Masciotra pavia 2012 clinical cases

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BREAST AND THYROID SONOELASTOGRAPHY Clinical session : Discussion of clinical cases Antonio Pio Masciotra – Campobasso - Italy

description

Clinical cases of thyroid and breast elastography are presented by dr. Antonio Pio Masciotra at 2nd Sono-Elastography International Meeting in Pavia on Oct. 2012.

Transcript of Masciotra pavia 2012 clinical cases

Page 1: Masciotra pavia 2012 clinical cases

BREAST AND THYROID SONOELASTOGRAPHY

Clinical session : Discussion of clinical cases

Antonio Pio Masciotra – Campobasso - Italy

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Thyroid sonoelastography

Clinical cases discussion

Dr. Antonio Pio Masciotra

Campobasso

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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.

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STRAIN ELASTOGRAPHY with different grades of compression

Inhomogeneous elasticity Uniform low elasticity

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SHEAR WAVE ELASTOGRAPHY

• Normal gland 8.29 kPa• Nodule 8.46 kPa

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Hashimoto thyroiditis

• Normal gland 8 kPa• Hashimoto 13-15 kPa

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Hashimoto thyroiditis

• Nodule 14.8 kPa• Parenchima 21.3 kPa

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Hashimoto thyroiditis – 3D US

• Nodule 14.8 kPa• Parenchima 21.3 kPa

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Hashimoto thyroiditis – 3D SWE

• Nodule 14.8 kPa• Parenchima 21.3 kPa

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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

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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

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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

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Thyroid nodules – Bidimensional US

Benign Malignant

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Thyroid nodules – Color and Powerdoppler

Benign Malignant

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Thyroid nodules – SW Elastography

Benign Malignant

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Breast sonoelastography

Clinical cases discussion

Dr. Antonio Pio Masciotra

Campobasso

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Breast SWE – hyperchoic nodule in fat

• Nodule 14.8 kPa• Parenchima 21.3 kPa

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Breast SWE – unilateral gynecomastia

• Nodule 14.8 kPa• Parenchima 21.3 kPa

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RT induced effects on breastBidimensional US

6 months after RT 13 years after RT

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RT induced effects on breastSW Elastography

6 months after RT 13 years after RT

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RT induced breast subacute effects3D US

• RT

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RT induced breast subacute effects3D SWE

• RT

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Breast complicated cystBidimensional US

First study 7 days after therapy

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Breast complicated cystPowerdoppler

First study 7 days after therapy

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Breast complicated cystSW Elastography

First study 7 days after therapy

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Breast complicated cyst3D US

First study 7 days after therapy

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Breast complicated cyst3D SWE

First study 7 days after therapy

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Breast complicated cyst SWE different settings

Resolution mode Penetration mode

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Breast fibroadenomas Bidimensional US

Almost homogeneous Inhomogeneous

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Breast fibroadenomas SW Elastography

Different kPa Similar elasticity ratio

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Breast papillary carcinoma

2008

2009

2010

2011

2008200920102011

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Breast carcinoma – Mammography

Benign Malignant

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Breast carcinoma – US

Bidimensional 3D

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Breast carcinoma – SWE

Bidimensional 3D

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Breast carcinoma – SWE

High transparence Low transparence

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2 more nodules in the same breast – Bidimensional US

Nodule n. 1 Nodule n. 2

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

Nodule n. 1 Nodule n. 2

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Breast carcinoma – Axilla US

Bidimensional 3D

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Breast carcinoma – Axilla SWE

Bidimensional 3D

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Lymphnodes 2D US

B cell Lymphoma Breast cancer metastasis

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Lymphnodes US 3D

B cell Lymphoma Breast cancer metastasis

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Lymphnodes SWE

B cell Lymphoma Breast cancer metastasis

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Lymphnodes in different sites in the same patientBidimensional US

B cell Lymphoma inguinal B cell Lymphoma ext. iliac

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Lymphnodes in different sites in the same patientSW Elastography

B cell Lymphoma inguinal B cell Lymphoma ext. iliac

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Lymphnodes SWE Different stiffness depending on histology

• B cell Lymphoma • Breast cancer metastasis

• NET metastasis

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Aims of elastography

Correct tissue elasticity quantification

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

diffuse and focal diseases

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