BREAST AND THYROID SONOELASTOGRAPHY Clinical session : Discussion of clinical cases Antonio Pio Masciotra – Campobasso - Italy

Thyroid sonoelastography Clinical cases discussion Dr. Antonio Pio Masciotra Campobasso

External Mechanical force Natural Hear t  SuperSonic Imagine has developed a novel method called SonicTouch, which is based on focused ultrasound, and can remotely generate Shear Wave-fronts providing uniform coverage of a 2D area interest.

STRAIN ELASTOGRAPHY with different grades of compression Inhomogeneous elasticityUniform low elasticity

SHEAR WAVE ELASTOGRAPHY Normal gland8.29 kPa Nodule8.46 kPa

Hashimoto thyroiditis Normal gland8 kPa Hashimoto13-15 kPa

Hashimoto thyroiditis Nodule14.8 kPa Parenchima21.3 kPa

Hashimoto thyroiditis – 3D US Nodule14.8 kPa Parenchima21.3 kPa

Hashimoto thyroiditis – 3D SWE Nodule14.8 kPa Parenchima21.3 kPa

4 months later 1 month later First exam Thyroid hemorragic cyst – Bidimensional US First exam – Volume 7.11 cc – Mainly fluid 1 month later – Volume 2.35 cc – Complex structure with thick layers of debris on all the walls 4 months later – Volume 2.16 cc – Mainly fluid with less thick layers of debris on only some of the walls

First exam 1 month later 4 months later Thyroid hemorragic cyst – PD and directional PD First exam – Only a few vessels streched on the wall due to the high intracystic pressure 1 month later – Vessels more visible, but always limited to the wall 4 months later – Vessels even more visible (due to reduced intracistic pressure), but always limited to the wall

First exam 1 month later 4 months later Thyroid hemorragic cyst – SW Elastography First exam – 6 kPa (min 0.1 – max 24.0) on hypoechoic layer of debris Surrounding tissue very stiff due to the high intracystic pressure 1 month later – 8 kPa (min 1.9 – max 18.6) on almost isoechoic layer of debris Surrounding tissue not stiff 4 months later – 29 kPa (min 3.9 – max 48.1) on hypoechoic layer of debris Surrounding tissue not stiff

Thyroid nodules – Bidimensional US BenignMalignant

Thyroid nodules – Color and Powerdoppler BenignMalignant

Thyroid nodules – SW Elastography BenignMalignant

Breast sonoelastography Clinical cases discussion Dr. Antonio Pio Masciotra Campobasso

Breast SWE – hyperchoic nodule in fat Nodule14.8 kPa Parenchima21.3 kPa

Breast SWE – unilateral gynecomastia Nodule14.8 kPa Parenchima21.3 kPa

RT induced effects on breast Bidimensional US 6 months after RT13 years after RT

RT induced effects on breast SW Elastography 6 months after RT 13 years after RT

RT induced breast subacute effects 3D US RT

RT induced breast subacute effects 3D SWE RT

Breast complicated cyst Bidimensional US First study7 days after therapy

Breast complicated cyst Powerdoppler First study7 days after therapy

Breast complicated cyst SW Elastography First study7 days after therapy

Breast complicated cyst 3D US First study7 days after therapy

Breast complicated cyst 3D SWE First study7 days after therapy

Breast complicated cyst SWE different settings Resolution modePenetration mode

Breast fibroadenomas Bidimensional US Almost homogeneousInhomogeneous

Breast fibroadenomas SW Elastography Different kPaSimilar elasticity ratio

Breast papillary carcinoma

Breast carcinoma – Mammography BenignMalignant

Breast carcinoma – US Bidimensional 3D

Breast carcinoma – SWE Bidimensional 3D

Breast carcinoma – SWE High transparence Low transparence

2 more nodules in the same breast – Bidimensional US Nodule n. 1 Nodule n. 2

2 more nodules in the same breast – SW Elastography (both benign at histology) Nodule n. 1 Nodule n. 2

Breast carcinoma – Axilla US Bidimensional 3D

Breast carcinoma – Axilla SWE Bidimensional 3D

Lymphnodes 2D US B cell LymphomaBreast cancer metastasis

Lymphnodes US 3D B cell Lymphoma Breast cancer metastasis

Lymphnodes SWE B cell Lymphoma Breast cancer metastasis

Lymphnodes in different sites in the same patient Bidimensional US B cell Lymphoma inguinal B cell Lymphoma ext. iliac

Lymphnodes in different sites in the same patient SW Elastography B cell Lymphoma inguinal B cell Lymphoma ext. iliac

Lymphnodes SWE Different stiffness depending on histology B cell Lymphoma Breast cancer metastasis NET metastasis

Aims of elastography Correct tissue elasticity quantification Identification of ‘cut off’ elasticity values for the right diagnostic workup of diffuse and focal diseases