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ECR 2018 / C-2627
Role of Elastography in the evaluation of soft tissue lesions. A preliminary study.
Congress: ECR 2018
Poster No.: C-2627
Type: Scientific Exhibit
Keywords: Tissue characterisation, Education and training, Technology assessment, Diagnostic procedure, Ultrasound-Colour Doppler, Ultrasound, Elastography, Soft tissues / Skin, Musculoskeletal soft tissue, Extremities
Authors: F. Sandomenico1, G. De Rosa2, O. Catalano1, S. Pizza1, G. Rusconi2, P. Vallone3, S. V. Setola1, F. De Rosa1, A. Petrillo1; 1Naples/IT, 2NAPOLI/IT, 3Naples, italy/IT


After observing all the elastograms, the radiologist assigned each image obtained, in one of 5 different elastographic scores (ES). 
A score of 1 indicated strain in the entire lesion, with absent or very small hard area (blue area). 
A score of 2 indicated strain in most of the lesion, with some hard areas (small scattered blue areas or total blue area <45%).
A score of 3 indicated few areas of strain with a greater hard part (large blue areas not scattered but confluent or total blue area >45%). 
A score of 4 indicated a hard peripheral part with central sparing part of strain (peripheral blue areas and the central part was green). 
A score of 5 indicated an entire hard lesion with no parts of strain (the entire lesion was blue).

Thus, type 1 and type 2 elasticity patterns represent lesions with predominant strain and high elasticity, type 4 and type 5 patterns represent those lesions with little or no strain and low elasticity, whereas type 3 pattern represent lesions with intermediate strain and elasticity.

The 34 lesions analyzed at "IRCCS G. Pascale Foundation", in Naples, Italy, showed the following pattern: 2ES, 5 ES2, 15 ES3, 8 ES4, and 4 ES5.

Specifically, 2 cases with Pattern ES 1, showed echographic features of benignity and elastographic features with high strain without hard area; the anatomo-pathological result was of sub-parotid lipomas (fig.1).

Five cases with Pattern ES 2, showed echographic features of benignity and elastographic features with  strain in most of the lesion, with some hard areas still less than 45%; the anatomo-pathological result was MAV (fig.2), sebaceous cyst (fig.3), giganto-cellular tumor and post-amputation neuroma (fig.4).

Lesions with pattern ES1 and ES2 were considered predictor of benignity, because all were negative for histology.

Fifteen cases with Pattern ES 3, showed intermediate echographic features, of probable benignity, and elastographic features with fewer areas of strain (less than a half) and hard areas more than 45%. 
The anatomo-pathological result was benign  in 8 out of 15 cases resulting as sebaceous cyst (2) (fig.5) schwannoma (2) and fusiform neuroma thickening (4) (fig.6);
The remaining 7\15 cases were histologically found as malignant resulting as metastasis (6) (fig.7) and dermatofibrosarcoma (1).

Eight cases with Pattern ES 4, showed echographic features of malignity and elastographic features with a smaller area of strain, localized in the centre of lesion with bigger peripheral hard areas; the anatomo-pathological result was metastasis in all cases (fig. 8).

Four cases with Pattern ES 5, showed echographic features of malignity and elastographic features with no strain areas in the entire lesion, both in centre and in the periphery; the anatomo-pathological result was  metastasis in all cases (fig. 9).



Lesions with pattern ES4 and ES5 were considered predictor of malignity, because all were histologically malignant.

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