Transient elastography of calcaneal tendon: preliminary results and future prospects

Purpose

To evaluate transient ShearWave elastography of the normal Achilles’ tendon.

Patients and methods

The Achilles’ tendon of 30 normal subjects were prospectively assessed using a Rubi V1Sq prototype (Supersonic Imagine). Quantitative elastography maps displayed in kilopascals with a scale of 0 to 600 kPa were generated from transverse and longitudinal images at 3 different levels of plantar flexion. Subgroups were compared and analyzed based on proven or suspected variation factors (age, gender, level of physical activity).

Results

On sagittal images, mean elasticity was 104 ± 46 kPa during extension, 464 ± 144 kPa in neutral position and 410 ± 196 kPa during maximum dorsiflexion. There was significant increase in elasticity when the Achilles’ tendon was maximally stretched (p < 0.01). The intra-individual correlation between right and left tendons during ankle extension was good (Pearson Coefficient 0.8; p < 0.01). Finally, physically active subjects showed significantly greater elasticity than non-active subjects (p < 0.05).

Conclusion

Transient ShearWave elastography of the Achilles’ tendon is a simple technique that provides real-time information about tissue elasticity.     

Sonoelastography versus dynamic magnetic resonance imaging in evaluating BI-RADS III and IV breast masses

Background

Several clinical studies showed that sonoelastography was useful for the differentiation of benign and malignant breast lesions. Contrast-enhanced MRI has emerged as a promising tool in the detection, diagnosis, and staging of breast cancer.

Aim of work

To study the role of sonoelastography versus dynamic MRI in evaluating BI-RADS III, IV breast masses and detect which modality is of better sensitivity and specificity trying to guide the patient either to follow-up the lesion or proceed to lesion excision.

Subjects and methods

The study included 50 Egyptian patients (age ranged from 32 to 58 years) who presented by breast masses and categorized as BI-RADS III, IV by mammography and ultrasound. Sonoelastography and dynamic MRI were done for all the patients.

Results

Differentiation between BI-RADS III and IV by US elastography had 84% sensitivity and 84% specificity and by MRI had 88% sensitivity and 80% specificity.

Conclusion

Regarding the sonoelastography, it is an easy and cheap modality. The elasticity score is an important parameter for lesion characterization. Combination of morphologic and dynamic MRI studies is very important for the breast lesion evaluation. MRI is more sensitive but less specific than sonoelastography. Finally if we find any suspicious character elicited by either sonoelastography or MRI (BI-RADS IV), lesion excision is recommended.     

Speckle reduction approach for breast ultrasound image and its application to breast cancer diagnosis

Objectives

To retrospectively evaluate the effects of a speckle reduction algorithm on radiologists’ diagnosis of malignant and benign breast lesions on ultrasound (US) images.

Methods

Using a database of 603 breast (US) images of 211 cases (109 benign lesions and 102 malignant ones), the original and speckle-reduced images were assessed by five radiologists and final assessment categories were assigned to indicate the probability of malignancy according to BI-RADS-US. The diagnostic sensitivity and specificity were investigated by the areas (Az) under the receiver operating characteristic (ROC) curves.

Results

The sensitivity and specificity of breast lesions on Ultrasound images improved from 88.7% to 94.3%, from 68.6% to 75.2%, respectively, and the area (Az) under ROC curve of diagnosis also increased from 0.843 to 0.939, Z = 4.969, there were significant differences in the Az between the original breast lesions and speckle-reduced ones on Ultrasound images (P < 0.001). The diagnostic accuracy of breast lesions had been highly improved from 78.67% to 92.73% after employing this algorithm.

Conclusions

The results demonstrate the promising performance of the proposed speckle reduction algorithm in distinguishing malignant from benign breast lesions which will be useful for breast cancer diagnosis.     

Virtual colonoscopy in paediatric patients: Usefulness of a colon dissection technique

Objective

To determine the usefulness of perspective-filet view for polypoid lesions in paediatric patients in comparison with conventional virtual colonoscopy (VC) analysis and optical colonoscopy.

Methods

Sixty-one patients (mean age 5 years old) with a previous episode of rectal bleeding were studied using a 16 slices CT scanner. All patients underwent a colonic preparation. Two acquisitions were done in supine and prone positions with slices of 2 mm thickness; increment 1 mm, 30-50 mA; 90-120 kV. In a workstation an experienced radiologist reviewed images twice. The first read was done using the conventional virtual colonoscopy technique with the evaluation of two-dimensional (2D), three-dimensional (3D) and endoscopical images. Later, in a second session, perspective-filet view was used. It shows a 360° unrolled visualization of the inner colon. The presence, size and location of the lesions were determined. A record of the reading time was made.

Results

At per patient evaluation the conventional virtual colonoscopy analysis obtained a sensitivity of 86% and a specificity of 98%. The perspective-filet view obtained a sensitivity of 91% and a specificity of 99%. In the evaluation on a per lesion basis the conventional analysis had a sensitivity of 81% and a specificity of 88%. Perspective-filet view, had a sensitivity of 82% and specificity of 90%. The average total reading time using conventional colonoscopy technique was 18 ± 3 min, versus 4 ± 1 min using the perspective-filet view.

Conclusion

Virtual colon dissection with perspective-filet view is more time-efficient than conventional virtual colonoscopy evaluation with correct correlation in results.     

Evaluation of contrast-enhanced digital mammography

Purpose

The goal of this prospective study was to evaluate the possible diagnostic benefits of contrast-enhanced digital mammography (CEDM) over conventional mammography.

Materials and methods

Our analysis included data from 70 patients with a total of 80 lesions (30 malignant and 50 benign). A series of contrast-enhanced images was acquired from each patient using a modified imaging system (GE Senographe 2000D with copper filter) suitable for displaying iodine contrast medium. After the mask image had been taken, the contrast medium was administered using a dosage of 1 ml/kg body weight at a rate of 4 ml/s. Three contrast-enhanced images in the cranio-caudal projection plane were then captured at intervals of 60 s. The mask image was logarithmically subtracted from the contrast-enhanced images. We performed a ROC analysis of diagnostic quality with three readers.

Results

On average, 5.66 more malignant lesions were detected with the addition of digital dynamic contrast mammography versus conventional mammography alone. The sensitivity was increased from an average of 0.43 in conventional mammography to an average of 0.62 with contrast mammography. Even in dense breast parenchyma, the sensitivity increased from an average of 0.35-0.59.In the multi-reader-ROC analyses of all readers, the differences in the AUC with p = 0.02 (BI-RADS) proved statistically significant in all cases. The Wilcoxon test showed that Readers I and II primarily used the CEDM to upgrade enhancing lesions to a higher BI-RADS category or a higher probability of malignancy. These two readers benefited most from the CEDM in the ROC analysis.

Conclusion

Overall, we conclude that the addition of dynamic digital subtraction mammography to conventional mammography can significantly improve diagnostic quality. The increased sensitivity is particularly pronounced in the case of dense breast tissue.     

Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours

Purpose

This study was undertaken to evaluate the value of quantitative elastography in the diagnosis of breast tumours.

Materials and methods

Conventional ultrasound (US) and quantitative elastography were performed in 108 women with 114 breast lesions by two experienced radiologists, and pathological results were available in all cases. For each lesion, the maximum, mean, and minimum (min) elasticity and elasticity ratio between lesions and surrounding tissue were measured. The Breast Imaging Reporting and Data System (BI-RADS) categories were assessed with conventional US in all lesions.

Results

Malignant lesions exhibited significantly higher maximum and mean elasticity (111.57±69.29 kPa and 54.49±33.70 kPa) than did benign lesions (59.00±45.3 kPa and 36.64±26.18 kPa) (p<0.01). For maximum elasticity versus BI-RADS, performance results were sensitivity 60.9 % vs. 78.3%, specificity 85.3% vs. 98.5%, positive predictive value (PPV) 73.7% vs. 97.3 %, negative predictive value (NPV) 76.3% vs. 87.0 % and accuracy 75.4% vs. 90.3%. BI-RADS had significantly better accuracy than maximum elasticity (p<0.01). Maximum and mean elasticity of invasive ductal carcinoma (IDC) were significantly higher than those of fibroadenoma (p<0.01), whereas the difference was not statistically significant with fibroadenosis, papilloma and inflammation (p>0.01). Maximum and mean elasticity and elasticity ratio of BI-RADS 5 were all significantly higher than those of BI-RADS 3 (p<0.01). Reliability for maximum and mean elasticity were almost perfect [intraclass correlation coefficients (ICC)=0.87 and 0.79].

Conclusions

Shear-wave elastography gives quantitative elasticity information that could potentially help in breast-lesion characterisation, although it cannot replace conventional BI-RADS in the differentiation of breast lesions.     

Qualitative pattern classification of shear wave elastography for breast masses: How it correlates to quantitative measurements

Objective

To determine the correlation of qualitative shear wave elastography (SWE) pattern classification to quantitative SWE measurements and whether it is representative of quantitative SWE values with similar performances.

Methods

From October 2012 to January 2013, 267 breast masses of 236 women (mean age: 45.12 ± 10.54 years, range: 21–88 years) who had undergone ultrasonography (US), SWE, and subsequent biopsy were included. US BI-RADS final assessment and qualitative and quantitative SWE measurements were recorded. Correlation between pattern classification and mean elasticity, maximum elasticity, elasticity ratio and standard deviation were evaluated. Diagnostic performances of grayscale US, SWE parameters, and US combined to SWE values were calculated and compared.

Results

Of the 267 breast masses, 208 (77.9%) were benign and 59 (22.1%) were malignant. Pattern classifications significantly correlated with all quantitative SWE measurements, showing highest correlation with maximum elasticity, r = 0.721 (P < 0.001). Sensitivity was significantly decreased in US combined to SWE measurements to grayscale US: 69.5–89.8% to 100.0%, while specificity was significantly improved: 62.5–81.7% to 13.9% (P < 0.001). Area under the ROC curve (A_z) did not show significant differences between grayscale US to US combined to SWE (P > 0.05).

Conclusion

Pattern classification shows high correlation to maximum stiffness and may be representative of quantitative SWE values. When combined to grayscale US, SWE improves specificity of US.     

Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US

Objectives

To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI).

Materials and methods

Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher’ exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated.

Results

Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p < 0.001). Agreement between both techniques was low (k = 0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes.

Conclusions

Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign.     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

Role of sonographic elastography in the differential diagnosis of papillary lesions in breast

Purpose

The purpose of this study was to compare the diagnostic performance of elastography, conventional ultrasonography (US) and combined conventional US and elastography for differentiation of papillary breast lesions.

Materials and methods

A total of 95 papillary lesions (69 benign, 20 atypical and 6 malignant) in 87 patients were examined with conventional US and elastography. We evaluated conventional US images according to the Breast Imaging Reporting and Data System and internal composition (solid vs. cystic) and elastographic images according to elasticity scores. We compared diagnostic performances of elastography, conventional US and the combined method.

Results

Areas under the receiver-operating curve were 0.794 for elastography, 0.875 for conventional US and 0.787 for the combined method. When the elasticity score cutoff was between 2 and 3, the sensitivity, specificity, positive predictive value and negative predictive value were 100, 55.1, 13 and 100?%, respectively. The combined method showed similar sensitivity (100 vs. 100?%) to and higher specificity (57.3 vs. 5.6?%) than conventional US alone. No significant difference was found in the elasticity scores of cystic papillary lesions according to pathology.

Conclusion

Elastography improved the specificity of conventional US in differentiating between benign or atypical and malignant papillary breast lesions when it was combined with conventional US.     

Analysis of 107 breast lesions with automated 3D ultrasound and comparison with mammography and manual ultrasound

Objectives

Our aim was to investigate the diagnostic potential of an automated ultrasound (US) breast scanner prototype and compare it with manual US and mammography.

Methods

Ninety-seven patients with a total of 107 breast lesions had mammograms, manual US and an automated breast US scan. Multiplanar reconstructions in coronal, axial and the sagittal view were reconstructed from the automated dataset and visualized. After biopsy, all lesions were confirmed histologically. The data were evaluated according to the BIRADS (Breast Imaging Reporting and Data System) classification. The sensitivity and specificity were analyzed.

Results

The BIRADS criterion “margin” was significantly related to the overall BIRADS classification, independently of the US method being used. The sensitivity of mammography was significantly lower than of each US method (Fisher's exact test with p < 0.05). There were no significant differences between the US methods.

Conclusions

The reconstructed third (axial) image plane of the whole breast, which corresponds to a craniocaudal mammogram, can give additional information about both, site and differential diagnosis of a lesion. Although image quality was sufficient, automated US is not good enough to replace manual US at this time.     

Comparison of 5-megapixel cathode ray tube monitors and 5-megapixel liquid crystal monitors for soft-copy reading in full-field digital mammography

Purpose

To retrospectively compare the image quality, lesion detection, and the diagnostic efficacy of 5-megapixel (MP) cathode ray tube monitors (CRTs) and 5-MP liquid crystal display monitors (LCDs) for soft-copy reading in full-field digital mammography (FFDM).

Materials and methods

Informed consent was waived by the Institutional Review Board for the data analysis. A total of 220 cases were compared with two 5-MP (2048 × 2560 pixels) CRTs and two 5-MP (2048 × 2560 pixels) LCDs. Nine aspects of image quality (brightness, contrast, sharpness, noise, skin, fat, retromamillary space, glandular tissue, and detection of calcifications) were evaluated. In addition, the detection of breast lesions (mass, calcifications) and diagnostic efficacy, based on the BI-RADS classification, were correlated with histologic results (n = 70) and follow-up (n = 150).

Results

Each aspect of the image quality was rated significantly better for 5-MP LCDs (p < 0.05) compared to the 5-MP CRTs. With 5-MP CRTs, 31 masses and 119 calcifications were detected, compared to 30 and 121 with 5-MP LCDs. The differences in diagnostic efficacy between 5-MP CRTs and 5-MP LCDs were not significant (p = 0.157) although 5-MP CRTs yielded two false-negative results. Both lesions were rated BI-RADS 3 with 5-MP CRTs. Both were invasive carcinomas at histology. The sensitivity, specificity, positive and negative predictive values, and accuracy were 0.966, 0.975, 0.933, 0.988, and 0.973 for 5-MP CRTs, compared to 1.0, 0.963, 0.903, 1.0, 0.973 for 5-MP LCDs.

Conclusion

The image quality of 5-MP LCDs is significantly better than that of 5-MP CRTs for soft-copy reading in FFDM, based on histologic and follow-up correlation. However, lesion detection and diagnostic efficacy are comparable to 5-MP CRTs. The interpretation of the false-negative results suggests that the characterization of breast lesions with FFDM is not defined solely by the monitors, but is strongly influenced by the radiologist.     

Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: A meta-analysis

Background and purpose

Bladder cancer is the most commonly diagnosed malignancy in patients presenting with haematuria. Early detection is crucial for improving patient prognosis. We therefore performed a meta-analysis to evaluate and compare the detection validity (sensitivity and specificity) of virtual cystoscopy (VC) and ultrasonography (US).

Methods

We searched MEDLINE, EMBASE, PubMed and the Cochrane Library for studies evaluating diagnosis validity of VC and US between January 1966 and December 2009. Meta-analysis methods were used to pool sensitivity and specificity and to construct a summary receiver-operating characteristic (SROC) curve.

Results

A total of 26 studies that included 3084 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for bladder cancer detection using CT virtual cystoscopy (CTVC), MR virtual cystoscopy (MRVC) and US was 0.939 (95% CI, 0.919-0.956), 0.908 (95% CI, 0.827-0.959) and 0.779 (95% CI, 0.744-0.812), respectively. The pooled specificity for bladder cancer detection using CTVC, MRVC and US was 0.981 (95% CI, 0.973-0.988), 0.948 (95% CI, 0.884-0.983) and 0.962 (95% CI, 0.953-0.969), respectively. The pooled diagnostic odd ratio (DOR) estimate for CTVC (604.22) were significantly higher than for MRVC (144.35, P < 0.001) and US (72.472, P < 0.001).

Conclusion

Our results showed that both CTVC and MRVC are better imaging methods for diagnosing bladder cancer than US. CTVC has higher diagnostic value (sensitivity, specificity and DOR) for the detection of bladder cancer than either MRCT or US.     

Diffusion-weighted imaging of breast tumors: Differentiation of benign and malignant tumors

Objective

The aim of this study was to evaluate the role of diffusion-weighted images (DWI) in the differentiation between benign and malignant breast tumors.

Patients and methods

This study included 62 females with focal breast lesions according to mammography or sonomamography. All patients underwent dynamic contrast enhanced MRI (DCE-MRI), and DWI of the breast. The mean apparent diffusion coefficient (ADC) values were calculated for all lesions and were correlated with the final histopathological results. The sensitivity and specificity of DWI in the differentiation between benign and malignant breast tumors were calculated.

Results

Seventy-eight lesions were detected in the examined 62 patients included in this study. Fifty one lesions were benign and 27 lesions were malignant according to the final histopathological results. (25/27) lesions were correctly diagnosed by ADC as malignant lesions with mean ADC value (0.92 ± 0.23 × 10⁻³ mm²/s) which was significantly lower than the mean ADC value for benign tumors (1.46 ± 0.48 × 10⁻³ mm²/s) and was correctly diagnosed in (50/51) lesions. The sensitivity and specificity of DWI in the differentiation between benign and malignant breast tumors were 92.6% and 98%, respectively.

Conclusion

DWI offers a useful method for differentiation of benign and malignant breast lesions with high sensitivity and specificity. Being a short unenhanced scan DWI can be safely added to the standard breast MRI protocol.     

Real-time ultrasound elastography: Does it improve B-mode ultrasound characterization of solid breast lesions?

Introduction

Elastography is a non-invasive medical imaging technique that detects tumors based on their stiffness (elasticity). Strain images display the relative stiffness of lesions compared with the stiffness of surrounding tissue as cancerous tumors tend to be many times stiffer than the normal tissue, which “gives” under compression. An image in which different degrees of stiffness show as different shades of light and dark is called an elastogram.

Purpose

To prospectively evaluate the sensitivity and specificity of the real-time sonoelastography as compared with B-mode US for distinguishing between benign and malignant solid breast masses. The density of the glandular breast tissue was taken in consideration in addition to the Breast Imaging Reporting and Data System (BI-RADS) categories of the lesions, with biopsy results as the reference standard.

Methods

A total of 216 candidate solid lesions (123 benign and 93 malignant) in 188 patients were examined with 2-dimensional ultrasonography, elastosonography and mammography (for 147 patients). The lesions were classified according to the density of the glandular breast tissue into low density group (D1) and a high density group (D2) and were categorized with the BIRADS score. Elastographic images were assigned an elasticity score of 1 to 5 (1–3, benign; 4 and 5, malignant) according to the Multi-Center Team of Study and the strain ratios of the lesions were measured. Concordance between the imaging findings and histopathologic results was documented. Statistical analysis was performed and sensitivity, specificity and positive and negative predictive values for both elastography and conventional sonography were calculated.

Results

Elastography showed less sensitivity but higher specificity than conventional sonography in the differentiation of benign from malignant solid lesions: B-mode sonography had sensitivity of 85.1%, specificity of 93.9%, a positive predictive value of 92.5% and a negative predictive value of 87.8%, compared with the sensitivity of 80.1%, specificity of 97.1%, a positive predictive value of 96.8% and a negative predictive value of 82.1% for elastography. Elastography was superior to B-mode US in diagnosing solid lesions in the low density group (D1) (96.6% vs. 92.4% specificity) and less in the dense glandular tissue (97.8% vs. 95.9% specificity).

Conclusions

Real-time sonoelastography is an useful technique for the characterization of benign and malignant solid lesions as it increases the diagnostic specificity comparable to B-mode ultrasound, particularly in both ACR 1 and 2, thus reducing the false-positive rate.     

Characterisation of indeterminate focal breast lesions on grey-scale ultrasound: role of ultrasound elastography

Purpose

This study was undertaken to evaluate the role of ultrasound (US) elastography in characterising focal breast lesions classified as indeterminate on B-mode US.

Materials and methods

Eighty-four focal breast lesions, 64 benign and 20 malignant (mean diameter, 15.1 mm), detected but not characterised on B-mode US in 72 women, Breast Imaging Reporting and Data System (BI-RADS) US category 3 (n=56) or category 4 (n=28), were studied with US elastography and classified in consensus by two radiologists according to a five-point colour scale. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of US elastography compared with conventional US were calculated in relation to microhistology (n=67) and cytology (n=17), which were used as the reference standard.

Results

A total of 65/84 (77.4%) lesions were correctly classified as benign or malignant using US elastography, whereas the remaining 19/84 (22.6%) were incorrectly assessed. There were no statistically significant differences between US elastography and B-mode US with regard to sensitivity (70% vs. 68.4%), specificity (79.6% vs. 78.5%), PPV (51.8% vs. 48.1%) and NPV 89% vs. 89.5% (p>0.5). By contrast, a statistically significant difference was noted in the evaluation of BI-RADS 3 lesions, in which US elastography had 50% sensitivity, 86% specificity, 30% PPV and 93.5% NPV compared with BI-RADS 4 lesions (78.6%, 57.1%, 64.7% and 72.7%) (p<0.5).

Conclusions

The high NPV of US elastography may help reduce the use of biopsy in BI-RADS 3 lesions, but its low PPV in BI-RADS 4 lesions does not allow avoidance of biopsy on the basis of the US elastographic score alone in this group of lesions.     

First clinical use of a standardized three-dimensional ultrasound for breast imaging

Objectives

The feasibility, image quality, and diagnostic potential of the prototype of an automated ultrasound (US) breast scanner were examined.

Methods

Ninety-seven patients with suspicious breast lesions had mammograms, manual US, and an automated breast US. The data were evaluated according to the breast imaging reporting and data system (BIRADS) classification, image quality, and amount to diagnostic information. All lesions were confirmed histological.

Results

The image quality of the three-dimensional (3D) data sets was equal to or satisfactory compared with cross-sectional images from manual US in at least 72% of cases (p < 0.05). The diagnostic information was equal or superior in at least 63% of cases (p < 0.05).

Conclusions

Standardized 3D US scanning is a promising diagnostic adjunct to mammography, but is no substitute for manual US at the current stage of development.     

Could ultrasonic elastography help the diagnosis of small (≤2 cm) breast cancer with the usage of sonographic BI-RADS classification?

Objectives

To evaluate the additive value of ultrasound strain elastography (USE) to BI-RADS for the differentiation of benign and malignant breast small lesions.

Methods

Breast masses (≤2 cm) with histological diagnosis examined by ultrasonography and USE in our department from April 2004 to December 2009 were reviewed. Conventional B-mode ultrasound findings were classified according to the BI-RADS classification. USE findings were classified according to the 5-point scale. Histological diagnosis was used as the reference standard.

Results

401 (246 benign (61.3%), 155 malignant (38.7%)) from 370 consecutive patients were included in the study. Sensitivity and specificity were 90.3%, 68.3% for BI-RADS; 72.3%, 91.9% for USE. The sensitivity of BI-RADS was better than that of USE (P < 0.05), while the specificity of USE was better than that of BI-RADS (P < 0.05). A revised BI-RADS combined with USE results was proposed in this study. Sensitivity and specificity were 83.9% and 87.8% for revised BI-RADS. The diagnostic performance of revised BI-RADS was better than BI-RADS (P < 0.05).

Conclusions

USE could give BI-RADS some help in the differentiation of benign and malignant breast small lesions. The addition of elastography to BI-RADS could improve the diagnostic performance in <2 cm lesions.     

Role of combined grey scale US and US tissue elastography in differentiating solid thyroid nodules

Background

Ultrasonographic (US) examination is an accurate method for detecting thyroid nodules, but its use in differentiating between benign and malignant thyroid nodules is relatively low. US elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions thus deviating a significant group of patients from unnecessary FNAB.

Objectives

The aim of the study is to evaluate the validity of combined grey scale US and tissue elastography in differentiating benign form malignant solid thyroid nodules.

Methods

The study included 46 selected patients with solid thyroid nodules according to our inclusion and exclusion criteria. The patients underwent surgery for compressive symptoms or suspicion of malignancy on FNA cytology. US features and tissue elastography were scored according to the Rago criteria (1).

Results

On US elastography: all the 31 cases with a final diagnosis of benign nodule had a score of 1–3, while 14 of 15 (94.1%) with a final diagnosis of carcinoma had a score of 4–5, with a sensitivity of 93.3%, a specificity of 100% and an accuracy of 97.8%. Combined US and elastography reveals that hypoechogenicity/score 4–5 was most predictive of malignancy with sensitivity 80% and specificity 100%; and accuracy 93.4%.

Conclusions

US elastography seems to have great potential as a new tool for differentiating solid thyroid nodules and for recommending FNAC. Combined grey scale US features and US elastography added no significant value when compared with US elastography alone. Further prospective studies are needed.     

Diagnostic performance of sonoelastographic Tsukuba score and strain ratio in evaluation of breast masses

The aim of this prospective study was to evaluate the diagnostic performance of the use of strain index ratio by sonoelastography to differentiate between benign and malignant breast lesions.