Objectives To evaluate whether real‐time elastography, a new, non‐invasive method for the diagnosis of breast cancer, improves the differentiation and characterization of benign and malignant breast lesions. Methods Real‐time elastography was carried out in 108 potential breast tumor patients with cytologically or histologically confirmed focal breast lesions (59 benign, 49 malignant; median age, 53.9 years; range, 16–84 years). Tumor and healthy tissue were differentiated by measurement of elasticity based on the correlation between tissue properties and elasticity modulus. Evaluation was performed using the three‐dimensional (3D) finite element method, in which the information is color‐coded and superimposed on the B‐mode ultrasound image. A second observer evaluated the elastography images, in order to improve the objectivity of the method. The results of B‐mode scan and elastography were compared with those of histology and previous sonographic findings. Sensitivities and specificities were calculated, taking histology as the gold standard. Results B‐mode ultrasound had a sensitivity of 91.8% and a specificity of 78%, compared with sensitivities of 77.6% and 79.6% and specificities of 91.5% and 84.7%, respectively, for the two observers evaluating elastography. Agreement between B‐mode ultrasound and elastography was good, yielding a weighted kappa of 0.67. Conclusions Our initial clinical results suggest that real‐time elastography improves the specificity of breast lesion diagnosis and is a promising new approach for the diagnosis of breast cancer. Elastography provides additional information for differentiating malignant BI‐RADS (breast imaging reporting and data system) category IV lesions. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.

Background. Conventional ultrasound parameters such as the resistance index (RI) are only of limited use in the diagnosis of early allograft dysfunction. We, therefore, performed a prospective study to compare the value of ultrasound contrast media (USCM) with conventional US in the diagnosis of early allograft dysfunction. Methods. A total of 48 consecutive kidney recipients underwent US examination after USCM administration 4–10 days after transplantation. Arterial inflow was determined in the interlobar artery and renal cortex using time–intensity curve (TIC) software. The difference in time-to-peak intensity between these two vascular territories was determined, and a perfusion quotient (PQ) was defined as the ratio of TIC increase of interlobar artery to renal cortex. Three patients with segmental loss of renal perfusion demonstrated by Doppler US were excluded. Results. Nineteen patients had an uneventful clinical course (control group); PQ was 1.2 ± 0.4. Seven patients with a large perirenal haematoma, without rejection had an increased PQ ( P < 0.05) and a prolonged time difference ( P < 0.05). Based on clinical and histological criteria, the remaining patients were classified as acute tubular necrosis (ATN) ( n = 7), non-vascular rejection ( n = 7) or vascular rejection ( n = 5). RI determination could not discriminate these groups. Patients with ATN (PQ = 1.6 ± 0.7) or non-vascular rejection (PQ = 1.1 ± 0.6) had a lower PQ than patients with vascular rejection (PQ = 2.2 ± 0.8, P < 0.05). The time difference in all three subgroups was longer compared with controls. Conclusions. USCM might be superior in the diagnosis of early kidney allograft dysfunction compared with conventional US by means of RI determination. Perirenal haematoma, ATN and vascular rejection are associated with characteristic changes of the TIC.

Objective: The preoperative diagnostical differentiation of parotid gland tumor (PGT) is not always simple due to several different entities. B-mode-ultrasound (US) remains the imaging modality of choice, while histopathology serves as the gold standard for finalizing the diagnosis. We aimed to evaluate the use of multiparametric US (mpUS) in the assessment of PGT. Methods: We included 97 PGTs from 96 patients. A standardized mpUS protocol using B-mode-US, shear-wave elastography (SWE), and standardized contrast-enhanced ultrasound (CEUS) was performed prior to surgical intervention. SWE was assessed by real-time measurement conducting a minimum of five measurements, while quantitative CEUS parameters were assessed with a post-processing perfusion software. Results: SWE allowed differentiation between benign PGT (Warthin’s Tumor (WT) paired with lymph nodes (LN) and pleomorphic adenoma (PA)), and WT and LN were softer compared to PA. WT showed lower velocities than squamous cell carcinoma (SCC): the most common malignant PGT. CEUS parameters showed significant group differences between WT and PA, WT and malignant lesions, WT and SCC, WT paired with LN versus PA, and WT paired with LN versus SCC. Conclusion: MpUS seems to be beneficial in the assessment of PGT characterization, with benign PGT appearing to be softer in SWE than tumors with malignant tendencies. The quantitative CEUS parameter shows higher perfusion in WT than in PA, and malignant PGTs are less vascularized than WTs.

To investigate whether rat prostate cancer can be detected by means of molecular ultrasound (US) using target-specific microbubbles versus a nonspecific contrast agent. A total of 20 Copenhagen rats were randomly examined 75 to 104 days after orthotopic implantation of G-Dunning rat prostatic tumor cells was using a high-end US system and either 1.2 mL/kg of the nonspecific agent A or 0.1 mL/kg of the target-specific agent B, containing vascular endothelial growth factor receptor 2 binding peptide. Contrast inflow (areas under the curve analysis) was determined during the first 30s, and all microbubbles were destroyed in the scan plane by means of the flash technique 20 minutes after intravenous administration to investigate specific accumulation of individual bubbles in tumors. Differences between normal prostate tissue and tumor were analyzed using luminance images. Sonographically determined tumor localization and extent were compared with magnetic resonance imaging and histology. The median tumor size in the 20 rats determined on US (2.3 mm) and magnetic resonance imaging (2.4 mm) showed a very high correlation (r = 0.92, P = 0.01). Both agent A and agent B demonstrated higher vascularization of tumor periphery compared with normal prostate (P < 0.05) based on contrast inflow and areas under the curve analysis. Twenty minutes after administration, luminance for agent B in the tumor was significantly higher (P = 0.003) compared with nonspecific agent A (11.8–0.1). In consensus reading, the increase in signal intensity of the tumor compared with normal prostate tissue was significantly higher for agent B (P = 0.005), whereas no significant difference was found for agent A (P = 0.180). The target-specific contrast agent was superior to the unspecific US contrast agent both with regard to early inflow analysis and specific accumulation in prostate cancer after 20 minutes.