Ultraschall-Elastografie in der Diagnostik von Mammatumoren

Zusammenfassung

Die Sonoelastografie ist eine bewährte Methode, um fokale Läsionen der Brust zu charakterisieren. Unterschiedliche Techniken und Bildanalysen können hierfür zum Einsatz kommen. Diese Publikation behandelt den Einsatz der Sonoelastografie bei der Brustkrebsdiagnostik. Im ersten Teil des Artikels werden die technischen Hintergründe von Strain- und Scherwellen-Elastografie erklärt und im darauf folgenden Abschnitt wird darauf eingegangen, wie man geeignete Elastografie-Bilder und Messungen erzielt. Der zweite Teil der Arbeit beschreibt die Anwendung der Elastografie in der klinischen Praxis zusätzlich zur B-Bild-Sonografie und diskutiert die möglichen diagnostischen Ziele und Limitationen der Elastografie.

Abstract

Ultrasound elastography is an established method for characterization of focal lesions in the breast. Different techniques and analyses of the images may be used for the characterization. This article addresses the use of ultrasound elastography in breast cancer diagnosis. In the first part of the article the techniques behind both strain- and shear-wave-elastography are explained and followed by a section on how to obtain adequate elastography images and measurements. In the second part of the article the application of elastography as an adjunct to B-mode ultrasound in clinical practice is described, and the potential diagnostic gains and limitations of elastography are discussed.

• Literatur

• 1 Bamber J, Cosgrove D, Dietrich CF et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 1: Basic Principles and Technology. Ultraschall in Med 2013; 34: 169-184
• 2 Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 2: Clinical Applications. Ultraschall in Med 2013; 34: 238-253
• 3 Carlsen J, Ewertsen C, Saftoiu A et al. Accuracy of Visual Scoring and Semi-Quantification of Ultrasound Strain Elastography – a Phantom Study. PLoS ONE, Online Publication 2014;
• 4 Paparo F, Corradi F, Cevasco L et al. Real-Time Elastography in the Assessment of Liver Fibrosis: A Review of Qualitative and Semi-quantitative Methods for Elastogram Analysis. Ultrasound Med Biol 2014; 40: 1923-1933
• 5 Veer V, Puttagunta S. The role of elastography in evaluating thyroid nodules: a literature review and meta-analysis. Eur Arch Otorhinolaryngol Online Publication 2014;
• 6 Dietrich CF, Ponnudurai R, Bachmann Nielsen M. Is there a need for new imaging methods for lymph node evaluation?. Ultraschall in Med 2012; 33: 411-414
• 7 Berg WA, Cosgrove DO, Doré CJ et al. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology 2012; 262: 435-449
• 8 Wojcinski S, Farrokh A, Weber S et al. Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS^®-US classification system with sonoelastography. Ultraschall in Med 2010; 31: 484-491
• 9 Yi A, Cho N, Chang JM et al. Sonoelastography for 1786 non-palpable breast masses: diagnostic value in the decision to biopsy. Eur Radiol 2012; 22: 1033-1040
• 10 Mendelson EB, Böhm-Vélez M, Berg WA et al. ACR BI-RADS^® Ultrasound. ACR BI-RADS^® Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013
• 11 Berg WA, Blume JD, Cormack JB et al. Training the ACRIN 6666 Investigators and Effects of Feedback on Breast Ultrasound Interpretive Performance and Agreement in BI-RADS Ultrasound Feature Analysis. Am J Roentgenol 2012; 199: 224-235
• 12 Garra BS, Cespedes EI, Ophir J et al. Elastography of breast lesions: initial clinical results. Radiology 1997; 202: 79-86
• 13 Tanter M, Bercoff J, Athanasiou A et al. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol 2008; 34: 1373-1386
• 14 Carlsen J, Ewertsen C, Lönn L et al. Strain Elastography Ultrasound: An Overview with Emphasis on Breast Cancer Diagnosis. Diagnostics 2013; 3: 117-125
• 15 Itoh A, Ueno E, Tohno E et al. Breast Disease: Clinical Application of US Elastography for Diagnosis1. Radiology 2006; 239: 341-350
• 16 Park CS, Kim SH, Jung NY et al. Interobserver variability of ultrasound elastography and the ultrasound BI-RADS lexicon of breast lesions. Breast Cancer Online Publication 2013;
• 17 Zhi H, Xiao XY, Yang HY et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol 2008; 15: 1347-1353
• 18 Havre RF, Waage JR, Gilja OH et al. Real-Time Elastography: Strain Ratio Measurements Are Influenced by the Position of the Reference Area. Ultraschall in Med Online Publication 2011;
• 19 Sadigh G, Carlos R, Neal C et al. Accuracy of quantitative ultrasound elastography for differentiation of malignant and benign breast abnormalities: a meta-analysis. Breast Cancer Res Treat 2012; 134: 923-931
• 20 Zhi H, Xiao XY, Ou B et al. Could ultrasonic elastography help the diagnosis of small (≤2cm) breast cancer with the usage of sonographic BI-RADS classification?. Eur J Radiol 2012; 81: 3216-3221
• 21 Wojcinski S, Brandhorst K, Sadigh G et al. Acoustic radiation force impulse imaging with Virtual Touch(TM) tissue quantification: mean shear wave velocity of malignant and benign breast masses. Int J Womens Health 2013; 5: 619-627
• 22 Kim S, Choi S, Choi Y et al. Diagnostic performance of shear wave elastography of the breast according to scanning orientation. J Ultrasound Med 2014; 33: 1797-1804
• 23 Evans A, Whelehan P, Thomson K et al. Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology 2012; 263: 673-677
• 24 Vinnicombe SJ, Whelehan P, Thomson K et al. What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?. Eur Radiol 2014; 24: 921-926
• 25 Sadigh G, Carlos RC, Neal CH et al. Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring. Breast Cancer Res Treat 2012; 133: 23-35
• 26 Chen L, He J, Liu G et al. Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis. Jpn J Radiol 2014; 32: 592-599
• 27 Stachs A, Hartmann S, Stubert J et al. Differentiating between malignant and benign breast masses: factors limiting sonoelastographic strain ratio. Ultraschall in Med 2013; 34: 131-136
• 28 Lee SH, Chang JM, Kim WH et al. Added Value of Shear-Wave Elastography for Evaluation of Breast Masses Detected with Screening US Imaging. Radiology 2014; 273: 61-69
• 29 Chiorean AR, Duma MM, Dudea SM et al. Typical and unusual sonoelastographic patterns of breast cystic lesions: impact on BI-RADS classification. Ultraschall in Med 2012; 33: E138-E144
• 30 Barr RG, Zhang Z. Effects of Precompression on Elasticity Imaging of the Breast Development of a Clinically Useful Semiquantitative Method of Precompression Assessment. J Ultrasound Med 2012; 31: 895-902
• 31 Ciurea AI, Bolboaca SD, Ciortea CA et al. The influence of technical factors on sonoelastographic assessment of solid breast nodules. Ultraschall in Med 2011; 32: S27-S34
• 32 Barr RG. Shear Wave Imaging of the Breast Still on the Learning Curve. J Utrasound Med 2012; 31: 347-350