BREAST AND THYROID SONOELASTOGRAPHY

Clinical session : Discussion of clinical cases

Antonio Pio Masciotra – Campobasso - Italy

Thyroid sonoelastography

Clinical cases discussion

Dr. Antonio Pio Masciotra

Campobasso

External

Mechanical force

Natural

Heart

SuperSonic Imagine has developed a novel method called SonicTouch,

which is based on focused ultrasound, and can remotely generate Shear Wave-fronts providing uniform coverage of a 2D area interest.

STRAIN ELASTOGRAPHY with different grades of compression

Inhomogeneous elasticity Uniform low elasticity

SHEAR WAVE ELASTOGRAPHY

• Normal gland 8.29 kPa• Nodule 8.46 kPa

Hashimoto thyroiditis

• Normal gland 8 kPa• Hashimoto 13-15 kPa

Hashimoto thyroiditis

• Nodule 14.8 kPa• Parenchima 21.3 kPa

Hashimoto thyroiditis – 3D US

• Nodule 14.8 kPa• Parenchima 21.3 kPa

Hashimoto thyroiditis – 3D SWE

• Nodule 14.8 kPa• Parenchima 21.3 kPa

4 months later

1 month later

First exam

Thyroid hemorragic cyst – Bidimensional US

First exam – Volume 7.11 cc – Mainly fluid 1 month later – Volume 2.35 cc – Complex structure with thick

layers of debris on all the walls4 months later – Volume 2.16 cc – Mainly fluid with less thick

layers of debris on only some of the walls

First exam

1 month later

4 months later

Thyroid hemorragic cyst – PD and directional PD

First exam – Only a few vessels streched on the wall due to the high intracystic pressure

1 month later – Vessels more visible, but always limited to the wall4 months later – Vessels even more visible (due to reduced intracistic pressure), but always limited to the wall

First exam

1 month later

4 months later

Thyroid hemorragic cyst – SW Elastography

First exam – 6 kPa (min 0.1 – max 24.0) on hypoechoic layer of debris Surrounding tissue very stiff due to the high intracystic

pressure1 month later – 8 kPa (min 1.9 – max 18.6) on almost isoechoic layer

of debris Surrounding tissue not stiff4 months later – 29 kPa (min 3.9 – max 48.1) on hypoechoic layer of debris Surrounding tissue not stiff

Thyroid nodules – Bidimensional US

Benign Malignant

Thyroid nodules – Color and Powerdoppler

Benign Malignant

Thyroid nodules – SW Elastography

Benign Malignant

Breast sonoelastography

Clinical cases discussion

Dr. Antonio Pio Masciotra

Campobasso

Breast SWE – hyperchoic nodule in fat

• Nodule 14.8 kPa• Parenchima 21.3 kPa

Breast SWE – unilateral gynecomastia

• Nodule 14.8 kPa• Parenchima 21.3 kPa

RT induced effects on breastBidimensional US

6 months after RT 13 years after RT

RT induced effects on breastSW Elastography

6 months after RT 13 years after RT

RT induced breast subacute effects3D US

• RT

RT induced breast subacute effects3D SWE

• RT

Breast complicated cystBidimensional US

First study 7 days after therapy

Breast complicated cystPowerdoppler

First study 7 days after therapy

Breast complicated cystSW Elastography

First study 7 days after therapy

Breast complicated cyst3D US

First study 7 days after therapy

Breast complicated cyst3D SWE

First study 7 days after therapy

Breast complicated cyst SWE different settings

Resolution mode Penetration mode

Breast fibroadenomas Bidimensional US

Almost homogeneous Inhomogeneous

Breast fibroadenomas SW Elastography

Different kPa Similar elasticity ratio

Breast papillary carcinoma

2008

2009

2010

2011

2008200920102011

Breast carcinoma – Mammography

Benign Malignant

Breast carcinoma – US

Bidimensional 3D

Breast carcinoma – SWE

Bidimensional 3D

Breast carcinoma – SWE

High transparence Low transparence

2 more nodules in the same breast – Bidimensional US

Nodule n. 1 Nodule n. 2

2 more nodules in the same breast – SW Elastography (both benign at histology)

Nodule n. 1 Nodule n. 2

Breast carcinoma – Axilla US

Bidimensional 3D

Breast carcinoma – Axilla SWE

Bidimensional 3D

Lymphnodes 2D US

B cell Lymphoma Breast cancer metastasis

Lymphnodes US 3D

B cell Lymphoma Breast cancer metastasis

Lymphnodes SWE

B cell Lymphoma Breast cancer metastasis

Lymphnodes in different sites in the same patientBidimensional US

B cell Lymphoma inguinal B cell Lymphoma ext. iliac

Lymphnodes in different sites in the same patientSW Elastography

B cell Lymphoma inguinal B cell Lymphoma ext. iliac

Lymphnodes SWE Different stiffness depending on histology

• B cell Lymphoma • Breast cancer metastasis

• NET metastasis

Aims of elastography

Correct tissue elasticity quantification

Identification of ‘cut off’ elasticity values for the right diagnostic workup of

diffuse and focal diseases