Qualitative and quantitative strain and shear wave elastography paradigm in differentiation of breast lesions

Background Breast cancer is the most common life-threatening cancer in women worldwide. A high number of women are going through biopsy procedures for characterization of breast masses every day and yet 75% of the pathological results prove these masses to be benign. Ultrasound (US) elastography is a non-invasive technique that measures tissue stiffness. It is convenient for differentiating benign from malignant breast tumors. Our study aims to evaluate the role of qualitative ultrasound elastography scoring (ES), quantitative mass strain ratio (SR), and shear wave elasticity ratio (SWER) in differentiation between benign and malignant breast lesions. Results Among 51 female patients with 77 histopathologically proved breast lesions, 57 breast masses were malignant and 20 were benign. All patients were examined by B-mode ultrasound then strain and shear wave elastographic examinations using ultrasound machine (Logiq E9, GE Medical Systems) with 8.5–12 MHz high-frequency probes. Our study showed that ES best cut-off point > 3 with sensitivity, specificity, PPV, NPP, accuracy was 94.7%, 85%, 94.7%, 85%, 90.9%, respectively, and AUC = 0.926 at P < 0.001, mass SR the best cut-off point > 4.6 with sensitivity, specificity, PPV, NPP, accuracy was 96.5%, 80%, 93.2%, 88.9%, 92.2%, respectively, and AUC = 0.860 at P < 0.001, SWER the best cut-off value > 4.9 with sensitivity, specificity, PPV, NPP and accuracy was 91.2%, 80%, 92.9%, 76.2%, 93.5%, respectively, and AUC = 0.890 at P < 0.001. The mean mass strain ratio for malignant lesions is 10.1 ± 3.7 SD and for solid benign lesions 4.7 ± 4.3 SD (p value 0.001). The mean shear wave elasticity ratio for malignant lesions is 10.6 ± 5.4 SD and for benign (solid and cystic) lesions 3.6 ± 4.2 SD. Using ROC curve and Youden index, the difference in diagnostic performance between ES, SR and SWER was not significant in differentiation between benign and malignant breast lesions and also was non-significant difference when comparing them with conventional US alone. Conclusion ES, SR, and SWER have a high diagnostic performance in differentiating malignant from benign breast lesions with no statistically significant difference between them.

Comparison between Histological Features and Strain Elastographic Characteristics in Canine Mammary Carcinomas

Elastography is a sonographic technique that provides a noninvasive evaluation of the stiffness of a lesion. The objective of this work was to evaluate the accuracy of strain elastography, the most accessible modality in clinical practice, to discriminate between different histological types of malignant mammary neoplasms in the canine species, which can provide complementary information in real time to the diagnosis and thus help in the choice of surgical technique. A total of 34 females with 56 mammary carcinomas were selected and classified into three histological groups according to their aggressiveness. The histological and elastographic characteristics of these malignant tumors were analyzed and compared to evaluate the diagnostic accuracy of strain elastography. Visual score presented a sensitivity of 88.0%, specificity of 58.1%, and accuracy of 71.43% in distinguishing the most aggressive group of carcinomas. The strain ratio had a sensitivity of 84.0%, specificity of 61.1%, and accuracy of 69.64%. On the other hand, intratumoral strain ratio obtained a sensitivity of 71.40% and specificity of 61.90% when intratumoral fibrosis was taken as reference, with an accuracy of 66.07%. Similarly, peritumoral strain ratio was also positively related to fibrosis in the periphery of lesions (p ≤ 0.001), with a sensitivity of 93.80%, specificity of 77.50% and an accuracy of 92.87%. In conclusion, accuracy of this elastographic modality can be a useful method to differentiate more aggressive histological types. Therefore, it represents an additional diagnostic technique useful in the daily clinic thanks to the short time required for the examination, which allows real-time visualization and immediate interpretation of the results.

Effect of a Continuous Annealing Temperature on the Microstructure, Mechanical Properties and Texture of Annealed Drawn and Ironed Plate

To improve the production process and produce high-quality annealed drawn and ironed (DI) plate, continuous annealing experiments were carried out at 620 °C, 640 °C, 680 °C, and 720 °C, and the effect of a continuous annealing temperature on the microstructure, mechanical characteristics, and texture of annealed DI plate were clarified. The microstructure was tested with a scanning electron microscope (SEM); the mechanical properties and weighted average of the plastic strain ratio (r¯) were measured using a tension test; and the texture characterizations were tested by X-ray powder diffractometer (XRD) and electron backscatter diffraction (EBSD). The results reveal that, with the increase of the annealing temperature, the average grain size grew from 5.14 μm to 6.56 μm, the yield strength and tensile strength decreased, and the elongation increased. The rolling textures drastically reduced after annealing. When annealed at a lower temperature of 620 °C, the texture content of {111} <110> was the highest. When the annealing temperature increased to 640 °C, 680 °C and 720 °C, the texture content of {111} <112> was higher than that of {111} <110>. The mechanical properties of the DI plate that was annealed at 640 °C are the best, with a higher r¯ value and a lower planar anisotropy value.

Crack-Bridging Property Evaluation of Synthetic Polymerized Rubber Gel (SPRG) through Yield Stress Parameter Identification

Yield stress parameter derivation was conducted by stress-strain curve analysis on four types of grout injection leakage repair materials (GILRM); acrylic, epoxy, urethane and SPRG grouts. Comparative stress-strain curve analysis results showed that while the yield stress point was clearly distinguishable, the strain ratio of SPRG reached up to 664% (13 mm) before material cohesive failure. A secondary experimental result comprised of three different common component ratios of SPRG was conducted to derive and propose an averaged yield stress curve graph, and the results of the yield stress point (180% strain ratio) were set as the basis for repeated stress-strain curve analysis of SPRGs of up to 15 mm displacement conditions. Results showed that SPRG yield stress point remained constant despite repeated cohesive failure, and the modulus of toughness was calculated to be on average 53.1, 180.7, and 271.4 N/mm2, respectively, for the SPRG types. The experimental results of this study demonstrated that it is possible to determine the property limits of conventional GILRM (acrylic, epoxy and urethane grout injection materials) based on yield stress. The study concludes with a proposal on potential application of GILRM toughness by finite element analysis method whereby strain of the material can be derived by hydrostatic pressure. Comparative analysis showed that the toughness of SPRG materials tested in this study are all able to withstand hydrostatic pressure range common to underground structures (0.2 N/mm2). It is expected that the evaluation method and model proposed in this study will be beneficial in assessing other GILRM materials based on their toughness values.

The role of real-time elastosonography in the diagnosis of quadriceps fat pad edema

Background Quadriceps fat pad edema (QFPE) is one of the causes of anterior knee pain. Real-time elastosonography (RTE) has been increasingly used in musculoskeletal disorders. Purpose To evaluate the role of RTE in the diagnosis of QFPE. Material and Methods A total of 23 patients with QFPE on magnetic resonance imaging (MRI) (study group) were prospectively compared with 29 patients with normal MRI findings (control group) using RTE. On MRI, the thickness of the quadriceps fat pad (QFP), and on RTE, strain ratio (SR) of QFP were measured and compared between the two groups. Results The study group contained 23 patients (12 men, 11 women; mean age = 41.6 ± 7.0 years) and the control group contained 29 patients (14 men, 15 women; mean age = 42.3 ± 6.1 years). No significant differences were found in terms of mean age and sex between the two groups ( P = 0.70, P = 0.78, respectively). The median thicknesses of the QFPs were 8.10 mm and 6.75 mm in the study and control groups, respectively ( P < 0.001). The median SR values of the study group and control group were found to be 63.20 and 6.24, respectively. The SR values were significantly higher in patients with QFPE ( P < 0.001). Conclusion RTE may be an effective imaging method for evaluating QFPE.

The Value of Ultrasound Elastography in Diffuse Thyroid Disease among a Sample of Iraqi Population

Background: Early detection of many thyroid disorders is essential in the management. Ultrasound elastography is beneficial in the assessment of diffuse thyroid diseases. Aim of study: To assess the role of ultrasound strain elastography in the diagnosis of diffuse non nodular thyroid disease in comparison to healthy controls and in the characterization and differentiation of the types of diffuse thyroid diseases. Patients and methods: It is a prospective analytic study performed in the Radiology Department of Oncology Teaching Hospital/Medical city Complex in Baghdad during the period from 1st of December 2019 to 30th of June, 2020 on convenient sample of 25 patients with diffuse thyroid disease, in addition to a sample of 25 healthy control persons. The diagnosis of diffuse thyroid diseases was made by combination of clinical symptoms, laboratory investigations and thyroid ultrasound. Results: The mean elastography strain ratio (1.36) of patients with diffuse thyroid disease was significantly higher than (0.82) mean of elastography strain ratio for healthy control persons (p<0.001). The acceptable cutoff elastography strain ratio in the diagnosis of diffuse thyroid disease was 0.89 with validity results (80% sensitivity, 70% specificity and 75% accuracy). The mean elastography strain ratio for patients with Hashimotos thyroiditis was significantly higher than the strain ratio of patients with Graves disease (p=0.002). Conclusions: The ultrasound elastography is useful in the assessment and characterization of diffuse thyroid disease. The ultrasound elastography strain ratio value is helpful in differentiation between different diffuse thyroid diseases especially between Hashimotos thyroiditis and Graves's disease

Added Value of a New Strain Elastography Technique in Conventional Ultrasound for the Diagnosis of Breast Masses: A Prospective Multicenter Study

ObjectiveThis study aimed to explore the value of elasticity score (ES) and strain ratio (SR) combined with conventional ultrasound in distinguishing benign and malignant breast masses and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.MethodsThis prospective, multicenter study included 910 patients from nine different hospitals. The acquisition and analysis of conventional ultrasound and strain elastography (SE) were obtained by radiologists with more than 5 years of experience in breast ultrasound imaging. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of conventional ultrasound alone and combined tests with ES and/or SR were calculated and compared.ResultsThe optimal cutoff value of SR for differentiating benign from malignant masses was 2.27, with a sensitivity of 60.2% and a specificity of 84.8%. When combined with ES and SR, the AUC of the new BI-RADS classification increased from 0.733 to 0.824 (p &lt; 0.001); the specificity increased from 48.1% to 68.5% (p &lt; 0.001) without a decrease in the sensitivity (98.5% vs. 96.4%, p = 0.065); and the PPV increased from 52.2% to 63.7% (p &lt; 0.001) without a loss in the NPV (98.2% vs. 97.1%, p = 0.327). All three combinations of conventional ultrasound, ES, and SR could reduce the biopsy rate of category 4a lesions without reducing the malignant rate of biopsy (from 100% to 68.3%, 34.9%, and 50.4%, respectively, all p &lt; 0.001).ConclusionsSE can be used as a useful and non-invasive additional method to improve the diagnostic performance of conventional ultrasound by increasing AUC and specificity and reducing the unnecessary biopsy of BI-RADS 4a lesions.

Diagnostic accuracy of B-mode ultrasound, ultrasound elastography and diffusion weighted MRI in differentiation of thyroid nodules (prospective study)

Background The incidence of the thyroid nodules and its detection is increasing rapidly. The most precise method for diagnosis of the nodules of the thyroid is FNAC. But, about 10–20% of specimens of FNAC are indeterminate and non-diagnostic. Therefore, there is a demand for another diagnostic method for evaluating thyroid nodules. Thyroid ultrasound elastography may improve the ability to differentiate malignant from benign thyroid nodules. Few articles were published about the results of DW MRI in thyroid nodules, with its results confirmed that malignant nodules have lower mean ADC values than benign nodules. This study aims to investigate and compare the accuracy of B-mode ultrasound, ultrasound elastography and diffusion-weighted MRI in characterization of the nodules of the thyroid. Results The study included 56 patients with thyroid nodules (36 benign and 20 malignant). Thyroid ultrasound, ultrasound elastography and DWI were done for all patients. Ultrasound-guided FNA Cytological examination (as the gold standard) was done for 48 patients and surgical histopathology was done to 8 patients with non-diagnostic FNAC. The results showed: TIRADS score had sensitivity 90%, specificity 77.8% and accuracy of 82.14%. The elastography score had sensitivity 80%, specificity 88.9% and accuracy 85.7%. The use of the strain ratio had 80% sensitivity, 94.4% specificity and 89.3% accuracy. DWI and ADC value had 100% sensitivity and 94.4% specificity and the accuracy was 96.4% for differentiating malignant from benign thyroid nodules. Multi-parametric analysis by TIRADS and ADC had 100% accuracy. Conclusion Ultrasound elastography add valuable data over ultrasound TIRADS. But, diffusion weighted MRI and ADC value has more accuracy in differentiating malignant from benign thyroid nodules. The best performance was achieved by the combination of ACR-TIRADS and ADC value.