Ultrasound Elastography of Pulmonary Lesions – A Feasibility Study

Abstract

In contrast to B-mode sonography, RTE is able to detect and visualize peripheral, non-pleural adherent pulmonary lesions.

Elastography Everywhere – Now Even the Lungs!

“…There was a good correlation between US-E and CT with regard to the size of the lesions and the distance of the lesions from the pleura. Figures 3 and 4 of this study [20] show a liquefactive metastasis with air in the center located in the left inferior pulmonary lobe in CT and the corresponding correlate in real-time US and US-E. The caption reads as follows: "The lesion showed a spreaching solid border which is reproducible as an inelastic, red margin in RTE.…”

“…However, under "future developments" the authors of the clinical portion of the EFSUMB Guidelines list US-E applications that currently cannot be sufficiently evaluated with respect to clinical value on the basis of the available data [2]. Some of these "exotic" applications are included in this issue [19 -21] and relate to US-E evaluations of arteriosclerotic plaque of the carotid artery [19], pulmonary nodules [20], and spleen stiffness [21]. To the best of knowledge, the feasibility study by a German workgroup regarding US-E of pulmonary nodules is the first use of this US technique for this purpose [20] even if it is not the first study addressing the imaging or measurement of pulmonary "elasticity" with US, CT, or MRI [22 -24].…”

“…Feasibility study: Whatever is conceivable is possible (Socrates). CT data from 8 patients with 18 pulmonary metastases were included in this study [20] to use real-time US and US-E (7.5 mHz transducer, eSie Touch Elasticity Imaging, Accuson Antares, Siemens, Erlangen, Germany, referred to as realtime elastography (RTE) in the study) to locate these lesions with CT knowledge of the exact location and size of these subpleural nodules that do not extend to the pleura. The results are surprising: As expected, none of the 18 pulmonary nodules > 1 cm could be visualized with real-time ultrasound since none of the nodules was in direct contact with the pleura.…”

“…Unter "zukünftige Entwicklungen" listen die Autoren des klinischen Teils der EFSUMB-Guidelines aber US-E-Anwendungen auf, die derzeit aufgrund der Datenlage im klinischen Stellenwert nicht ausreichend beurteilt werden können [2]. Einige dieser "exotischen" Anwendungen finden Sie auch in diesem Heft [19 -21] und betreffen US-E-Evaluierungen von arteriosklerotischen Plaque der A. carotis [19], von pulmonalen Rundherden [20] und der Steifigkeit der Milz [21]. Dabei ist die Machbarkeitsstudie einer Deutschen Arbeitsgruppe zur US-E von pulmonalen Rundherden (RH) nach bestem Wissen die erste Anwendung dieser US-Technik in dieser Fragestellung [20] wenn auch nicht die erste Studie, die sich mit der bildgebenden Darstellung bzw.…”

Letter to the Editor: Mostbeck G. Elastography Everywhere – Now Even the Lungs! Ultraschall in Med. 2014; 35: 5 – 8

“…Last but not least, the present hard "caveats" addressed by Mostbeck are welcome since some US aspects of lung imaging by US are unrealistic due to its aerial physical properties. [17], in which some aspects of transthoracic ultrasound elastography (TUS elastography) were highlighted, based on a recent publication on TUS elasticity of pulmonary metastases by B. R.Adamietz et al [18] in this journal. G.Trovato et al point to the fact that TUS is a well-established technique in chest imaging, including not only real-time US [19 -23] but also contrast-enhanced US (CEUS), as indicated by the recent EFSUMB guidelines [24].…”