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

2. Thyroid sonoelastography Clinical cases discussion Dr. Antonio Pio Masciotra Campobasso

3. 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.

4. STRAIN ELASTOGRAPHY with different grades of compression Inhomogeneous elasticityUniform low elasticity

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

6. Hashimoto thyroiditis Normal gland8 kPa Hashimoto13-15 kPa

7. Hashimoto thyroiditis Nodule14.8 kPa Parenchima21.3 kPa

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

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

10. 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

11. 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

12. 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

13. Thyroid nodules – Bidimensional US BenignMalignant

14. Thyroid nodules – Color and Powerdoppler BenignMalignant

15. Thyroid nodules – SW Elastography BenignMalignant

16. Breast sonoelastography Clinical cases discussion Dr. Antonio Pio Masciotra Campobasso

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

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

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

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

21. RT induced breast subacute effects 3D US RT

22. RT induced breast subacute effects 3D SWE RT

24. Breast complicated cyst Bidimensional US First study7 days after therapy

25. Breast complicated cyst Powerdoppler First study7 days after therapy

26. Breast complicated cyst SW Elastography First study7 days after therapy

27. Breast complicated cyst 3D US First study7 days after therapy

28. Breast complicated cyst 3D SWE First study7 days after therapy

29. Breast complicated cyst SWE different settings Resolution modePenetration mode

30. Breast fibroadenomas Bidimensional US Almost homogeneousInhomogeneous

31. Breast fibroadenomas SW Elastography Different kPaSimilar elasticity ratio

32. Breast papillary carcinoma 20082009 20102011 2008 2009 2010 2011

33. Breast carcinoma – Mammography BenignMalignant

34. Breast carcinoma – US Bidimensional 3D

35. Breast carcinoma – SWE Bidimensional 3D

36. Breast carcinoma – SWE High transparence Low transparence

37. 2 more nodules in the same breast – Bidimensional US Nodule n. 1 Nodule n. 2

38. 2 more nodules in the same breast – SW Elastography (both benign at histology) Nodule n. 1 Nodule n. 2

39. Breast carcinoma – Axilla US Bidimensional 3D

40. Breast carcinoma – Axilla SWE Bidimensional 3D

41. Lymphnodes 2D US B cell LymphomaBreast cancer metastasis

42. Lymphnodes US 3D B cell Lymphoma Breast cancer metastasis

43. Lymphnodes SWE B cell Lymphoma Breast cancer metastasis

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

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

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

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