ELASTOGRAPHY

DR SHAILENDRA SAVALE

 Palpation is the age old method of surgical

diagnosis.

What we see in elastography?

It calculates strain produced by the tissue. It characterises stiffness of underlying

tissue.

PRINCIPLE
Distortion when matter subjected to external

force. Hookes law Youngs modulus Poissons ratio.

HOOKE,S LAW

F=-Kx(F RESTORING FORCE ) (x DISPLACEMENT)

YOUNGS MODULUS
Relation of stress vs strain of material

following hookes law.

Unit is pascal/pound per square inch(US)

POISSONS RATIO
When sample material is compressed in one

dimension,it expands in other dimensions.

Basic principles
Benign and malignant lesions have different

firmness. Strain imaging display relative firmness of lesion compared to surrounding normal tissue.

 Stiffer areas deform less easily than

surrounding. Colour codestiffer areas dark softer areas light

 Elasticity correlates with pathological

changes.

How to perform ?
Trasducer moved over affected area. Machine records two images

simultaneously. a)B mode picture b)Elastogram

 Both images are displayed side by side.

B MODE ELASTOGRAM

Interpretation
Compare area on B mode and elastogram.

COMPARE B MODE AND ELASTOGRAM

BENIGN MALIGNANT

AREA OF STIFFNESS

SMALLER THAN B MODE

LARGER THAN B MODE DARK WITH HIGH CONTRAST

APPEARANCE DARK BT LESS CONTRAST

IS IT BENIGN OR MALIGNANT?

All lesions are iso-echoic on B mode.but on elastography their appearance vary.

CAN IT BE COLOURFUL?

TSUKUBA ELASTICITY SCORE

Score 4

Score 1

 Is breast only organ to be imaged by

elastography?

LIVER

ENTIRE LESION HOMOGENEOU GREEN (1)

MOSAIC PATTERN WITH DOMINANT GREEN AREAS(2)

MOSAIC PATTERN WITH DOMINENT BLUE(3)

METASTATIC LIVER CA FRO CA COLON(4)

POST ART EMBOLISATIO RF ABLASION HYPERECHOIC ON B SCALE

S/O DEGENERAT CHANGES

LYMPH NODES

PATTERN 1

PATTERN 2

PATTERN 3

PATTERN 4

PATTERN 5

THYROID

SKIN

PROSTATE

ADVANTAGES
It show lesions not detected by conventional

ultrasonography. Diagnostic accuacy to differenciate benign from malignant lesions. Guideline for core needle biopsy.

 Reduction of biopsy rates in benign lesions. More accurate tumour surgeries with less

re-operation rates.

WHATS NEW?

MR ELASTOGRAPHY
To diagnose liver fibrosis before it reaches

untreatable fibrosis.
Only way to diagnose it liver biopsy which

is invasive.

MRE DRIVER SYSTEM CAPABLE OF GENERATING VIBRATIONS IN ENVIRONMENT OF MRI SCANNER

Mechanical waves of very small amplitude(less than tenth of mm)are generated inside the liver by acoustic driver placed on abdominal wall. Modified phase contrast MR sequence is used to image propagation waves.Wave image is superimposed on anatomical image.

A mathematical algorithm used 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 stiffness of this patient was 5.6 kPa. (normal upper limit is 2.5). also distribution of stiffness was inhomogeneous than normal liver.

Normal MRE showing avarage stiffness of 2 showing homogeneous stiffness throughout.

NORMAL

FIBROSIS

SUMMARY
FUTURE PERSPECTIVE- FOR

DIAGNOSIS AND DIFFERENTIATION OF BENIGN AND MALIGNANT BREAST LESION. NON INVASIVE DIAGNOSIS OF LIVER FIBROSIS. IT CAN BE USED THYROID,SKIN AND LYMPH NODE PATHOLOGIES.

THANK YOU