Artifacts and Technical Restrictions in 2D Shear Wave Elastography

Abstract

2 D shear wave elastography (2D-SWE) is the latest evolution of elastography techniques and allows real-time quantitative assessment of the medium stiffness. The aim of this review is to identify, describe, explain and illustrate some technical restrictions and artifacts in 2D-SWE. Encountered artifacts and technical restrictions may be categorized according to acquisition technique, medium, or operator:

• Acquisition technique: B-mode & SWE entanglement, transducer frequency, posterior elastographic shadowing artifact, mirrored elastogram artifact, “vertical striped” artifact, resolution limits in SWE, non-equivalence of elastographic devices

• Medium: SWE in liquid medium, “black hole phenomenon”, pseudo-liquid lesions, musculotendinous anisotropy, intrinsic stiffness variations of tendons and muscles, depth of analysis, movement artifacts

• Operator: Region of interest compression, acquisition and measurement parameters (ROI size, ROI location, elastogram acquisition time)

Clear knowledge of the underlying physical basis is necessary in 2D-SWE because radiologists have to deal with technical restrictions and a wide range of artifacts. Proper use of 2D-SWE ensures the reliability and reproducibility of the technique.

Zusammenfassung

Die 2D-Scherwellen-Elastografie (2D-SWE) ist die neueste Entwicklung in der Elastografie und ermöglicht die quantitative Beurteilung der mittleren Steifigkeit in Echtzeit. Das Ziel dieser Übersichtsarbeit ist die Erkennung, Beschreibung, Erklärung und anschauliche Darstellung einiger technischer Einschränkungen und Artefakte in der 2D-SWE. Die auftretenden Artefakte und technischen Einschränkungen können nach Aufnahmetechnik, Medium oder Anwender kategorisiert werden:

• Aufnahmetechnik: B-Mode & SWE-Verschränkung, Frequenz des Schallkopfes, posteriores elastografisches Schattenartefakt, gespiegeltes Elastogramm-Artefakt, „vertikal gestreiftes“ Artefakt, Auflösungsgrenzen in der SWE, nicht äquivalente elastografische Geräte

• Medium: SWE in flüssigem Medium, „Black-Hole-Phänomen“, pseudoflüssige Läsionen, muskulotendinöse Anisotropie, intrinsische Steifigkeitsschwankungen der Sehnen und Muskeln, Tiefe der Analyse, Bewegungsartefakte

• Anwender: Parameter der Kompression, Erfassung und Messung der „region-of-interest“ (ROI-Größe, Position der ROI, Aufnahmedauer des Elastogramms)

In der 2D-SWE ist ein fundiertes Wissen über die physikalischen Grundlagen erforderlich, da sich Radiologen mit technischen Einschränkungen und einer Vielzahl von Artefakten auseinandersetzen müssen. Die korrekte Anwendung der 2D-SWE gewährleistet die Zuverlässigkeit und Reproduzierbarkeit dieser Technik.

Key words

shear wave elastography - artifact - quality improvement - shear wave speed - stiffness

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