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Review
. 2017 Sep;3(4):E137-E149.
doi: 10.1055/s-0043-119412. Epub 2017 Dec 7.

Strain Elastography - How To Do It?

Christoph F Dietrich  1 , Richard G Barr  2 , André Farrokh  3 , Manjiri Dighe  4 , Michael Hocke  5 , Christian Jenssen  6 , Yi Dong  7 , Adrian Saftoiu  8 , Roald Flesland Havre  9
Affiliations
Review

Strain Elastography - How To Do It?

Christoph F Dietrich et al. Ultrasound Int Open. 2017 Sep.

Abstract

Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.

Keywords: endoscopic ultrasound; real-time; tissue elastography (TE); ultrasound.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Footplate extenders for linear probe
Fig. 2
Fig. 2
Phantom image of a hard inclusion in a softer homogeneous background. The best assessment of relative lesion stiffness is obtained when the area of interest occupies no more than 25–50% of the elastography ROI. In the right image, strain concentration is seen between the stress source (probe) and the hard lesion, indirectly confirming the presence of the harder lesion.
Fig. 3
Fig. 3
Diagrammatic explanation of the generation of the BGR artifact a . An example of the jugular vein displaying the BGR artifact b .
Fig. 4
Fig. 4
Soft tissue above stiff lesion shows more strain (red coloring) than adjacent tissue at the same depth (green coloring).
Fig. 5
Fig. 5
‘Soft rim’ sign seen at the periphery of a normal prostate.
Fig. 6
Fig. 6
Strain ratio measurement as applied to the breast. ROI A is placed within the breast mass, and ROI in adjacent fat layer. Fat to lesion ratio=B/A
See this image and copyright information in PMC

References

    1. Bamber J, Cosgrove D, Dietrich C F, Fromageau J, Bojunga J, Calliada F, Cantisani V et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 2013;34:169–184. - PubMed
    1. Shiina T, Nightingale K R, Palmeri M L, Hall T J, Bamber J C, Barr R G, Castera L et al.WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41:1126–1147. - PubMed
    1. Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas J M, Gilja O H, Klauser A S et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med. 2013;34:238–253. - PubMed
    1. Ferraioli G, Filice C, Castera L, Choi B I, Sporea I, Wilson S R, Cosgrove D et al.WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol. 2015;41:1161–1179. - PubMed
    1. Dong Y, Sirli R, Ferraioli G, Sporea I, Chiorean L, Cui X, Fan M et al.Shear wave elastography of the liver - review on normal values. Z Gastroenterol. 2017;55:153–166. - PubMed