Ultrasound elastography: advantages, limitations and artefacts of the different techniques from a study on a phantom

Ultrasound elastography is a technique currently under development. Its use in clinical practice is complicated because of the wide range of techniques used by the different manufacturers and the parameters proposed to characterise tissues. A comparative analysis on five ultrasound diagnostic systems has been performed on a calibrated elasticity phantom and demonstrated that: (1) all systems tested are reliable for simple qualitative analysis: is a nodule present and is it harder or softer than neighbouring tissues? (2) the deformation or hardness ratios between two regions are usually, however, not proportional to the theoretical ratios and only a binary analysis greater than 1 (harder) and less than 1 (softer) is reliable and could be used as a negative predictive value (NPV) for malignant lesions, as has been suggested by some authors; (3) finally, quantitative analysis using shear wave techniques performed variably, reliable measurements being obtained with only one of the systems. Measurements produced by these different systems must not be compared in clinical practice to monitor a patient and the threshold values proposed in the literature must only be used in an analysis carried out with the same system and same probe.