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ELASTOGRAPHY

DR SHAILENDRA SAVALE

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Palpation is the age old method of surgical

diagnosis.

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What we see in elastography? It calculates strain produced by the tissue.

It characterises stiffness of underlying

tissue.

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PRINCIPLEDistortion when matter subjected to external

force.Hookes law

Youngs modulusPoissons ratio.

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HOOKE,S LAW F=-Kx(F RESTORING FORCE )

(x DISPLACEMENT)

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YOUNGS MODULUSRelation of stress vs strain of material

following hookes law.

Unit is pascal/pound per square inch(US)

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POISSONS RATIOWhen sample material is compressed in one

dimension,it expands in other dimensions.

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Basic principlesBenign and malignant lesions have different

firmness.Strain imaging display relative firmness of

lesion compared to surrounding normaltissue.

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Stiffer areas deform less easily than

surrounding.Colour codestiffer areas dark

softer areas light

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Elasticity correlates with pathological

changes.

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How to perform ?

Trasducer moved over affected area.

Machine records two images

simultaneously. a)B mode picture

b)Elastogram

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Both images are displayed side by side.

B MODE ELASTOGRAM

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Interpretation

Compare area on B mode and elastogram.

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COMPARE B MODE AND

ELASTOGRAMBENIGN MALIGNANT

AREA OF

STIFFNESS

SMALLER

THAN B

MODE

LARGER

THAN B

MODE

APPEARANCE DARK BTLESS

CONTRAST

DARK WITHHIGH

CONTRAST

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IS IT BENIGN OR MALIGNANT?

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All lesions are iso-echoic on

B mode.but on elastography

their appearance vary.

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CAN IT BE COLOURFUL?

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TSUKUBA ELASTICITY SCORE

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http://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpg

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Score 4

Score 1

http://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpghttp://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpghttp://www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/breast1.jpg

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Is breast only organ to be imaged by

elastography?

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LIVER

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ENTIRE LESIO

HOMOGENEO

GREEN (1)

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MOSAIC

PATTERN

WITHDOMINANT

GREEN

AREAS(2)

MOSAIC

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MOSAIC

PATTERN WIT

DOMINENTBLUE(3)

METASTATIC

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METASTATIC

LIVER CA FR

CA COLON(4)

POST ART

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POST ART

EMBOLISATI

RF ABLASIONHYPERECHOI

ON B SCALE

S/O DEGENERA

CHANGES

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LYMPH NODES

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PATTERN 1

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PATTERN 2

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PATTERN 3

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PATTERN 4

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PATTERN 5

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THYROID

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SKIN

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PROSTATE

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ADVANTAGES

It show lesions not detected by conventional

ultrasonography.Diagnostic accuacy to differenciate benign

from malignant lesions.

Guideline for core needle biopsy.

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Reduction of biopsy rates in benign lesions.

More accurate tumour surgeries with lessre-operation rates.

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WHATS NEW?

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MR ELASTOGRAPHY

To diagnose liver fibrosis before it reaches

untreatable fibrosis.

Only way to diagnose it liver biopsy whichis invasive.

MRE DRIVER SYSTEM CAPABLE OF GENERATING

VIBRATIONS IN ENVIRONMENT OF MRI SCANNER

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VIBRATIONS IN ENVIRONMENT OF MRI SCANNER

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Mechanical waves of

very small amplitude(less

than tenth of mm)are

generated inside the liver

by acoustic driver placedon abdominal wall.

Modified phase contrast

MR sequence is used toimage propagation

waves.Wave image is

superimposed onanatomical image.

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A mathematical algorithmused to process the wave

images to calculate the

stiffness of the tissue.

the resultant image is called

elastogram which shows

stiffness in units of kilo

pascal(kPa).Average stiffnessof this patient was 5.6 kPa.

(normal upper limit is 2.5).

also distribution of stiffnesswas inhomogeneous than

normal liver.

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Normal MRE showing

avarage stiffness of 2

showing homogeneous

stiffness throughout.

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NORMALFIBROSIS

SUMMARY

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SUMMARY

FUTURE PERSPECTIVE- FOR

DIAGNOSIS AND DIFFERENTIATIONOF BENIGN AND MALIGNANT

BREAST LESION.

NON INVASIVE DIAGNOSIS OF LIVER

FIBROSIS.

IT CAN BE USED THYROID,SKIN ANDLYMPH NODE PATHOLOGIES.

THANK YOU

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THANK YOU