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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.

S LAW F=-Kx(F RESTORING FORCE ) (x DISPLACEMENT) .HOOKE.

♦ Unit is pascal/pound per square inch(US) .YOUNG’S MODULUS ♦ Relation of stress vs strain of material following hooke’s law.

it expands in other dimensions. .POISSON’S RATIO ♦ When sample material is compressed in one dimension.

.

Basic principles ♦ Benign and malignant lesions have different firmness. . ♦ Strain imaging display relative firmness of lesion compared to surrounding normal tissue.

♦ Colour code…stiffer areas dark ♦ softer areas light .♦ Stiffer areas deform less easily than surrounding.

.♦ Elasticity correlates with pathological changes.

How to perform ? ♦ Trasducer moved over affected area. ♦ Machine records two images simultaneously. ♦ a)B mode picture ♦ b)Elastogram .

B MODE ELASTOGRAM .♦ Both images are displayed side by side.

.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? .

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

CAN IT BE COLOURFUL? .

TSUKUBA ELASTICITY SCORE .

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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.

♦ More accurate tumour surgeries with less re-operation rates.♦ Reduction of biopsy rates in benign lesions. .

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 .

Wave image is superimposed on anatomical image. .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.

also distribution of stiffness was inhomogeneous than normal liver. (normal upper limit is 2.A mathematical algorithm used to process the wave images to calculate the stiffness of the tissue. .5). 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 MRE showing avarage stiffness of 2 showing homogeneous stiffness throughout.

NORMAL FIBROSIS .

SUMMARY ♦ FUTURE PERSPECTIVE.SKIN AND LYMPH NODE PATHOLOGIES. ♦ NON INVASIVE DIAGNOSIS OF LIVER FIBROSIS. ♦ IT CAN BE USED THYROID.FOR DIAGNOSIS AND DIFFERENTIATION OF BENIGN AND MALIGNANT BREAST LESION. .

THANK YOU .