This document discusses the use of breast and thyroid sonoelastography and shear wave elastography in evaluating various clinical cases. It presents case studies demonstrating how elastography can help characterize nodules, cysts, lymph nodes and tissue changes after radiation therapy. Quantitative shear wave elastography provides stiffness measurements that can help differentiate benign from malignant lesions and identify tissue abnormalities. The goal of elastography is to correctly quantify tissue elasticity and identify elasticity cut-off values to aid the diagnostic evaluation of diffuse and focal diseases.

1. BREAST AND THYROID SONOELASTOGRAPHY
Clinical session : Discussion of clinical cases
Antonio Pio Masciotra – Campobasso - Italy

2. Thyroid sonoelastography
Clinical cases discussion
Dr. Antonio Pio Masciotra
Campobasso

3. External Natural
Mechanical force 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.

4. STRAIN ELASTOGRAPHY
with different grades of compression
Inhomogeneous elasticity Uniform low elasticity

5. SHEAR WAVE ELASTOGRAPHY
• Normal gland 8.29 kPa
• Nodule 8.46 kPa

6. Hashimoto thyroiditis
• Normal gland 8 kPa
• Hashimoto 13-15 kPa

7. Hashimoto thyroiditis
• Nodule 14.8 kPa
• Parenchima 21.3 kPa

8. Hashimoto thyroiditis – 3D US
• Nodule 14.8 kPa
• Parenchima 21.3 kPa

9. Hashimoto thyroiditis – 3D SWE
• Nodule 14.8 kPa
• Parenchima 21.3 kPa

10. Thyroid hemorragic cyst – Bidimensional US
First exam
1 month later
14month later – Volume 2.35 cccc Complex fluid with with thick
months later – Volume 2.16 – – Mainly structure less thick
First exam – Volume 7.11 cc – Mainly fluid
layers of debris on only all the of the walls
layers of debris on some walls
4 months later

11. Thyroid hemorragic cyst – PD and directional PD
First exam
1 month later
First exam – Only a few vessels streched on the wall due to the
4 months later – high intracystic pressure
1 month later – Vessels more even more visible (due to reduced
Vessels visible, but always limited to the wall
intracistic pressure), but always limited to the wall
4 months later

12. Thyroid hemorragic cyst – SW Elastography
First exam
1 month later
First exam – 6 kPa (min 0.1 – max 24.0) on hypoechoic layer of
1 month later – 8 kPa (min 1.9 – max 18.6)to the high isoechoic layer
debris Surrounding tissue very stiff due on almost intracystic
4 months later – of debris Surrounding tissue not hypoechoic layer of
3.9 – max
29 kPa (min pressure 48.1) on stiff
4 months later debris Surrounding tissue not stiff

13. Thyroid nodules – Bidimensional US
Benign Malignant

14. Thyroid nodules – Color and Powerdoppler
Benign Malignant

15. Thyroid nodules – SW Elastography
Benign Malignant

16. Breast sonoelastography
Clinical cases discussion
Dr. Antonio Pio Masciotra
Campobasso

17. Breast SWE – hyperchoic nodule in fat
• Nodule 14.8 kPa
• Parenchima 21.3 kPa

18. Breast SWE – unilateral gynecomastia
• Nodule 14.8 kPa
• Parenchima 21.3 kPa

19. RT induced effects on breast
Bidimensional US
6 months after RT 13 years after RT

20. RT induced effects on breast
SW Elastography
6 months after RT 13 years after RT

21. RT induced breast subacute effects
3D US
• RT

22. RT induced breast subacute effects
3D SWE
• RT

24. Breast complicated cyst
Bidimensional US
First study 7 days after therapy

25. Breast complicated cyst
Powerdoppler
First study 7 days after therapy

26. Breast complicated cyst
SW Elastography
First study 7 days after therapy

27. Breast complicated cyst
3D US
First study 7 days after therapy

28. Breast complicated cyst
3D SWE
First study 7 days after therapy

29. Breast complicated cyst
SWE different settings
Resolution mode Penetration mode

30. Breast fibroadenomas
Bidimensional US
Almost homogeneous Inhomogeneous

31. Breast fibroadenomas
SW Elastography
Different kPa Similar elasticity ratio

32. Breast papillary carcinoma
2008
2009
2010
2009
2008
2011
2010
2011

33. Breast carcinoma – Mammography
Benign Malignant

34. Breast carcinoma – US
Bidimensional 3D

35. Breast carcinoma – SWE
Bidimensional 3D

36. Breast carcinoma – SWE
High transparence Low transparence

37. 2 more nodules in the same breast –
Bidimensional US
Nodule n. 1 Nodule n. 2

38. 2 more nodules in the same breast –
SW Elastography (both benign at histology)
Nodule n. 1 Nodule n. 2

39. Breast carcinoma – Axilla US
Bidimensional 3D

40. Breast carcinoma – Axilla SWE
Bidimensional 3D

41. Lymphnodes 2D US
B cell Lymphoma Breast cancer metastasis

42. Lymphnodes US 3D
B cell Lymphoma Breast cancer metastasis

43. Lymphnodes SWE
B cell Lymphoma Breast cancer metastasis

44. Lymphnodes in different sites in the same patient
Bidimensional US
B cell Lymphoma inguinal B cell Lymphoma ext. iliac

45. Lymphnodes in different sites in the same patient
SW Elastography
B cell Lymphoma inguinal B cell Lymphoma ext. iliac

46. Lymphnodes SWE
Different stiffness depending on histology
• B cell Lymphoma • Breast cancer metastasis
• NET metastasis

48. Aims of elastography
Correct tissue elasticity quantification
Identification of ‘cut off’ elasticity values
for the right diagnostic workup of
diffuse and focal diseases