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Simmons L, Feng L, Fatemi-Ardekani A, Noseworthy MD. The Role of Calcium in Non-Invasively Imaging Breast Cancer: An Overview of Current and Modern Imaging Techniques. Crit Rev Biomed Eng 2023; 51:43-62. [PMID: 37602447 DOI: 10.1615/critrevbiomedeng.2023047683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The landscape of breast cancer diagnostics has significantly evolved over the past decade. With these changes, it is possible to provide a comprehensive assessment of both benign and malignant breast calcifications. The biochemistry of breast cancer and calcifications are thoroughly examined to describe the potential to characterize better different calcium salts composed of calcium carbonate, calcium oxalate, or calcium hydroxyapatite and their associated prognostic implications. Conventional mammographic imaging techniques are compared to available ones, including breast tomosynthesis and contrast-enhanced mammography. Additional methods in computed tomography and magnetic resonance imaging are discussed. The concept of using magnetic resonance imaging particularly magnetic susceptibility to characterize the biochemical characteristics of calcifications is described. As we know magnetic resonance imaging is safe and there is no ionization radiation. Experimental findings through magnetic resonance susceptibility imaging techniques are discussed to illustrate the potential for integrating this technique to provide a quantitative assessment of magnetic susceptibility. Under the right magnetic resonance imaging conditions, a distinct phase variability was isolated amongst different types of calcium salts.
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Affiliation(s)
- Lyndsay Simmons
- Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada; Mohawk College, Institute for Applied Health Sciences, Hamilton, ON, Canada; Imaging Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Ave. E., Hamilton, ON, Canada
| | - Lisa Feng
- Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada
| | - Ali Fatemi-Ardekani
- Medical Physics, Merit Health, Southeast Cancer Network; Department of Physics, Jackson State University
| | - Michael D Noseworthy
- Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada; Imaging Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Ave. E., Hamilton, ON, Canada; Department of Electrical and Computer Engineering, McMaster University, 280 Main Street W., Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton ON, Canada; Department of Radiology, McMaster University, 1280 Main St. W., Hamilton, ON, Canada
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Clinical Significance of Ultrasound Elastography and Fibrotic Focus and Their Association in Breast Cancer. J Clin Med 2022; 11:jcm11247435. [PMID: 36556052 PMCID: PMC9783036 DOI: 10.3390/jcm11247435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Ultrasound (US) elastography is an imaging technology that reveals tissue stiffness. This study aimed to investigate whether fibrotic focus (FF) affects elastographic findings in breast cancer, and to evaluate the clinical significance of US elastography and FF in breast cancer. (2) Methods: In this study, 151 patients with breast cancer who underwent surgery were included. Strain elastography was performed and an elasticity scoring system was used to assess the findings. The elasticity scores were classified as negative, equivocal, or positive. FF was evaluated in the surgical specimens. Medical records were reviewed for all patients. (3) Results: Elastographic findings were equivocal in 30 patients (19.9%) and positive in 121 patients (80.1%). FF was present in 68 patients (46.9%). There was no correlation between elastographic findings and FF. Older age, larger tumor size, lymph node metastasis, and higher tumor stage were associated with positive elastographic results. FF showed a positive correlation with age, postmenopausal status, tumor size, lymphovascular invasion, lymph node metastasis, tumor stage, and intratumoral and peritumoral inflammation. (4) Conclusions: Our study showed that positive elastographic results and FF were associated with poor prognostic factors for breast cancer. FF did not affect the elastographic findings of this study.
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Kohlenberg J, Gu J, Parvinian A, Webb J, Kawkgi OE, Larson NB, Ryder M, Fatemi M, Alizad A. Added value of mass characteristic frequency to 2-D shear wave elastography for differentiation of benign and malignant thyroid nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1663-1671. [PMID: 35672198 PMCID: PMC9246930 DOI: 10.1016/j.ultrasmedbio.2022.04.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/17/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Mass characteristic frequency (fmass) is a novel shear wave (SW) parameter that represents the ratio of the averaged minimum SW speed within the regions of interest to the largest dimension of the mass. Our study objective was to evaluate if the addition of fmass to conventional 2-D shear wave elastography (SWE) parameters would improve the differentiation of benign from malignant thyroid nodules. Our cohort comprised 107 patients with 113 thyroid nodules, of which 67 (59%) were malignant. Two-dimensional SWE data were obtained using the Supersonic Imagine Aixplorer ultrasound system equipped with a 44- to 15-MHz15-MHz linear array transducer. A receiver operating characteristic curve was generated based on a multivariable logistic regression analysis to evaluate the ability of SWE parameters with/without fmass and with/without clinical factors to discriminate benign from malignant thyroid nodules. The addition of fmass to conventional SW elasticity parameters increased the area under the curve from 0.808 to 0.871 (p = 0.02). The combination of SW elasticity parameters plus fmass plus clinical factors provided the strongest thyroid nodule malignancy probability estimate, with a sensitivity of 93.4% and specificity of 91.1% at the optimal threshold. In summary, fmass can be a valuable addition to conventional 2-D SWE parameters.
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Affiliation(s)
- Jacob Kohlenberg
- Division of Endocrinology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Diabetes, Department of Medicine, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - Juanjuan Gu
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ahmad Parvinian
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Jeremy Webb
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Omar El Kawkgi
- Division of Endocrinology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mabel Ryder
- Division of Endocrinology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA.
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Gu J, Ternifi R, Larson NB, Carter JM, Boughey JC, Stan DL, Fazzio RT, Fatemi M, Alizad A. Hybrid high-definition microvessel imaging/shear wave elastography improves breast lesion characterization. Breast Cancer Res 2022; 24:16. [PMID: 35248115 PMCID: PMC8898476 DOI: 10.1186/s13058-022-01511-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low specificity in current breast imaging modalities leads to increased unnecessary follow-ups and biopsies. The purpose of this study is to evaluate the efficacy of combining the quantitative parameters of high-definition microvasculature imaging (HDMI) and 2D shear wave elastography (SWE) with clinical factors (lesion depth and age) for improving breast lesion differentiation. METHODS In this prospective study, from June 2016 through April 2021, patients with breast lesions identified on diagnostic ultrasound and recommended for core needle biopsy were recruited. HDMI and SWE were conducted prior to biopsies. Two new HDMI parameters, Murray's deviation and bifurcation angle, and a new SWE parameter, mass characteristic frequency, were included for quantitative analysis. Lesion malignancy prediction models based on HDMI only, SWE only, the combination of HDMI and SWE, and the combination of HDMI, SWE and clinical factors were trained via elastic net logistic regression with 70% (360/514) randomly selected data and validated with the remaining 30% (154/514) data. Prediction performances in the validation test set were compared across models with respect to area under the ROC curve as well as sensitivity and specificity based on optimized threshold selection. RESULTS A total of 508 participants (mean age, 54 years ± 15), including 507 female participants and 1 male participant, with 514 suspicious breast lesions (range, 4-72 mm, median size, 13 mm) were included. Of the lesions, 204 were malignant. The SWE-HDMI prediction model, combining quantitative parameters from SWE and HDMI, with AUC of 0.973 (95% CI 0.95-0.99), was significantly higher than the result predicted with the SWE model or HDMI model alone. With an optimal cutoff of 0.25 for the malignancy probability, the sensitivity and specificity were 95.5% and 89.7%, respectively. The specificity was further improved with the addition of clinical factors. The corresponding model defined as the SWE-HDMI-C prediction model had an AUC of 0.981 (95% CI 0.96-1.00). CONCLUSIONS The SWE-HDMI-C detection model, a combination of SWE estimates, HDMI quantitative biomarkers and clinical factors, greatly improved the accuracy in breast lesion characterization.
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Affiliation(s)
- Juanjuan Gu
- grid.66875.3a0000 0004 0459 167XDepartment of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905 USA
| | - Redouane Ternifi
- grid.66875.3a0000 0004 0459 167XDepartment of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905 USA
| | - Nicholas B. Larson
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN 55905 USA
| | - Jodi M. Carter
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905 USA
| | - Judy C. Boughey
- grid.66875.3a0000 0004 0459 167XDepartment of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN 55905 USA
| | - Daniela L. Stan
- grid.66875.3a0000 0004 0459 167XDepartment of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905 USA
| | - Robert T. Fazzio
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905 USA
| | - Mostafa Fatemi
- grid.66875.3a0000 0004 0459 167XDepartment of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905 USA
| | - Azra Alizad
- grid.66875.3a0000 0004 0459 167XDepartment of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905 USA
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Kayadibi Y, Ucar N, Kaya MF, Yildirim E, Bektas S. Characterization of Suspicious Microcalcifications on Mammography Using 2D Shear-Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2532-2542. [PMID: 34127332 DOI: 10.1016/j.ultrasmedbio.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
Our aim was to investigate the correlations between the findings of two-dimensional shear-wave elastography (2D-SWE) and the histopathologic results of microcalcifications (MCs) visualized using ultrasonography (USG). Fifty people with suspicious MCs without accompanying mass were evaluated. They underwent USG and 2D-SWE before USG-guided tru-cut biopsy. SWE values and histopathologic features were compared statistically. The variables between groups were analyzed using the Mann-Whitney U test. Receiver operating characteristic analysis was performed and cut-off values determined to discriminate malignancy, invasiveness and high grade. Pathology confirmed 27 malignant lesions (18 invasive ductal carcinomas, one invasive lobular and eight ductal carcinomas in situ) and 23 benign ones. There was a statistically significant difference between the SWE values of malignant and benign MCs (p < 0.001). The diagnostic performance of SWE for malignancy, invasiveness and high grade were as follows, repectively: sensitivity (93%, 83%, 88%), specificity (91%, 88%, 53%), positive predictive value (93%, 94%, 44%), negative predictive value (91%, 70%, 90%) and area under the curve (0.952, 0.885, 0.776). Cut-off values were determined as 57 kPa for malignancy, 124 kPa for invasiveness and 124.5 kPa for high grade. In conclusion, SWE is a useful method in clinical practice for characterizing MCs that can be visualized with USG.
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Affiliation(s)
- Yasemin Kayadibi
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul Universitesi-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
| | - Nese Ucar
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Mehmet Fatih Kaya
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Emine Yildirim
- Department of General Surgery, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Sibel Bektas
- Department of Pathology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
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Gu J, Polley EC, Boughey JC, Fazzio RT, Fatemi M, Alizad A. Prediction of Invasive Breast Cancer Using Mass Characteristic Frequency and Elasticity in Correlation with Prognostic Histologic Features and Immunohistochemical Biomarkers. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2193-2201. [PMID: 33994231 PMCID: PMC8243825 DOI: 10.1016/j.ultrasmedbio.2021.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 05/17/2023]
Abstract
This purpose of this study is to correlate a new shear-wave elastography (SWE) parameter, mass characteristic frequency (fmass) and other elasticity measure with the prognostic histological factors and immunohistochemical (IHC) biomarkers for the evaluation of heterogeneous breast carcinomas. The new parameter, fmass, first introduced in this paper, is defined as the ratio of the averaged minimum shear wave speed taken spatially within regions of interest to the largest mass dimension. 264 biopsy-proven breast cancerous masses were included in this study. Mean (Emean), maximum (Emax), minimum (Emin) shear wave elasticity and standard deviation (Esd) of shear wave elasticity were found significantly correlated with tumor size, axillary lymph node (ALN) status, histological subtypes and IHC subtypes. The areas under the curve for the ALN prediction are 0.73 (95% confidence interval [CI]: 0.67-0.80) and 0.75 (95% CI: 0.69-0.81) for the combination of Emean with Breast Imaging Reporting and Data System (BI-RADS) score and Emax with BI-RADS score, respectively. fmass was significantly correlated with the presence of calcifications, ALN status, histological grade, the expressions of IHC biomarkers and IHC subtypes. To conclude, poor prognostic factors were associated with high shear wave elasticity values and low mass characteristic frequency value. Therefore, SWE provides valuable information that may help with prediction of breast cancer invasiveness.
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Affiliation(s)
- Juanjuan Gu
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Eric C Polley
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Judy C Boughey
- Division of Subspecialty General Surgery, Department of General Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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Xu YJ, Gong HL, Hu B, Hu B. Role of "Stiff Rim" sign obtained by shear wave elastography in diagnosis and guiding therapy of breast cancer. Int J Med Sci 2021; 18:3615-3623. [PMID: 34522189 PMCID: PMC8436109 DOI: 10.7150/ijms.64243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/18/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Because the halo around the tumor in shear wave elastography (SWE) is defined as the "stiff rim" sign, the diagnosis of breast lesions with the stiff rim sign is popular. However, only a few studies have described the stiff rim sign quantitatively. Objective: This study aimed to investigate the usefulness of the stiff rim sign in the diagnosis and tumor, node, metastasis stage of breast cancer. Methods: Two hundred and ten breast lesions were analyzed retrospectively. The maximum, mean, minimum Young's modulus (YM), and the YM standard deviation in the lesion, the peritumoral stiffness (shell), and the region containing lesion and shell were obtained. The suspicious SWE feature with the best diagnostic performance was chosen to downgrade or upgrade the Breast Imaging Reporting and Data System (BI-RADS) classification. The coincidence rates of SWE and B-mode ultrasound in T staging and their positive predictive value (PPV) for T staging were compared. Results: The presence of "stiff rim" sign was selected to upgrade or downgrade the BI-RADS classification because of its best performance. In pathological benign lesions, 18.9% (25 of 132) of lesions should undergo biopsy if BI-RADS combined with the stiff rim sign were referred while it was 57.6% (76 of 132) if BI-RADS alone was referred. The coincidence rate of T2 staging evaluated by SWE was significantly higher than B-mode ultrasound (about 30% increase, P < 0.001). The PPVs of SWE for T1 and T2 staging were higher than B-mode ultrasound (P < 0.05). Conclusions: BI-RADS combined with "stiff rim" sign is expected to improve the diagnostic performance of breast lesions to avoid unnecessary biopsy. The maximum diameter of the lesion measured in SWE is more accurate than B-mode ultrasound in the estimation of T staging, which is beneficial to the treatment and prognosis of breast cancer.
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Affiliation(s)
- Yan-Jun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R, China
| | - Hui-Ling Gong
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai 201199, P.R, China
| | - Bin Hu
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai 201199, P.R, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R, China
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Choi SH, Ko EY, Han BK, Ko ES, Choi JS, Park KW. Effect of Calcifications on Shear-Wave Elastography in Evaluating Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:95-103. [PMID: 33097314 DOI: 10.1016/j.ultrasmedbio.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to investigate the effect of calcifications on shear-wave elastography in evaluating breast lesions. We retrospectively reviewed ultrasound images of 673 breast lesions and compared the elasticity between lesions with and without calcifications in three subgroups: benign lesions, in situ carcinomas and invasive carcinomas. Breast lesions were confirmed histologically (n = 401) or by follow-up images for more than 2 y (n = 272). Calcifications were present in 25.3% (170/673) of the lesions. The Emean values with and without calcifications, respectively, were as follows: 62.8 and 29.8 kPa in benign lesions (p = 0.000), 114.6 and 52.8 kPa in in situ carcinomas (p = 0.037) and 171.9 and 146.4 kPa in invasive carcinomas (p = 0.018). The presence of calcifications significantly increased the Emean of breast lesions. Shear-wave elastography should be carefully interpreted in benign lesions with calcifications and in situ carcinomas without calcifications.
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Affiliation(s)
- Seung Hee Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ghavami S, Babaniyi O, Adabi S, Rosen D, Alizad A, Aquino W, Fatemi M. Ultrasound elastography using a regularized modified error in constitutive equations (MECE) approach: a comprehensive phantom study. Phys Med Biol 2020; 65:225026. [PMID: 33032271 DOI: 10.1088/1361-6560/abbf97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many of the current techniques in transient elastography, such as shear wave elastography (SWE) assume a dominant planar shear wave propagating in an infinite medium. This underlying assumption, however, can be easily violated in real scenarios in vivo, leading to image artifacts and reconstruction errors. Other approaches that are not bound to planar shear wave assumption, such solutions based on the partial differential equation, can potentially overcome the shortcomings of the conventional SWE. The main objective of this paper is to demonstrate the advantages of the modified error in constitutive equations (MECE) formulation with total variation regularization (MECE + TV) over SWE in reconstructing the elastic moduli of different tissue-mimicking phantoms. Experiments were conducted on phantoms with inclusions of well-defined shapes to study the reconstruction of specific features relevant to practical applications. We compared the performances of MECE + TV and SWE in terms of quantitative metrics to estimate reconstruction accuracy, inclusion shape recovery, edge preservation and edge sharpness, inclusion size representation, and shear elasticity and contrast accuracies. The results indicate that the MECE + TV approach outperforms SWE based on several of these metrics. It is concluded that, with further development, the proposed method may offer elastography reconstructions that are superior to SWE in clinical applications.
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Affiliation(s)
- S Ghavami
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States of America
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Xue HH, Wang YY. Study on association between shear wave elastography parameters and clinicopathological characteristics in breast cancer: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e23082. [PMID: 33217808 PMCID: PMC7676536 DOI: 10.1097/md.0000000000023082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to explore the association between shear wave elastography parameters (SWEPs) and clinicopathological characteristics (CPCs) in breast cancer (BC). METHODS The electronic databases of Cochrane Library, MEDLINE, EMBASE, Allied and Complementary Medicine Database, WANGFANG, VIP, and China National Knowledge Infrastructure will be used to search for studies dated from database inception to the present. No limitations of language and publication status will be applied in this study. Only case-controlled study and randomized controlled trials investigating the association between SWEP and CPC in BC will be included. Cochrane risk of bias will be used to assess study quality for each included study. RevMan 5.3 software will be utilized for statistical analysis. RESULTS This study will provide accurate data to appraise the association between SWEP and CPC in BC. CONCLUSION This study will summarize the most recent evidence to improve our understanding of the association between SWEP and CPC in BC. OSF REGISTRATION NUMBER:: osf.io/vmkwu.
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Affiliation(s)
- Hong-hong Xue
- Department of Ultrasound, Yanan University Affiliated Hospital
| | - Yuan-yuan Wang
- Department of Breast Surgery, Yan’an People's Hospital, Yan’an, Shaanxi, China
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Individualized-thresholding Shear Wave Elastography combined with clinical factors improves specificity in discriminating breast masses. Breast 2020; 54:248-255. [PMID: 33188991 PMCID: PMC7670190 DOI: 10.1016/j.breast.2020.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the diagnostic role of new metrics, defined as individualized-thresholding of Shear Wave Elastography (SWE) parameters, in association with clinical factors (such as age, mammographic density, lesion size and depth) and the BI-RADS features in differentiating benign from malignant breast lesions. METHODS Of 644 consecutive patients (median age, 55 years), prospectively referred for evaluation, 659 ultrasound detected breast lesions underwent SWE measurements. Multivariable logistic regression analysis was used to estimate the probability of malignancy. The area under the curve (AUC), optimal cutoff value, and the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. RESULTS 265 of 659 (40.2%) masses were malignant. Using two Emean cutoffs, 69.6 kPa for large superficial lesions (size >10 mm, depth ≤5 mm) and 39.2 kPa for the rest, the overall specificity, sensitivity, PPV and NPV were 92.6%, 86.8%, 88.8% and 91.3%, respectively. Combining multiple factors, including Emean with two cutoffs, age and BI-RADS, the new ROC curve based on the malignancy probability calculation showed the highest AUC (0.954, 95% CI: 0.938-0.969). Using the optimal probability threshold of 0.514, the corresponding specificity, sensitivity, PPV and NPV were 92.9%, 89.1%, 89.4% and 92.7%, respectively. CONCLUSIONS The false-positive rate can be significantly reduced when applying two Emean cutoffs based on lesion size and depth. Moreover, the combination of age, Emean with two cutoffs and BI-RADS can further reduce the false negatives and false positives. Overall, this multifactorial analysis improves the specificity of ultrasound while maintaining a high sensitivity.
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Rus G, Faris IH, Torres J, Callejas A, Melchor J. Why Are Viscosity and Nonlinearity Bound to Make an Impact in Clinical Elastographic Diagnosis? SENSORS (BASEL, SWITZERLAND) 2020; 20:E2379. [PMID: 32331295 PMCID: PMC7219338 DOI: 10.3390/s20082379] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
The adoption of multiscale approaches by the biomechanical community has caused a major improvement in quality in the mechanical characterization of soft tissues. The recent developments in elastography techniques are enabling in vivo and non-invasive quantification of tissues' mechanical properties. Elastic changes in a tissue are associated with a broad spectrum of pathologies, which stems from the tissue microstructure, histology and biochemistry. This knowledge is combined with research evidence to provide a powerful diagnostic range of highly prevalent pathologies, from birth and labor disorders (prematurity, induction failures, etc.), to solid tumors (e.g., prostate, cervix, breast, melanoma) and liver fibrosis, just to name a few. This review aims to elucidate the potential of viscous and nonlinear elastic parameters as conceivable diagnostic mechanical biomarkers. First, by providing an insight into the classic role of soft tissue microstructure in linear elasticity; secondly, by understanding how viscosity and nonlinearity could enhance the current diagnosis in elastography; and finally, by compounding preliminary investigations of those elastography parameters within different technologies. In conclusion, evidence of the diagnostic capability of elastic parameters beyond linear stiffness is gaining momentum as a result of the technological and imaging developments in the field of biomechanics.
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Affiliation(s)
- Guillermo Rus
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
- Excellence Research Unit “ModelingNature” MNat UCE.PP2017.03, University of Granada, 18071 Granada, Spain
| | - Inas H. Faris
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Jorge Torres
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Antonio Callejas
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Juan Melchor
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
- Excellence Research Unit “ModelingNature” MNat UCE.PP2017.03, University of Granada, 18071 Granada, Spain
- Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain
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13
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Sun JW, Wang XL, Zhao Q, Zhou H, Tao L, Jiang ZP, Zhang WY, Zhou XL. Virtual touch tissue imaging and quantification (VTIQ) in the evaluation of breast lesions: The associated factors leading to misdiagnosis. Eur J Radiol 2018; 110:97-104. [PMID: 30599880 DOI: 10.1016/j.ejrad.2018.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the factors that could cause a misdiagnosis in virtual touch tissue imaging and quantification (VTIQ) when differentiating benign and malignant breast lesions, and to analyze the imaging characteristics of those lesions with incorrect findings. METHODS The conventional ultrasound (CUS) features and the VTIQ parameters of 153 benign lesions and 99 malignant lesions were retrospectively analyzed and compared with histopathological and/or core-needle biopsy (CNB)-proven results. Independent variables that led to inaccurate VTIQ results were selected by binary logistic regression analysis. RESULTS The maximum shear wave speed (SWS-max), the mean SWS (SWS-mean), the minimum SWS (SWS-min), the lesion-to-fat SWS ratio (SWS-L/F), and the lesion-to-gland SWS ratio (SWS-L/G) in malignant lesions were significantly higher than those in benign lesions (all P < 0.001). The false-positive rate (FPR) of benign lesions and the false-negative rate (FNR) of malignant lesions were 9.8% and 19.2%, respectively, using an SWS-max cut-off value of 4.46 m/s. Diameter, depth, and posterior acoustic features were independent variables related to false-positive VTIQ findings (P: 0.049, 0.010 and 0.032, respectively). The invasive status and the histologic grade of infiltrating carcinoma were significantly associated with false-negative VTIQ findings (P: 0.026 and 0.015). CONCLUSION Diameter, depth, posterior acoustic features, invasive status, and histologic grade have a significant influence on the accuracy of VTIQ results, and these characteristics of breast lesions should be taken into account when interpreting the results of VTIQ examinations.
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Affiliation(s)
- Jia-Wei Sun
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Lei Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing Zhao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hang Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Tao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhao-Peng Jiang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wan-Yu Zhang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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14
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Gregory A, Bayat M, Kumar V, Denis M, Kim BH, Webb J, Meixner DD, Ryder M, Knudsen JM, Chen S, Fatemi M, Alizad A. Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography: A Preliminary Two-plane View Study. Acad Radiol 2018; 25:1388-1397. [PMID: 29573939 DOI: 10.1016/j.acra.2018.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 02/28/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. MATERIALS AND METHODS A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5-68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. RESULTS Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. CONCLUSIONS The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P < .0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.
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15
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Flood R, Karteszi H. Incidental thoracic, hepatic and peritoneal calcifications: a case of Pentastomiasis. BJR Case Rep 2018; 5:20180058. [PMID: 31131130 PMCID: PMC6519502 DOI: 10.1259/bjrcr.20180058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 11/27/2022] Open
Abstract
Incidental findings are not uncommon in radiology. In this case, although the
incidental findings could be described as an Aunt Minnie, the patient underwent
multiple investigations due to the rarity of the causative parasite. The current
literature concerning Pentastomiasis suggests it may become more common in
future. Our hope is that this case report will help future patients who present
with the radiological pattern described to be more rapidly diagnosed and
reassured.
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Affiliation(s)
- Richard Flood
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - Hedvig Karteszi
- Department of Radiology, University Hospitals Bristol, Bristol, UK
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16
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Value of shear wave arrival time contour display in shear wave elastography for breast masses diagnosis. Sci Rep 2017; 7:7036. [PMID: 28765627 PMCID: PMC5539095 DOI: 10.1038/s41598-017-07389-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 12/21/2022] Open
Abstract
To evaluate the diagnostic performance of shear wave arrival time contour (SWATC) display for the diagnosis of breast lesions and to identify factors associated with the quality of shear wave propagation (QSWP) in breast lesions. This study included 277 pathologically confirmed breast lesions. Conventional B-mode ultrasound characteristics and shear wave elastography parameters were computed. Using the SWATC display, the QSWP of each lesion was assigned to a two-point scale: score 1 (low quality) and score 2 (high quality). Binary logistic regression analysis was performed to identify factors associated with QSWP. The area under the receiver operating characteristic curve (AUROC) for QSWP to differentiate benign from malignant lesions was 0.913, with a sensitivity of 91.9%, a specificity of 90.7%, a positive predictive value (PPV) of 74.0%, and a negative predictive value (NPV) of 97.5%. Compared with using the standard deviation of shear wave speed (SWSSD) alone, SWSSD combined with QSWP increased the sensitivity from 75.8% to 93.5%, but decreased the specificity from 95.8% to 89.3% (P < 0.05). SWSSD was identified to be the strongest factor associated with the QSWP, followed by tumor malignancy and the depth of the lesion. In conclusion, SWATC display may be useful for characterization of breast lesions.
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17
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Durhan G, Öztekin PS, Ünverdi H, Değirmenci T, Durhan A, Karakaya J, Nercis Koşar P, Necip Köseoğlu E, Hücümenoğlu S. Do Histopathological Features and Microcalcification Affect the Elasticity of Breast Cancer? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1101-1108. [PMID: 28240797 DOI: 10.7863/ultra.16.06064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate any association between histological grade, molecular subtypes of breast cancer, and strain elastography, and to investigate whether microcalcification affects the stiffness of tumor in breast cancers with the same histological grade. METHODS Between April 2015 and March 2016, 94 lesions of 94 patients with the diagnosis of invasive ductal carcinoma were included in the study. Strain elastography was performed on all patients before biopsy. Histological grades (Grades 1, 2, and 3), molecular subtypes (luminal A, luminal B, Her-2, and basal-like), and strain ratio (SR) were compared. In the same histological grades, patients were divided into two groups according to the presence of microcalcifications, and the groups were compared with each other. RESULTS Compared with Grades 1 (20.5) and 2 (23.7), Grade 3 (11.7) showed lower SR values (Grade 3-2, P = .01; Grade 3-1, P = .2). The groups with microcalcification had slightly higher SR in all histological grades, but not of statistical significance. In molecular subtypes, luminal A and B demonstrated higher SR, whereas HER2 and basal-like had lower SR (P > .05 for all group comparisons). CONCLUSIONS Grade 3 invasive ductal carcinomas are different from other grades with lower SR values. The presence of microcalcifications and molecular subtypes do not affect elasticity like a high histological grade does.
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Affiliation(s)
- Gamze Durhan
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Pelin Seher Öztekin
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Ünverdi
- Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Tülin Değirmenci
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Abdullah Durhan
- Department of General Surgery, Surgical Oncology Unit, Ankara University Medical School, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Medical School, Ankara, Turkey
| | - Pınar Nercis Koşar
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Enver Necip Köseoğlu
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Sema Hücümenoğlu
- Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
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18
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Chen BD, Xu HX, Zhang YF, Liu BJ, Guo LH, Li DD, Zhao CK, Li XL, Wang D, Zhao SS. The diagnostic performances of conventional strain elastography (SE), acoustic radiation force impulse (ARFI) imaging and point shear-wave speed (pSWS) measurement for non-calcified thyroid nodules. Clin Hemorheol Microcirc 2017; 65:259-273. [PMID: 27567801 DOI: 10.3233/ch-16178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Non-calcified thyroid nodules are relatively difficult to diagnose only relying on features of at conventional US images. OBJECTIVE To investigate the diagnostic performances of conventional strain elastography (SE), acoustic radiation force impulse (ARFI) SE and point shear-wave speed (pSWS) measurement for non-calcified thyroid nodules. METHODS A total of 201 non-calcified thyroid nodules in 195 patients were studied. They were examined with conventional ultrasound (US), conventional SE, ARFI SE and pSWS measurement. Their diagnostic performances and multivariable models were assessed with receiver operating characteristic (ROC) curve and logistic regression analyses respectively. RESULTS There were 156 benign and 45 malignant non-calcified nodules proven by histopathology or cystology. The mean diameters of the nodules were 21.2±10.8 mm. Areas under receiver operating characteristic curve (AUCs) of elastography features (ranged, 0.488-0.745) were all greater than that of US (ranged, 0.111-0.332). At multivariate analysis, there were three predictors of malignancy for non-calcified nodules, including pSWS of nodule (odds ratio [OR], 34.960; 95% CI, 11.582-105.529), marked hypoechogenicity (OR, 16.223; 95% CI, 1.761-149.454) and ARFI SE grade (OR, 10.900; 95% CI, 3.567-33.310). US+SE+pSWS owned the largest AUC (0.936; 95% CI, 0.887-0.985; P < 0.05), followed by US+pSWS (0.889; 95% CI, 0.823-0.955), and the poorest was US (0.727; 95% CI, 0.635-0.819). CONCLUSIONS ARFI SE and pSWS measurement had better diagnostic performances than conventional SE and US. When US combined with SE and pSWS measurement, it could achieve an excellent diagnostic performance and might contribute a better decision-making of FNA for non-calcified thyroid nodules.
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Affiliation(s)
- Bao-Ding Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Research Center of Thyroid Diseases, Shanghai, China
| | - Shuang-Shuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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19
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Bayat M, Denis M, Gregory A, Mehrmohammadi M, Kumar V, Meixner D, Fazzio RT, Fatemi M, Alizad A. Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation. PLoS One 2017; 12:e0172801. [PMID: 28257467 PMCID: PMC5336209 DOI: 10.1371/journal.pone.0172801] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/09/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lesion stiffness measured by shear wave elastography has shown to effectively separate benign from malignant breast masses. The aim of this study was to evaluate different aspects of Comb-push Ultrasound Shear Elastography (CUSE) performance in differentiating breast masses. METHODS With written signed informed consent, this HIPAA- compliant, IRB approved prospective study included patients from April 2014 through August 2016 with breast masses identified on conventional imaging. Data from 223 patients (19-85 years, mean 59.93±14.96 years) with 227 suspicious breast masses identifiable by ultrasound (mean size 1.83±2.45cm) were analyzed. CUSE was performed on all patients. Three regions of interest (ROI), 3 mm in diameter each, were selected inside the lesion on the B-mode ultrasound which also appeared in the corresponding shear wave map. Lesion elasticity values were measured in terms of the Young's modulus. In correlation to pathology results, statistical analyses were performed. RESULTS Pathology revealed 108 lesions as malignant and 115 lesions as benign. Additionally, 4 lesions (BI-RADS 2 and 3) were considered benign and were not biopsied. Average lesion stiffness measured by CUSE resulted in 84.26% sensitivity (91 of 108), 89.92% specificity (107 of 119), 85.6% positive predictive value, 89% negative predictive value and 0.91 area under the curve (P<0.0001). Stiffness maps showed spatial continuity such that maximum and average elasticity did not have significantly different results (P > 0.21). CONCLUSION CUSE was able to distinguish between benign and malignant breast masses with high sensitivity and specificity. Continuity of stiffness maps allowed for choosing multiple quantification ROIs which covered large areas of lesions and resulted in similar diagnostic performance based on average and maximum elasticity. The overall results of this study, highlights the clinical value of CUSE in differentiation of breast masses based on their stiffness.
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Affiliation(s)
- Mahdi Bayat
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Max Denis
- Department of Radiology, Mayo Clinic College of Medicine, SW, Rochester, MN, United States of America
| | - Adriana Gregory
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Mohammad Mehrmohammadi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Viksit Kumar
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Duane Meixner
- Department of Radiology, Mayo Clinic College of Medicine, SW, Rochester, MN, United States of America
| | - Robert T. Fazzio
- Department of Radiology, Mayo Clinic College of Medicine, SW, Rochester, MN, United States of America
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, United States of America
- Department of Radiology, Mayo Clinic College of Medicine, SW, Rochester, MN, United States of America
- Department of Internal Medicine, Mayo Clinic College of Medicine, SW, Rochester, MN, United States of America
- * E-mail:
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20
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Shear wave elastography in the diagnosis of breast non-mass lesions: factors associated with false negative and false positive results. Eur Radiol 2017; 27:3788-3798. [PMID: 28168373 DOI: 10.1007/s00330-017-4763-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate factors related to false shear wave elastography (SWE) results for breast non-mass lesions (NMLs) detected by B-mode US. METHODS This retrospective study enrolled 152 NMLs detected by B-mode US and later pathologically confirmed (79 malignant, 73 benign). All lesions underwent B-mode US and SWE. Quantitative (mean elasticity [E mean]) and qualitative (maximum stiffness colour) SWE parameters were assessed, and 'E mean > 85.1 kPa' or 'stiff colour (green to red)' determined malignancy. Final SWE results were matched to pathology results. Multivariate logistic regression analysis identified factors associated with false SWE results for diagnosis of breast NMLs. RESULTS Associated calcifications (E mean: odds ratio [OR] = 7.60, P < 0.01; maximum stiffness colour: OR = 6.30, P = 0.02), in situ cancer compared to invasive cancer (maximum stiffness colour: OR = 5.29, P = 0.02), and lesion size (E mean: OR = 0.90, P < 0.01; maximum stiffness colour: OR = 0.91, P = 0.01) were significantly associated with false negative SWE results for malignant NMLs. Distance from the nipple (E mean: OR = 0.84, P = 0.03; maximum stiffness colour: OR = 0.93, P = 0.04) was significantly associated with false positive SWE results for benign NMLs. CONCLUSIONS Presence of associated calcifications, absence of the invasive component, and smaller lesion size for malignant NMLs and shorter distance from the nipple for benign NMLs are factors significantly associated with false SWE results. KEY POINTS • Calcification and size are associated with false negative SWE in malignant NMLs. • In situ cancer is associated with false negative SWE in malignant NMLs. • Distance from the nipple is associated with false positive SWE in benign NMLs. • These factors need consideration when performing SWE on breast NMLs.
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21
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Denis M, Gregory A, Bayat M, Fazzio RT, Whaley DH, Ghosh K, Shah S, Fatemi M, Alizad A. Correlating Tumor Stiffness with Immunohistochemical Subtypes of Breast Cancers: Prognostic Value of Comb-Push Ultrasound Shear Elastography for Differentiating Luminal Subtypes. PLoS One 2016; 11:e0165003. [PMID: 27776153 PMCID: PMC5077080 DOI: 10.1371/journal.pone.0165003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of our study is to correlate quantitatively measured tumor stiffness with immunohistochemical (IHC) subtypes of breast cancer. Additionally, the influence of prognostic histologic features (cancer grade, size, lymph node status, and histological type and grade) to the tumor elasticity and IHC profile relationship will be investigated. METHODS Under an institutional review board (IRB) approved protocol, B-mode ultrasound (US) and comb-push ultrasound shear elastography (CUSE) were performed on 157 female patients with suspicious breast lesions. Out of 157 patients 83 breast cancer patients confirmed by pathology were included in this study. The association between CUSE mean stiffness values and the aforementioned prognostic features of the breast cancer tumors were investigated. RESULTS Our results demonstrate that the most statistically significant difference (p = 0.0074) with mean elasticity is tumor size. When considering large tumors (size ≥ 8mm), thus minimizing the statistical significance of tumor size, a significant difference (p< 0.05) with mean elasticity is obtained between luminal A of histological grade I and luminal B (Ki-67 > 20%) subtypes. CONCLUSION Tumor size is an independent factor influencing mean elasticity. The Ki-67 proliferation index and histological grade were dependent factors influencing mean elasticity for the differentiation between luminal subtypes. Future studies on a larger group of patients may broaden the clinical significance of these findings.
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Affiliation(s)
- Max Denis
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Adriana Gregory
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Mahdi Bayat
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Dana H Whaley
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Karthik Ghosh
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, United States of America
| | - Sejal Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Azra Alizad
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America.,Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, United States of America
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22
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Chen BD, Xu HX, Zhang YF, Liu BJ, Guo LH, Li DD, Zhao CK, Li XL, Wang D, Zhao SS. Calcification of thyroid nodules increases shear-wave speed (SWS) measurement: using multiple calcification-specific SWS cutoff values outperforms a single uniform cutoff value in diagnosing malignant thyroid nodules. Oncotarget 2016; 7:66149-66159. [PMID: 27588492 PMCID: PMC5323222 DOI: 10.18632/oncotarget.11710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Conventional ultrasound cannot satisfactorily distinguish malignant and benign thyroid nodules. Shear-wave elastography (SWE) can evaluate tissue stiffness and complement conventional ultrasound in diagnosing malignant nodules. However, calcification of nodules may affect the results of SWE. The purposes of this study are to compare the differences of shear-wave speed (SWS) measurement among different calcification groups and compare the diagnostic performance between using a single uniform SWS cutoff value and multiple individual calcification-specific cutoff values using technique of point SWS measurement. We retrospectively identified 517 thyroid nodules (346 benign and 171 malignant nodules) examined by conventional ultrasound and point SWS measurement. There were 177 non-calcified, 159 micro-calcified and 181 macro-calcified nodules. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) was computed. The mean SWS in malignant nodules more than doubled that of benign nodules (4.81±2.03 m/s vs. 2.29±0.99 m/s, p<0.001). The mean SWS of nodules progressively increased from the non-calcification (2.60±1.49 m/s), to micro-calcification (3.27±1.85 m/s) and to macro-calcification (3.68±2.26 m/s) groups (p<0.001), which was true in both the benign and malignant nodules. If we used individual SWS cutoff values for non- (SWS >2.42 m/s), micro- (SWS >2.88 m/s) and macro-calcification (SWS >3.59 m/s) nodules in the whole group, the AUC was 0.859 (95% confidence interval [CI], 0.826-0.888), which was significantly better than the AUC of 0.816 (95% CI, 0.780-0.848) if a single uniform cutoff value (SWS >2.72 m/s) was applied to all the nodules regardless of calcification status (p=0.011). The cutoff values of SWS for different calcified nodules warrant future prospective validation.
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Affiliation(s)
- Bao-Ding Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China.,Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center of Thyroid Diseases, Shanghai, China
| | - Shuang-Shuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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23
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Akkus Z, Bayat M, Cheong M, Viksit K, Erickson BJ, Alizad A, Fatemi M. Fully Automated and Robust Tracking of Transient Waves in Structured Anatomies Using Dynamic Programming. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2504-12. [PMID: 27425150 PMCID: PMC6494618 DOI: 10.1016/j.ultrasmedbio.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/19/2016] [Accepted: 06/02/2016] [Indexed: 05/12/2023]
Abstract
Tissue stiffness is often linked to underlying pathology and can be quantified by measuring the mechanical transient transverse wave speed (TWS) within the medium. Time-of-flight methods based on correlation of the transient signals or tracking of peaks have been used to quantify the TWS from displacement maps obtained with ultrasound pulse-echo techniques. However, it is challenging to apply these methods to in vivo data because of tissue inhomogeneity, noise and artifacts that produce outliers. In this study, we introduce a robust and fully automated method based on dynamic programming to estimate TWS in tissues with known geometries. The method is validated using ultrasound bladder vibrometry data from an in vivo study. We compared the results of our method with those of time-of-flight techniques. Our method performs better than time-of-flight techniques. In conclusion, we present a robust and accurate TWS detection method that overcomes the difficulties of time-of-flight methods.
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Affiliation(s)
- Zeynettin Akkus
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
| | - Mahdi Bayat
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mathew Cheong
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kumar Viksit
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Bradley J Erickson
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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24
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Eghtedari M, Yang WT. Advances in Breast Ultrasound. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Correction: Effect of Calcifications on Breast Ultrasound Shear Wave Elastography: An Investigational Study. PLoS One 2016; 11:e0147462. [PMID: 26765844 PMCID: PMC4713114 DOI: 10.1371/journal.pone.0147462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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