for benign and malignant masses was 34.04 ± 19.51 kPa and 161.92 ± 58.14 kPa, respectively. Both modalities had diagnostic agreement with histopathologic results (p<0.001). Kappa coefficient was 0.87 for SWE and 0.42 for MRI. The sensitivity of both methods was 94.59% (95% CI: 81.81-99.34), while the specificity and accuracy were 48.84% [95% CI: 33.31-64.54] and 70.0% [95% CI: 58.72-79.74] for MRI, and 93.02% [95% CI: 80.94-98.54] and 93.75% [95% CI: 86.01-97.94] for SWE. CONCLUSIONS SWE has better diagnostic value in terms of determining the nature of the breast masses. SWE can increase the diagnostic function of differentiating benign masses from malignant ones.
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Affiliation(s)
- Maryam Farghadani
- Department of Radiology, Cancer Prevention Research Center, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rozbeh Barikbin
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Haji Rezaei
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Hekmatnia
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Aalinezhad
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hosein Zare
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Zhang X, Liang M, Yang Z, Zheng C, Wu J, Ou B, Li H, Wu X, Luo B, Shen J. Deep Learning-Based Radiomics of B-Mode Ultrasonography and Shear-Wave Elastography: Improved Performance in Breast Mass Classification. Front Oncol 2020; 10:1621. [PMID: 32984032 PMCID: PMC7485397 DOI: 10.3389/fonc.2020.01621] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Shear-wave elastography (SWE) can improve the diagnostic specificity of the B-model ultrasonography (US) in breast cancer. However, whether deep learning-based radiomics signatures based on the B-mode US (B-US-RS) or SWE (SWE-RS) could further improve the diagnostic performance remains to be investigated. We aimed to develop the B-US-RS and SWE-RS and determine their performances in classifying breast masses. MATERIALS AND METHODS This retrospective study included 291 women (mean age ± standard deviation, 40.9 ± 12.3 years) from two centers who had US-visible solid breast masses and underwent biopsy and/or surgical resection between June 2015 and July 2017. B-mode US and SWE images of the 198 masses in 198 patients (training cohort) from center 1 were segmented, respectively, to construct B-US-RS and SWE-RS using the least absolute shrinkage and selection operator regression and tested in an independent validation cohort of 65 masses in 65 patients from center 1 and in an external validation cohort of 28 masses in 28 patients from center 2. The performances of B-US-RS and SWE-RS were assessed using receiver operating characteristic (ROC) analysis and compared with that of radiologist assessment [Breast Imaging Reporting and Data System (BI-RADS)] and quantitative SWE parameters [maximum elasticity (E max), mean elasticity (E mean), elasticity ratio (E ratio), and elastic modulus standard deviation (E SD)] by using the McNemar test. RESULTS The single best-performing quantitative SWE parameter, E max, had a higher specificity than BI-RADS assessment in the training and independent validation cohorts (P < 0.001 for both). The areas under the ROC curves (AUCs) of B-US-RS and SWE-RS both were 0.99 (95% CI = 0.99-1.00) in the training cohort, 1.00 (95% CI = 1.00-1.00) in the independent validation cohort, and 1.00 (95% CI = 1.00-1.00) in the external validation cohort. The specificities of B-US-RS and SWE-RS were higher than that of E max in the training (P < 0.001 for both) and independent validation cohorts (P = 0.02 for both). CONCLUSION The B-US-RS and SWE-RS outperformed the quantitative SWE parameters and BI-RADS assessment for classifying breast masses. The integration of the deep learning-based radiomics approach would help improve the classification ability of B-mode US and SWE for breast masses.
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Affiliation(s)
- Xiang Zhang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zehong Yang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayi Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Ou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Wu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Multifactor Analysis of Thyroid Stiffness in Graves Disease: A Preliminary Study. AJR Am J Roentgenol 2019; 212:950-957. [PMID: 30807222 DOI: 10.2214/ajr.18.20414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE. The aim of this study was to evaluate the value of shear wave elastography (SWE) in Graves disease (GD) and to identify the potential factors influencing thyroid stiffness. MATERIALS AND METHODS. A total of 207 subjects were enrolled and underwent SWE examination in the study, including 162 patients with GD and 45 healthy volunteers with normal thyroids, matched for age and sex. For all subjects, five measurements of elastic modulus values (SWE mean, SWE minimum, and SWE maximum of a 9-mm ROI) were performed on each thyroid lobe, and a mean value was calculated. The indicators including free three-triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid size, isthmus thickness, anti-thyroid peroxidase (TPO) antibodies (Abs), and antithyroglobulin (TG) Abs were detected in the 162 patients with GD, among whom 88 patients underwent initial TSH receptor (TR) Ab examination. RESULTS. The elastic modulus values for patient with GD were significantly higher than those for healthy control subjects. The ROC AUC values for GD by SWE mean was 0.656, and the cutoff value was 15.45 kPa. The sensitivity and specificity were 56.8% and 71.1%, respectively. The duration of disease, thyroid size, isthmus thickness, and levels of TPO Ab, TG Ab, and TR Ab were positively correlated with SWE mean in GD. However, there was no correlation between age, FT3, FT4, TSH, and SWE mean. CONCLUSION. Quantitative SWE helps in the diagnosis of GD. The duration of disease, thyroid size, isthmus thickness, and levels of thyroid autoantibodies (TPO Ab, TG Ab, and TR Ab) could influence thyroid stiffness of GD.
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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: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To prospectively evaluate the diagnostic performance of three-dimensional (3D) shear wave elastography (SWE) for breast lesions with quantitative stiffness information from transverse, sagittal and coronal planes. METHODS Conventional ultrasound (US), two-dimensional (2D)-SWE and 3D-SWE were performed for 122 consecutive patients with 122 breast lesions before biopsy or surgical excision. Maximum elasticity values of Young's modulus (Emax) were recorded on 2D-SWE and three planes of 3D-SWE. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity of US, 2D-SWE and 3D-SWE were evaluated. Two combined sets (i.e., BI-RADS and 2D-SWE; BI-RADS and 3D-SWE) were compared in AUC. Observer consistency was also evaluated. RESULTS On 3D-SWE, the AUC and sensitivity of sagittal plane were significantly higher than those of transverse and coronal planes (both P < 0.05). Compared with BI-RADS alone, both combined sets had significantly (P < 0.05) higher AUCs and specificities, whereas, the two combined sets showed no significant difference in AUC (P > 0.05). However, the combined set of BI-RADS and sagittal plane of 3D-SWE had significantly higher sensitivity than the combined set of BI-RADS and 2D-SWE. CONCLUSIONS The sagittal plane shows the best diagnostic performance among 3D-SWE. The combination of BI-RADS and 3D-SWE is a useful tool for predicting breast malignant lesions in comparison with BI-RADS alone.
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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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Xiang L, Ma F, Yao M, Xu G, Pu H, Liu H, Fang Y, Wu R. Benign lesion evaluation: Factors causing the "stiff rim" sign in breast tissues using shear-wave elastography. Br J Radiol 2018; 92:20180602. [PMID: 30303694 DOI: 10.1259/bjr.20180602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE: To investigate the factors causing the "stiff rim" sign in breast lesions using shear-wave elastography. METHODS: A total of 907 patients with 907 lesions were included retrospectively in this study. Traditional ultrasound and shear-wave elastography imaging were both performed. Patients age, maximum diameter, depth, distance, echogenicity, shape, boundary, margin, internal components, CDFI, calcification, echogenicity attenuation and longitudinal growth of lesions were observed and calculated by both univariate and multivariate analyses. RESULTS: Univariate analyses indicated that the age, depth, shape, margin, internal components, CDFI, calcification and pathology showed significant difference between the benign lesions with and without a "stiff rim", whereas there was no correlation of "stiff rim" with maximum diameter, distance, boundary, echogenicity, echo attenuation and longitudinal growth of the lesions. Multivariate analysis expressed that CDFI, margin, internal components, depth and age were significantly associated with the "stiff rim" sign in breast benign lesions, whereas there was no correlation with the pathology, shape or calcification of the lesions. CONCLUSIONS: The "stiff rim" sign can be helpful for differentiation between benign and malignant lesions. Older patients with a "stiff rim" sign whose benign masses are deep, poorly defined, heterogeneous and have a positive CDFI should be examined more closely to avoid unnecessary false-positives. ADVANCES IN KNOWLEDGE: The "stiff rim" sign can be helpful for differentiation between benign and malignant lesions. Positive CDFI, poorly defined margin, heterogeneous internal components, deep depth and older age were significantly associated with the "stiff rim" sign in benign breast lesions.
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Affiliation(s)
- Lihua Xiang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Fang Ma
- 3 Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People'sHospital , Shanghai , China
| | - Minghua Yao
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Guang Xu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Huan Pu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Hui Liu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Yan Fang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Rong Wu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,4 Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong UniversitySchool of Medicine , Shanghai , China
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Park HS, Shin HJ, Shin KC, Cha JH, Chae EY, Choi WJ, Kim HH. Comparison of peritumoral stromal tissue stiffness obtained by shear wave elastography between benign and malignant breast lesions. Acta Radiol 2018; 59:1168-1175. [PMID: 29359949 DOI: 10.1177/0284185117753728] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Aggressive breast cancers produce abnormal peritumoral stiff areas, which can differ between benign and malignant lesions and between different subtypes of breast cancer. Purpose To compare the tissue stiffness of the inner tumor, tumor border, and peritumoral stroma (PS) between benign and malignant breast masses by shear wave elastography (SWE). Material and Methods We enrolled 133 consecutive patients who underwent preoperative SWE. Using OsiriX commercial software, we generated multiple 2-mm regions of interest (ROIs) in a linear arrangement on the inner tumor, tumor border, and PS. We obtained the mean elasticity value (Emean) of each ROI, and compared the Emean between benign and malignant tumors. Odds ratios (ORs) for prediction of malignancy were calculated. Subgroup analyses were performed among tumor subtypes. Results There were 85 malignant and 48 benign masses. The Emean of the tumor border and PS were significantly different between benign and malignant masses ( P < 0.05 for all). ORs for malignancy were 1.06, 1.08, 1.05, and 1.04 for stiffness of the tumor border, proximal PS, middle PS, and distal PS, respectively ( P < 0.05 for all). Malignant masses with a stiff rim were significantly larger than malignant masses without a stiff rim, and were more commonly associated with the luminal B and triple negative subtypes. Conclusion Stiffness of the tumor border and PS obtained by SWE were significantly different between benign and malignant masses. Malignant masses with a stiff rim were larger in size and associated with more aggressive pathologic subtypes.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki Chang Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Yin L, Lu R, Cao W, Zhang L, Li W, Sun H, Guo R. Three-Dimensional Shear Wave Elastography of Skeletal Muscle: Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2053-2062. [PMID: 29399850 DOI: 10.1002/jum.14559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Two-dimensional (2D) shear wave elastography (SWE) can measure the elasticity of skeletal muscle, tendons, and ligaments. Three-dimensional (3D) SWE has been used to detect breast cancer but has not been applied to the musculoskeletal system. This study aimed to investigate whether 3D SWE could be used in skeletal muscles in vivo. METHODS The study enrolled 20 healthy volunteers at Beijing Chaoyang Hospital from August to October 2016. Two-dimensional and 3D SWE scans were used to measure the Young modulus of the flexor carpi radialis in the relaxed state. Longitudinal and transverse scanning was performed. Data were analyzed by a 1-way analysis of variance/least significant difference post hoc test, a paired t test, and Bland-Altman plots. RESULTS The participants included 10 male and 10 female volunteers with a mean age ± SD of 25 ± 5 years. The Young modulus did not differ between 3D and 2D SWE for the sagittal plane (longitudinal scanning, 34.9 ± 5.7 versus 32.7 ± 5.2 kPa; P = .096) or transverse plane (transverse scanning, 9.1 ± 2.1 versus 9.2 ± 1.6 kPa; P = .877). The Young modulus did not differ between sagittal, transverse, and coronal planes for 3D SWE longitudinal scanning (34.9 ± 5.7, 34.3 ± 5.8, and 34.8 ± 5.9 kPa, respectively; P = .936) or 3D SWE transverse scanning (9.1 ± 2.0, 9.1 ± 2.1, and 8.8 ± 2.1 kPa; P = .838). However, the Young modulus for each individual plane (sagittal, transverse, or coronal) differed significantly between longitudinal and transverse scanning (P < .001). CONCLUSIONS Both 2D SWE and 3D SWE are suitable techniques for clinical use, depending on the examiner's experience/preference. However, 3D SWE provides a multiplanar/multislice view that better illustrates the spatial characteristics of muscle tissue. Three-dimensional SWE may be a new method for fully visualizing the musculoskeletal system.
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Affiliation(s)
- Li Yin
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruigang Lu
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen Cao
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lingling Zhang
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenjing Li
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Sun
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Yu Y, Xiao Y, Cheng J, Chiu B. Breast lesion classification based on supersonic shear-wave elastography and automated lesion segmentation from B-mode ultrasound images. Comput Biol Med 2017; 93:31-46. [PMID: 29275098 DOI: 10.1016/j.compbiomed.2017.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022]
Abstract
Supersonic shear-wave elastography (SWE) has emerged as a useful imaging modality for breast lesion assessment. Regions of interest (ROIs) were required to be specified for extracting features that characterize malignancy of lesions. Although analyses have been performed in small rectangular ROIs identified manually by expert observers, the results were subject to observer variability and the analysis of small ROIs would potentially miss out important features available in other parts of the lesion. Recent investigations extracted features from the entire lesion segmented by B-mode ultrasound images either manually or semi-automatically, but lesion delineation using existing techniques is time-consuming and prone to variability as intensive user interactions are required. In addition, rich diagnostic features were available along the rim surrounding the lesion. The width of the rim analyzed was subjectively and empirically determined by expert observers in previous studies after intensive visual study on the images, which is time-consuming and susceptible to observer variability. This paper describes an analysis pipeline to segment and classify lesions efficiently. The lesion boundary was first initialized and then deformed based on energy fields generated by the dyadic wavelet transform. Features of the SWE images were extracted from inside and outside of a lesion for different widths of the surrounding rim. Then, feature selection was performed followed by the Support Vector Machine (SVM) classification. This strategy obviates the empirical and time-consuming selection of the surrounding rim width before the analysis. The pipeline was evaluated on 137 lesions. Feature selection was performed 20 times using different sets of 14 lesions (7 malignant, 7 benign). Leave-one-out SVM classification was performed in each of the 20 experiments with a mean sensitivity, specificity and accuracy of 95.1%, 94.6% and 94.8% respectively. The pipeline took an average of 20 s to process a lesion. The fact that this efficient pipeline generated classification accuracy superior to that of existing algorithms suggests that improved efficiency did not compromise classification accuracy. The ability to streamline the quantitative assessment of SWE images will potentially accelerate the adoption of the combined use of ultrasound and elastography in clinical practice.
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Affiliation(s)
- Yanyan Yu
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jieyu Cheng
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China.
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Ren WW, Li XL, He YP, Li DD, Wang D, Zhao CK, Bo XW, Liu BJ, Yue WW, Xu HX. Two-dimensional shear wave elastography of breast lesions: Comparison of two different systems. Clin Hemorheol Microcirc 2017; 66:37-46. [PMID: 28211807 DOI: 10.3233/ch-16243] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of two different shear wave elastography (SWE) techniques in distinguishing malignant breast lesions from benign ones. MATERIALS AND METHODS From March 2016 to May 2016, a total of 153 breast lesions (mean diameter, 16.8 mm±10.5; range 4.1-90.0 mm) in 153 patients (mean age, 46.4 years±15.1; age range 20-86 years) were separately performed by two different SWE techniques (i.e. T-SWE, Aplio500, Toshiba Medical System, Tochigi, Japan; and S-SWE, the Aixplorer US system, SuperSonic Imagine, Provence, France). The maximum (Emax), mean (Emean) and standard deviation (ESD) of elasticity modulus values in T-SWE and S-SWE were analyzed. All the lesions were confirmed by ultrasound (US)-guided core needle biopsy (n = 26), surgery (n = 122), or both (n = 5), with pathological results as the gold standard. The areas under the receiver operating characteristic curves (AUROCs) were calculated. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were calculated to assess the diagnostic performance between T-SWE and S-SWE. Operator consistency was also evaluated. RESULTS Among the 153 lesions, 41 (26.8%) were malignant and 112 (73.2%) were benign. Emax (T-SWE: 40.10±37.14 kPa vs. 118.78±34.41 kPa; S-SWE: 41.22±22.54 kPa vs. 134.77±60.51 kPa), Emean (T-SWE: 19.75±16.31 kPa vs. 52.93±25.75 kPa; S-SWE: 20.95±10.98 kPa vs. 55.95±22.42 kPa) and ESD (T-SWE: 9.00±8.55 kPa vs. 38.44±12.30 kPa; S-SWE: 8.17±6.14 kPa vs. 29.34±13.88 kPa) showed statistical differences in distinguishing malignant lesions from benign ones both in T-SWE and S-SWE (all p < 0.05). In T-SWE, the diagnostic performance of ESD was the highest (AUROC = 0.958), followed by Emax (AUROC = 0.909; p = 0.001 in comparison with ESD) and Emean (AUROC = 0.892; p < 0.001 in comparison with ESD), while in S-SWE, the diagnostic performance of Emax was the highest (AUROC = 0.967), followed by ESD (AUROC = 0.962, p > 0.05 in comparison with Emax) and Emean (AUROC = 0.930, p = 0.034 in comparison with Emax). AUROC-max (T-SWE: 0.909 vs. S-SWE 0.967), AUROC-mean (T-SWE: 0.892 vs. S-SWE 0.930) and AUROC-SD (T-SWE: 0.958 vs. S-SWE 0.962) showed no significant difference between T-SWE and S-SWE (all p > 0.05). The intra-class correlation coefficients (ICC) of the intra-operator consistency and inter-operator consistency respectively were 0.961 and 0.898 in T-SWE, while 0.954 and 0.897 in S-SWE. CONCLUSION T-SWE and S-SWE are equivalent for distinguishing the breast lesions. In T-SWE, ESD had the best diagnostic performance, while in S-SWE, Emax had the best diagnostic performance.
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Kang HJ, Kim JY, Lee NK, Lee JW, Song YS, Park SY, Shin JK. Three-dimensional versus two-dimensional shear-wave elastography: Associations of mean elasticity values with prognostic factors and tumor subtypes of breast cancer. Clin Imaging 2017; 48:79-85. [PMID: 29055275 DOI: 10.1016/j.clinimag.2017.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To explore associations between prognostic factors and subtypes of invasive breast cancer (IBC) and elasticity values using three-dimensional (3D) and two-dimensional (2D) shear-wave elastography (SWE). MATERIALS AND METHODS Mean elasticity values (kPa) of 121 IBCs were measured using both 3D and 2D SWE. Associations between these values and prognostic factors and subtypes were analyzed using linear regression model. RESULTS In both 3D and 2D SWE, larger size and presence of lymphovascular invasion were independent factors influencing higher mean elasticity on multivariate analyses (all p values<0.05). CONCLUSIONS Using either 3D or 2D SWE, higher mean elasticity values are associated with poor prognostic factors of IBC.
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Affiliation(s)
- Hyun Jung Kang
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea; Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea.
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Shin Young Park
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jong Ki Shin
- Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea
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22
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Xue Y, Yao S, Li X, Zhang H. Value of shear wave elastography in discriminating malignant and benign breast lesions: A meta-analysis. Medicine (Baltimore) 2017; 96:e7412. [PMID: 29049174 PMCID: PMC5662340 DOI: 10.1097/md.0000000000007412] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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
The analysis was aimed to evaluate the diagnostic accuracy of shear wave elastography (SWE) for malignant breast lesions through a meta-analysis.Related articles were searched from Pubmed, Embase, and Cochrane library. Overall sensitivity and specificity were analyzed with DerSimonian and Laird random effects model. Area under curve with corresponding 95% confidence interval (were calculated to evaluate the diagnostic accuracy of SWE. Sensitivity and publication bias were assessed as well.A total of 25 articles including 4128 patients and 4546 breast lesions were included in the pooled analysis. In the subgroup analysis, diagnostic sensitivity and specificity of SWE in Asian population were 0.84 (0.79-0.88) and 0.87 (0.84-0.90), respectively, whereas they were 0.92 (0.86-0.96) and 0.89 (0.84-0.92) in Caucasian population. The diagnostic accuracy of SWE was a little higher for Caucasians than for Asians (0.95 vs. 0.92). The diagnostic sensitivity and specificity of virtual touch tissue quantification were 0.85 (0.77-0.91) and 0.93 (0.88-0.96), respectively. It showed a little higher value in specificity and summary ROC curve than SWE (0.93 vs. 0.87; 0.95 vs. 0.93). In addition, maximum stiffness exhibited higher detection sensitivity than that of mean stiffness (0.91 vs. 0.85).SWE serves as an accurate diagnostic technology for discriminating between malignant and benign breast lesions.
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Affiliation(s)
- Yan Xue
- Department of Ultrasonography, Linyi People's Hospital, Linyi City, Shandong
| | - Shuxin Yao
- Department of Ultrasonography, Heze Municipal Hospital, Heze City, Shandong
| | - Xiaodong Li
- Department of Radiology, Linyi People's Hospital, Linyi City, Shandong, China
| | - Huarong Zhang
- Department of Ultrasonography, Linyi People's Hospital, Linyi City, Shandong
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23
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Xue Y, Yao S, Li X, Zhang H. Benign and malignant breast lesions identification through the values derived from shear wave elastography: evidence for the meta-analysis. Oncotarget 2017; 8:89173-89181. [PMID: 29179509 PMCID: PMC5687679 DOI: 10.18632/oncotarget.21124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/30/2017] [Indexed: 12/21/2022] Open
Abstract
Objective The analysis was aimed to evaluate the diagnostic accuracy of shear wave elastography (SWE) for malignant breast lesions through a meta-analysis. Materials and Methods Related articles were searched in databases of Pubmed, Embase and Cochrane library. Overall sensitivity and specificity were analyzed with DerSimonian and Laird random effects model. Area under curve (AUC) with corresponding 95% confidence interval were also analyzed to evaluate the diagnostic accuracy of SWE. P value < 0.05 predicted the significant heterogeneity between study. Sensitivity and publication bias were assessed as well. Results According to the inclusion criteria, 25 articles were selected. In the subgroup analysis, diagnostic sensitivity and specificity of SWE in Asian population were 0.84 (0.79-0.88) and 0.87 (0.84-0.90), respectively, while they were 0.92 (0.86-0.96) and 0.89 (0.84-0.92) in Caucasian population. The diagnostic accuracy of SWE was a little higher for Caucasians than for Asians (0.95 vs. 0.92). The diagnostic sensitivity and specificity of virtual touch tissue quantification (VTTQ) were 0.85 (0.77-0.91) and 0.93 (0.88-0.96), respectively. It showed a little higher value in specificity and summary receiver operating curve (sROC) than that of SWE (0.93 vs. 0.87; 0.95 vs. 0.93). In addition, maximum stiffness exhibited higher detection sensitivity than that of mean stiffness (0.91 vs. 0.85). Conclusions SWE serves as an accurate diagnostic technology for discriminating malignant and benign breast lesions.
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Affiliation(s)
- Yan Xue
- Department of Ultrasonography, Linyi People's Hospital, Linyi City, Shandong Province 276000, China
| | - Shuxin Yao
- Department of Ultrasonography, Heze Municipal Hospital, Heze City, Shandong Province 274000, China
| | - Xiaodong Li
- Department of Radiology, Linyi People's Hospital, Linyi City, Shandong Province 276000, China
| | - Huarong Zhang
- Department of Ultrasonography, Linyi People's Hospital, Linyi City, Shandong Province 276000, China
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24
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Tyagi M, Wang Y, Hall TJ, Barbone PE, Oberai AA. Improving three-dimensional mechanical imaging of breast lesions with principal component analysis. Med Phys 2017; 44:4194-4203. [PMID: 28547868 DOI: 10.1002/mp.12372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/27/2017] [Accepted: 05/12/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Elastography has emerged as a new tool for detecting and diagnosing many types of diseases including breast cancer. To date, most clinical applications of elastography have utilized two-dimensional strain images. The goal of this paper is to present a new quasi-static elastography technique that yields shear modulus images in three dimensions. METHODS An automated breast volume scanner was used to acquire ultrasound images of the breast as it was gently compressed. Cross-correlation between successive images was used to determine the displacement within the tissue. The resulting displacement field was filtered of all but compressive motion through principal component analysis. This displacement field was used to infer spatial distribution of shear modulus by solving a 3D elastic inverse problem. RESULTS Three dimensional shear modulus images of benign breast lesions for two subjects were generated using the techniques described above. It was found that the lesions were visualized more clearly in images generated using the displacement data de-noised through the use of principal components. CONCLUSIONS We have presented experimental and algorithmic techniques that lead to three-dimensional imaging of shear modulus using quasi-static elastography. This work demonstrates feasibility of this approach, and lays the foundation for images of other, more informative, mechanical parameters.
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Affiliation(s)
- Mohit Tyagi
- Scientific Computation Research Center, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY , 12120, USA
| | - Yuqi Wang
- Department of Medical Physics, University of Wisconsin, Madison, WI, 53706, USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI, 53706, USA
| | - Paul E Barbone
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215, USA
| | - Assad A Oberai
- Scientific Computation Research Center, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY , 12180, USA
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25
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Choi HY, Sohn YM, Seo M. Comparison of 3D and 2D shear-wave elastography for differentiating benign and malignant breast masses: focus on the diagnostic performance. Clin Radiol 2017; 72:878-886. [PMID: 28526455 DOI: 10.1016/j.crad.2017.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/23/2017] [Accepted: 04/10/2017] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the diagnostic performance of three-dimensional (3D) image shear-wave elastography (SWE) for differentiating benign from malignant breast masses compared to two-dimensional (2D) SWE and B-mode ultrasound (US). MATERIALS AND METHODS This study consisted of 205 breast lesions from 199 patients who underwent B-mode US and SWE before biopsy from January 2014 to March 2016. Quantitative elasticity values (maximum and mean elasticity, Emax and Emean) obtained from 2D and 3D SWE (axial, sagittal, and coronal images) were reviewed retrospectively, in addition to the histopathological findings including immunohistochemistry profiles (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative breast cancer) in cases of malignancy. Histopathological findings were regarded as the reference standard. The diagnostic performance of each data set was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) analysis to compare sensitivity and specificity. RESULTS Among 205 lesions, 105 (51.22%) were malignant and 100 (48.78%) were benign. Compared to benign masses, malignant masses had higher values of Emax and Emean on both 2D and 3D SWE, the differences of which were statistically significant (p<0.001). The AUCs of 2D, 3D axial, and sagittal SWE were significantly higher than that of 3D coronal SWE (p<0.05). In addition, the sensitivities of axial, sagittal, and coronal 3D SWE were all higher than that of 2D SWE for Emean (81.9%, 87.6%, and 89.5% versus 70.5%, respectively, p<0.05). Conversely, the specificity of 2D and 3D axial SWE was higher than that of 3D sagittal and coronal SWE (Emax, 84%, 83% versus 76%, 73%; Emean, 85%, 81% versus 68%, 50%, respectively, p<0.05). We also assessed changes in Breast Imaging-Reporting and Data System (BI-RADS) category 3 and category 4a lesions by adding each of the parameters for 2D and 3D SWE in B-mode US. The specificity, PPV, and accuracy of combined 2D or combined 3D SWE with B-mode US was statistically higher than that of B-mode US alone for differentiating benign and malignant lesions (p<0.05). CONCLUSIONS Among SWE images, 2D SWE, and 3D SWE axial and sagittal images exhibited superior diagnostic performance compared to 3D coronal images. Addition of 3D SWE images to B-mode US improved the diagnostic performance for distinguishing benign from malignant masses.
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Affiliation(s)
- H Y Choi
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Y-M Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, South Korea.
| | - M Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, South Korea
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26
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Youk JH, Gweon HM, Son EJ. Shear-wave elastography in breast ultrasonography: the state of the art. Ultrasonography 2017; 36:300-309. [PMID: 28513127 PMCID: PMC5621798 DOI: 10.14366/usg.17024] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 12/18/2022] Open
Abstract
Shear-wave elastography (SWE) is a recently developed ultrasound technique that can visualize and measure tissue elasticity. In breast ultrasonography, SWE has been shown to be useful for differentiating benign breast lesions from malignant breast lesions, and it has been suggested that SWE enhances the diagnostic performance of ultrasonography, potentially improving the specificity of conventional ultrasonography using the Breast Imaging Reporting and Data System criteria. More recently, not only has SWE been proven useful for the diagnosis of breast cancer, but has also been shown to provide valuable information that can be used as a preoperative predictor of the prognosis or response to chemotherapy.
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Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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27
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Marcon J, Trottmann M, Rübenthaler J, D’Anastasi M, Stief C, Reiser M, Clevert D. Three-dimensional vs. two-dimensional shear-wave elastography of the testes – preliminary study on a healthy collective. Clin Hemorheol Microcirc 2017; 64:447-456. [DOI: 10.3233/ch-168115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Marcon
- Department of Urology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
| | - M. Trottmann
- Department of Urology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
| | - J. Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
| | - M. D’Anastasi
- Department of Clinical Radiology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
| | - C.G. Stief
- Department of Urology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
| | - M.F. Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
| | - D.A. Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University Munich – Campus Grosshadern, Munich, Germany
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28
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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: 28] [Impact Index Per Article: 3.5] [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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29
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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: 0.7] [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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30
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Eisenbrey JR, Dave JK, Forsberg F. Recent technological advancements in breast ultrasound. ULTRASONICS 2016; 70:183-190. [PMID: 27179143 DOI: 10.1016/j.ultras.2016.04.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 06/05/2023]
Abstract
Ultrasound is becoming increasingly common as an imaging tool for the detection and characterization of breast tumors. This paper provides an overview of recent technological advancements, especially those that may have an impact in clinical applications in the field of breast ultrasound in the near future. These advancements include close to 100% fractional bandwidth high frequency (5-18MHz) 2D and 3D arrays, automated breast imaging systems to minimize the operator dependence and advanced processing techniques, such as those used for detection of microcalcifications. In addition, elastography and contrast-enhanced ultrasound examinations that are expected to further enhance the clinical importance of ultrasound based breast tumor screening are briefly reviewed. These techniques have shown initial promise in clinical trials and may translate to more comprehensive clinical adoption in the future.
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Affiliation(s)
- John R Eisenbrey
- Thomas Jefferson University, Department of Radiology, Division of Ultrasound, 132 South 10th St., Philadelphia, PA 19107, United States.
| | - Jaydev K Dave
- Thomas Jefferson University, Department of Radiology, Division of Ultrasound, 132 South 10th St., Philadelphia, PA 19107, United States
| | - Flemming Forsberg
- Thomas Jefferson University, Department of Radiology, Division of Ultrasound, 132 South 10th St., Philadelphia, PA 19107, United States
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31
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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: 58] [Impact Index Per Article: 6.4] [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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Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.14.13448] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zhang Q, Xiao Y, Chen S, Wang C, Zheng H. Quantification of elastic heterogeneity using contourlet-based texture analysis in shear-wave elastography for breast tumor classification. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:588-600. [PMID: 25444693 DOI: 10.1016/j.ultrasmedbio.2014.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/23/2014] [Accepted: 09/02/2014] [Indexed: 06/04/2023]
Abstract
Ultrasound shear-wave elastography (SWE) has become a valuable tool for diagnosis of breast tumors. The purpose of this study was to quantify the elastic heterogeneity of breast tumors in SWE by using contourlet-based texture features and evaluating their diagnostic performance for classification of benign and malignant breast tumors, with pathologic results as the gold standard. A total of 161 breast tumors in 125 women who underwent B-mode and SWE ultrasonography before biopsy were included. Five quantitative texture features in SWE images were extracted from the directional subbands after the contourlet transform, including the mean (Tmean), maximum (Tmax), median (Tmed), third quartile (Tqt), and standard deviation (Tsd) of the subbands. Diagnostic performance of the texture features and the classic features was compared using the area under the receiver operating characteristic curve (AUC) and the leave-one-out cross validation with Fisher classifier. The feature Tmean achieved the highest AUC (0.968) among all features and it yielded a sensitivity of 89.1%, a specificity of 94.3% and an accuracy of 92.5% for differentiation between benign and malignant tumors via the leave-one-out cross validation. Compared with the best classic feature, i.e., the maximum elasticity, Tmean improved the AUC, sensitivity, specificity and accuracy by 3.5%, 12.7%, 2.8% and 6.2%, respectively. The Tmed, Tqt and Tsd were also superior to the classic features in terms of the AUC and accuracy. The results demonstrated that the contourlet-based texture features captured the tumor's elastic heterogeneity and improved diagnostic performance contrasted with the classic features.
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Affiliation(s)
- Qi Zhang
- School of Communication and Information Engineering, Shanghai University, Shanghai, China.
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Shuai Chen
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Congzhi Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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Pastore AL, Palleschi G, Maceroni P, Manfredonia G, Autieri D, Cacciotti J, Sardella B, Porta N, Petrozza V, Carbone A. Correlation between semiquantitative sonoelastography and immunohistochemistry in the evaluation of testicular focal lesions. Cancer Imaging 2014; 14:29. [PMID: 25609382 PMCID: PMC4331834 DOI: 10.1186/s40644-014-0029-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/25/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sonoelastography is a novel and promising imaging tool, which has been applied to breast, thyroid, and prostate tissues. The aim of this study was to evaluate focal lesions of the testes with diameters of <10 mm using sonoelastography, B-mode sonography (US), and colour Doppler ultrasonography (CDU). METHODS Thirty patients who were referred to our outpatient clinics for varicocoeles, scrotal pain, scrotal enlargements, epididymitis, palpable testicular nodules, or infertility, were prospectively enrolled into this study. Ultrasound evaluations had revealed that 27 subjects had focal testicular lesions with diameters of <10 mm and 3 subjects had 10-mm spherical non-homogeneous testicular nodules. All lesions were evaluated using semiquantitative sonoelastography, and the patients underwent orchifunicolectomies. The testicular lesions were examined histopathologically. The vascularization of the lesions and the surrounding testicular parenchyma was evaluated by analysing the immunohistochemical distribution of the cluster of differentiation 31 and by calculating the vascular indices (VI). Potential associations between the strain ratios (stiffness of the lesions) and the VI were tested. RESULTS Analyses of the strain fields obtained using semiquantitative sonoelastography yielded different values for the masses and the surrounding tissues, which led to significant increases in the strain ratios. Sonoelastography upheld all of the diagnoses that were suspected when the patients were physically examined, when the serum markers were analysed, and after the patients had undergone US and CDU. Histopathological examinations confirmed the neoplastic characteristics of these masses. A significant inverse correlation was determined between the sonoelastographic strain ratio and the VI (Pearson correlation coefficient, r, = - 0.93; P < 0.001). CONCLUSION Our investigation shows that semiquantitative sonoelastography may provide additional objective information to support the algorithm used to diagnose testicular lesions. This might be of crucial diagnostic importance for lesions with diameters of <10 mm, particularly if they are not palpable, are negative for serum tumour markers, and if the findings from ultrasonography and CDU are equivocal. The findings from semiquantitative sonoelastography might indicate the need for surgical exploration. Further investigations with larger numbers of patients are required to corroborate these data and to support the use of semiquantitative sonoelastography in the evaluation of testicular lesions.
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Youk JH, Son EJ, Gweon HM, Kim H, Park YJ, Kim JA. Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2336-2344. [PMID: 25130444 DOI: 10.1016/j.ultrasmedbio.2014.05.020] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/13/2014] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
Our aim was to compare the diagnostic performance of strain elastography (SE) and shear-wave elastography (SWE), combined with B-mode ultrasonography (US), in breast cancer. For 79 breast lesions that underwent SE and SWE, two radiologists reviewed five data sets (B-mode US, SWE, SE and two combined sets). Qualitative and quantitative elastographic data and Breast Imaging Reporting and Data System (BI-RADS) categories were recorded. The area under the receiver operating characteristic curve (AUC) was evaluated. No significant difference in the AUC between the two elastography methods was noted. After subjective assessment by reviewers, the AUC for the combined sets was improved (SWE, 0.987; SE, 0.982; B-mode US, 0.970; p < 0.05). When SE and SWE were added, 38% and 56% of benign BI-RADS category 4a lesions with a low suspicion of cancer were downgraded without false-negative results, respectively. SE and SWE performed similarly. Therefore, addition of SE or SWE improved the diagnostic performance of B-mode US, potentially reducing unnecessary biopsies.
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Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hana Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joo Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Sugimoto K, Oshiro H, Ogawa S, Honjo M, Hara T, Moriyasu F. Radiologic-pathologic correlation of three-dimensional shear-wave elastographic findings in assessing the liver ablation volume after radiofrequency ablation. World J Gastroenterol 2014; 20:11850-11855. [PMID: 25206291 PMCID: PMC4155377 DOI: 10.3748/wjg.v20.i33.11850] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/24/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the usefulness of three-dimensional (3D) shear-wave elastography (SWE) in assessing the liver ablation volume after radiofrequency (RF) ablation.
METHODS: RF ablation was performed in vivo in 10 rat livers using a 15-gauge expandable RF needle. 3D SWE as well as B-mode ultrasound (US) were performed 15 min after ablation. The acquired 3D volume data were rendered as multislice images (interslice distance: 1.10 mm), and the estimated ablation volumes were calculated. The 3D SWE findings were compared against digitized photographs of gross pathological and histopathological specimens of the livers obtained in the same sectional planes as the 3D SWE multislice images. The ablation volumes were also estimated by gross pathological examination of the livers, and the results were then compared with those obtained by 3D SWE.
RESULTS: In B-mode US images, the ablation zone appeared as a hypoechoic area with a peripheral hyperechoic rim; however, the findings were too indistinct to be useful for estimating the ablation area. 3D SWE depicted the ablation area and volume more clearly. In the images showing the largest ablation area, the mean kPa values of the peripheral rim, central zone, and non-ablated zone were 13.1 ± 1.5 kPa, 59.1 ± 21.9 kPa, and 4.3 ± 0.8 kPa, respectively. The ablation volumes depicted by 3D SWE correlated well with those estimated from gross pathological examination (r2 = 0.9305, P = 0.00001). The congestion and diapedesis of red blood cells observed in histopathological examination were greater in the peripheral rim of the ablation zone than in the central zone.
CONCLUSION: 3D SWE outperforms B-mode US in delineating ablated areas in the liver and is therefore more reliable for spatially delineating thermal lesions created by RF ablation.
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Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis. Jpn J Radiol 2014; 32:592-9. [PMID: 25195123 DOI: 10.1007/s11604-014-0349-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 08/01/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine the performance of shear-wave elastography (SWE) for the differentiation of benign and malignant breast lesions using a meta-analysis. MATERIALS AND METHODS PubMed, Embase and the Cochrane library were searched for studies published up to January 2014. The references of retrieved relevant articles were reviewed to identify potential publications. Random-effect meta-analysis was conducted to assess the overall sensitivity and specificity of SWE in the differentiation of breast lesions. RESULTS A total of 11 articles, including 2424 patients, were included in the present meta-analysis. The summarized sensitivity and specificity of the shear wave elastography performance based on maximum elasticity were 0.93 (95 % CI 0.91-0.95) and 0.81 (95 % CI 0.78-0.83), respectively. For the mean elasticity, the summarized sensitivity and specificity were 0.94 (95 % CI 0.92-0.96) and 0.71 (95 % CI 0.69-0.74), respectively. The summarized sensitivity and specificity were 0.77 (95 % CI 0.70-0.83) and 0.88 (95 % CI 0.84-0.91) for the SD of elasticity. CONCLUSION SWE has a high sensitivity and specificity in the differentiation of benign and malignant breast lesions. More large and prospective studies are warranted to further examine the performance of SWE.
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Zhou J, Zhan W, Chang C, Zhang X, Jia Y, Dong Y, Zhou C, Sun J, Grant EG. Breast lesions: evaluation with shear wave elastography, with special emphasis on the "stiff rim" sign. Radiology 2014; 272:63-72. [PMID: 24661245 DOI: 10.1148/radiol.14130818] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To analyze the diagnostic performance of shear wave elastography (SWE) in differentiating between benign and malignant breast lesions, with special emphasis on the value of the "stiff rim" sign, as compared with conventional ultrasonography (US). MATERIALS AND METHODS For this ethics committee-approved retrospective study, all patients provided verbal informed consent for the analysis of their imaging data. A total of 193 consecutive women (age range, 18-82 years; mean age, 46 years) with 193 breast lesions (56 malignant, 137 benign) were included. The stiff rim sign, a qualitative SWE feature, was evaluated at the display setting of less than 180 kPa and at 180 kPa. The quantitative SWE features were assessed. Sensitivity, specificity, the area under the receiver operating characteristic curve (Az), and positive and negative likelihood ratios were calculated for conventional US features, for SWE features, and for combined conventional US and SWE features. RESULTS Among all qualitative and quantitative SWE features, the stiff rim sign at the display setting (<180 kPa) showed the highest Az (0.918; 95% confidence interval [CI]: 0.870, 0.953), which was comparable to that for conventional US (0.891; 95% CI: 0.838, 0.931) (P = .40). The combination of the stiff rim sign at less than 180 kPa and conventional US features, with a positive likelihood ratio of 12.23 (95% CI: 11.5, 13.0) and a negative likelihood ratio of 0.02 (95% CI: 0.003, 0.1), yielded the highest Az (0.982; 95% CI: 0.951, 0.995)-higher than those for conventional US only and for any single SWE feature alone (P < .001 for all)-and yielded higher sensitivity (98.2% [55 of 56]; 95% CI: 90.4%, 100.0%) and similar specificity (92.0% [126 of 137]; 95% CI: 86.1%, 95.9%) compared with conventional US (P < .001 and P = .58, respectively). With use of this combination, the rate of recommendation of benign lesions for interventional procedures would decrease from 56.9% (78 of 137) (on the basis of conventional US features) to 15.3% (21 of 137), and 100.0% (56 of 56) (95% CI: 93.6%, 100.0%) malignant lesions would be correctly selected for biopsy. CONCLUSION Adding SWE features, especially the stiff rim sign at the display setting (<180 kPa), to conventional US has the potential to improve the differentiation of breast lesions.
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Affiliation(s)
- JianQiao Zhou
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z., W.W.Z., X.X.Z., Y.J., Y.J.D., C.Z.); Department of Ultrasound, Cancer Hospital, Fudan University, Shanghai 200032, China (C.C.); Department of Obstetrics and Gynecology, Shekou People's Hospital, Shenzhen, China (J.S.); and Department of Radiology, University of Southern California, Keck School of Medicine, USC University Hospital, Los Angeles, Calif (E.G.G.)
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Wang S, Larin KV. Shear wave imaging optical coherence tomography (SWI-OCT) for ocular tissue biomechanics. OPTICS LETTERS 2014; 39:41-4. [PMID: 24365817 PMCID: PMC4057602 DOI: 10.1364/ol.39.000041] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We report on a noncontact low-coherence optical phase-based imaging method, termed shear wave imaging optical coherence tomography (SWI-OCT), which enables 2D depth-resolved visualization of the low-amplitude elastic wave propagation in tissue with ultrahigh frame rate. SWI-OCT is based on 1D transverse scanning of the M-mode OCT imaging that is precisely synchronized with a low-pressure short-duration air-puff loading system. This approach of scanning and data recording allows visualization of the induced tissue deformation at high frame rate. The applied phase-resolved interferometric technique, with sensitivity on the nanometer scale, makes the low-amplitude tissue displacement detectable. For the demonstration of this method, and to study its application for tissue biomechanics, we performed pilot experiments on agar phantoms and ex vivo rabbit corneas. Samples with different elastic properties can be differentiated based on the velocity of the elastic wave propagation that is directly visualized with a 25 kHz frame rate. Our results indicate that SWI-OCT has the potential to be further developed as a major technique for depth-resolved high-resolution tissue elastography in vivo.
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Affiliation(s)
- Shang Wang
- Department of Biomedical Engineering, University of Houston, 3605 Cullen Blvd., Houston, Texas 77204-5060, USA
| | - Kirill V. Larin
- Department of Biomedical Engineering, University of Houston, 3605 Cullen Blvd., Houston, Texas 77204-5060, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
- Corresponding author:
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Youk JH, Son EJ, Park AY, Kim JA. Shear-wave elastography for breast masses: local shear wave speed (m/sec) versus Young modulus (kPa). Ultrasonography 2013; 33:34-9. [PMID: 24936493 PMCID: PMC4058968 DOI: 10.14366/usg.13005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/17/2013] [Accepted: 11/15/2013] [Indexed: 01/20/2023] Open
Abstract
Purpose: To evaluate and compare the performance of shear-wave elastography (SWE) for breast masses using the local shear wave speed (m/sec) vs. Young modulus (kPa). Methods: A total of 130 breast lesions in 123 women who underwent SWE before ultrasound- guided core needle biopsy or surgical excision were included. With the region-of-interest placed over the stiffest areas of the lesion on SWE, the quantitative mean, maximum, and standard deviation (SD) of the elasticity values were measured in kPa and m/sec for each lesion. The SD was also measured with the region-of-interest including the whole breast lesion (wSD). The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of each elasticity value measured in kPa and m/sec were compared. Results: Of the 130 lesions, 49 (37.7%) were malignant and 81 (62.3%) were benign. The AUCs for the mean, maximum, and SD of the elasticity values using kPa and m/sec did not differ significantly: mean, 0.974 vs. 0.974; maximum, 0.960 vs. 0.976; SD, 0.916 vs. 0.916. However, the AUC for wSD showed a significant difference: 0.964 (kPa) vs. 0.960 (m/sec) (P=0.036). There was no significant difference in the sensitivity and specificity of the mean, maximum, and wSD of the elasticity values. However, the specificity of the SD was significantly different between the two different measurements: 95.1% (kPa) vs. 87.7% (m/sec) (P=0.031). Conclusion: The quantitative elasticity values measured in kPa and m/sec on SWE showed good diagnostic performance. The specificity of the SD and AUC of the wSD measured in kPa were significantly higher than those measured in m/sec.
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Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Cui XW, Friedrich-Rust M, Molo CD, Ignee A, Schreiber-Dietrich D, Dietrich CF. Liver elastography, comments on EFSUMB elastography guidelines 2013. World J Gastroenterol 2013; 19:6329-6347. [PMID: 24151351 PMCID: PMC3801303 DOI: 10.3748/wjg.v19.i38.6329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/11/2013] [Accepted: 09/16/2013] [Indexed: 02/06/2023] Open
Abstract
Recently the European Federation of Societies for Ultrasound in Medicine and Biology Guidelines and Recommendations have been published assessing the clinical use of ultrasound elastography. The document is intended to form a reference and to guide clinical users in a practical way. They give practical advice for the use and interpretation. Liver disease forms the largest section, reflecting published experience to date including evidence from meta-analyses with shear wave and strain elastography. In this review comments and illustrations on the guidelines are given.
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