Echtzeit-Gewebeelastografie

 

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Zusammenfassung

Entzündliche Veränderungen oder Tumoren führen zu einer Veränderung der normalen Gewebestruktur. Dies führt in der Regel zu einer Verhärtung der Gewebestruktur, d. h. zu einer Veränderung des Elastizitätsmodulus. Die Darstellung der Gewebeelastizitäten kann einen potenziell wichtigen Beitrag für die Diagnostik von Tumorerkrankungen und inflammatorischen Prozessen liefern. Sonografische Verfahren zur Abbildung der elastischen Gewebeeigenschaften wurden in den letzten Jahren entwickelt und experimentell evaluiert. Das Prinzip der Elastizitätsdarstellung beruht auf der unterschiedlichen Verformbarkeit und Verschieblichkeit von einem Objekt in einem elastisch unterschiedlichen Medium. Unter anderem wird sich unter gleicher Druckbelastung das weichere Gewebe stärker verformen als festere Gewebestrukturen. Diese Verformung wird aus den Ultraschalldaten abgeleitet und visualisiert. Die Untersuchung wird mit Standardschallsonden ohne zusätzliche Apparaturen durchgeführt (Systeme zur Messung der eingeleiteten Drucks, Vibrationsquellen, etc.), ähnlich einer Farbdoppleruntersuchung. Die Berechnung der Elastizitätsverhältnisse erfolgt in Echtzeit, die Ergebnisse werden dem konventionellen B-Bild farbkodiert überlagert. In der folgenden Übersicht werden Anwendungsmöglichkeiten dargestellt.

Abstract

It is well known that inflammatory conditions and tumours lead to an alteration of the normal tissue structure causing hardening of the tissue and an alteration of its elasticity. The elasticity modulus is a measure of the stress which is applied to tissue structures relative to the strain or deformation produced. The assessment and visualisation of tissue elasticity provides the clinician with potentially important information that can be used in the diagnosis of tumours and inflammatory conditions. Various ultrasound techniques have been developed and experimentally evaluated in the last few years to visualise the elastic properties of tissue. Soft tissues will be compressed more than hard tissue structures under the same pressure. This deformation can be detected from the ultrasound data and can be displayed. The SonoElastography modality described here uses standard ultrasound probes and there is no requirement for additional equipment such as pressure or vibration measurement systems, etc. The implementation is sim­ilar to a conventional Colour Doppler examination. The measurement of the tissue elasticity is acquired in real-time and presented as a colour overlay of the conventional B-Mode image. In the following article applications are discussed.

Literatur

• 1 Friedrich-Rust M, Ong M F et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis.  Gastroenterology. 2008;  134 960-974
  CrossrefPubMedGoogle Scholar
• 2 Friedrich-Rust M, Wunder K, Kriener S et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography.  Radiology. 2009;  252 595-604
  CrossrefPubMedGoogle Scholar
• 3 Frey H. [Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity].  Radiologe. 2003;  43 850-855
  CrossrefPubMedGoogle Scholar
• 4 Frey H, Ignee A, Dietrich C F. Ein neues sonographisches Verfahren für die Darstellung der Gewebeelastizität, Elastographie.  Endoskopie Heute. 2006;  19 117-120
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Krouskop T A, Wheeler T M, Kallel F et al. Elastic moduli of breast and prostate tissues under compression.  Ultrason Imaging. 1998;  20 260-274
  CrossrefPubMedGoogle Scholar
• 6 Thomas A, Kummel S, Gemeinhardt O et al. Real-time sonoelastography of the cervix: tissue elasticity of the normal and abnormal cervix.  Acad Radiol. 2007;  14 193-200
  CrossrefPubMedGoogle Scholar
• 7 Hirche T O, Ignee A, Barreiros A P et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions.  Endoscopy. 2008;  40 910-917
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Dietrich C F, Hirche T O, Ott M et al. Real-time tissue elastography in the diagnosis of autoimmune pancreatitis.  Endoscopy. 2009;  41 718-720
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Friedrich-Rust M, Ong M F, Herrmann E et al. Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis.  AJR Am J Roentgenol. 2007;  188 758-764
  CrossrefPubMedGoogle Scholar
• 10 Saftoiu A, Vilmann P, Ciurea T et al. Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes.  Gastrointest Endosc. 2007;  66 291-300
  CrossrefPubMedGoogle Scholar
• 11 Saftoiu A, Vilmann P, Hassan H et al. Analysis of endoscopic ultrasound elastography used for characterisation and differentiation of benign and malignant lymph nodes.  Ultraschall Med. 2006;  27 535-542
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Janssen J, Dietrich C F, Will U et al. Endosonographic elastography in the diagnosis of mediastinal lymph nodes.  Endoscopy. 2007;  39 952-957
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Jenssen C, Dietrich C F. Endoscopic ultrasound of gastrointestinal subepithelial lesions.  Ultraschall Med. 2008;  29 236-256
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Jenssen C, Dietrich C F. Endoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology – An overview.  Best Pract Res Clin Gastroenterol. 2009;  23 743-759
  CrossrefPubMedGoogle Scholar
• 15 Janssen J. [(E)US elastography: current status and perspectives].  Z Gastroenterol. 2008;  46 572-579
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Saftoiu A, Vilmann P, Gorunescu F et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer.  Gastrointest Endosc. 2008;  68 1086-1094
  CrossrefPubMedGoogle Scholar
• 17 Dietrich C F, Jenssen C, Allescher H D et al. [Differential diagnosis of pancreatic lesions using endoscopic ultrasound].  Z Gastroenterol. 2008;  46 601-617
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Garra B S. Imaging and estimation of tissue elasticity by ultrasound.  Ultrasound Q. 2007;  23 255-268
  CrossrefPubMedGoogle Scholar
• 19 Janssen J, Schlorer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions.  Gastrointest Endosc. 2007;  65 971-978
  CrossrefPubMedGoogle Scholar
• 20 Janssen J. The impact of EUS in primary gastric lymphoma.  Best Pract Res Clin Gastroenterol. 2009;  23 671-678
  CrossrefPubMedGoogle Scholar
• 21 Dietrich C F, Schneider J, Ignee A. Schilddrüsensonographie: Eine Übersicht.  Endoskopie Heute. 2007;  20 17-27
  Article in Thieme ConnectPubMedGoogle Scholar
• 22 Lyshchik A, Higashi T, Asato R et al. Thyroid gland tumor diagnosis at US elastography.  Radiology. 2005;  237 202-211
  CrossrefPubMedGoogle Scholar
• 23 Hong Y, Liu X, Li Z et al. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules.  J Ultrasound Med. 2009;  28 861-867
  CrossrefPubMedGoogle Scholar
• 24 Rubaltelli L, Corradin S, Dorigo A et al. Differential diagnosis of benign and malignant thyroid nodules at elastosonography.  Ultraschall Med. 2009;  30 175-179
  Article in Thieme ConnectPubMedGoogle Scholar
• 25 Dighe M, Bae U, Richardson M L et al. Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation.  Radiology. 2008;  248 662-669
  CrossrefPubMedGoogle Scholar
• 26 Asteria C, Giovanardi A, Pizzocaro A et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules.  Thyroid. 2008;  18 523-531
  CrossrefPubMedGoogle Scholar
• 27 Rago T, Santini F, Scutari M et al. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules.  J Clin Endocrinol Metab. 2007;  92 2917-2922
  CrossrefPubMedGoogle Scholar
• 28 Garra B S, Cespedes E I, Ophir J et al. Elastography of breast lesions: initial clinical results.  Radiology. 1997;  202 79-86
  CrossrefPubMedGoogle Scholar
• 29 Scaperrotta G, Ferranti C, Costa C et al. Role of sonoelastography in non-palpable breast lesions.  Eur Radiol. 2008;  18 2381-2389
  CrossrefPubMedGoogle Scholar
• 30 Ou J J, Ong R E, Yankeelov T E et al. Evaluation of 3D modality-independent elastography for breast imaging: a simulation study.  Phys Med Biol. 2008;  53 147-163
  CrossrefPubMedGoogle Scholar
• 31 Booi R C, Carson P L, O’Donnell M et al. Characterization of cysts using differential correlation coefficient values from two dimensional breast elastography: preliminary study.  Ultrasound Med Biol. 2008;  34 12-21
  CrossrefPubMedGoogle Scholar
• 32 Tardivon A, El Khoury C, Thibault F et al. [Elastography of the breast: a prospective study of 122 lesions].  J Radiol. 2007;  88 (5 Pt 1) 657-662
  CrossrefPubMedGoogle Scholar
• 33 Melodelima D, Bamber J C, Duck F A et al. Elastography for breast cancer diagnosis using radiation force: system development and performance evaluation.  Ultrasound Med Biol. 2006;  32 387-396
  CrossrefPubMedGoogle Scholar
• 34 Cho N, Moon W K, Park J S. Real-time US elastography in the differentiation of suspicious microcalcifications on mammography.  Eur Radiol. 2009;  19 1621-1628
  CrossrefPubMedGoogle Scholar
• 35 Thomas A, Fischer T, Frey H et al. Real-time elastography – an advanced method of ultrasound: First results in 108 patients with breast lesions.  Ultrasound Obstet Gynecol. 2006;  28 335-340
  CrossrefPubMedGoogle Scholar
• 36 Itoh A, Ueno E, Tohno E et al. Breast Disease: Clinical Application of US Elastography for Diagnosis.  Radiology. 2006;  239 341-350
  CrossrefPubMedGoogle Scholar
• 37 Lyshchik A, Higashi T, Asato R et al. Cervical lymph node metastases: diagnosis at sonoelastography – initial experience.  Radiology. 2007;  243 258-267
  CrossrefPubMedGoogle Scholar
• 38 Kim K, Johnson L A, Jia C et al. Noninvasive ultrasound elasticity imaging (UEI) of Crohn’s disease: animal model.  Ultrasound Med Biol. 2008;  34 902-912
  CrossrefPubMedGoogle Scholar
• 39 Al Taie O H, Dietrich C F, Dietrich C G et al. [Role of endoscopic ultrasound in gastrointestinal lymphomas].  Z Gastroenterol. 2008;  46 618-624
  Article in Thieme ConnectPubMedGoogle Scholar
• 40 Dietrich C F, Barreiros A P, Nuernberg D et al. [Perianal ultrasound].  Z Gastroenterol. 2008;  46 625-630
  PubMedGoogle Scholar
• 41 Allgayer H, Dietrich C F. [A 64-year-old woman with perianal bleeding, chronic diarrhea and severe fecal incontinence].  Z Gastroenterol. 2009;  47 361-364
  Article in Thieme ConnectPubMedGoogle Scholar
• 42 Allgayer H, Dietrich C F, Rohde W et al. Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic / endosonographic findings.  Scand J Gastroenterol. 2005;  40 1168-1175
  CrossrefPubMedGoogle Scholar
• 43 Hirche T O, Ignee A, Hirche H et al. Evaluation of hepatic steatosis by ultrasound in patients with chronic hepatitis C virus infection.  Liver Int. 2007;  27 748-757
  CrossrefPubMedGoogle Scholar
• 44 Dietrich C F, Schall H, Kirchner J et al. Sonographic detection of focal changes in the liver hilus in patients receiving corticosteroid therapy.  Z Gastroenterol. 1997;  35 1051-1057
  PubMedGoogle Scholar
• 45 Giovannini M, Hookey L C, Bories E et al. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients.  Endoscopy. 2006;  38 344-348
  Article in Thieme ConnectPubMedGoogle Scholar
• 46 Giovannini M, Thomas B, Erwan B et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study.  World J Gastroenterol. 2009;  15 1587-1593
  CrossrefPubMedGoogle Scholar
• 47 Mork H, Ignee A, Schuessler G et al. Analysis of neuroendocrine tumour metastases in the liver using contrast enhanced ultrasonography.  Scand J Gastroenterol. 2007;  42 652-662
  CrossrefPubMedGoogle Scholar
• 48 Schurich M, Aigner F, Frauscher F et al. The role of ultrasound in assessment of male fertility.  Eur J Obstet Gynecol Reprod Biol. 2009;  144 Suppl 1 192-198
  CrossrefPubMedGoogle Scholar
• 49 Eggert T, Khaled W, Wenske S et al. [Impact of elastography in clinical diagnosis of prostate cancer. A comparison of cancer detection between B-mode sonography and elastography-guided 10-core biopsies].  Urologe A. 2008;  47 1212-1217
  CrossrefPubMedGoogle Scholar
• 50 Cagiannos I. Editorial comment on: evaluation of prostate cancer detection with ultrasound real-time elastography: a comparison with step section pathological analysis after radical prostatectomy.  Eur Urol. 2008;  54 1361-1362
  CrossrefPubMedGoogle Scholar
• 51 Salomon G, Kollerman J, Thederan I et al. Evaluation of prostate cancer detection with ultrasound real-time elastography: a comparison with step section pathological analysis after radical prostatectomy.  Eur Urol. 2008;  54 1354-1362
  CrossrefPubMedGoogle Scholar
• 52 Zhang M, Nigwekar P, Castaneda B et al. Quantitative characterization of viscoelastic properties of human prostate correlated with histology.  Ultrasound Med Biol. 2008;  34 1033-1042
  CrossrefPubMedGoogle Scholar
• 53 Kamoi K, Okihara K, Ochiai A et al. The utility of transrectal real-time elastography in the diagnosis of prostate cancer.  Ultrasound Med Biol. 2008;  34 1025-1032
  CrossrefPubMedGoogle Scholar
• 54 Pallwein L, Aigner F, Faschingbauer R et al. Prostate cancer diagnosis: value of real-time elastography.  Abdom Imaging. 2008;  33 729-735
  CrossrefPubMedGoogle Scholar
• 55 Pallwein L, Mitterberger M, Pelzer A et al. Ultrasound of prostate cancer: recent advances.  Eur Radiol. 2008;  18 707-715
  CrossrefPubMedGoogle Scholar
• 56 Nelson E D, Slotoroff C B, Gomella L G et al. Targeted biopsy of the prostate: the impact of color Doppler imaging and elastography on prostate cancer detection and Gleason score.  Urology. 2007;  70 1136-1140
  CrossrefPubMedGoogle Scholar
• 57 Sumura M, Shigeno K, Hyuga T et al. Initial evaluation of prostate cancer with real-time elastography based on step-section pathologic analysis after radical prostatectomy: a preliminary study.  Int J Urol. 2007;  14 811-816
  CrossrefPubMedGoogle Scholar
• 58 Tsutsumi M, Miyagawa T, Matsumura T et al. The impact of real-time tissue elasticity imaging (elastography) on the detection of prostate cancer: clinicopathological analysis.  Int J Clin Oncol. 2007;  12 250-255
  CrossrefPubMedGoogle Scholar
• 59 Taylor L S, Rubens D J, Porter B C et al. Prostate cancer: three-dimensional sonoelastography for in vitro detection.  Radiology. 2005;  237 981-985
  CrossrefPubMedGoogle Scholar
• 60 Konig K, Scheipers U, Pesavento A et al. Initial experiences with real-time elastography guided biopsies of the prostate.  J Urol. 2005;  174 115-117
  CrossrefPubMedGoogle Scholar
• 61 Wu Z, Taylor L S, Rubens D J et al. Shear wave focusing for three-dimensional sonoelastography.  J Acoust Soc Am. 2002;  111 (1 Pt 1) 439-446
  CrossrefPubMedGoogle Scholar
• 62 Ophir J, Alam S K, Garra B et al. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues.  Proc Inst Mech Eng H. 1999;  213 203-233
  PubMedGoogle Scholar
• 63 Konig K, Scheipers U, Pesavento A et al. Initial experiences with real-time elastography guided biopsies of the prostate.  J Urol. 2005;  174 115-117
  CrossrefPubMedGoogle Scholar
• 64 Frauscher F, Gradl J, Pallwein L. Prostate ultrasound--for urologists only?.  Cancer Imaging. 2005;  5 Spec No A 76-82
  PubMedGoogle Scholar
• 65 Gibbon W W, Cooper J R, Radcliffe G S. Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic achilles tendinosis.  J Clin Ultrasound. 2000;  28 61-66
  CrossrefPubMedGoogle Scholar

Prof. Dr. C. F.  Dietrich

Innere Medizin 2 · Caritas-Krankenhaus Bad Mergentheim

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D-97980 Bad Mergentheim

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