AAPM/RSNA physics tutorial for residents: topics in US: beyond the basics: elasticity imaging with US

A new mode of imaging with ultrasonography (US) is under development in several laboratories around the world. This technique allows estimation of some measure of the viscoelastic properties of tissue. The information displayed in the images is a surrogate for that obtained with manual palpation. Fundamental concepts in elasticity imaging include stress, strain, and the elastic modulus; strain imaging has received the most attention from researchers. A system for elasticity imaging is under development that produces images of mechanical strain in real time by means of a freehand scanning technique. This system is integrated into a clinical US system without any external equipment and involves software changes only. Data obtained with this system demonstrate that the relative stiffness of many fibroadenomas changes as they and the surrounding tissue are deformed. At elasticity imaging of in vivo breast lesions, invasive ductal carcinomas appear, on average, more than twice as large on the elasticity image than on the B-mode image, but fibroadenomas and cysts are nearly equal in size on the two image types. The usefulness of this technology and the new information it provides suggest that it might soon be available on commercial US systems.