e Last Ography
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Transcript of e Last Ography
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ELASTOGRAPHY
DR SHAILENDRA SAVALE
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Palpation is the age old method of surgical
diagnosis.
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What we see in elastography? It calculates strain produced by the tissue.
It characterises stiffness of underlying
tissue.
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PRINCIPLEDistortion when matter subjected to external
force.Hookes law
Youngs modulusPoissons ratio.
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HOOKE,S LAW F=-Kx(F RESTORING FORCE )
(x DISPLACEMENT)
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YOUNGS MODULUSRelation of stress vs strain of material
following hookes law.
Unit is pascal/pound per square inch(US)
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POISSONS RATIOWhen sample material is compressed in one
dimension,it expands in other dimensions.
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Basic principlesBenign and malignant lesions have different
firmness.Strain imaging display relative firmness of
lesion compared to surrounding normaltissue.
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Stiffer areas deform less easily than
surrounding.Colour codestiffer areas dark
softer areas light
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Elasticity correlates with pathological
changes.
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How to perform ?
Trasducer moved over affected area.
Machine records two images
simultaneously. a)B mode picture
b)Elastogram
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Both images are displayed side by side.
B MODE ELASTOGRAM
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Interpretation
Compare area on B mode and elastogram.
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COMPARE B MODE AND
ELASTOGRAMBENIGN MALIGNANT
AREA OF
STIFFNESS
SMALLER
THAN B
MODE
LARGER
THAN B
MODE
APPEARANCE DARK BTLESS
CONTRAST
DARK WITHHIGH
CONTRAST
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IS IT BENIGN OR MALIGNANT?
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All lesions are iso-echoic on
B mode.but on elastography
their appearance vary.
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CAN IT BE COLOURFUL?
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TSUKUBA ELASTICITY SCORE
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http://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpg -
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Score 4
Score 1
http://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpghttp://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpghttp://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpg -
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Is breast only organ to be imaged by
elastography?
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LIVER
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ENTIRE LESIO
HOMOGENEO
GREEN (1)
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MOSAIC
PATTERN
WITHDOMINANT
GREEN
AREAS(2)
MOSAIC
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MOSAIC
PATTERN WIT
DOMINENTBLUE(3)
METASTATIC
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METASTATIC
LIVER CA FR
CA COLON(4)
POST ART
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POST ART
EMBOLISATI
RF ABLASIONHYPERECHOI
ON B SCALE
S/O DEGENERA
CHANGES
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LYMPH NODES
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PATTERN 1
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PATTERN 2
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PATTERN 3
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PATTERN 4
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PATTERN 5
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THYROID
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SKIN
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PROSTATE
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ADVANTAGES
It show lesions not detected by conventional
ultrasonography.Diagnostic accuacy to differenciate benign
from malignant lesions.
Guideline for core needle biopsy.
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Reduction of biopsy rates in benign lesions.
More accurate tumour surgeries with lessre-operation rates.
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WHATS NEW?
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MR ELASTOGRAPHY
To diagnose liver fibrosis before it reaches
untreatable fibrosis.
Only way to diagnose it liver biopsy whichis invasive.
MRE DRIVER SYSTEM CAPABLE OF GENERATING
VIBRATIONS IN ENVIRONMENT OF MRI SCANNER
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VIBRATIONS IN ENVIRONMENT OF MRI SCANNER
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Mechanical waves of
very small amplitude(less
than tenth of mm)are
generated inside the liver
by acoustic driver placedon abdominal wall.
Modified phase contrast
MR sequence is used toimage propagation
waves.Wave image is
superimposed onanatomical image.
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A mathematical algorithmused to process the wave
images to calculate the
stiffness of the tissue.
the resultant image is called
elastogram which shows
stiffness in units of kilo
pascal(kPa).Average stiffnessof this patient was 5.6 kPa.
(normal upper limit is 2.5).
also distribution of stiffnesswas inhomogeneous than
normal liver.
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Normal MRE showing
avarage stiffness of 2
showing homogeneous
stiffness throughout.
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NORMALFIBROSIS
SUMMARY
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SUMMARY
FUTURE PERSPECTIVE- FOR
DIAGNOSIS AND DIFFERENTIATIONOF BENIGN AND MALIGNANT
BREAST LESION.
NON INVASIVE DIAGNOSIS OF LIVER
FIBROSIS.
IT CAN BE USED THYROID,SKIN ANDLYMPH NODE PATHOLOGIES.
THANK YOU
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THANK YOU