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Antonio Pio MasciotraCampobasso Molise Italy

Website www.masciotra.net

YouTube channelhttps://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQQuestions and answers emerging in the approach to Shear Wave Elastography

Antonio Pio Masciotra Molise Italy

Questions and answers emerging in the approach to Shear Wave Elastography

Antonio Pio Masciotra is the uptodate evolution of the Homo Aeserniensis who lived more than 700.000 years ago in the land where Ive born and then generated my kids and grankids.Hopefully Shear Wave Elastography will require a large shorter time to reach its full expression.But like in the life of everyone, its evolution has to pass through discussions and debates that have to be always based on the CURIOSITY

Questions and answers emerging in the approach to Shear Wave Elastography

So Im grateful to all friends worldwide who shared their experiences and their doubts stimulating my mind to find plausible explanations based on my own still too young experience.I trust that this kind of debate is a very useful tool and in short time Ill try to start on YouTube a dedicated channel where community can share doubts, questions, opinions and answers.This file, like all the other Ive posted in Video format on YouTube, can be downloaded as PDF or PPSX file at my website www.masciotra.net or at www.researchgate.net at the following linkhttps://www.researchgate.net/profile/Antonio_pio_Masciotra/?ev=hdr_xprfThe vision will be large better if done at full screen.

Case 1 - DCIS II

Why was this blue, if its malignant?Why we can see black areas inside?Could it be because of the wrong settings?

Tissue/OrganYoungs modulus E (kPa)Density(kg/L)BreastNormal fat18-24

1.0 10% ~ WaterNormal gland28-66Fibrous tissue96-244Carcinoma22-560ProstateNormal anterior gland55-63Normal posterior gland (peripheral zone)62-71Benign Hyperplasia36-41Carcinoma96-241

Why was this blue if its malignant?In the table above you can see that the elasticity of breast cancer tissue is by itself highly variable (from 22 to 560 kPa!) and with large overlapping to the values of normal breast tissuesThe same table shows that uptodate prostate is the only organ in which theres no overlapping of cancer stiffness (96 - 241 kPa) on normal tissue elasticity (36 71 kPa)

Could it be because of the wrong settings? Why was this blue if its malignant?

Could it be because of the wrong settings? Why was this blue if its malignant?

Optimization of SWE map in acquisition

Resolution mode is for shallow and/or wellcircumscribed lesions. Excellent axial resolution and less persistence is applied. Improves clearing of fluid-filled lesion.

Standard default setting, to be used forevaluation of the elasticity within the ROI.More persistence is applied to create asmoother appearance.

Penetration mode for deep, and/or large, and/or anechoic or hypoechoic lesions with posterior dropout. Improves penetration at the cost of axial resolution.

Why was this blue if its malignant?Could it be because of the wrong settings?

High transparenceBetter visualization of the boundaries between the lesion and the surrounding tissuesLow transparenceBetter visualization of the core of the focal lesion

28Optimization of SWE map in postprocessingOpacity

Its adjustment from 0 to 100% gives less and more priority to the SWE map over the B-Mode image highlighting different features of focal lesions like in this case of breast cancerWhy was this blue if its malignant?Could it be because of the wrong settings?

Why we can see black areas inside?

Shear Wave Elastography

Highly-localized estimation of tissue elasticity Especially, inside hard lesions

Phantom with liquid center inside hard lesion

Strain Elastography interprets the wholelesion as hard, because the applied manualcompression cannot penetrate the hard shell.Shear Wave Elastography can see insidethe hard lesion, because the shear waves can propagate through the hard shell.

Why we can see black areas inside?

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SHEAR WAVE PROPAGATION

Why we can see black areas inside?

Case 2 - DCIS I cribriform+solid, RE=90%, RP=90%, Her2=0, Ki67=5%

Why was this blue, if its malignant?See the former slides.

Case 3 - CDI + CDISWhy was this blue, if its malignant?Why black areas inside?

Case 3 - CDI + CDISWhy was this blue, if its malignant?Why black areas inside?See the former slides and then :

Here the focal zone is between 19 and 32 mm deepThe lower limit of the focal zone is far out (lower) of the lower border of the color box (ROI)The center of the lesion is 10 mm deep , far outside the upper limit of the focal zone

Case 4 - CDI NST IWhy different results for the same lesion?

Case 4 - CDI NST IWhy different results for the same lesion?

The differences are due to the huge differences in the 2 acquisitions with malpositioning of both the focal zone and the colorbox in the first case.A good SWE image for a reliable stiffness representation and quantification does always require :The best quality of the B scan image (like in the second sampling)The accurate positioning of the focal zone and the color box having the lesion in the middle of bothThe right time to stabilize the SW signal with the least possible probe pressure

Here the focal zone is between 19 and 32 mm deepThe lower limit of the focal zone is far out (lower) of the lower border of the color box (ROI)The center of the lesion is 20 mm deep , almost outside the upper limit of the focal zone

Here the focal zone is between 11 and 24 mm deepThe lower limit of the focal zone is well inside the lower border of the color box (ROI)The center of the lesion is 18 mm deep,well inside the focal zone

Case 5 - ???Why blue?See the former slides (colorscale adjustment)

Case 6 - FibroadenomaWhy black?

Could it be because of the wrong settings? Why was this blue if its malignant?We need to learn that in SW Elastography the colorscale adjustments have to been used with the same principles we use the greyscale in CT images viewing (acting on the window width choice and windows center positioning when in the same scan we want to see better bone, lung, mediastinum or other structures).

Why do we have red inside the benign lesion?

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Why do we have red inside the benign lesion?

Because the colorscale range setting here was between 0 (blue) and 40 kPa (red).The quantification of the red spot in fact corresponds to a maximum stiffness of only 33 kPa (which is not hard).In a colorscale setting as usual (0 blue -180 Kpa red) all the world would seem been blue!

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Could it be because of the wrong settings? Why was this blue if its malignant?We need to learn that in SW Elastography the colorscale adjustments have to been used with the same principles we use the greyscale in CT images viewing (acting on the window width choice and windows center positioning according if in the same scan we want to see better bone, lung, mediastinum or other structures).

Please explain to us, with examples if possible!

Please explain to us, with examples if possible!Same nodule with 3 different modes acquisition

CONCLUSIONS

Sono-Elastography adds valuable information to the study of all organs, potentially resulting in a virtual biopsy .

This final aim will be achieved when further improvement of Shear Wave Elastography technology (the only actually capable to quantify elasticity or stiffness) will give us the right consistency of the quantitative measurements of tissue elasticity that up todate is still lacking.

Hence the RSNA initiative of Quantitative Imaging Biomarkers Alliance applied to Sono-Elastography too.This means that if the intrinsic elasticity of the testis is 2 kPa all the measurements have to give this value, not depending on the probes frequency or on other variables.

When this requirement will be accomplished well can really establish the cutoff value between normal and abnormal tissues both in focal and in diffuse diseases.Therefore well can rely on it at same extent we actually rely on the use a thermometer to check the behavior of the fever during an infection (if its responding to the treatment).

Then lets go on!Lessons need to be drawn from two great men of the past who had the vision to preparing for the future.

Galileo Galilei

"Any problem that wants to be solved starts with curiosity."

"Knowing is not enough, we must apply. Willing is not enough, we must do."Johann Wolfgang von Goethe

Questions and answers emerging in the approach to Shear Wave Elastography

Again a lot of thanks to all friends worldwide who shared their experiences and their doubts stimulating my mind to find plausible explanations based on my own still too young experience.I trust that this kind of debate is a very useful tool and in short time Ill try to start on YouTube a dedicated channel where community can share doubts, questions, opinions and answers.This file, like all the other Ive posted in Video format on YouTube, can be downloaded as PDF or PPSX file at my website www.masciotra.net or at www.researchgate.net at the following linkhttps://www.researchgate.net/profile/Antonio_pio_Masciotra/?ev=hdr_xprfThe vision will be large better if done at full screen.