Real-time Tissue Elastography (RTE)

Clinical Applications

RTE is compatible with over 20 different transducers and its diagnostic value has been proven in a variety of different clinical areas, notably breast, urology, pancreas and lymph nodes.

In breast applications, RTE has a complementary diagnostic role to the conventional B-mode:

  • The assessment of elasticity can be made in real-time
  • The Tsukuba score classification is simple to use and suitable for routine clinical use (see figure 3)
  • RTE is proven in multicentre studies to be an effective and reproducible US modality and is not time-consuming
  • RTE offers increased specificity afforded by the addition of new benign criteria
  • RTE has the potential to eliminate unnecessary benign core biopsies especially in breast masses categorized as BI-RADS categories 3 and 4
  • The Fat to Lesion Ratio (Strain Ratio) can provide greater objectivity in assessing the elastography image

Two hypoechoic lesions with rounded shape on conventional B-mode:

RTE of the prostate offers a new approach for the detection and visualization of cancer:

  • RTE can detect prostate cancer foci with good accuracy
  • It allows the estimation of tumour location and extent
  • The cancer yield with RTE – guided targeted biopsies can equal that of systematic biopsy for less than half the number of cores

RTE can also improve the detection and differentiation of testicular masses

  • Endoscopic RTE allows the characterisation and differentiation of benign and malignant lymph nodes with a high sensitivity, specificity and accuracy
  • It provides better targeting for fine needle aspiration (FNA) procedures in patients with multiple enlarged lymph nodes
  • Mapping of the tissue elasticity distribution can provide more information for differentiation of focal pancreatic masses
  • RTE can be used to target EUS-FNA biopsy into stiffer regions of the pancreas suspicious for malignancy

Thyroid nodules are very common, but less than 5% are malignant. Conventional US can predict malignancy with high specificity in less than 20% patients.

  • RTE can provide quick and easy characterisation of thyroid nodules thereby allowing identification of patients at high risk of malignancy
  • A low elasticity score on RTE (stiff lesion) has been shown to be highly predictive of malignancy
  • An entirely elastic nodule pattern has been observed only in relation to benign nodules, in which case the indication for a biopsy is questionable
  • In a multinodular goiter, high true positive results have been achieved when RTE is used to target a particular nodule for biopsy which is hard on RTE

Complex multinodular thyroid glands showing mixed elasticity patterns. High true positive results have been achieved when RTE is used to target a particular nodule for biopsy which is hard on RTE:

Hitachi’s Real-time Tissue Elasticity is the only elastography with the dynamic range necessary to provide strain images with the subtle detail you require.

Examples of other clinical areas where preliminary studies have shown RTE to be a promising diagnostic tool are shown below, all acquired using standard ultrasound imaging transducers.

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