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Clinical cases of thyroid and breast elastography are presented by dr. Antonio Pio Masciotra at 2nd Sono-Elastography International Meeting in Pavia on Oct. 2012.
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BREAST AND THYROID SONOELASTOGRAPHY
Clinical session : Discussion of clinical cases
Antonio Pio Masciotra – Campobasso - Italy
Thyroid sonoelastography
Clinical cases discussion
Dr. Antonio Pio Masciotra
Campobasso
External
Mechanical force
Natural
Heart
SuperSonic Imagine has developed a novel method called SonicTouch,
which is based on focused ultrasound, and can remotely generate Shear Wave-fronts providing uniform coverage of a 2D area interest.
STRAIN ELASTOGRAPHY with different grades of compression
Inhomogeneous elasticity Uniform low elasticity
SHEAR WAVE ELASTOGRAPHY
• Normal gland 8.29 kPa• Nodule 8.46 kPa
Hashimoto thyroiditis
• Normal gland 8 kPa• Hashimoto 13-15 kPa
Hashimoto thyroiditis
• Nodule 14.8 kPa• Parenchima 21.3 kPa
Hashimoto thyroiditis – 3D US
• Nodule 14.8 kPa• Parenchima 21.3 kPa
Hashimoto thyroiditis – 3D SWE
• Nodule 14.8 kPa• Parenchima 21.3 kPa
4 months later
1 month later
First exam
Thyroid hemorragic cyst – Bidimensional US
First exam – Volume 7.11 cc – Mainly fluid 1 month later – Volume 2.35 cc – Complex structure with thick
layers of debris on all the walls4 months later – Volume 2.16 cc – Mainly fluid with less thick
layers of debris on only some of the walls
First exam
1 month later
4 months later
Thyroid hemorragic cyst – PD and directional PD
First exam – Only a few vessels streched on the wall due to the high intracystic pressure
1 month later – Vessels more visible, but always limited to the wall4 months later – Vessels even more visible (due to reduced intracistic pressure), but always limited to the wall
First exam
1 month later
4 months later
Thyroid hemorragic cyst – SW Elastography
First exam – 6 kPa (min 0.1 – max 24.0) on hypoechoic layer of debris Surrounding tissue very stiff due to the high intracystic
pressure1 month later – 8 kPa (min 1.9 – max 18.6) on almost isoechoic layer
of debris Surrounding tissue not stiff4 months later – 29 kPa (min 3.9 – max 48.1) on hypoechoic layer of debris Surrounding tissue not stiff
Thyroid nodules – Bidimensional US
Benign Malignant
Thyroid nodules – Color and Powerdoppler
Benign Malignant
Thyroid nodules – SW Elastography
Benign Malignant
Breast sonoelastography
Clinical cases discussion
Dr. Antonio Pio Masciotra
Campobasso
Breast SWE – hyperchoic nodule in fat
• Nodule 14.8 kPa• Parenchima 21.3 kPa
Breast SWE – unilateral gynecomastia
• Nodule 14.8 kPa• Parenchima 21.3 kPa
RT induced effects on breastBidimensional US
6 months after RT 13 years after RT
RT induced effects on breastSW Elastography
6 months after RT 13 years after RT
RT induced breast subacute effects3D US
• RT
RT induced breast subacute effects3D SWE
• RT
Breast complicated cystBidimensional US
First study 7 days after therapy
Breast complicated cystPowerdoppler
First study 7 days after therapy
Breast complicated cystSW Elastography
First study 7 days after therapy
Breast complicated cyst3D US
First study 7 days after therapy
Breast complicated cyst3D SWE
First study 7 days after therapy
Breast complicated cyst SWE different settings
Resolution mode Penetration mode
Breast fibroadenomas Bidimensional US
Almost homogeneous Inhomogeneous
Breast fibroadenomas SW Elastography
Different kPa Similar elasticity ratio
Breast papillary carcinoma
2008
2009
2010
2011
2008200920102011
Breast carcinoma – Mammography
Benign Malignant
Breast carcinoma – US
Bidimensional 3D
Breast carcinoma – SWE
Bidimensional 3D
Breast carcinoma – SWE
High transparence Low transparence
2 more nodules in the same breast – Bidimensional US
Nodule n. 1 Nodule n. 2
2 more nodules in the same breast – SW Elastography (both benign at histology)
Nodule n. 1 Nodule n. 2
Breast carcinoma – Axilla US
Bidimensional 3D
Breast carcinoma – Axilla SWE
Bidimensional 3D
Lymphnodes 2D US
B cell Lymphoma Breast cancer metastasis
Lymphnodes US 3D
B cell Lymphoma Breast cancer metastasis
Lymphnodes SWE
B cell Lymphoma Breast cancer metastasis
Lymphnodes in different sites in the same patientBidimensional US
B cell Lymphoma inguinal B cell Lymphoma ext. iliac
Lymphnodes in different sites in the same patientSW Elastography
B cell Lymphoma inguinal B cell Lymphoma ext. iliac
Lymphnodes SWE Different stiffness depending on histology
• B cell Lymphoma • Breast cancer metastasis
• NET metastasis
Aims of elastography
Correct tissue elasticity quantification
Identification of ‘cut off’ elasticity values for the right diagnostic workup of
diffuse and focal diseases