Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters

Shear wave elastography for solid breast masses evaluation: Quantitative measurement of mean elasticity value and elasticity ratio

Purpose

Shear wave elastography (SWE), an ultrasonographic technique to measure the elasticity of mass lesions to evaluate breast mass. This study aimed to find out the cutoff values identifying breast malignancy using the mean elasticity (E-mean) and elasticity ratio (E-ratio) of breast masses.

Methods

This retrospective study included women underwent SWE and US-guided biopsy of breast masses. During conventional US, the SWE mode was also performed, determining elasticity measurements, E-mean and E-ratio. Histopathological reports were obtained to identify mass status. The optimal and alternative cutoff values for E-mean and E-ratio to determine malignancy were assessed by receiver operating characteristic (ROC) curve analysis and Youden's index score.

Results

Among 147 benign and 93 malignant masses, the median of E-means were 26.20 (IQR 15.70-56.60) and 141.60 (IQR 119.80-154.60) kPa and the median E-ratios were 3.11 (IQR 1.83-5.23) and 9.24 (IQR 6.76-12.44), respectively. Using Youden's index, the optimal cutoff values for E-mean and E-ratio were 90.35 and 5.89, with sensitivity of 87.1 % and 82.8 %, specificity of 89.1 % and 83.7 %, positive predictive value (PPV) of 83.5 % and 76.2 %, negative predictive value (NPV) of 91.6 % and 88.5 %, positive likelihood ratio (LR+) of 8.00 and 5.07, and negative likelihood ratio (LR-) of 0.14 and 0.21, respectively.

Conclusion

This study revealed that SWE is useful in predicting malignancy. With the optimal cutoff values of E-mean and E-ratio at 90.35 kPa and 5.89, the sensitivity was nearly 90 % with E-mean and slightly over 80 % with E-ratio, respectively. These findings could be used in conjunction with conventional US.

Value of placental virtual magnetic resonance elastography and intravoxel incoherent motion-based diffusion and perfusion in predicting adverse outcomes of small-for-gestational-age infants

OBJECTIVE

It is critical to early monitor and manage small-for-gestational age (SGA) infants with truly adverse outcomes not detected by conventional methods. We aimed to explore the value of diffusion-weighted imaging (DWI)-based virtual magnetic resonance elastography (vMRE) and intravoxel incoherent motion (IVIM)-based biexponential and stretched exponential parameters in predicting adverse outcomes of SGA infants.

METHODS

Twenty SGA infants with adverse outcomes and forty without adverse outcomes were included in this prospective study. One DWI-based vMRE parameter [the stiffness value (μdiff)], five IVIM-based parameters [true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), diffusion distribution coefficient (DDC), and diffusion heterogeneity index (Alpha)] and apparent diffusion coefficient (ADC) were calculated and compared between groups. The predictive efficiency was compared by the logistic regression analysis and receiver operating characteristic curve analysis. The relationship between the μdiff value with gestational age was also evaluated.

RESULTS

The placental μdiff value was remarkably higher, and the f, DDC, and ADC values were considerably lower in the SGA infants with adverse outcomes compared with those without adverse outcomes. The μdiff and f value were predictive risk factors for SGA infants with adverse outcomes. A combined predictive model (μdiff and f) improved the predictive efficacy. Moreover, there was no statistically significant correlation between the placental stiffness value and gestational age.

CONCLUSIONS

Functional MRI parameters to quantify placenta elastography and microcirculation in SGA patients. This might be a useful tool to assess placental function and a vital non-invasive supplement for predicting adverse outcomes of SGA infants.

CRITICAL RELEVANCE STATEMENT

This prospective study shows DWI-based virtual magnetic resonance elastography and intravoxel incoherent motion-based functional parameters to quantify placenta elastography and microcirculation in small-for-gestational-age patients, which could complement existing non-invasive methods for monitoring and predicting neonatal perinatal adverse outcome.

KEY POINTS

• vMRE is an emerging non-invasive imaging technique for evaluating placenta stiffness. • SGA infants with adverse outcome have stiffer placental elasticity and lower microcirculation. • Risk factors combination displayed better efficacy in predicting adverse outcomes of SGA.

Prediction of clinical response to neoadjuvant therapy in advanced breast cancer by baseline B-mode ultrasound, shear-wave elastography, and pathological information

Background

Neoadjuvant therapy (NAT) is the preferred treatment for advanced breast cancer nowadays. The early prediction of its responses is important for personalized treatment. This study aimed at using baseline shear wave elastography (SWE) ultrasound combined with clinical and pathological information to predict the clinical response to therapy in advanced breast cancer.

Methods

This retrospective study included 217 patients with advanced breast cancer who were treated in West China Hospital of Sichuan University from April 2020 to June 2022. The features of ultrasonic images were collected according to the Breast imaging reporting and data system (BI-RADS), and the stiffness value was measured at the same time. The changes were measured according to the Response evaluation criteria in solid tumors (RECIST1.1) by MRI and clinical situation. The relevant indicators of clinical response were obtained through univariate analysis and incorporated into a logistic regression analysis to establish the prediction model. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction models.

Results

All patients were divided into a test set and a validation set in a 7:3 ratio. A total of 152 patients in the test set, with 41 patients (27.00%) in the non-responders group and 111 patients (73.00%) in the responders group, were finally included in this study. Among all unitary and combined mode models, the Pathology + B-mode + SWE model performed best, with the highest AUC of 0.808 (accuracy 72.37%, sensitivity 68.47%, specificity 82.93%, P<0.001). HER2+, Skin invasion, Post mammary space invasion, Myometrial invasion and Emax were the factors with a significant predictive value (P<0.05). 65 patients were used as an external validation set. There was no statistical difference in ROC between the test set and the validation set (P>0.05).

Conclusion

As the non-invasive imaging biomarkers, baseline SWE ultrasound combined with clinical and pathological information can be used to predict the clinical response to therapy in advanced breast cancer.

Correlation of Shear-Wave Elastography and Apparent Diffusion Coefficient Values in Breast Cancer and Their Relationship with the Prognostic Factors

Background: Diffusion-weighted imaging and elastography are widely accepted methods in the evaluation of breast masses, however, there is very limited data comparing the two methods. The apparent diffusion coefficient is a measure of the diffusion of water molecules obtained by diffusion-weighted imaging as a part of breast MRI. Breast elastography is an adjunct to conventional ultrasonography, which provides a noninvasive evaluation of the stiffness of the lesion. Theoretically, increased tissue density and stiffness are related to each other. The purpose of this study is to compare MRI ADC values of the breast masses with quantitative elastography based on ultrasound shear wave measurements and to investigate their possible relation with the prognostic factors and molecular subtypes. Methods: We retrospectively evaluated histopathologically proven 147 breast lesions. The molecular classification of malignant lesions was made according to the prognostic factors. Shear wave elastography was measured in kiloPascal (kPa) units which is a quantitative measure of tissue stiffness. DWI was obtained using a 1.5-T MRI system. Results: ADC values were strongly inversely correlated with elasticity (r = −0.662, p < 0.01) according to Pearson Correlation. In our study, the cut-off value of ADC was 1.00 × 10−3 cm2/s to achieve a sensitivity of 84.6% and specificity of 75.4%, and the cut-off value of elasticity was 105.5 kPa to achieve the sensitivity of 96.3% and specificity 76.9% to discriminate between the malignant and benign breast lesions. The status of prognostic factors was not correlated with the ADC values and elasticity. Conclusions: Elasticity and ADC values are correlated. Both cannot predict the status of prognostic factors and differentiate between molecular subtypes.

Clinical Value of Contrast-Enhanced Ultrasound in Breast Cancer Diagnosis

Breast cancer (BC) ranks first in morbidity and mortality among female malignant tumors worldwide. This study is aimed at clarifying clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis and differentiation of BC. A total of 108 BC patients admitted to our hospital from January 2019 to December 2021 were enrolled. All patients underwent conventional color Doppler ultrasound and CEUS imaging examination. All ultrasound images were analyzed by a senior (5+ years) sonographer. The lesion location, echo, size, and color Doppler flow imaging (CDFI) blood flow distribution of benign and malignant BC were assessed. The transverse and longitudinal diameters of malignant BC presented significant elevation compared with the control group (P < 0.05). CEUS is more reliable than conventional ultrasound in the differentiation of benign and malignant breast lesions, and CEUS has the best reliability. The comparison of CEUS observation indicators between benign and malignant groups demonstrated that CEUS enhancement patterns (time and intensity) and morphological features (lesion boundary, shape, range, homogeneity, and filling defect) presented statistical significance (P < 0.01). Irregular shape and range expansion were high-specificity indicators (all >90.00%); fast-forward, high enhancement, clear boundary, and range expansion were high-sensitivity (all >90.00%); and fast-forward, high enhancement, and clear boundary were low-specificity indicators (all <50.00%); moderate sensitivity is as follows: homogeneous enhancement and range expansion (all >80.00%). The area under curve of CEUS (0.735 ± 0.053) presented elevation relative to conventional ultrasound (0.901 ± 0.024), with statistical significance (Z1 = 2.462, P < 0.05). Relative to conventional ultrasound, the specificity and positive predictive value of CEUS presented elevation (P < 0.05). In conclusion, in the differentiation of benign and malignant breast lesions, CEUS has better diagnostic accuracy and reliability than conventional ultrasound. The diagnostic advantages of CEUS are to elevate the diagnostic specificity and positive predictive value and reduce the misdiagnosis rate.

Which combination of different ultrasonography modalities is more appropriate to diagnose breast cancer?: A network meta-analysis (a PRISMA-compliant article)

BACKGROUND

Abundant amount of literature that analyze the various detection of different ultrasound methods, no comprehensive literature that investigates the diagnostic values of breast cancer (BC) by different ultrasonography modalities through a network meta-analysis (NMA) has been made available. Each imaging diagnostic examination has its own advantages and disadvantages, and any imaging examination is not enough to make an accurate diagnosis of the disease. Thus, this study aimed to compare diagnostic values among different ultrasonography modalities, including the information of 2-dimension, stiffness and blood flow, by a network meta-analysis in the hopes of understanding which imaging methods are better and which combination of different ultrasonography modalities is more appropriate to diagnose BC.

METHODS

We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the 8 different ultrasound methods.

RESULTS

A total of 36 eligible diagnostic tests regarding 8 ultrasound methods were included in the study. According to this network meta-analysis, Breast Imaging Reporting and Data System (BI-RADS) 4b exhibited higher specificity, PPV, and accuracy and lower sensitivity and NPV than BI-RADS 4a. Contrast-enhanced ultrasound (CEUS) had the highest sensitivity, PPV, NPV and accuracy and superb microvascular imaging (SMI) had the highest specificity among color Doppler flow imaging (CDFI), power Doppler imaging(PDI), SMI and CEUS. There was no significant difference in diagnostic indexes between SMI and CEUS. Shear wave elastrography (SWE) had higher PPV and accuracy and lower sensitivity, specificity NPV than strain elastography (SE).

CONCLUSION

The results of this network meta-analysis suggested more appropriate combination of different ultrasound modalities is BI-RADS 4b, SMI, and SWE for the diagnosis of breast cancer.

Evaluation of Tissue Stiffness Around Lesions by Sound Touch Shear Wave Elastography in Breast Malignancy Diagnosis

The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee-approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, E_max and E_mean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding E_max-shell and E_mean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of E_{max-shell-2.0} was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, E_{max-shell-2.0} and age were independent predictors of malignancy. E_{max-shell-2.0} was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and E_{max-shell-2.0} performs best.

Differential diagnosis of B-mode ultrasound Breast Imaging Reporting and Data System category 3-4a lesions in conjunction with shear-wave elastography using conservative and aggressive approaches

BACKGROUND

The high false-positive rates of US Breast Imaging Reporting and Data System (BI-RADS) category 3-4a breast lesions leads to excessive biopsies of many benign lesions, and our aim was to investigate the diagnostic performance achieved by adding a maximum elasticity (Emax) of shear-wave elastography (SWE) to ultrasound (US) to evaluate US BI-RADS category 3-4a breast lesions using conservative and aggressive approaches. We explored the capacity of using this method to avoid unnecessary biopsies without increasing the probability of missing breast cancers.

METHODS

A total of 123 breast lesions of 120 patients classified as BI-RADS category 3 or 4a were enrolled from January 2019 to December 2019. The US features were evaluated according to the US BI-RADS lexicon. The maximum diameter measured on the US was defined as the size of the lesion. The Emax was assessed by SWE, and the average Emax of breast lesions on two images were calculated and recorded as the final maximum Young's modulus. The diagnostic performance of the combined B-mode US and SWE approach for BI-RADS category 3-4a breast lesions was tested using a conservative approach and an aggressive approach. In the conservative approach, the lesions were downgraded with Emax of 30 kPa or less and upgraded with Emax of 160 kPa or more. In the aggressive approach, the lesions were downgraded with Emax of 80 kPa or less and upgraded with Emax of 160 kPa or more. Pathologic results were defined as the reference standard.

RESULTS

Among all 123 breast lesions, there were 60 lesions classified as BI-RADS category 3 and 63 lesions classified as BI-RADS category 4a. Compared to the B-mode US, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic (ROC) curve (AUC) of the combined B-mode US and SWE with a conservative approach changed from 88.9% to 94.4%, 55.2% to 60.0%, 25.4% to 28.8%, 96.7% to 98.4%, 60.2% to 65.0%, and 0.721 to 0.772, respectively. The specificity, PPV, and accuracy of combined B-mode US and SWE with an aggressive approach increased from 55.2% to 72.4%, 25.4% to 29.3%, and 60.2% to 71.5%, respectively, but this was accompanied with decreases in the sensitivity from 88.9% to 66.7%, the NPV from 96.7% to 92.7%, and the AUC from 0.721 to 0.695.

CONCLUSIONS

The addition of SWE improves the diagnostic performance of breast US. Adding the diagnostic criteria of SWE to the BI-RADS assessment of B-mode US, downgrading the lesions with Emax 30 kPa or less, and upgrading the lesions with Emax 160 kPa or more helped discriminate low suspicion lesions from benign lesions in order to decrease false-positive findings and avoid missing cancer diagnosis.

The Value of Shear Wave Elastography in the Diagnosis of Breast Cancer Axillary Lymph Node Metastasis and Its Correlation With Molecular Classification of Breast Masses

OBJECTIVE

To explore the diagnostic value of shear wave elastography examination (SWE) on axillary node metastasis (ANM) in breast cancer, this study aimed to evaluate the correlation between the SWE features and different molecular types of breast cancer, and to check the elastic modulus differences among the molecular types.

METHODS

Breast cancer patients from November 2020 to December 2021 were subjected to both conventional ultrasonic examination (CUE) and SWE before ultrasound-guided percutaneous biopsy or axillary lymph node dissection (ALND). We used the pathological results as the gold standard to draw the receiver operating characteristic (ROC) curve.

RESULTS

SWE outperforms CUE, but their conjunctive use is the best option. No significant correlation was found between the elastic modulus values and the molecular types of breast cancer.

CONCLUSION

SWE can be used as an routine auxiliary method of CUE for ANM.

Non-invasive intracranial pressure assessment using shear-wave elastography in neuro-critical care patients

OBJECTIVE

To determine if Young's modulus of the optic nerve (ON) structure as measured by shear-wave elastography can suggest changes in intracranial pressure (ICP) in neuro-critical care patients.

MATERIALS AND METHODS

Thirty-one healthy volunteers and twenty-two neuro-critical care patients were enrolled. ON sheath (ONS) diameter (ONSD) values and Young's modulus measurements of volunteers were collected in a calm state and during a Valsalva maneuver (VM). Ultrasound measurements and ICP values of patients were collected on operation day and at 24 and 48 h after the operation; measurements were thereafter assigned to three groups: severely elevated (ICP greater than 22 mmHg), mildly elevated (ICP = 14-22 mmHg), and normal (ICP ≤ 13 mmHg).

RESULTS

ONSD and Young's modulus for the ON and ONS of volunteers during VM were higher than those in the calm state (all P < 0.001). In contrast to ONSD, Young's modulus for ON and ONS did not correlate with age, body mass index, or sex. The best cutoff values of Young's modulus for ON for predicting elevated and severely elevated ICP were 16.67 kPa and 22.74 kPa, respectively. Accordingly, the sensitivity values were 96.7% and 88.9%, and the specificity values were 86.1% and 73.7%, which had the same diagnostic performance as ONSD.

CONCLUSION

Young's modulus of the ON accurately reflects changes in ICP. It is not confounded by age, sex, or body mass index compared to ONSD.

Tumor stiffness measured by shear-wave elastography: association with disease-free survival in women with early-stage breast cancer

OBJECTIVE

To determine whether shear-wave elastography (SWE)-measured tumor stiffness is associated with disease-free survival in females with early-stage invasive breast cancer.

METHODS

This retrospective study included 202 consecutive females (mean age, 52.9 years; range, 25-84 years) with newly diagnosed T1-two breast cancer who underwent preoperative SWE between April 2015 and January 2016. Tumor stiffness was assessed and quantitative SWE features of each breast lesion were obtained by a breast radiologist. Cox proportional hazard models were used to identify associations between SWE features and disease-free survival after adjusting for clinicopathologic factors.

RESULTS

Fifteen (7.4%) patients exhibited recurrence after a median follow-up of 56 months. Mean (Emean), minimum, and maximum elasticity values were higher in females with recurrence than in those without recurrence (184.4, 138.3, and 210.5 kPa vs 134.9, 101.7, and 159.8 kPa, respectively; p = 0.005, p = 0.005, and p = 0.012, respectively). Receiver operating characteristics curve analysis for prediction of recurrence showed that Emean yielded the largest area under the curve (0.717) among the quantitative SWE parameters, and the optimal cut-off value was 121.7 kPa. Multivariable Cox proportional hazards analysis revealed that higher Emean (>121.7 kPa) [adjusted hazard ratio (HR), 10.01; 95% CI: 1.31-76.33; p = 0.026] and lymphovascular invasion (adjusted HR, 7.72; 95% CI: 1.74-34.26; p = 0.007) were associated with worse disease-free survival outcomes.

CONCLUSION

Higher SWE-measured Emean was associated with worse disease-free survival in females with early-stage invasive breast cancer.

ADVANCES IN KNOWLEDGE

Tumor stiffness assessed with shear-wave elastography might serve as a quantitative imaging biomarker of disease-free survival in females with T1-two breast cancer.

[Ultrasound elastography techniques in breast cancer]

BACKGROUND

Elasticity assessment of breast lesions can also be used as an associated criterion in the B‑mode ultrasound (US) assessment for differentiation between benign or malignant lesions.

OBJECTIVES

The goal was to identify techniques available to measure US elasticity, assess the use of B‑mode BI-RADS® classification combined with elastography, and identify which artefacts influence the US elasticity result.

MATERIALS AND METHODS

Based on different studies and meta-analyses, clinical application in daily routine of the presented US elastography techniques will be investigated concerning the statistical performance of semi-quantitative and quantitative cut-off values to differentiate benign from malignant lesions.

RESULTS

Supported by meta-analyses, all presented US elastography techniques improve the specificity by decreasing the B‑mode sensitivity. In the literature the semi-quantitative and quantitative cut-off values often vary considerably. The interobserver variability of strain elastography shows a fair agreement and the interobserver variability of shear wave elastography a substantial agreement.

CONCLUSIONS

Considering the limitations and artefacts of each technique, US elastography is able to enhance the true positive and true negative results. In the case of a higher B‑mode BI-RADS® classification (4b, 4c, 5) or in a high-risk situation to develop breast cancer, a large core needle biopsy should be performed despite lesion softness in elastography.

Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis

Purpose

This study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE.

Methods

A systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool.

Results

Twenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively.

Conclusion

Adding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies.

Shear wave elastography for treatment monitoring of plantar fasciitis

BACKGROUND

Plantar fasciitis is a common cause of heel pain. Monitoring therapy effects is challenging with conventional B-mode ultrasound. Shear wave elastography (SWE) provides important diagnostic information beyond B-mode, with typically lower tissue stiffness in symptomatic plantar fascia. Up to now little is known about SWE features for therapy monitoring in plantar fasciitis. We evaluated the clinical effects of a 3-month physical therapy based treatment and its influence on B-mode and SWE ultrasound findings in patients suffering from plantar fasciitis, correlating ultrasound findings to score-based symptom development.

METHODS

Prospective, IRB-approved clinical study in plantar fasciitis patients undergoing a 3-month physical therapy based treatment. Measurement time points were before (T0), after 1 (T1) and 3 (T2) months of treatment, consisting of clinical orthopedic (FFI, AOFAS-Score) and multimodal radiologic sonographic examinations (B-mode/SWE) using a high-resolution linear 18-MHz probe.

RESULTS

A total of 33 patients with 43 symptomatic plantar fascia were included. We found a significant (P<0.001) clinical score improvement (AOFAS +14, FFI-Pain -21, FFI-Function -18) between T0 and T2. Mean initial thickness (T0) of symptomatic plantar fascia was 4.2 (±1.2) mm, compared to 3.2 (±0.7) mm at the asymptomatic contralateral side (P<0.001). No significant thickness changes were seen at T1 (4.2±1.1 mm) and T2 (4.5±1.3 mm), even though clinical scores improved significantly. Mean initial stiffness (T0) of symptomatic plantar fascia was 59.57 (±43.3) kPa, compared to 83.23 (±47.3) kPa at the asymptomatic contralateral side (P<0.001). In contrast to B-mode ultrasound, SWE values increased significantly between T0 (59.6±43.3 kPa), T1 (82.6±47.3 kPa) and T2 (102.5±47.2 kPa) (P<0.001-0.009), with positive correlations for AOFAS/FFI-Pain/Function scores (r=0.285-0.473, P<0.001-0.002).

CONCLUSIONS

A physical therapy based treatment relieves plantar fasciitis symptoms during a 3-month period. In line with symptom reduction, stiffness (Young's-moduli) of plantar fascia increased significantly, while B-mode ultrasound revealed no measurable changes during the healing process. Shear wave elastography was able to quantify plantar fascia pathologies and their recovery under therapy.

The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography

Background

Elastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE.

Methods

Between September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (E_mean), elasticity maximum (E_max), and elasticity minimum (E_min), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models.

Results

This prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of E_max-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the E_max-3shell and the E_min-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86.

Conclusions

SWE features, particularly the combination of E_max-3shell and E_min-3shell can improve the diagnosis of breast lesions.

Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility

PURPOSE

The purpose of this study was to determine quantitative testicular tissue stiffness values in normal and infertile men using shear wave elastography (SWE), and to evaluate the relationship between infertility and testicular stiffness value.

METHODS

In total, 100 testes of 50 infertile patients with abnormal semen parameters were classified as group A, and 100 testes of 50 control subjects were classified as group B. These two groups were compared in terms of age, testicular volume, and SWE values. The group B testes were randomly chosen from patients who had applied for ultrasonography for any reason, and who had no testis disease and no history of infertility.

RESULTS

The mean age of the patients was 27.83 years, and no significant difference in age was found between the groups (P = 0.133). No significant difference in testicular volume was found between the groups (P = 0.672). The SWE values were significantly higher in group A than in group B (P = 0.000 for both m/s and kPa values). SWE values had a negative correlation with mean testicular volume in group A (for m/s values: P = 0.043; for kPa values: P = 0.024).

CONCLUSION

SWE can be a useful technique for assessing testicular stiffness in infertile patients to predict parenchymal damage in testicular tissue that leads to an abnormality in sperm quantity. In addition, decreased testicular volume, together with increased SWE values, can reflect the degree of parenchymal damage.

Simultaneous comparison between strain and shear wave elastography of breast masses for the differentiation of benign and malignant lesions by qualitative and quantitative assessments

PURPOSE

To compare the addition of diagnostic strain elastography (SE) and shear wave elastography (SWE) values to the conventional B-mode ultrasonography in differentiating between benign and malignant breast masses by qualitative and quantitative assessments.

MATERIALS AND METHODS

B-mode ultrasound, SE, and SWE were simultaneously performed using one ultrasound system in 148 breast masses; 88 of them were malignant. The breast imaging reporting and data system category in the B-mode, Tsukuba score (SE_Tsu), Fat-Lesion-Ratio (SE_FLR) in SE, and five-point color assessment (SWE_col) and elasticity values (SWE_ela) in SWE were assessed. The results were compared using the area under the receiver-operating characteristic curve (AUC).

RESULT

The AUC for B-mode and each elastography were similar (B-mode, 0.889; SE_Tsu, 0.885; SE_FLR, 0.875; SWE_col, 0.881; SWE_ela, 0.885; P > 0.05). The combined sets between B-mode and either of the elastography technique showed good diagnostic performance (B-mode + SE_Tsu, 0.903; B-mode + SE_FLR, 0.909; B-mode + SWE_col, 0.919; B-mode + SWE_ela, 0.914). B-mode + SWE_col and B-mode + SWE_ela showed a higher AUC than B-mode alone (P = 0.026 and 0.029), and B-mode + SE_Tsu and B-mode + SE_FLR showed comparable AUC to B-mode alone (P = 0.196 and 0.085). There was no significant difference between qualitative and quantitative assessments for the combined sets of B-mode and elastography (P > 0.05).

CONCLUSION

The addition of both SE and SWE to B-mode ultrasound improved the diagnostic performance with increased AUC, and especially SWE was more useful than SE, and no significant difference was found between qualitative and quantitative assessments.

Dual-mode artificially-intelligent diagnosis of breast tumours in shear-wave elastography and B-mode ultrasound using deep polynomial networks

The main goal of this study is to build an artificial intelligence (AI) architecture for automated extraction of dual-modal image features from both shear-wave elastography (SWE) and B-mode ultrasound, and to evaluate the AI architecture for classification between benign and malignant breast tumors. In this AI architecture, ultrasound images were segmented by the reaction diffusion level set model combined with the Gabor-based anisotropic diffusion algorithm. Then morphological features and texture features were extracted from SWE and B-mode ultrasound images at the contourlet domain. Finally, we employed a framework for feature learning and classification with the deep polynomial network (DPN) on dual-modal features to distinguish between malignant and benign breast tumors. With the leave-one-out cross validation, the DPN method on dual-modal features achieved a sensitivity of 97.8%, a specificity of 94.1%, an accuracy of 95.6%, a Youden's index of 91.9% and an area under the receiver operating characteristic curve of 0.961, which was superior to the classic single-modal methods, and the dual-modal methods using the principal component analysis and multiple kernel learning. These results have demonstrated that the dual-modal AI-based technique with DPN has the potential for breast tumor classification in future clinical practice.