How To: Elastography - HD

Introduction to ShearWave Elastography

This demonstration will show you how to perform
and interpret a ShearWave Elastography exam.
ShearWave Elastography is a real time
and reproducible method
of measuring the stiffness of tissue.
This information can be used in conjunction
with gray scale imaging to provide the clinician
with additional information
to better characterize tissue in abnormal states such
as lesions and diffuse disease.
The supersonic imagine elastography can be used in breast,
abdominal, thyroid, prostate, and MSK applications.

Thyroid Gland Demonstration

I will now demonstrate how
to perform a ShearWave Elastography exam
in the thyroid gland.
The first step is to perform a 2D image.
I've now optimized my 2D image
and I'm ready to turn on my ShearWave Elastography.
ShearWave Elastography is very easy to use
with just one push of a button.
I have my ShearWave window.
I can make this window larger
or smaller depending on the area of interrogation
that I would like to see.
As you can see, I am scanning in real time.
I can move the transducer
and I have my ShearWave or stiffness information,
And I do not need to compress ShearWave.
Elastography does not need any compression.
I'm going to freeze the image and here you can see
from the scale what type
of information we're looking at.
Looking at the scale on the right side of the monitor,
soft is coded as blue
and the higher you go to the scale,
the stiffer the tissue becomes.
Looking at my ShearWave window, I can see
that the thyroid tissue is blue
and uniform indicating from
what we know normal thyroid tissue.

Breast Phantom Demonstration

I will now demonstrate ShearWave elastography
using a breast phantom.
This phantom has multiple inclusions which demonstrate
different levels of stiffness.

Complex Lesion

This particular lesion appears on the 2D image to be
a complex lesion when I activate the
ShearWave elastography.
I have a window where my
elasticity information is acquired.
Using my trackball, I can move that window
using my trackball ring.
I can make it larger or smaller.
I am not applying any pressure
but scanning with normal scanning pressure
that I would use for a 2D image.
This is very important to ensure
reproducibility of the result.
I'm going to freeze this image,
and here you can see this lesion is very stiff
Because it's coded stiffer than the normal
surrounding blue tissue.
Within the lesion, we have different stiffness levels,
so this would be considered a heterogeneous lesion
'cause it has yellow, aqua,
and red as compared to the normal surrounding tissue.

Soft Lesion

In contrast, I'm going to demonstrate to you a soft lesion.
I'm just going to adjust my depth, move my focus down.
It's very important to have optimal 2D image quality
before entering my ShearWave mode.
This lesion, as you can see,
appears somewhat similar as the other lesion in that it has,
it's a complex lesion
with different levels of shades of gray.
When I activate my ShearWave, I see
that in contrast to the very stiff
pattern of the other lesion.
This lesion is soft as compared to the surrounding tissue.
When doing shear wave, you always want
to compare your target
or your lesion to the surrounding tissue
okay.

Isoechoic Lesion

This lesion is very isoechoic by 2D and barely visible.
When I activate the shear wave,
I can see that the lesion becomes much more conspicuous.
In this case, the shear wave
was very helpful in identifying the lesion, which
by 2D was very difficult to see.

Cystic Lesion

In contrast to solid lesions,
I'll demonstrate a cystic lesion or a lesion.
That's fluid component.
Anything that is liquid or fluid
with a low viscosity will not produce a ShearWave.
When I enter the ShearWave mode
and bring my box down to the cyst,
just give it some time to update
and I see that the cyst is clear, which validates
that this is indeed a lesion
with fluid component.

Clinical Application Example

ShearWave Elastography provides additional information
to the clinician as in this case
of invasive lobular carcinoma,
which was not detected on mammography.
Thank you for your attention.