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Objective To determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls. Methods From October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients. Results The maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p p p = 0.001). Conclusions The application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.

Physiotherapy is one of the preferred treatment options in patients with dentomaxillofacial region painful musculoskeletal problems. In initial diagnosis and posttreatment of follow-up, musculoskeletal soft tissue imaging is necessary to assess the morphologic and metabolic status of soft tissues. In recent years, elastography has gradually been used for examining musculoskeletal tissues. There are several elastography techniques in clinical practice; sonoelastography and shear-wave elastography are the most common techniques to evaluate soft tissue elasticity. However, shear-wave elastography is considered to be more objective, quantitative, and reproducible than compression sonoelastography with increasing applications to the musculoskeletal system. Musculoskeletal soft tissues have different characteristics which may affect the evaluation procedures. This chapter describes the basic features of elastography and analyzes the factors that can influence measurements of soft tissue, limitations of techniques, and provides an overview of potential clinical applications.

Ultrasound is a low-cost, quick and non-invasive imaging method, providing an excellent view of peripheral nerve anatomy as well as of surrounding structures. US provides high spatial resolution and the ability to explore long segments of nerve trunks in a single study, also allowing nerves examination in both static and dynamic conditions, during passive or active movements of the extremities. In this chapter, we describe the normal US anatomy and the scanning technique of the most relevant nerves of upper and lower limb also including dedicated anatomic schemes.

This chapter describes and illustrates a new approach of the diagnosis of the male breast, with distinction between the physiological and pathological gynecomastia, pseudo-gynecomastia, and male breast cancer. The anatomical Ultrasonography (US) scanning and interpreting using the radial and antiradial technique offers the possibility to understand the development of the lobar architecture of the male breast similar to the first stages of development of the female breast. The use of Doppler and of the sonoelastography (SE) as complementary techniques realizes a new concept of the Full Breast US (FBU), which allows a better differential diagnosis and may reduce both unnecessary biopsies and the cost of additional techniques of radiological and imaging diagnosis.

The anatomical ductal echography as a new technique of acquisition is presented with the recommended equipment characteristics and parameter adjustments. The dedicated transducers are adapted with greater longings of acoustic surface of scanning and high frequency, are provided with a water-bag device, and offer the possibility of Doppler and sonoelastography examination. The patient positioning, the modality of acquisition, and reporting data are illustrated. The role of 3D and 4D examinations related to the ductal echography is illustrated in a new vision.

The principles of sonoelastography and the most important manufacturers’ offers are presented, with the advantages and the limits of the various procedures. Elastography is presented as only another descriptor of a tissue/tumor used in FBU, a complementary tool of US, and not as a technique alone. The most important technical recommendations for good imaging acquisitions and the Ueno/Tsukuba scoring as the basis for the breast diagnosis are detailed and illustrated in the following chapter.

Benign findings are presented as they appear on FBU, with detailed aspects about the anatomical location in the DE scanning and with the imaging descriptors according to the US BI-RADS assessment in use; the diagnosis is completed by analyzing the vasculature using Doppler techniques and sonoelastography, with respect to the Ueno/Tsukuba scoring and the FLR quantitative evaluation.

Thyroid, cervical lymph nodes and parathyroid glands, for their superficial location, are well suitable to be studied with ultrasound, color Doppler and sonoelastography. Over last 30 years the ecography has well depicted the normal and pathological features of these organs. New technologies in the field of ultrasound has allowed the realization of broadband probes with high resolution/high penetration, software for the study of micro-vasculature (an imaging tool that effectively separates flow components from overlaying tissue motion preserving even the subtlest low-flow components with unmatched detail and definition) and realtime compression elastography to quantify palpation of masses with a robust numerical indicator. These tools, in the hands of experienced operators, defined the normal and pathological patterns of the neck. Ultrasound study of the neck initially are performed only by radiologist but over time increased the number of other professionals involved in this methodology (internal medicine, orthopaedic, surgery, etc.). Surgeons have a peculiarity which makes them more suitable for the execution of a neck ultrasound; they have a good knowledge of cervical anatomy that is essential to perform a proper ultrasound scan. The purpose of this chapter is to summarize these features for the practice of endocrine surgeons.

The aim of this study was to develop a tool to classify breast lesions using ultrasound elastography. Our dataset included a total of 78 patients enrolled for percutaneous biopsy of 85 breast lesions. These lesions were classified into three sonoelastographic scores, where scores of 1 and 2 were considered negative --- soft and intermediate respectively; the score 3 was considered positive --- hard. The visual classification of elastography performed by two radiologists was compared with our semi-automatic method. This classification aims to segment the red pixels found in the color elastography, quantify them and characterize the lesion by comparing the areas in red with the manually segmented lesion by the two radiologists. Our semi-automated technique had comparable performance to that of the two radiologists: sensitivity of 54.5i¾?% and specificity of 90.5i¾?%. The agreement kappa was greater than 0.8 for all observers. Thus, we concluded that the proposed method achieved a high rate of agreement between observers. In addition, the method presented high diagnostic specificity in classifying breast elastography images. By including more image features in the future, we expect our classifier can be use to standardize the classification of breast elastography.

Pancreatic cancer (PC) continues to vex and frustrate clinicians largely due to their inability to impact this sinister disease, which is often metastatic upon presentation. Endoscopic ultrasound (EUS) has rapidly cemented its role in the armamentarium of diagnostic tools available for accurate staging of PC. Initial euphoria touting EUS’ superiority in staging accuracy for EUS was soon met by the stark reality that EUS was no better than the latest cross-sectional imaging available for assessing vascular invasion. Endosonographers recommend that EUS should be performed when no detectable mass lesion is identified on CT in the face of clinical suspicion of PC. Patients and clinicians should take solace when EUS fails to detect a pancreatic mass as the likelihood of a pancreatic cancer is near zero. Contrast enhancement, sonoelastography, and confocal laser endomicroscopy represent few extensions of EUS in the ongoing quest to differentiate benign from malignant masses. The unlimited therapeutic potential of EUS is just now being realized. EUS has been used to access the bile and/or pancreatic duct to help relieve malignant biliary obstruction when ERCP has been unsuccessful or in the setting of altered anatomy. Initial reports of EUS-directed fiducial placement and/or direct intratumoral injection offer hope as a combined partner to conventional treatment for attacking and dissolving tumors. Finally, EUS-guided celiac plexus neurolysis allows ablation of the ganglion to relieve the crippling pain encountered by our patients.

Diagnosis of PD is based on medical and sexual history, physical examination and mostly imaging. US is the primary imaging modality of choice due to its easy availability, low risk and ability to image and quantify both calcified and soft tissue elements of PD. A Colour Doppler Penile Ultrasound study is necessary to evaluate vascular status of penile arteries for better surgical choice. Mammography technique and CT are able to detect calcifications of Peyronie’s plaques and to determine the degree of plaque calcification. Non-calcified plaques, however, cannot be shown accurately. MRI is at least as sensitive as ultrasonography to determine the extent of plaque formation and to assess whether the corpora cavernosa and the penile septum are involved. Nevertheless, MRI is an expensive imaging modality and is not commonly used in our clinical practice to evaluate patients with PD. Penile sonoelastography can be a valuable diagnostic tool but needs further clinical studies.

The validation of elastographic methods benefits from the use of properly calibrated physical phantoms. In this work, the results of the characterization of gelatin phantoms using crawling Wave Sonoelastography (CWS) are presented. Phantoms with different gelatin concentrations were prepared, and the elastic modulus was estimated using CWS at several frequencies between 80 and 340 Hz and temperatures between 12 and 20 degrees Celsius. It was found that the average elastic modulus from a single phantom ranged between 50 and 140 KPa depending on the gelatin concentration, vibration frequency and temperature. The results suggest that reproducible results in terms of elastic behavior can be obtained when following the procedure for phantom manufacturing. Further, the estimated elatic moduli were consistent with the theory of viscoelastic materials, specifically in terms of the relationship of the Young’s modulus with the concentration of gelation and the temperature of the phantom.

Sonoelastography (SE) is a new technique that can assess differences in tissue stiffness. This study investigated the performance of SE for the differentiation of supraspinatus (SSP) tendon alterations of tendinopathy compared to magnetic resonance imaging (MRI) and conventional ultrasonography (US).One hundred and eighteen consecutively registered patients with symptoms and MRI findings of SSP tendinopathy were assessed with US and SE. Coronal images of the SSP tendon were obtained using US and SE. Increased signal intensity on T2-weighted images in the coronal planes were graded according to the extent of the signal changes from ventral to dorsal. SE images were evaluated by reviewers using an experimentally proven color grading system.Using SE, 7.6 % of the SSP tendons were categorized as grade 0, 30.5 % as grade 1, 19.5 % as grade 2, and 42.4 % as grade 3. Evaluation of the interobserver reliability of the SE findings showed "almost perfect agreement", with a weighted kappa coefficient of 0.83. By comparing the MRI findings with the SE findings, grades of MRI and SE had a positive correlation (r = 0.829, p = 0.001). Furthermore, grades of US and SE also had a positive correlation (r = 0.723, p = 0.001).SE is valuable in the detection of the intratendinous and peritendinous alterations of the SSP tendon and has excellent interobserver reliability and excellent correlation with MRI findings and conventional ultrasonography findings.La sonoelastografia (SE) è una nuova tecnica in grado di valutare le differenze di rigidità dei tessuti. Questo studio ha valutato le capacità della SE nella differenziazione delle alterazioni tendinee da tendinopatia del sovraspinato (SSP) rispetto a risonanza magnetica (MRI) ed ecografia convenzionale (US).Centoventuno pazienti con sintomi e reperti MRI di tendinopatia del SSP sono stati valutati con US e SE. Si sono realizzate immagini coronali del tendine SSP utilizzando US e SE. Sono state valutate immagini T2-pesate, per la maggiore intensità del segnale, nei piani coronali, da ventrale a dorsale. Immagini di SE sono state valutate da revisori che utilizzavano un sistema di grading di colore sperimentale.Utilizzando la SE, 7,4 % dei tendini SSP sono stati classificati come di grado 0, 29,8 % di grado 1, 19,8 % di grado 2, e 43,0 % di grado 3. La valutazione inter-osservatori dei risultati SE ha mostrato “accordo quasi perfetto”, con un coefficiente kappa pesato di 0,83. Confrontando i risultati della risonanza magnetica con i risultati della SE, risonanza magnetica e SE hanno avuto una correlazione positiva (r = 0,849, p = 0.001). Inoltre, anche US e SE hanno avuto una correlazione positiva (r = 0,706, p = 0,001).La SE è valida nella rilevazione delle alterazioni intra-tendinee e peri-tendinee del tendine SSP e ha un’ottima affidabilità inter-osservatori e un’eccellente correlazione con RM e reperti di ecografia convenzionale.

With the patient in a comfortable position, the US exam should be started with the evaluation of the muscle at rest. Then the examiner continues the US exam with the first dynamic manoeuvre: the direct compression of the muscle with the probe helps to assess muscle thickness and also the elastic properties of the muscle fibres under compression. Further, in case of injury the compression could be helpful to squeeze muscular bundles and evaluate post-traumatic intramuscular fluid collection or subfascial haematoma, properly defining its content and extent.