KEYWORDS Sonoelastography; Breast elastography; Breast lesions.Abstract Breast elastography is a new sonographic imaging technique which provides information on breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a noninvasive evaluation of the stiffness of a lesion. Today, two technical solutions are available for clinical use: strain elastography and shear wave elastography. Initial evaluations of these techniques in clinical trials suggest that they may substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses. This article reviews the basics of this technique, how to perform the examination, image interpretation and the results of major clinical studies. Although elastography is easy to perform, training and technical knowledge are required in order to obtain images permitting a correct interpretation. This paper will highlight the technique and point out common pitfalls.Sommario L'elastosonografia mammaria è una nuova tecnica di imaging a ultrasuoni che fornisce informazioni aggiuntive sulle lesioni della mammella rispetto all'ecografia e alla mammografia. Consente una valutazione non invasiva della rigidità tessutale di una lesione. Sono attualmente disponibili due soluzioni tecniche per uso clinico: l'elastografia con strain e l'elastografia shear wave. I primi studi clinici di valutazione di queste tecniche suggeriscono che esse possano migliorare la caratterizzazione delle lesioni mammarie differenziando quelle benigne dalle maligne e riducendo in modo sostanziale il numero di biopsie per lesioni benigne. Questo articolo rivisita le basi tecniche, i criteri interpretativi delle immagini, i principali studi clinici e le possibili cause di errore. Per quanto l'elastosonografia sia di facile esecuzione, richiede tuttavia un training e delle conoscenze tecniche adeguate per ottenere immagini correttamente interpretabili. ª

ObjectivesTo assess the ability of Real-time Elastography (RTE) to differentiate malignant from benign testicular lesions.MethodsIn 88 testicles ultrasound identified 144 lesions, which were examined by RTE. Elasticity images of the lesions were assigned the colour-coded score of Itoh (Radiology 2006), according to the distribution of strain induced by light compression. RTE findings were analysed considering shape (nodular/pseudo-nodular), size (<5 mm, 6–10 mm, >11 mm) and score (SC1-5) of the lesions.Results93.7% of all benign lesions showed a complete elastic pattern (SC1). 92.9% of benign nodules <5 mm and 100% of the pseudonodules showed a nearly complete elastic pattern (mainly SC1). 87.5% of malignant nodules showed a stiff pattern (SC4-5). RTE gave 87.5% sensitivity, 98.2% specificity, 93.3% positive predictive value, 96.4% negative predictive value and 95.8% accuracy in differentiating malignant from benign lesions.ConclusionsRTE is a useful technique in assessing small testicular nodules and pseudo-nodules. This is relevant in clinical practice allowing expectant management in RTE selected cases. The role of RTE seems less relevant for larger lesions because most of them are malignant at clinical and ultrasound assessment, limiting RTE to simply confirmation role.Key Points• An emerging role for Elastography in allowing surveillance for small testicular lesions• Elastography can better differentiate benign from malignant testicular lesions• Follow up can be reduced for elastic testicular lesions at Elastography.

Level III, cross-sectional study, prevalence study.

Carotid artery atherosclerotic disease is still a significant cause of cerebrovascular morbidity and mortality. A new angle-independent technique, measuring and visualizing blood flow velocities in all directions, called vector flow imaging (VFI) is becoming available from several vendors. VFI can provide more intuitive and quantitative imaging of vortex formation, which is not clearly distinguishable in the color Doppler image. VFI, as quantitative method assessing disturbed flow patterns of the carotid bifurcation, has the potential to allow better understanding of the diagnostic value of complex flow and to enhance risk stratification. This pictorial review article will show which new information VFI adds for the knowledge of hemodynamics in comparison to the conventional ultrasound techniques.Teaching points• VFI is an angle-independent technique measuring flow velocities in all directions. • This kind of VFI is based on a plane wave multidirectional excitation technique. • VFI allows quantitative assessment of carotid streamlines progression and visualizes vorticity. • VFI does not allow a precise comprehension of streamlines’ 3D shape. • VFI allows a better understanding of carotid artery complex flows. Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-017-0554-5) contains supplementary material, which is available to authorized users.

Doppler ultrasonography is routinely used to identify abnormal blood flow. Nevertheless, conventional Doppler can be used to determine only the axial component of blood flow velocity and is angle dependent. A new method of multidimensional angle-independent estimation of flow velocity, called Vector Flow Imaging (VFI), has been proposed. It quantitatively evaluates the true velocity vector's amplitude and direction at any location into a vessel and displays a more intuitive depiction of the flow movements. High frame rate VFI, based on plane wave imaging, allows a detailed dynamic visualization of complex flow by showing even transient events, otherwise undetectable. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:582-588, 2017.