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Alterations in neck anatomy after thyroid surgery and post-operative fibrosis may be misleading by causing sonoelastographic changes in recurrent tissues in patients with recurrent nodular goiter and so may result in unnecessary biopsies or surgical procedures. Here, the aim was to examine thyroid sonoelastography values in patients developing a recurrence and presenting with recurrent nodular goiter with benign cytology after total or near-total thyroidectomy (T/N-TT). Twenty-nine nodules from 22 patients with a recurrence after T/N-TT whose biopsies were found to be benign constituted the patients, and 23 nodules from 23 participants among the non-operated patients having solitary or multiple thyroid nodules and with age, gender and body mass index values similar to those of the patients constituted our controls. Shear-wave velocity (SWV) values were measured. Average elapsed time after T/N-TT was 11.82 (4:25) y. No difference was detected between the groups in terms of localization and sonographic structures of the nodules. Nodule SWV values were higher in the operated recurrent nodular goiter group than in the controls (2.93 ± 0.87 m/s vs. 2.43 ± 0.33 m/s, respectively, p = 0.011). Because SWV values are high in operated recurrent nodular goiter patients, the utilization of reference sonoelastography values in those with unoperated goiter may yield misleading results in the differentiation of benign and malignant lesions.

Introduction:Fibroepithelial lesions are the most common benign lesions of the breast. When detected by mammography and ultrasonography (USG), the limitations of these examinations and the goal of diagnosing malignant lesions at an early stage may lead to off-label biopsies. Unnecessary biopsy procedures can be avoided by developing additional reliable methods to complement existing diagnostic procedures. For more accurate characterization of breast lesions, US elastography is used, which gives information about elasticity and deformability of the tissue. In our study, we aimed to determine the contribution of elastography to the diagnosis in the evaluation of fibroepithelial lesions of the breast with USG and to determine the relationship between strain index (SI) values and pathological subgroups.Methods:Our study included 160 lesions in 105 patients who were diagnosed with pathologically proven fibroepithelial lesion in the Radiology Clinic of İstanbul Training and Research Hospital between September 2013 and November 2014, or who were followed up for at least two years with no pathology and whose radiological appearance was interpreted in favor of fibroadenoma (FA). Voluntary consent form and ethics committee approval for the study were obtained from the patients. USG examinations were performed with a 13-18 MHz linear high resolution volumetric probe. Considering the color map obtained in the elastography evaluation, different measurements were made from the hardest areas in the mass.Results:In the sonoelastographic evaluation of fibroepithelial lesions, the median mean SI value was calculated as 3.30 (between: 0.35 and 28.80). The SI value was found to be higher in complex FAs than in other subgroups. It was observed that the mean size decreased as the age group got older. A statistically significant positive correlation was found between elastography stiffness index and size (p

Properly diagnosed benign ovarian formations are a condition for appropriate treatment choice. Qualitative assessment of signs detected by multiparametric ultrasound, including compression elastography, is highly effective in the differential diagnosis of benign ovarian formations. Our study became especially relevant for women in the reproductive period since the correct diagnosis influenced the choice of surgical treatment in order to preserve the ovarian reserve. The detailed sonographic aspect of these formations in B-mode, Doppler mode and compression sonoelastography mode is analyzed in the article. Color Flow Mapping, power Doppler and pulsed wave Doppler were used to study blood vessels. Pulsed wave Doppler characterized blood flow quantitatively. Color Flow Mapping was used to determine vessels localization, and power Doppler was used to provide a detailed qualitative assessment of blood flow loci. Elastotype according to the Ueno scale as a qualitative feature and Strain Ratio (coefficient of deformation) as a quantitative indicator were determined for all types of benign ovarian formations. Serous and mucinous cystadenomas were found to belong to elastotypes 0 and I according to the Ueno scale, the papillary component of serous superficial papillomas was mapped as elastotype I and II, fibroids predominantly belonged to elastotype II and III, mature teratoma appertained to elastotypes IV and V. Quantitative coefficient of deformation for all benign ovarian formations ranged from 0.63 to 24.9. According to our results, ultrasound examination of ovarian formations is an accurate and highly informative method for stratification of risks in accordance with the O-RADS classification.

Introduction: Pheochromocytoma are tumors arising from the chromaffin tissue located in the adrenal medulla, associated with typical symptoms and signs. Case Presentation: Occasionally, metastasis, defined as the presence of tumor cells at sites other than the original site, secondary to pheochromocytoma have been reported. Pelvic metastatic malignant pheochromocytoma has rarely been reported in English literature. Conclusion: Here, we have reported a very rare case of pelvic metastatic malignant pheochromocytoma, with a particular focus on sonoelastographic features.

The diversity of the clinical picture and the asymptomatic nature of the clinical manifestations of myometrial pathology cause difficulties in diagnosis. There is a lack of reliable diagnostic criteria for this pathology, in particular, imaging, especially with the simultaneous combination of adenomyosis and leiomyoma. The aim of the research. Determination of the possibility of compression sonoelastography in the diagnosis of myometrial pathology and determination of its sonoelastography characteristics in leiomyoma and adenomyosis, as well as comparison of sonoelastography results with histological data. Materials and methods. Elastography images of 155 patients with adenomyosis and leiomyoma, as well as combined pathology, were analyzed, the elastography diagnosis of which was confirmed by histological examination. Results. Leiomyoma and adenomyosis had different elastography characteristics (strain ratios) with different color mapping; their specific characteristics and main differences are determined. Based on sonoelastography, the majority of patients (n=30) were suspected of having uterine fibroids, 14 had adenomyosis, and 42 had adenomyosis and fibroids. Sonoelastography revealed histological signs of adenomyosis in 3 patients with uterine leiomyoma. Conclusions. Ultrasound examination using compression sonoelastography in such pathological conditions of the myometrium as adenomyosis and leiomyoma, as well as unchanged myometrium, makes it possible to determine changes in the degree of elasticity of the myometrium in the corresponding pathology. Sonoelastography allows the identification of clear distinguishing features of fibroids and adenomyosis. The unchanged myometrium has a certain elasticity, which can be equated to a specific numerical value – the coefficient of deformation. This indicator has different meanings in myoma and adenomyosis, which makes it possible to differentiate these pathological conditions of the myometrium. Compression sonoelastography is able to identify clear distinguishing features of leiomyoma and adenomyosis, and consistency of diagnoses based on sonoelastography and histology is significant but not optimal.

Background/Aim: Hepatic fibrosis is caused by excessive accumulation of collagen-containing extracellular matrix proteins in chronic liver diseases. The gold standard for determining the degree of liver fibrosis is liver biopsy, which is an invasive method with complication risks. This study aimed to evaluate the potential role of ultrasound elastography, a non-invasive method, in the assessment of hepatic fibrosis among pediatric patients. Methods: Twenty-four pediatric (0-18 years) patients with chronic liver disease and suspected hepatic fibrosis were included in this study. All patients were evaluated with B-mode and sonoelastography using Hitachi EUB 7500 digital ultrasound equipment. The biopsy procedure was performed on all patients a week after sonoelastography. Elastographic scores of liver parenchyma were categorized into four main groups, nonfibrotic, mild, moderate, and severe fibrosis. Strain index values were calculated. The elastographic scores and mean strain index values of the liver parenchyma were correlated with their pathological diagnosis. Results: Elastographic scores and strain index values were significant for the presence of hepatic fibrosis (P=0.001 and P=0.006 respectively). Elastography has 100% sensitivity and 83.3% specificity to distinguish hepatic fibrosis when the cut-off value of strain index is 1.03. Conclusion: Our findings support that real-time elastography is a non-invasive method for the diagnosis and staging of hepatic fibrosis with the potential to prevent recurrent biopsy and complications.

Background The aim of this study was to verify the findings of color-coded sonoelastography in Achilles tendon disorders against ultrasonographic and MR imaging findings, describing the elastographic patterns and correlating their diagnostic ability to magnetic resonance imaging (MRI) as a gold standard. Results Our study showed that sonoelastography appeared to be highly sensitive to ultrasonographically detected changes, with 100% sensitivity, 16.6% specificity, 73% positive predictive value, and 100% negative predictive value, making it a good negative test to exclude suspected tendinopathy in equivocal cases. MRI examination was used as a gold standard. Elastographic grades showed moderate agreement to those of MRI (κ = 0.44, p < 0.001), while elastography had overall sensitivity of 87.5%, 100% specificity, and 90% accuracy in differentiating normal and pathological tendons. Conclusion We concluded that sonoelastography is a sensitive method in the diagnosis of Achilles tendon pathologies detected by ultrasound examination and it can be well correlated to MRI with high specificity for pathological tendons.

Cervical lymphadenopathy is a common clinical entity with varied causes. The current study aims to evaluate the diagnostic performance of sonography, sonoelastography, and their combination for differentiation between benign and malignant causes of cervical lymphadenopathy. After approval of study protocol by the hospital review board and written informed consent, 70 neck nodes in 70 patients were evaluated with grayscale ultrasound and color Doppler followed by ultrasound strain elastography (USE). The final diagnosis was based on ultrasound-guided fine-needle aspiration cytology (FNAC)/histopathological examination (HPE). Various ultrasound features observed were nodal size, shape, presence of echogenic hilum, intranodal necrosis, and pattern of vascularity. Score was given for each feature and the sum was used for calculation of diagnostic accuracy of sonography. Ultrasound elastography was interpreted by obtaining color-coded elastogram and strain ratio. Cut-offs for all the parameters were determined from receiver operating characteristic (ROC) curve. The diagnostic performance of conventional ultrasound and sonoelastography was evaluated individually as well as in combination against cytological or histopathological diagnosis. Out of 70 nodes examined, 36 were malignant and 34 were benign on histopathology. Among all ultrasound features, pattern of vascularity on color Doppler showed maximum sensitivity, i.e., 94%, while intranodal necrosis had maximum specificity, i.e., 70%, for differentiation between benign and malignant cervical lymphadenopathy. Sensitivity, specificity, and accuracy were 68.6%, 60%, and 64.3%, respectively, for ultrasound with Doppler; 77.15, 92.3%, and 85.7% for sonoelastography; and 60%, 97.1%, and 77.1% for combined evaluation. Strain ratio had highest specificity (94.3%) and diagnostic accuracy (85.7%) among all ultrasound and elastographic parameters. Combined ultrasound and ultrasound elastographic evaluation shows better diagnostic accuracy compared to conventional ultrasound evaluation. Ultrasound evaluation should be followed by elastography in all cases of cervical lymphadenopathy wherever possible.

Introduction We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. Material and Methods A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. Results Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. Conclusion Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

Background. Intrauterine pathological processes, the most common medical conditions of which are leiomyoma, adenomyosis and infiltrative adenocarci- noma, currently represent a quite prevailing group of gynecological pathology, dangerous due to the potential of malignancy and recurrence. The development of an integrated non-invasive diagnostic approach that takes into account risk factors, symptoms, clinical examination and imaging, makes it possible to make an accurate diagnosis, which is essential to determine therapeutic strategy. Рurpose – to carry out a systematic analysis of the uptodate scientific literature regarding the use of imaging methods in diagnosis of pathological processes of the myometrium and determine the main directions of their development in these pathologies. Materials and methods. The material for the study were publications and results of clinical trials found in Scopus, Web of Science Core Collection and PubMed databases for the period from 2013 to 2020 based on the keywords like “adeno- myosis”, “leiomyoma”, “adenocarcinoma”, “sonography”, “sonoelastography”. Results and discussion. The complexity of diagnosing myometrial neoplasms, especially in case of combinations, initiates the search for new algorithms for diagnosing pathological processes of the myometrium, the purpose of which, ultimately, is to determine personalized strategy of treatment of female patients. According to the literature, recently sonoelastography potential has been increasingly used in diagnosis of the reproductive system diseases and assessment of the functional state of uterine tissues, contributing to differential diagnosis, monitoring and treatment of these diseases. Conclusions. Thus, there is a limited number of studies on the diagnosis of myometrium pathology along with insufficient general standards of technique for conducting and interpreting the findings of sonoelastography in the reproductive system pathology. Adding sonoelastography data to sonographic images in B-mode is useful for differentiating leiomyoma, adenomyosis, and normal uterus, which is reflected in increased accuracy and diagnostic consistency. Sonoelastography potential consists in increasing the accuracy of diagnosis, safety and availability of the method, its low cost. This contributes to the possibility of wider implementation of the technique in clinical practice in order to obtain additional diagnostic information., Актуальність. Внутрішньоматкові патологічні процеси, найпоширені- шими нозологіями яких є лейоміома, аденоміоз та інфільтративна форма аденокарциноми, нині являють досить розповсюджену групу гінеколо- гічної патології, небезпечну через можливість злоякісності та рецидиву- вання. Розроблення інтегрованого неінвазивного діагностичного підходу, який бере до уваги чинники ризику, симптоми, клінічне обстеження та візуалізацію, створює можливість встановлення точного діагнозу для визначення терапевтичної тактики. Мета роботи – провести систематичний аналіз сучасної наукової літера- тури щодо застосування методів візуалізації в діагностиці патологічних процесів матки та визначити основні напрямки їхнього розвитку при зазначених патологіях. Матеріали та методи. Було проаналізовано і систематизовано дані повно- текстових публікацій у закордонних (англомовних) наукових виданнях за період 2013–2020 рр., відібраних шляхом пошуку в базах даних Scopus, Web of Science Core Collection і PubMed за ключовими словами «adenomy- osis», «leiomyoma», «adenocarcinoma», «sonography», «sonoelastography». Результати та їх обговорення. Складність діагностики новоутворень міометрія, особливо їхньої сполученості, спрямовує на пошук нових алгоритмів діагностики патологічних процесів міометрія, метою чого, у кінцевому рахунку, є визначення персоніфікованої тактики лікування хворих жінок. За даними літератури, останнім часом усе частіше застосовують можливості соноеластографії в діагностиці хвороб репродуктивної системи та оцінюванні стану тканин матки, що сприяє диференційній діагностиці, моніторингу та лікуванню зазначених захворювань. Висновки. На сьогодні зазначається обмежена кількість досліджень щодо питань діагностики патології матки та брак загальних стандартів техніки проведення та інтерпретації отриманих результатів соноеластографії при патології репродуктивної системи. Додавання даних соноеластографії до сірошкальних діагностичних зображень є корисним для диференціації лейоміоми, аденоміозу та нормальної матки, що відбивається у підвищенні точності та діагностичній узгодженості. Перспективність соноеластографії полягає в підвищенні точності діагностики, безпечності та доступності методу, невеликій вартості. Це сприяє можливості більш широкого впровадження методу в клінічну практику з метою отримання додаткової діагностичної інформації.

Andrei Corbu,1 Dan Ionut Cosma,2 Dana Elena Vasilescu,3 Dan Vasilescu,4 Stefan Cristea1 1University of Medicine and Pharmacy Carol Davila Bucharest, Romania, Department of Orthopaedics and Traumatology, Bucharest, Romania; 2Clinical Rehabilitation Hospital Cluj-Napoca, Department of Orthopaedics and Traumatology, Cluj-Napoca, Cluj, Romania; 3University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; Department of Orthopaedics-Traumatology and Paediatric Orthopaedics, Cluj-Napoca, Cluj, Romania; 4Clinical Emergency Hospital Cluj-Napoca, Department of Radiology and Imaging, Cluj-Napoca, Cluj, RomaniaCorrespondence: Dan VasilescuClinical Emergency Hospital Cluj-Napoca, Department of Radiology and Imaging, Clinicilor 3-5, Cluj-Napoca, Cluj, RomaniaTel +40 264 592 771Email danvasi76@yahoo.comPurpose: One of the main features of congenital idiopathic clubfoot is the increased stiffness of soft tissues. With the growing popularity and availability of sonoelastography as a method to assess the stiffness of different tissues, we considered applying it to congenital clubfeet in order to to determine whether sonoelastography can be a useful imaging method for the evaluation of clubfeet, to assess whether there are any differences in stiffness of specific tendons between clubfeet and normal contralateral feet and to observe which treatment methods have an impact on the aspect of these structures on the elastograms.Patients and Methods: A case-control study was performed involving 10 adolescent patients with unilateral idiopathic congenital clubfeet who were treated either with the Ponseti method or surgically with posteromedial release (PMR) during early infancy. Using compression sonoelastography, we obtained semi-quantitative data expressed as fat to tendon ratios in treated clubfeet and normal contralateral feet. The tendons of the following muscles were examined: tibialis anterior, tibialis posterior, flexor hallucis longus, peroneus longus and Achilles tendon at three levels (calcaneal insertion, lengthened zone and musculotendinous junction).Results: The only statistically significant difference in the strain ratio (p = 0.023) between clubfeet and normal feet was at the level of the calcaneal insertion of the Achilles tendon, which was stiffer in clubfeet. Although other differences were not statistically significant, they may reflect some of the pathological modifications of clubfeet.Conclusion: Overall, sonoelastography may be a useful examination tool in the quantitative and qualitative assessment of soft tissue stiffness in clubfeet, but further research is necessary.Keywords: soft tissue elasticity, stiffness, tendons, clubfoot, ultrasound, elastography, Achilles tendon

This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.

Background and objectives Testicular sperm extraction (TESE) has been a useful diagnostic and therapeutic tool with sperm retrieval opportunity varying according to the pathological finding in azoospermic patients. Sonoelastography (SE) is an exciting radiologic method that can measure relative elasticity of different tissues in a selected region of interest (ROI) by depending on fast cross-correlation technique and a combined autocorrelation method. Real-time elastography (RTE) can be used for structural analysis of testicular tissue to detect pathological tissue alterations. We aimed in the current study to evaluate the efficacy of shear wave elastography (SWE) in predicting sperm retrieval in non-obstructive azoospermic (NOA) patients undergoing TESE. Patients and methods This prospective study included 50 NOA patients who did two successive semen analyses with normal or elevated gonadotrophic hormones. All participants were subjected to SWE imaging on the testes by a radiologist. The measurements were recorded in terms of kPa using the SWE mode. They were done on each testis in the longest longitudinal plane. SWE images were viewed using dual mode: elasticity mode (kPa) and propagation (arrival time contour) mode then patients underwent TESE. Results A significant difference in SWE values was observed between patients with successful sperm retrieval and those with negative sperm retrieval providing 94.7% negative predictive value and 50.0% positive predictive value for sperm retrieval in NOA patients undergoing TESE with 75.0% sensitivity and 85.71% specificity (p = 0.0001). Mean stiffness index measured by SWE correlated significantly with the histopathological types as 8 patients only were diagnosed as having severe hypospermatogenesis. Discussion and conclusion These prime data suggest that SWE as a non-invasive, easily applicable, and repeatable imaging method has a promising potential to be one of the reliable sonographic modalities that can be used as one of the predictors for sperm retrieval in NOA patients.

Chronic allograft nephropathy is the most common cause of graft failure and is characterized by interstitial fibrosis and tubular atrophy, this study evaluated the role of shear-wave sonoelastography in the differentiation of stable renal allograft from allograft dysfunction & establish the correlation of parenchymal stiffness values with resistive index (RI), serum creatinine level, estimated glomerular filtration rate (eGFR). A prospective study of 40 patients who had undergone renal transplantation was conducted between October 2018 and July 2020. Patients were classified as having stable allograft and allograft dysfunction on the basis of clinical parameters practised in our institution. Receiver operating characteristic curve were drawn to obtain a cut off value with maximum sensitivity and specificity. Pearson’s correlation was used to evaluate different renal parameters and their correlation with the shear wave elastography (SWE) value. In this study 27 patients had graft dysfunction and 13 had stable graft. Use of the threshold value of 8.23kPa for SWE resulted in a sensitivity of 70% and specificity of 100% for the differentiation of stable allograft from allograft dysfunction. Parenchymal stiffness showed inverse correlation with eGFR (r = -.756, P

Background. Uterine leiomyoma and endometriosis are common gynecological diseases of women in childbearing potential. This fact necessitates developing an optimal protocol for examination of patients in order to implement an individual approach to treatment. Diagnosis of mixed forms of pathological myometrium conditions causes some difficulties. Elastography technique makes it possible to assess the density of the myometrium, which may be essential for differentiating the diagnosis of leiomyoma and adenomyosis in mixed forms. Рurpose – to ascertain the potential of transvaginal ultrasound along with compression sonoelastography to determine the deformation coefficient in differential diagnosis of various pathological myometrium conditions. Materials and methods. The paper presents the analysis of elastographic findings of the uterus in 155 women obtained via compression sonoelastography performed by means of HITACHI AVIUS device. Patients were divided into 4 groups: control, women with uterine leiomyoma, uterine adenomyosis, with combined leiomyoma and adenomyosis. The transabdominal/ transvaginal ultrasound findings were confirmed by histopathological examination. The standard point scale was used to determine the deformation coefficient. Results. Elastographic characteristics were assessed in accordance with sonoelastography findings, i. e. deformation coefficients common in leiomyoma and adenomyosis. The maximum values of the deformation coefficient were obtained in leiomyoma (in an amount of 2 to 6.0 units). In case of diffuse or focal adenomyosis, the deformation coefficient was in an amount of 0.5 to 1.5 units indicating high myometrial elasticity vs the unchanged myometrium. For its part, in Group I (control), the deformation coefficient ranged from 1 to 1.7 units. High myometrial elasticity in adenomyosis vs the unchanged myometrium as well low elasticity or high density of the myometrium in leiomyoma were observed. Conclusions. The deformation coefficients in patients with leiomyoma and adenomyosis and unchanged myometrium were obtained via ultrasound with compression sonoelastography and they made it possible to determine the degree of elasticity of the myometrium and its changes in the relevant pathology. Elastography is capable of identifying clear distinctive features of leiomyoma and adenomyosis. The coincidence of the diagnosis of adenomyosis based on elastography and histology is significant, but not optimal. The unchanged myometrium has a certain elasticity, which can be equated to a numerical value, i. e. the deformation coefficient, and this param changes in case of leiomyoma or adenomyosis, which makes it possible to differentiate these pathological conditions of the myometrium., Актуальність. Лейоміома матки й ендометріоз є поширеними гінекологічними захворюваннями жінок репродуктивного віку. Це створює потребу розроблення оптимального протоколу обстеження хворих для реалізації індивідуального підходу в лікуванні. Діагностика змішаних форм патологічних станів міометрія викликає певні труднощі. Методика еластографії дає змогу оцінити щільність міометрія, що може мати значення для диференціації діагнозу лейоміоми й аденоміозу при змішаних формах. Мета роботи – виявити можливості трансвагінального ультразвукового дослідження із застосуванням компресійної соноеластографії з визначенням коефіцієнта деформації в диференційній діагностиці різних патологічних станів міометрія. Матеріали та методи. Проведено аналіз еластографічних даних матки 155 жінок, отриманих із застосуванням компресійної соноеластографії апаратом HITACHI AVIUS. Хворих розподілили на 4 групи: порівняння, жінки з лейоміомою матки, з аденоміозом матки, з поєднаними лейоміомою й аденоміозом. Результати трансабдомінального / трансвагінального УЗД підтверджувалися патогістологічним дослідженням. За стандартною бальною шкалою жорсткості визначали коефіцієнт деформації. Результати та їх обговорення. За соноеластограмами визначені еластографічні характеристики — коефіцієнти деформації, характерні для лейоміоми й аденоміозу. Максимальні значення коефіцієнта деформації отримані при лейоміомі (у межах від 2,0 до 6,0 од. виміру). При наявності дифузного або вогнищевого аденоміозу коефіцієнт деформації був у межах від 0,5 до 1,5 од. вимірювання, що свідчить про високу еластичність міометрія проти незміненого міометрія. У I групі (порівняння) коефіцієнт деформації коливався в межах від 1,0 до 1,7 од. вимірювання. Відзначається висока еластичність міометрія при аденоміозі проти незміненого міометрія; низька еластичність або висока щільність міометрія при лейоміомі. Висновки. При проведенні УЗД із застосуванням компресійної соноеластографії у пацієнток із лейоміомою й аденоміозом і незміненим міометрієм отримані коефіцієнти деформації, які дають змогу визначити ступінь еластичності міометрія та його зміни при відповідній патології. Еластографія дає змогу ідентифікувати чіткі відмітні ознаки лейоміоми й аденоміозу. Збіг між діагностикою аденоміозу на основі еластографії та гістології є істотним, але не оптимальним. Незмінений міометрій має певну еластичність, яку можна прирівняти до числового значення, а саме коефіцієнта деформації, і цей показник змінюється в разі наявності лейоміоми або аденоміозу, що створює можливість диференціювати ці патологічні стани міометрія.

Purpose: This study investigated the effectiveness of major salivary gland ultrasonography (MSGUS) using a new grading system and shear wave elastography (SWE) in evaluating the major salivary glands of patients with Sjögren syndrome (SjS).Methods: This prospectively-designed cross-sectional study included 49 SjS patients and 49 healthy controls. Major salivary glands were examined with gray-scale ultrasonography and SWE. A new grading system for salivary glands was developed using MSGUS findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGUS and shear wave velocity (SWV) values were investigated. The MSGUS grading system and SWV values were evaluated together by logistic regression analysis. A cutoff value of SWE for salivary glands was determined.Results: The sensitivity, specificity, PPV, and NPV of MSGUS were 69.4%, 73.5%, 72.3%, and 70.6% for the submandibular gland and 69.4%, 65.3%, 66.7%, and 68.1% for the parotid gland, respectively. The mean SWV values of the parotid and submandibular glands were significantly higher in SjS patients than in controls (P

Objective: The objective of this study was to determine the elasticity of sternocleidomastoid muscle (SCM) in patients with congenital muscular torticollis (CMT). Methods: In all, 41 patients and 22 controls were included in the study, and the elasticity of the patients’ SCM was measured. Echogenicity, thickness, and strain values of the SCM were also obtained. Results: The thickness and strain values of the SCM were higher in the patient group than in the control group ( P = .02 and P = .15). For median values, there was no difference in echogenicity and strain. In the strain elastography evaluation of the receiver operating curve (ROC) for muscle echogenicity in the isoechoic muscle group, the specificity and sensitivity were determined to be 100% and 22%, respectively, for the area under the curve (AOC) value of 0.558 (95% confidence interval [CI], 0.424–0.6686), and the cutoff value was 1.4 with 100% sensitivity and 20.75 specificity. Conclusions: The strain elastography technique can be used in the diagnosis of CMT.

Objectives Changes in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions. Methods Longitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices; two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2). Results SE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa. Conclusions Strain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated.

Background Sonoelastography (SEL) is widely used for assessing tissue stiffness and pathophysiology. It has also been used to diagnose carpal tunnel syndrome (CTS). However, the current criteria to diagnose CTS in SEL are diverse. The aim of this study was to systematically review the literature and assess the diagnostic value of SEL for CTS. Methods A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for primary research articles using the keywords sonoelastography and carpal tunnel syndrome. Data related to diagnostic and cutoff value were extracted. Bias assessment was performed. Results A total of 121 publications were reviewed. Nineteen primary case series met the inclusion criteria and were selected for full analysis. Different diagnostic approaches were identified, with units/expressions including kilopascals, conduct velocity, and strain ratio. The kilopascals and conduct velocity were measured using shear wave elastography, whereas strain ratio was calculated by relative compression quantification. A mean shear modulus cutoff value from 38.25 to 86 kPa and an acoustic radiation force impulse cutoff value of 3.0 to 3.23 m/s were used to diagnose CTS. Eight articles reported strain ratio between the median nerve and nearby tissues with diverse results due to different reference points. The other 3 additional diagnostic values were reported. Conclusions Sonoelastography is a useful noninvasive and promising modality to diagnose CTS. It may reflect both the condition of soft tissue scarring and quantitative values for CTS and median nerve stiffness. A diversity of examination values was found in different modalities. A high level of evidence was absent.

Introduction: The classification of multiple, simultaneous, ipsilateral breast cancer after localization in arbitrarily delimited quadrants, according to BI-RADS criteria, is in disagreement with pathological and cytogenetic investigations and with the evolution of the disease. This classification is related to the non-anatomical examination in two standard mammographic projections, including tomosynthesis, and to the non-anatomical orthogonal scanning in the classical ultrasonography and magnetic resonance imaging of the breasts. Case Report: We illustrate a case of a 69-year-old woman with multicentric breast cancer detected and characterized by a non-invasive technique of diagnosis, based on the triad: anatomical ductal radial and antiradial breast ultrasound, Doppler study and strain sonoelastography, briefly named the full breast ultrasonography. Conclusion: The complete technique of ultrasonography has the advantages of high availability, low costs, standardization of scanning and reporting, and especially a detailed imaging illustration of the breast anatomical normal and abnormal structures correlated with the pathological findings.

Aim of the work To assess the role of sonoelastography (SE) and conventional ultrasound (US) in detection of rotator cuff (RC) lesions as compared to magnetic resonance imaging (MRI). Patients and methods This study included 36 patients with > 3 months (chronic) shoulder pain and limitation of movement examined by US, SE and MRI. US and SE findings of RC tendinopathy and tears were compared to MRI as a gold standard. Results The mean age of the patients was 47.8 ± 10.04 years, 20 males and 16 females. The mean duration of symptoms was 6 ± 2.9 months. On MRI, 16 (44.4%) were diagnosed as RC tendinopathy, 10(27.8%) showed partial tears and 10(27.8%) full thickness tears. On US, tendinopathy was detected in 15(41.7%), partial tears in 8(22.2%) and full tears in 9 (25%). SE could identify tendinopathy in 15(41.7%), partial and full tears in 9 (25%) cases each. Compared to MRI, US sensitivity for tendinopathy detection was 81.3% with 95% specificity and 88.9% accuracy while for partial tears, its sensitivity, specificity and accuracy were 80%, 92.3% and 88.9% respectively. In full thickness tears its sensitivity, specificity, accuracy were 90%, 100% and 97.2% respectively. Compared to MRI, SE sensitivity for tendinopathy detection was 93.8%, 95% specificity and 94.4% accuracy while for partial tears, its sensitivity, specificity and accuracy were 90%, 92.3% and 91.7% respectively and in full tears were 90%, 100%, 97.2% respectively. Conclusion SE is more sensitive than conventional US in detection of rotator cuff tendinopathy and partial thickness tears as compared to MRI.

Objectives To compare the diagnostic accuracy of US shear wave elastography (SWE) and magnetic resonance elastography (MRE) for classifying fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD). Methods Patients from a prospective single-center cohort with clinical liver biopsy for known or suspected NAFLD underwent contemporaneous SWE and MRE. AUCs for classifying biopsy-determined liver fibrosis stages ≥ 1, ≥ 2, ≥ 3, and = 4, and their respective performance parameters at cutoffs providing ≥ 90% sensitivity or specificity were compared between SWE and MRE. Results In total, 100 patients (mean age, 51.8 ± 12.9 years; 46% males; mean BMI 31.6 ± 4.7 kg/m2) with fibrosis stage distribution (stage 0/1/2/3/4) of 43, 36, 5, 10, and 6%, respectively, were included. AUCs (and 95% CIs) for SWE and MRE were 0.65 (0.54–0.76) and 0.81 (0.72–0.89), 0.81 (0.71–0.91) and 0.94 (0.89–1.00), 0.85 (0.74–0.96) and 0.95 (0.89–1.00), and 0.91 (0.79–1.00) and 0.92 (0.83–1.00), for detecting fibrosis stage ≥ 1, ≥ 2, ≥ 3, and = 4, respectively. The differences were significant for detecting fibrosis stage ≥ 1 and ≥ 2 (p Conclusions In adults with NAFLD, MRE was more accurate than SWE in diagnosing stage ≥ 1 and ≥ 2 fibrosis, but not stage ≥ 3 or 4 fibrosis. Key Points • For detecting any fibrosis or mild fibrosis, MR elastography was significantly more accurate than shear wave elastography. • For detecting advanced fibrosis and cirrhosis, MRE and SWE did not differ significantly in accuracy. • For excluding advanced fibrosis and potentially ruling out the need for biopsy, SWE and MRE did not differ significantly in negative predictive value. • Neither SWE nor MRE had sufficiently high positive predictive value to rule in advanced fibrosis.

The occurrence of focal lesions in the thyroid gland affects up to 65% of the general population, and an important element of diagnostics is the most precise possible distinction between benign and malignant lesions. Despite advanced knowledge and developed algorithms, in some cases the decision to proceed further may cause problems even for an experienced clinician. A promising tool in estimating oncological risk is sonoelastography. This article aims to approximate and organize knowledge in this field in relation to focal lesions of the thyroid gland and to encourage the implementation of the method in everyday practice.

Objectives: The study aims were to evaluate the contribution of sonoelastography to Breast Imaging Reporting, and Data System (BI-RADS) scoring of breast images. Materials and Methods: Two observers evaluated the BI-RADS category, Tsukuba score, and the strain index of 83 lesions of 73 consecutive patients. A new scoring system was established to evaluate the lesions by using the BI-RADS score, Tsukuba score, and strain index ratio. Results: There was a statistically significant difference between the strain index value of benign (3.08 ± 2.71) and malignant group (4.62 ± 2.70) ( P < .05). The sensitivity and specificity were 59.1% and 65.1% for the 3.12 cut-off value for the strain index. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of the only BI-RADS score was 0.834, both BT (BI-RADS + revised Tsukuba score) score and the total score (BI-RADS + revised Tsukuba score + strain index score) was 0.843. The interclass correlation coefficient for the two observers’ measurements of the strain index was weak, with .266 ( P < .05). Conclusion: The potential contribution of sonoelastography on lesion characterization is still controversial. In this study, the agreement among the observers was inadequate, and the contribution of sonoelastography on BI-RADS classification was limited. In addition, in the daily practice of sonoelastograpic evaluation, the Tsukuba score, was easier to apply and should be used rather than strain index measurements.

Budd-Chiari syndrome is a vascular pathology of the liver, commonly seen in adults and uncommon in children. Most children with Budd-Chiari syndrome present with ascites, and an etiology is found in only about 50%. Ultrasonography (US) with color Doppler is the main modality used in the diagnosis. US imaging additionally guides radiologic interventions and follow-up after recanalization or shunt procedure. In this pictorial review, we illustrate the findings in pediatric Budd-Chiari syndrome as seen on B-mode and color Doppler US and describe the role of US in guiding percutaneous radiologic interventions, with a brief description of the role of US contrast agent and sonoelastography in this setting.

Introduction: Ultrasound elastography is a technique used to quantify biomechanical changes that occur in parenchymal tissue with disease. Recent research has applied the technique to the placenta in order to investigate changes associated with uteroplacental dysfunction. We performed a literature review to summarise the current available information regarding this novel technique. Methods: Pubmed, CINAHL and Embase were searched using the terms “placenta”, “ultrasound” and “elastography”. Only full text studies written in English and limited to placental sonoelastography were included. Results: Twenty-eight studies met the inclusion criteria and were included in this review. Publications were divided into in vivo and ex vivo groups, and further categorised into four subgroups: normal pregnancy, pregnancy-induced hypertension and pre-eclampsia, fetal growth restriction and other pregnancy complications. Conclusion: Ultrasound elastography can quantitatively assess biomechanical properties of the placenta in conditions where placental function is compromised.

Background To evaluate the performance of transvaginal sonoelastography (TVSE) for differential diagnosis between malignant and benign cervical lesions using a meta‐analysis. Methods An independent literature search was conducted on the English medical database, including PubMed, Embase and Medline, Cochrane Library, Web of Science, and OVID. The diagnostic accuracy of TVSE was compared with that of histopathology, which is the gold reference standard for diagnosis. The accuracy of TVSE was assessed by calculating the pooled sensitivity, specificity, diagnostic odds ratio, and area under the curve (AUC). The imaging mechanisms, assessment methods, and QUADAS scores were assessed with a meta‐regression analysis. A Deeks funnel plot was performed for evaluating publication bias. Results Six eligible studies reported a total sample of 615 cervical lesions (415 cancers, 200 benign lesions). TVSE showed a pooled diagnostic odds ratio of 21.42 (95% CI 13.65‐33.61), sensitivity of 0.87 (95% CI 0.84‐0.90), specificity of 0.79 (95% CI 0.72‐0.84), and an AUC of 0.892 (Q* = 0.822). The results of the meta‐regression analysis showed that the imaging mechanism (P = .253), the assessment method (P = .279), or QUADAS score (P = .205) did not affect the study heterogeneity. Conclusion TVSE has a relatively high and satisfactory value for differential diagnosis between malignant and benign cervical lesions. The diagnostic performance of strain elastography and shear wave elastography were similar and good. However, to accommodate heterogeneity and publication bias, high‐quality studies are required to further comparative effectiveness analyses to verify the efficacy of ultrasound detection., Overall, TVSE has a relatively high and satisfactory value for differential diagnosis between malignant and benign cervical lesions. SE and SWE have similar and good diagnostic performance without constituting heterogeneity. A large‐sample, multi‐center, prospective, and well‐represented trials are still needed to confirm the findings.

Ultrasound as a non-ionizing imaging procedure is one of the most important diagnostic procedures in everyday clinical practice. The technology is widely used. Due to constant technical innovations, sonographic procedures, such as contrast-enhanced ultrasound (CEUS), sonoelastography, new microvascular Doppler modalities and, as an example of interventional procedures, sonographically controlled microwave ablation (MWA), are becoming increasingly important in diagnostic imaging and interventional medicine alongside CT and MRI. However, this also requires greater expertise, specialization and qualification on the part of users. This review article provides information about the range of technical innovations in ultrasound in recent years and describes the underlying technology, the clinical applications, and their diagnostic value. These are presented in the context of the current literature, explaining their advantages and disadvantages and their clinical value. Contrast-enhanced ultrasound (CEUS), microvascular Doppler modalities, fusion imaging and elastography complement B-scan ultrasound and conventional Doppler procedures for various problems. Microwave ablation (MWA) has a firm place as an ablative procedure for local tumor therapy in different organ systems and can be performed under ultrasound guidance. Thanks to new developments, the possibilities of ultrasound are now greater than ever. Knowledge of the technology, indications, and possible applications of newer procedures is essential for adequate patient care. · Contrast-enhanced ultrasound (CEUS) allows an increase in sensitivity and specificity in the assessment of parenchymal lesions.. · CEUS allows the microperfusion to be visualized and quantified. For larger vessels, CEUS is an important instrument in diagnosing endoleak after stenting.. · Microvascular Doppler techniques with clutter suppression algorithms allow a more accurate representation of the smallest vessels than regular color or power Doppler.. · Elastography of the liver in diffuse hepatopathies is a noninvasive diagnostic tool to exclude higher grade fibrosis/cirrhosis.. · Microwave ablation (MWA) also offers sonographically controlled ablation of tumors..· Kloth C, Kratzer W, Schmidberger J et al. Ultrasound 2020 - DiagnosticsTherapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography . Fortschr Röntgenstr 2021; 193: 23 - 32. Ultraschall als nichtionisierendes bildgebendes Verfahren stellt eines der wichtigsten diagnostischen Verfahren im Klinikalltag dar. Bei weiter Verbreitung findet es flächendeckenden Einsatz. Durch stetige technische Innovationen gewinnen sonografische Verfahren wie kontrastverstärkter Ultraschall (CEUS), Sono-Elastografie, neue mikrovaskuläre Dopplermodalitäten und als Beispiel für interventionelle Verfahren die sonografisch gesteuerte Mikrowellenablation (MWA) zunehmend an Bedeutung innerhalb der bildgebenden Diagnostik und Intervention neben der CT- und MRT-Schnittbildtechnik. Dies erfordert jedoch auch eine höhere Expertise, Spezialisierung und Qualifikation bei den Anwendern. Dieser Übersichtsartikel informiert über das Spektrum technischer Neuerungen im Ultraschall der letzten Jahre und beschreibt die zugrunde liegende Technik, die klinischen Anwendungsmöglichkeiten und deren diagnostischen Stellenwert. Diese werden unter Darlegung von Vor- und Nachteilen sowie ihrer klinischen Wertigkeit im Kontext der aktuellen Literatur vorgestellt. Die Verfahren des kontrastverstärkten Ultraschalls (CEUS), mikrovaskulärer Dopplermodalitäten, der Fusionsbildgebung und der Elastografie ergänzen den B-Bild-Ultraschall und konventionelle Doppler-Verfahren bei unterschiedlichen Fragestellungen. Die Mikrowellenablation (MWA) hat einen festen Stellenwert als ablatives Verfahren zur lokalen Tumortherapie an verschiedenen Organsystemen und kann ultraschallgesteuert erfolgen. Die Möglichkeiten des Ultraschalls sind dank neuer Entwicklungen heutzutage größer denn je. Die Kenntnis über Technik, Indikationen und Anwendungsmöglichkeiten neuerer Verfahren sind für eine adäquate Patientenversorgung obligat. · Kontrastverstärkter Ultraschall (CEUS) steigert die Sensitivität und Spezifität bei der Beurteilung von Parenchymläsionen.. · CEUS ermöglicht die Darstellung und Quantifizierung der Mikroperfusion. Für größere Gefäße ist CEUS ein wichtiges Instrument in der Endoleak-Diagnostik nach Stent-Versorgung.. · Mikrovaskuläre Doppler-Verfahren mit Störungsunterdrückungsalgorithmus erlauben eine genauere Darstellung kleinster Gefäße als der reguläre Farb- oder Powerdoppler.. · Die Elastografie stellt an der Leber bei diffusen Hepatopathien eine nichtinvasive Diagnostik zum Ausschluss einer höhergradigen Fibrose/Zirrhose dar.. · Die Mikrowellenablation (MWA) bietet auch sonografisch gesteuert die Möglichkeit zur Ablation von Tumoren..· Kloth C, Kratzer W, Schmidberger J et al. Ultrasound 2020 – DiagnosticsTherapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography . Fortschr Röntgenstr 2021; 193: 23 – 32.

To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma.SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2 mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy.Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had ElStiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.ZIEL: Es soll untersucht werden, ob der Second-Look-US mittels Scherwellen-Elastografie (SWE) nützlich ist, um zwischen benignen und malignen Veränderungen in der postoperativen Brust nach der operativen Therapie des Mammakarzinoms zu differenzieren.SWE und die damit verbundenen sonografischen Merkmale wurden bei 90 Patientinnen mit Anamnese einer operativen Therapie des Mammakarzinoms und einer bei der MRT-Nachuntersuchung entdeckten verdächtigen Läsion überprüft. Ein einziger erfahrener Radiologe führte alle Second-Look-US-Untersuchungen mit SWE-Messungen durch, indem er eine kreisförmige Region of Interest von 2 mm Durchmesser über dem steifsten Teil der Läsion legte. Gewebeproben für die histopathologische Untersuchung wurden dabei durch Stanzbiopsie entnommen.Von 90 Läsionen erwiesen sich 39 als maligne in der histopathologischen Untersuchung. Von den malignen Läsionen zeigten 50 % ElSteifere Läsionen in der postoperativen Brust sollten im Second-Look-Ultraschall als suspekt angesehen werden. SWE kann eine hilfreiche Methode zur Identifizierung maligner Läsionen sein, insbesondere im Zusammenhang mit einer eingeschränkten Diffusion in der MRT-Untersuchung. Die Steifigkeit der Läsion sollte jedoch nicht als unabhängiger Prädiktor für die Läsionsmalignität in der postoperativen Brust angesehen werden, da in der SWE benigne Veränderungen steif, Karzinomrezidive hingegen weich erscheinen können.

Aim of the study: To evaluate the sonoelastic response of the median nerve in patients with carpal tunnel syndrome following conservative rehabilitation with splint plus exercise regimens. Materials and methods: A total of thirty-five patients diagnosed with mild carpal tunnel syndrome and treated with splint plus exercise therapy; hand resting splint all day for 3 weeks and then only at nights along with nerve gliding exercises in 10 repetitions 3 times a day. The median nerve was evaluated clinically prior to the treatment and at week 6 of therapy using physical examination, electrodiagnostic neurophysiology tests and radiological imaging; Boston Scores, electromyogram, ultrasonography and sonoelastography. Results: Following the 6-week treatment protocol on 35 subjects with mild carpal tunnel syndrome, sonoelastography showed significantly softer median nerve, while the traditional parameters based on Boston Scores and cross-sectional area based on ultrasonography remained nearly unresponsive. Such early indication of biomechanical changes in the nerve may be of clinical importance if it can offer a prognostic value of the applied treatment, while tissue softening suggests the alleviation of nerve compression. Conclusions: Sonoelasticity of the median nerve can serve as a reliable marker for assessing therapeutic changes in median nerve stiffness and potentially the outcome early on in mild carpal tunnel syndrome. Aim of the study: To evaluate the sonoelastic response of the median nerve in patients with carpal tunnel syndrome following conservative rehabilitation with splint plus exercise regimens. Materials and methods: A total of thirty-five patients diagnosed with mild carpal tunnel syndrome and treated with splint plus exercise therapy; hand resting splint all day for 3 weeks and then only at nights along with nerve gliding exercises in 10 repetitions 3 times a day. The median nerve was evaluated clinically prior to the treatment and at week 6 of therapy using physical examination, electrodiagnostic neurophysiology tests and radiological imaging; Boston Scores, electromyogram, ultrasonography and sonoelastography. Results: Following the 6-week treatment protocol on 35 subjects with mild carpal tunnel syndrome, sonoelastography showed significantly softer median nerve, while the traditional parameters based on Boston Scores and cross-sectional area based on ultrasonography remained nearly unresponsive. Such early indication of biomechanical changes in the nerve may be of clinical importance if it can offer a prognostic value of the applied treatment, while tissue softening suggests the alleviation of nerve compression. Conclusions: Sonoelasticity of the median nerve can serve as a reliable marker for assessing therapeutic changes in median nerve stiffness and potentially the outcome early on in mild carpal tunnel syndrome.

Purpose The aim of this study was to investigate the sensitivity, specificity, and diagnostic accuracy of sonoelastography (SE), strain ratio (SR), elasticity to B- mode (E/B) ratio, and color Doppler ultrasonography (US) in suspected breast lesions. Materials and methods This prospective study was conducted on women referred to Alzahra university hospital of Tabriz for annual screening of breast cancer between May 2017 and December 2018. B-mode US, SE, and color Doppler imaging were conducted in females with suspected mammography reports. The lesions in B-mode were classified according to the Breast Imaging Reporting and Data System (B-RADS). The results of SE imaging were graded based on five-grade SE score. SR and E/B ratio of each lesion were also analyzed in SE images. Color Doppler findings were categorized from 0 (no visible vessel) to 2 (> two vessels) based on the vascularity of the tumor. Pathology results were used as the gold standard to measure the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and diagnostic accuracy of each modality. Results One-hundred and ten breast lesions of 104 women aged 42.05±10.33 years were included in the study. Seventy-seven of the lesions were benign and 3 were malignant. Sensitivity and specificity of 97.0% and 77.9% for B-mode US, 93.9% and 87.0% for SE score, 81.8% and 66.2% for color Doppler US, 72.7% and 77.6% for E/B ratio (cutoff: 1.05), and 77.3% and 79.6% for SR (cutoff: 1.90) were obtained, respectively. Addition of SE score to B-mode US increased the sensitivity to 93.9%, specificity to 93.5%, and AUC from 0.95 to 0.97. Cumulative color Doppler US with B-mode US did not enhance the diagnostic accuracy of B-mode US. Conclusion SE was more effective than color Doppler US for distinguishing malignant from benign breast lesion. Among the three different SE features, five-grade SE score was superior to E/B ratio and SR.

Purpose of review Several imaging modalities exist for the assessment of Peyronie's disease. However, comprehensive recommendations for using these objective modalities based on large-scale evidence-based studies do not yet exist. Our objective is to evaluate current imaging techniques and provide a model that we follow in our clinic in the workup and management of Peyronie's disease. Recent findings Computed tomography and radiography excellently visualize penile plaque calcifications, and MRI adeptly identifies plaques in complex locations, such as the corporal septum. Ultrasonography has extensive applications in plaque localization and characterization. Used along with color Doppler ultrasound, it is capable of detecting vascular abnormalities. Sonoelastography is an emerging subtype of ultrasongraphy that utilizes elastic properties of tissue to identify penile plaques that may not be visualized with other modalities. Summary Ultrasonography is the preferred imaging modality in Peyronie's disease and noninvasively characterizes penile plaques and monitors plaque response to various treatments. At our center, we perform ultrasonography with intracavernosal injection in all patients with Peyronie's disease to evaluate the degree of curvature, plaque characteristics, and concomitant erectile dysfunction to better guide management decisions.

Background/aim: We aimed to investigate the role of Shearwave Elastography SWE in the evaluation of response to uterine artery embolization UAE in patients with uterine leiomyomas. Materials and methods: SWE images of the dominant uterin leiomyomas were obtained before and 1.5 months after performing UAE in 33 women suffering from symptoms due to leiomyomas menometrorrhagia, bulk related symptoms, pelvic pain . Leiomyomas were also evaluated by 2 observers for location and longest diameter in axial plane. Interobserver agreement in the quantitative SWE analysis was calculated using intraclass correlation coefficients. Results: Thirty-three women mean age, 39.7 years; range, 31-48 years were examined with SWE 1.5 months after UAE. After treatment, 3 patients 9.1% had fever, 1 patient had nausea and 29 patients 87.9% had no complications. The post UAE stiffness measurements of leiomyomas mean SWE ± SD = 13.34 ± 3.9kPa were significantly lower than the pre UAE measurements mean SWE ± SD = 17.16 ± 4.8kPa P < 0.001 . There was excellent agreement between the 2 blinded observers in SWE measurements. Conclusion: SWE values of leiomyomas after UAE significantly decreased. SWE, with its high reproducibility, could become a useful tool in the follow up of uterin leiomyomas after UAE.

Background Nowadays, breast cancer is the second cause of death after cardiovascular diseases. In general, about one out of eight women (about 12%) suffer from this disease during their life in the USA and European countries. If breast cancer is detected at an early stage, its survival rate will be very high. Several methods have been introduced to diagnose breast cancer with their clinical advantages and disadvantages. Main text In this review, various methods of breast imaging have been introduced. Furthermore, the sensitivity and specificity of each of these methods have been investigated. For each of the imaging methods, articles that were relevant to the past 10 years were selected through electronic search engines, and then the most relevant papers were selected. Finally, about 40 articles were studied and their results were categorized and presented in the form of a report as follows. Various breast cancer imaging techniques were extracted as follows: mammography, contrast-enhanced mammography, digital tomosynthesis, sonography, sonoelastography, magnetic resonance imaging, magnetic elastography, diffusion-weighted imaging, magnetic spectroscopy, nuclear medicine, optical imaging, and microwave imaging. Conclusion The choice of these methods depends on the patient’s state and stage, the age of the individual and the density of the breast tissue. Hybrid imaging techniques appear to be an acceptable way to improve detection of breast cancer. This review article can be useful in choosing the right method for imaging in people suspected of breast cancer.

Purpose This study investigated whether shear wave elastography (SWE) could be used to estimate the chronicity of supraspinatus tendon (SST) tears. Methods A retrospective study was performed. From November 2015 to July 2016, 113 patients (52 men, 61 women; age range, 21 to 79 years) with persistent shoulder pain underwent 119 rotator cuff tendon examinations by routine B-mode ultrasonography, while SST elasticity was measured using SWE. Following the exclusion of eight suboptimal examinations, four examinations with missing SST measurements, and 27 examinations of patients with other conditions, 80 examinations were analyzed. A torn SST was found in 54 examinations (27 with a partial-thickness tear and 27 with a full-thickness tear). Elasticity values were compared in multiple ways. The results were analyzed using the Mann-Whitney U test or Kruskal-Wallis test. Results No statistically significant difference in elasticity values (in kPa) was found between normal (median, 94.65; interquartile range [IQR], 87.43 to 105.47) and torn SSTs (median, 96.79; IQR, 86.71 to 108.56) or between full-thickness tears (median, 93.80; IQR, 82.50 to 108.33) and partial-thickness tears (median, 96.83; IQR, 90.60 to 112.20). However, there was a statistically significant difference in elasticity according to whether the duration of symptoms was 1 year or less (median, 92.20; IQR, 84.01 to 104.38) or longer than 1 year (median, 105.10; IQR, 100.41 to 116.03; P=0.032). Conclusion Elasticity values were significantly higher in torn SSTs in patients with chronic shoulder pain that had persisted for more than 1 year. Further studies with larger samples seem warranted to determine whether elasticity values measured by SWE can be used preoperatively as a surrogate marker of the chronicity of a rotator cuff tendon tear.

Modern ultrasound examination (US), unlike other modalities, allows to assess the stiffness of the lesions, with the help of a new technology named sonoelastography (SEG). According to many scientific studies, with the addition of SEG to the B-mode, the diagnostic efficiency of ultrasound of breast lesions significantly increases. According to Thomas et al. B-mode has a sensitivity of 91,8% and a specificity of 78%. When a compression SEG is added to a diagnostic study, the specificity increases to 91,5%. The purpose of this study was to determine the diagnostic effectiveness of SEG and compare it with the effectiveness of B-mode and color Doppler mapping (CDC) in the primary diagnosis of breast tumors, as well as to identify diagnostically and statistically significant SEG signs of breast cancer ( ВС ). Materials and methods . The study was performed from 2017 to 2019 on the basis of the «NMRC Oncology. named after N. N. Petrov» Ministry of Health of Russia. 277 women with complaints of lump or pain in the breast were included in the study, for all of them there was performed the multiparametric ultrasound examination with application of CDM and SEG. According to our own results, SEG is more effective at detection of malignant and benign lesions, than ultrasoumd examination in B and CDM modes. Results: 0, 1, 2, 3 elastotypes are the highly significant diagnostic signs of benign process, and the elastotype 5 is a reliable diagnostic marker of malignant process. The effectiveness of CDM and SEG in the differential diagnosis of breast lesions showed: sensitivity — 77,6% vs. 85,5%; specificity — 51,7% vs. 84,6%; accuracy — 58,8% vs. 84,8%. Conclusions: according to our own research results, SEG is more effective in detecting malignant and benign tumors than ultrasound in B and CDM modes.

Background: The purpose of this study was to evaluate the diagnostic value of transrectal real- time strain elastography (RTE) in identifying prostatic carcinoma (PCa). Methods: 60 patients suspected of having PCa based on abnormal digital rectal examination and raised prostate specific antigen levels underwent transrectal ultrasound (TRUS), color Doppler (CD) and RTE. Elastograms were scored on a five point scale based on distribution of strain in relation to hypoechoic area on TRUS. Twelve core systematic biopsy as well as targeted biopsy was performed from suspicious areas on TRUS and RTE. Diagnostic performance of sonoelastography was evaluated using histopathology as reference standard. Results: Histopathology revealed cancer in 28 out of 60 patients (47%) studied. Gleason score ranged from 6 to 9. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TRUS in detecting prostate cancer were 78.57%, 81.25%, 78.57%, and 81.25%, respectively. On CD evaluation 87.5% (n = 28) of benign lesions showed symmetric, radial flow compared to 14.3% (n = 4) of malignant lesions (P < 0.0001). The sensitivity and specificity of RTE was 89.29% and 56.25% with PPV and NPV being 58.13% and 82.35%, respectively. Higher elastography score was found to be significantly associated with malignant histopathology (P = 0.004). Cancer detection rate with RTE was greater for tumors with higher Gleason score. Conclusion: RTE was found to have better sensitivity than TRUS as well as combination of TRUS and CD. Although less specific, RTE can be an effective adjuvant tool to TRUS for guidance of biopsy and improve detection rate of PCa.

Myofibrolastoma of the breast (MFB) is a rare and benign stromal tumor. Although MFB is a benign entity, in radiologic evalu-ation, there is no specific diagnostic feature. Conventional breast imaging findings have been published before. Sonoelas-tography has been used as an imaging method that allows us to evaluate tissue stiffness in vivo and increases the specificity of B-mode ultrasonography in the discrimination of benign-malignant lesions. In this case report, it was shown that MFB is of high stiffness in shear wave elastography (SWE) evaluation. SWE findings of MFB, which is a benign lesion, have been described for the first time in the literature.

Background Mammography and Sonography are the important sensitive imaging modalities available in detection of breast cancer. Sonoelastography is a relatively new imaging technique which acts as a complementary tool to improve the diagnostic ability of ultrasound for evaluating patients with breast masses. Objective To evaluate the role of sonoelastography characterization information on solid breast lesions over conventional sonography and mammography either benign or malignant lesions to reduce the number of benign biopsies performed. Methods A prospective study was carried at private centers, starting from august 2019 till december 2019. Results The study conducted on 40 patients with palpable breast lesions classified to BIRADS 3 and 4a according to conventional ultrasound and mammographic criteria. Their ages ranged from 18 to '75 years with a mean age 47.72 14.91, 22 cases (55%) had no family history of pervious breast disease, and 18 cases (45%) had family history of pervious breast disease. All patients were subjected to full history taking, clinical examination, conventional gray scale ultrasound, and mammography and ultrasound elastography. All patients underwent histopathological assessment to reach the final diagnosis. Among Studied cases , 28 lesions were sampled by fine needle biopsy (70%) and 12 lesions were sampled by true cut needle (30%) .the results revealed 27 breast lesions were benign (67.5%), 9 malignant lesions (22.5%) and 4 lesions shows atypia (10%) according to histopathological assessment. Among final diagnosis of breast lesions fibro adenoma was the most frequent benign breast lesion detected as 12 lesions from 27 benign breast lesions were fibroadenoma., Also infiltrative ductal carcinoma was the moste frequent among malignant breast lesions as 5 lesions from 9 malignant lesions were infiltrative ductal carcinoma. Conclusion Ultrasoundelastography has significant complementray role beside conventional mammogram and ultrasound in characterization of solid breast lesions.

Ultrasonography has gained increasing attention as a non-invasive and radiation-free instrument for the assessment of swallowing function. In the past decades, an extensive repertoire of ultrasonographic techniques, such as, B-mode dynamic scanning, pixel analysis, M-mode, Doppler, 3D reconstruction, and sonoelastography, has been applied in the evaluation of oropharyngeal structures and movement. Yet, a universal consensus on the examination protocols and clinical implications remains to be established. This review aimed to provide a brief introduction of the application of ultrasound in dysphagia assessment and intervention, encompassing the ultrasonography of swallowing-related muscles, tongue movement, and hyolaryngeal excursion, as well as ultrasound-guided interventions in the management of dysphagia. In addition to non-invasiveness, ultrasonography, a portable, easy to use, and low-cost technique, could compliment videofluoroscopic swallowing study as a first-line screening and follow-up tool for the evaluation of swallowing function, although further study is warranted to provide quantitative diagnostic and prognostic values. Finally, ultrasonography aids in the precisely targeted injection of botulinum toxin in patients exhibiting oropharyngeal muscle spasticity.

Background: Sonoelastography is extensively used for clinical diagnosis. Different types of elastography can be used to assess the elastic properties (stiffness) of tissues. For quantitative analyses, shear wave elastography (SWE) has been applied as a non-invasive method in the past decade. Today, SWE is widely used for diagnosing diseases. However, a limited number of studies have investigated musculoskeletal injuries and neoplastic diseases. Objectives: This study aimed to evaluate the postoperative functional recovery of Achilles tendon ruptures by SWE to determine the Achilles tendon function and provide reliable evidence for clinicians. Patients and Methods: SWE was used to measure elasticity in 67 patients with Achilles tendon ruptures. In the postoperative stage, 17 patients were lost to follow-up. The remaining 50 patients with Achilles tendon ruptures were examined. Each patient was followed-up for one, three, and six months postoperatively. The 0° flexion of the ankle joint was considered as the standard position. The mean elasticity (Emean) of the Achilles tendon was measured and recorded at different time points before and after surgery. Besides, the thickness and width of the Achilles tendon were measured at the corresponding time points. Results: The mean elasticity (Emean) of normal and ruptured Achilles tendons was 447.4 ± 59.57 and 63.84 ± 45.18 kPa, respectively in 50 patients with ruptured Achilles tendons before surgery. On the other hand, the Emean values of ruptured Achilles tendons in one-, three-, and six-month follow-ups were 110.3 ± 35.60, 183.4 ± 46.08, and 279.1 ± 48.18 kPa in 50 patients, respectively. Regarding the Emean, the difference between the five time points was significant (F = 418.5, P < 0.01). With prolongation of postoperative recovery, the Emean of the Achilles tendon gradually increased; the Emean value significantly increased at six months after surgery. Conclusion: The quantitative analysis of the postoperative function of Achilles tendon, based on the Emean value obtained by SWE, can be helpful in guiding clinicians to objectively examine the prognosis of patients.

Sonoelastography is a relatively new non-invasive imaging tool to assess in-vivo qualitative and quantitative biomechanical properties of various tissues. Two types of sonoelastography are commonly explored: strain and shear wave. Sonoelastography can be used in multiple medical subspecialties to assess pathological tissular changes by obtaining mechanical properties, shear wave speed, and strain ratio data. Although there are various radiological imaging methods such as magnetic resonance imaging or computerized tomography scan to assess musculoskeletal structures (muscles, tendons, joint capsules), sonoelastography is more accessible since this approach is of low cost and non-radiating. As of 2018, sonoelastography has garnered promising data in multiple studies. Preliminary clinico-radiological correlations have been established in an attempt to bridge tissue biomechanical findings with their respective clinical pathologies. Specifically, concerning the shoulder complex, recent findings have described mechanical tissue changes in shoulder capsulitis. The long head of biceps and supraspinatus sonoelastography were amongst recently studied structures with regards to conditions concerning impingement, tendinosis, and tears. Since ultrasonography has established itself as an important tool in shoulder evaluation, it completes clinician’s history and physical examination skills. This paper will provide an update on the most recent findings on sonoelastography of shoulder structures.

Many diagnostic approaches have been described for imaging the thyroid including Ultrasonography with Colour Doppler, Scintigraphy, CT, Sonoelastography, Magnetic Resonance Imaging, Positron Emission Tomography, and Single Photon Emission Computed Tomography Ultrasound examination is a relatively cheaper and easily available and sensitive modality for imaging the thyroid without the hazards of radiation. This was a prospective study to evaluate if nodule/s is/are benign or malignant by ultrasonography and Doppler study and pathological correlation in at least 50 patients referred in view of clinically / incidentally (Carotid Duplex Doppler / neck ultrasound for non thyroid pathologies) detected goitre / thyroid nodule. Of the pathologically proven cases of malignant nodules (2), one (1.43%) case with malignant nodule showed evidence of microcalcifications and one (1.43%) did not. Out of all 70 nodules, 2 (2.86%) cases of pathologically proven benign nodules showed micro calcifications and 66 (94.29%) benign cases were negative for microcalcification. The sensitivity of micro calcifications as a ultrasound risk factor for malignancy was found to be 50% and specificity, 97.1%.

B-mode ultrasonography and sonoelastography are used in the clinical diagnosis of prostate cancer (PCa). A combination of the two ultrasound (US) modalities using computer aid may be helpful for improving the diagnostic performance. A technique for computer-aided diagnosis (CAD) of PCa is presented based on multimodal US. Firstly, quantitative features are extracted from both B-mode US images and sonoelastograms, including intensity statistics, regional percentile features, gray-level co-occurrence matrix (GLCM) texture features and binary texture features. Secondly, a deep network named PGBM-RBM2 is proposed to learn and fuse multimodal features, which is composed of the point-wise gated Boltzmann machine (PGBM) and two layers of the restricted Boltzmann machines (RBMs). Finally, the support vector machine (SVM) is used for prostatic disease classification. Experimental evaluation was conducted on 313 multimodal US images of the prostate from 103 patients with prostatic diseases (47 malignant and 56 benign). Under five-fold cross-validation, the classification sensitivity, specificity, accuracy, Youden’s index and area under the receiver operating characteristic (ROC) curve with the PGBM-RBM2 were 87.0%, 88.8%, 87.9%, 75.8% and 0.851, respectively. The results demonstrate that multimodal feature learning and fusion using the PGBM-RBM2 can assist in the diagnosis of PCa. This deep network is expected to be useful in the clinical diagnosis of PCa.

Objective. To provide a rationale for using sonoelastography (SEG) in the differential diagnosis of thyroid cancer (TC).Material and methods. Thirty patients with thyroid nodules of various morphological structures were examined. The authors studied the data of SEG and immunohistochemistry (IHC) with monoclonal antibodies against types III and IV collagen (they evaluated the degree of the expressed collagen fibers). Analysis of variance, ROC analysis, and logistic regression were used (by comparing with the expression of collagens) to assess the predictive ability of ultrasound.Results. The study showed that irregular and uneven contours, microcalcifications, and “the height greater than the width” were most significant among the ultrasound signs in the diagnosis of TC. Cool colors prevailed when performing SEG in the pattern of thyroid cancer. Purple-blue hues were predominantly recorded (pConclusion. SEG may suppose the probable nature of thyroid nodules on the basis of their morphological features. The low degree of the stromal component and the low content of types III and IV collagen make follicular colloid goiter and adenoma soft, which is recorded at SEG. TC is characterized by a high collagen level attributable to the characteristics of the metabolism of cancer cells, which makes them solid in the mode of SEG.

Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively steep learning curve, and variability in methods between vendors. This article describes our protocol for performing breast elastography using both strain elastography and shear wave elastography, which produces high sensitivity and specificity. Additionally, we will describe the most commonly known false-positive and false-negative lesions as well as how to detect them.

Purpose The purpose of this study was to identify practice trends and opinions concerning breast sonoelastography in two different health care systems, one in Europe (France) and the other in North America (Province of Quebec/Canada). Materials and methods We distributed an 11-item online survey among French and Canadian breast radiologists. The survey comprised of four sections: (i) personal practice characteristics, (ii) breast sonoelastography usage in daily practice and evaluation of its usefulness, (iii) limitations and roles of sonoelastogrpahy in their clinical practice, and (iv) types of elastographic technique and interpretation. Results We found that sonoelastography of the breast appears unpopular among Canadian radiologists, and poorly credible among French radiologists, who perceive it as an unreliable technique. To date, its real impact in clinical practice remains uncertain. Conclusion Continued learning and awareness of the indications, advantages and limitations of breast sonoelastography may motivate breast radiologists to adopt its use.