Showing papers on "Elastography published in 2014"

Radiologic evaluation of nonalcoholic fatty liver disease

Abstract: Nonalcoholic fatty liver disease (NAFLD) is a frequent cause of chronic liver diseases, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH)-related liver cirrhosis. Although liver biopsy is still the gold standard for the diagnosis of NAFLD, especially for the diagnosis of NASH, imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy. Ultrasonography is a well-established and cost-effective imaging technique for the diagnosis of hepatic steatosis, especially for screening a large population at risk of NAFLD. Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis, operator-dependent, and rather qualitative. Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard. However, computed tomography may be effective in specific clinical situations, such as evaluation of donor candidates for hepatic transplantation. Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice, especially for longitudinal follow-up of patients with NAFLD. Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis. This article will review current imaging methods used to evaluate hepatic steatosis, including the diagnostic accuracy, limitations, and practical applicability of each method. It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD.

A Review of Optical Coherence Elastography: Fundamentals, Techniques and Prospects

Abstract: In optical coherence elastography, images are formed by mapping a mechanical property of tissue. Such images, known as elastograms, are formed on the microscale, intermediate between that of cells and whole organs. Optical coherence elastography holds great promise for detecting and monitoring the altered mechanical properties that accompany many clinical conditions and pathologies, particularly in cancer, cardiovascular disease and eye disease. In this review, we first consider how the mechanical properties of tissue are linked with tissue function and pathology. We then describe currently prominent optical coherence elastography techniques, with emphasis on the methods of mechanical loading and displacement estimation. We highlight the sensitivity to microstrain deformations at tens of micrometer resolution. Throughout, optical coherence elastography is considered in the context of other elastography methods, mainly ultrasound elastography and magnetic resonance elastography. This context serves to highlight its advantages, early stage of development of applications, and strong prospects for future impact.

High-contrast ultrafast imaging of the heart

Abstract: Noninvasive ultrafast imaging of intrinsic waves such as electromechanical waves or remotely induced shear waves in elastography imaging techniques for human cardiac applications remains challenging. In this paper, we propose ultrafast imaging of the heart with adapted sector size by coherently compounding diverging waves emitted from a standard transthoracic cardiac phased-array probe. As in ultrafast imaging with plane wave coherent compounding, diverging waves can be summed coherently to obtain high-quality images of the entire heart at high frame rate in a full field of view. To image the propagation of shear waves with a large SNR, the field of view can be adapted by changing the angular aperture of the transmitted wave. Backscattered echoes from successive circular wave acquisitions are coherently summed at every location in the image to improve the image quality while maintaining very high frame rates. The transmitted diverging waves, angular apertures, and subaperture sizes were tested in simulation, and ultrafast coherent compounding was implemented in a commercial scanner. The improvement of the imaging quality was quantified in phantoms and in one human heart, in vivo. Imaging shear wave propagation at 2500 frames/s using 5 diverging waves provided a large increase of the SNR of the tissue velocity estimates while maintaining a high frame rate. Finally, ultrafast imaging with 1 to 5 diverging waves was used to image the human heart at a frame rate of 4500 to 900 frames/s over an entire cardiac cycle. Spatial coherent compounding provided a strong improvement of the imaging quality, even with a small number of transmitted diverging waves and a high frame rate, which allows imaging of the propagation of electromechanical and shear waves with good image quality.

Shear wave imaging optical coherence tomography (SWI-OCT) for ocular tissue biomechanics.

Abstract: We report on a noncontact low-coherence optical phase-based imaging method, termed shear wave imaging optical coherence tomography (SWI-OCT), which enables 2D depth-resolved visualization of the low-amplitude elastic wave propagation in tissue with ultrahigh frame rate. SWI-OCT is based on 1D transverse scanning of the M-mode OCT imaging that is precisely synchronized with a low-pressure short-duration air-puff loading system. This approach of scanning and data recording allows visualization of the induced tissue deformation at high frame rate. The applied phase-resolved interferometric technique, with sensitivity on the nanometer scale, makes the low-amplitude tissue displacement detectable. For the demonstration of this method, and to study its application for tissue biomechanics, we performed pilot experiments on agar phantoms and ex vivo rabbit corneas. Samples with different elastic properties can be differentiated based on the velocity of the elastic wave propagation that is directly visualized with a 25 kHz frame rate. Our results indicate that SWI-OCT has the potential to be further developed as a major technique for depth-resolved high-resolution tissue elastography in vivo.

Sonoelastography: musculoskeletal applications.

Abstract: All participants for image samplings provided written informed consent. Conventional B-mode ultrasonography (US) has been widely utilized for musculoskeletal problems as a first-line approach because of the advantages of real-time access and the relatively low cost. The biomechanical properties of soft tissues reflect to some degree the pathophysiology of the musculoskeletal disorder. Sonoelastography is an in situ method that can be used to assess the mechanical properties of soft tissue qualitatively and quantitatively through US imaging techniques. Sonoelastography has demonstrated feasibility in the diagnosis of cancers of the breast and liver, and in some preliminary work, in several musculoskeletal disorders. The main types of sonoelastography are compression elastography, shear-wave elastography, and transient elastography. In this article, the current knowledge of sonoelastographic techniques and their use in musculoskeletal imaging will be reviewed.

Shear wave elastography for evaluation of liver fibrosis.

Abstract: The prognosis and management of chronic viral hepatitis mainly depend on the extent of liver fibrosis, particularly in chronic hepatitis C. Liver histologic analysis is still considered the reference standard in the assessment of liver fibrosis despite the interobserver and interobserver variability in staging and some morbidity and mortality risks. Thus, noninvasive methods for assessing liver fibrosis are of great clinical interest. In the last decade, ultrasound-based techniques to estimate the stage of liver fibrosis have become commercially available. They all have the capability to noninvasively evaluate differences in the elastic properties of soft tissues by measuring tissue behavior when a mechanical stress is applied. Shear wave elastography relies on the generation of shear waves determined by the displacement of tissues induced by the force of a focused ultrasound beam or by an external push. This article reviews the results that have been obtained with shear wave elastography for assessment of liver fibrosis.

Hepatic Fibrosis: Prospective Comparison of MR Elastography and US Shear-Wave Elastography for Evaluation

Abstract: Liver stiffness (LS) values measured at MR elastography and those measured at US shear-wave elastography (SWE) showed moderate correlation; however, MR elastography yielded higher rates of reliable LS measurements than did SWE.

Muscle shear modulus measured with ultrasound shear‐wave elastography across a wide range of contraction intensity

Abstract: Introduction: In this study we examine the repeat- ability of measuring muscle shear modulus using ultrasound shear-wave elastography between trials and between days, and the association between shear modulus and contraction inten- sity over a wide range of intensities. Methods: Shear modulus of the biceps brachii was determined using ultrasound shear- wave elastography during static elbow flexion (up to 60% of maximal contraction) in healthy young adults. Results: The cor- respondence of shear modulus was confirmed in phantoms between the manufacturer-calibrated values and the shear- wave elastography values. The intraclass correlation coefficient of muscle shear modulus was high: 0.978 between trials and 0.948 between days. Shear modulus increased linearly with elbow flexion torque across contraction intensity, and its slope was associated negatively with muscle strength. Conclusions: Muscle shear modulus measured with ultrasound shear-wave elastography may be useful for inferring muscle stiffness across a wide range of contraction intensity. In addition, it has high repeatability between trials and between days. Muscle Nerve 50: 103-113, 2014

Noncontact depth-resolved micro-scale optical coherence elastography of the cornea.

Abstract: High-resolution elastographic assessment of the cornea can greatly assist clinical diagnosis and treatment of various ocular diseases Here, we report on the first noncontact depth-resolved micro-scale optical coherence elastography of the cornea achieved using shear wave imaging optical coherence tomography (SWI-OCT) combined with the spectral analysis of the corneal Lamb wave propagation This imaging method relies on a focused air-puff device to load the cornea with highly-localized low-pressure short-duration air stream and applies phase-resolved OCT detection to capture the low-amplitude deformation with nano-scale sensitivity The SWI-OCT system is used here to image the corneal Lamb wave propagation with the frame rate the same as the OCT A-line acquisition speed Based on the spectral analysis of the corneal temporal deformation profiles, the phase velocity of the Lamb wave is obtained at different depths for the major frequency components, which shows the depthwise distribution of the corneal stiffness related to its structural features Our pilot experiments on ex vivo rabbit eyes demonstrate the feasibility of this method in depth-resolved micro-scale elastography of the cornea The assessment of the Lamb wave dispersion is also presented, suggesting the potential for the quantitative measurement of corneal viscoelasticity

Optical coherence micro-elastography: mechanical-contrast imaging of tissue microstructure

Abstract: We present optical coherence micro-elastography, an improved form of compression optical coherence elastography. We demonstrate the capacity of this technique to produce en face images, closely corresponding with histology, that reveal micro-scale mechanical contrast in human breast and lymph node tissues. We use phase-sensitive, three-dimensional optical coherence tomography (OCT) to probe the nanometer-to-micrometer-scale axial displacements in tissues induced by compressive loading. Optical coherence micro-elastography incorporates common-path interferometry, weighted averaging of the complex OCT signal and weighted least-squares regression. Using three-dimensional phase unwrapping, we have increased the maximum detectable strain eleven-fold over no unwrapping and the minimum detectable strain is 2.6 μe. We demonstrate the potential of mechanical over optical contrast for visualizing micro-scale tissue structures in human breast cancer pathology and lymph node morphology.

High-resolution mechanical imaging of glioblastoma by multifrequency magnetic resonance elastography.

Abstract: Objective To generate high-resolution maps of the viscoelastic properties of human brain parenchyma for presurgical quantitative assessment in glioblastoma (GB). Methods Twenty-two GB patients underwent routine presurgical work-up supplemented by additional multifrequency magnetic resonance elastography. Two three-dimensional viscoelastic parameter maps, magnitude |G*|, and phase angle φ of the complex shear modulus were reconstructed by inversion of full wave field data in 2-mm isotropic resolution at seven harmonic drive frequencies ranging from 30 to 60 Hz. Results Mechanical brain maps confirmed that GB are composed of stiff and soft compartments, resulting in high intratumor heterogeneity. GB could be easily differentiated from healthy reference tissue by their reduced viscous behavior quantified by φ (0.37±0.08 vs. 0.58±0.07). |G*|, which in solids more relates to the material's stiffness, was significantly reduced in GB with a mean value of 1.32±0.26 kPa compared to 1.54±0.27 kPa in healthy tissue (P = 0.001). However, some GB (5 of 22) showed increased stiffness. Conclusion GB are generally less viscous and softer than healthy brain parenchyma. Unrelated to the morphology-based contrast of standard magnetic resonance imaging, elastography provides an entirely new neuroradiological marker and contrast related to the biomechanical properties of tumors.

MR elastography of the liver and the spleen using a piezoelectric driver, single-shot wave-field acquisition, and multifrequency dual parameter reconstruction

Abstract: Purpose Viscoelastic properties of the liver are sensitive to fibrosis. This study proposes several modifications to existing magnetic resonance elastography (MRE) techniques to improve the accuracy of abdominal MRE. Methods The proposed method comprises the following steps: (i) wave generation by a nonmagnetic, piezoelectric driver suitable for integration into the patient table, (ii) fast single-shot 3D wave-field acquisition at four drive frequencies between 30 and 60 Hz, and (iii) single-step postprocessing by a novel multifrequency dual parameter inversion of the wave equation. The method is tested in phantoms, healthy volunteers, and patients with portal hypertension and ascites. Results Spatial maps of magnitude and phase of the complex shear modulus were acquired within 6–8 min. These maps are not subject to bias from inversion-related artifacts known from classic MRE. The spatially averaged modulus for healthy liver was 1.44 ± 0.23 kPa with ϕ = 0.492 ± 0.064. Both parameters were significantly higher in the spleen (2.29 ± 0.97 kPa, P = 0.015 and 0.749 ± 0.144, P = 6.58·10−5, respectively). Conclusion The proposed method provides abdominal images of viscoelasticity in a short time with spatial resolution comparable to conventional MR images and improved quality without being compromised by ascites. The new setup allows for the integration of abdominal MRE into the clinical workflow. Magn Reson Med 71:267–277, 2014. © 2013 Wiley Periodicals, Inc.

Principles and clinical application of ultrasound elastography for diffuse liver disease.

Abstract: Accurate assessment of the degree of liver fibrosis is important for estimating prognosis and deciding on an appropriate course of treatment for cases of chronic liver disease (CLD) with various etiologies. Because of the inherent limitations of liver biopsy, there is a great need for non-invasive and reliable tests that accurately estimate the degree of liver fibrosis. Ultrasound (US) elastography is considered a non-invasive, convenient, and precise technique to grade the degree of liver fibrosis by measuring liver stiffness. There are several commercial types of US elastography currently in use, namely, transient elastography, acoustic radiation force impulse imaging, supersonic shear-wave imaging, and real-time tissue elastography. Although the low reproducibility of measurements derived from operator-dependent performance remains a significant limitation of US elastography, this technique is nevertheless useful for diagnosing hepatic fibrosis in patients with CLD. Likewise, US elastography may also be used as a convenient surveillance method that can be performed by physicians at the patients' bedside to enable the estimation of the prognosis of patients with fatal complications related to CLD in a non-invasive manner.

Ultrasound elastography for thyroid nodules: recent advances.

Abstract: Ultrasonography (US)-based elastography has been introduced as a noninvasive technique for evaluating thyroid nodules that encompasses a variety of approaches such as supersonic shear imaging and acoustic radiation force impulse imaging as well as real-time tissue elastography. However, the diagnostic performances for differentiating malignant thyroid nodules from benign ones with elastography as an adjunctive tool of gray-scale US is still under debate. In this review article, diagnostic performances of conventional US and a combination of conventional US and elastography are compared according to the type of elastography. Further, the interobserver variability of elastography is presented according to the type of elastography.

Acoustic Radiation Force Impulse Elastography of the Kidneys Is Shear Wave Velocity Affected by Tissue Fibrosis or Renal Blood Flow

Abstract: Objectives The aim of this study was to identify the main influencing factor of the shear wave velocity (SWV) of the kidneys measured by acoustic radiation force impulse elastography. Methods The SWV was measured in the kidneys of 14 healthy volunteers and 319 patients with chronic kidney disease. The estimated glomerular filtration rate was calculated by the serum creatinine concentration and age. As an indicator of arteriosclerosis of large vessels, the brachial-ankle pulse wave velocity was measured in 183 patients. Results Compared to the degree of interobserver and intraobserver deviation, a large variance of SWV values was observed in the kidneys of the patients with chronic kidney disease. Shear wave velocity values in the right and left kidneys of each patient correlated well, with high correlation coefficients (r = 0.580–0.732). The SWV decreased concurrently with a decline in the estimated glomerular filtration rate. A low SWV was obtained in patients with a high brachial-ankle pulse wave velocity. Despite progression of renal fibrosis in the advanced stages of chronic kidney disease, these results were in contrast to findings for chronic liver disease, in which progression of hepatic fibrosis results in an increase in the SWV. Considering that a high brachial-ankle pulse wave velocity represents the progression of arteriosclerosis in the large vessels, the reduction of elasticity succeeding diminution of blood flow was suspected to be the main influencing factor of the SWV in the kidneys. Conclusions This study indicates that diminution of blood flow may affect SWV values in the kidneys more than the progression of tissue fibrosis. Future studies for reducing data variance are needed for effective use of acoustic radiation force impulse elastography in patients with chronic kidney disease.

Utilization of FibroScan in Clinical Practice

Abstract: The evaluation of liver fibrosis is critical, particularly to rule out cirrhosis. Novel non-invasive tests such as transient ultrasound elastography are widely used to stage liver fibrosis as an alternative to liver biopsy, and this technology has recently been approved in the US. In this review, we discuss the performance characteristics of elastography for a variety of liver diseases and highlight practical appropriate suggestions for how to incorporate this technology into clinical practice.

Shear wave elastography imaging of carotid plaques: feasible, reproducible and of clinical potential

Abstract: Background: Shear Wave Elastography (SWE) imaging is a novel ultrasound technique for quantifying tissue elasticity. Studies have demonstrated that SWE is able to differentiate between diseased and normal tissue in a wide range clinical applications. However its applicability to atherosclerotic carotid disease has not been established. The aim of this study was to assess the feasibility and potential clinical benefit of using SWE imaging for the assessment of carotid plaques. Methods: Eighty-one patients (mean age 76 years, 51 male) underwent greyscale and SWE imaging. Elasticity was quantified by measuring mean Young’s Modulus (YM) within the plaque and within the vessel wall. Echogenicity was assessed using the Gray-Weale classification scale and the greyscale median (GSM). Results: Fifty four plaques with stenosis greater than 30% were assessed. Reproducibility of YM measurements, quantified by the inter-frame coefficient of variation, was 22% within the vessel wall and 19% within the carotid plaque. Correlation with percentage stenosis was significant for plaque YM (p = 0.003), but insignificant for plaque GSM (p = 0.46). Plaques associated with focal neurological symptoms had significantly lower mean YM than plaques in asymptomatic patients (62 kPa vs 88 kPa; p = 0.01). Logistic regression and Receiver Operating Characteristic (ROC) analysis showed improvements in sensitivity and specificity when percentage stenosis was combined with the YM (area under ROC = 0.78). Conclusions: Our study showed SWE is able to quantify carotid plaque elasticity and provide additional information that may be of clinical benefit to help identify the unstable carotid plaque.

Prediction of Esophageal Varices in Patients with Cirrhosis: Usefulness of Three-dimensional MR Elastography with Echo-planar Imaging Technique

Abstract: The diagnostic accuracy of MR elastography in the prediction of esophageal varices is comparable to that of dynamic contrast material–enhanced (DCE) MR imaging, while combined assessment with MR elastography and DCE MR imaging can increase diagnostic sensitivity.

Ultrasound elastography - review of techniques and its clinical applications.

Abstract: Sonoelastography is a modern ultrasound method, which enables the representation of tissues and organs with the evaluation of their elasticity, "stiffness". The principle of elastography is to use repeated, slight pressure on the examined organ with the ultrasound transducer. Changes in elasticity and deformation of tissues arising whilst the compression is processed and presented in real time with color-coded maps, is called elastograms. The method is applicable mainly in diagnosing malignant lesions. Tumor tissues have different elasticity and undergo different deformations under pressure than healthy tissues. As a result of computer analysis, images in various colors are generated. Based on the nature of areas of normal and increased stiffness classifications of the images in point scales have been developed. Ultrasound devices equipped with sonoelastography option enable more accurate imaging and evaluation of the nature of lesions situated at small depth, e.g. breast, thyroid, testicles, prostate, some groups of lymph nodes. They increase the accuracy of ultrasound in diagnostics and the evaluation of the stage of malignant lesions. This also helps to indicate more precisely the areas that require the biopsy.

Non-invasive evaluation of liver fibrosis: a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C

Abstract: Objective To compare the diagnostic accuracy of TE and MRE and establish cutoff levels and diagnostic strategies for both techniques, enabling selection of patients for liver biopsy.

“Soft, hard, or just right?” Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries

Abstract: Injury to a tendon leads to alterations in the mechanical properties of the tendon. Axial-strain sonoelastography and shear-wave elastography are relatively new, real-time imaging techniques that evaluate the mechanical properties of tendons in addition to the existing morphological and vascular information that is obtained with traditional imaging tools. Axial-strain sonoelastography displays the subjective distribution of strain data on an elastogram caused by tissue compression, whereas shear-wave elastography provides a more objective, quantitative measure of the intrinsic tissue elasticity using the acoustic push-pulse. Recent studies suggest that axial-strain sonoelastography is able to distinguish between asymptomatic and diseased tendons, and is potentially more sensitive than conventional ultrasound in detecting early tendinopathy. Shear-wave elastography seems to be a feasible tool for depicting elasticity and functional recovery of tendons after surgical management. While initial results have been promising, axial-strain sonoelastography and shear-wave elastography have not yet found routine use in wider clinical practice. Possible barriers to the dissemination of axial-strain sonoelastography technique include operator dependency, technical limitations such as artefacts and lack of reproducibility and quantification of sonoelastography data. Shear-wave elastography may improve the reproducibility of elastography data, although there is only one published study on the topic to date. Large-scale longitudinal studies are needed to further elucidate the clinical relevance and potential applications of axial-strain sonoelastography and shear-wave elastography in diagnosing, predicting, and monitoring the progress of tendon healing before they can be widely adopted into routine clinical practice.

Real-time ultrasound elastography for differentiation of benign and malignant thyroid nodules: a meta-analysis.

Abstract: Objectives The clinical challenge of managing thyroid nodules nowadays is to diagnose the minority of malignant disease. Real-time ultrasound elastography, which can measure tissue elasticity, is used as a complement to conventional sonography for improving the diagnosis of thyroid tumors. There are 2 common criteria for evaluating an elastogram: the elasticity score and strain ratio. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ultrasound elastography in differentiating benign and malignant thyroid nodules for elasticity score and strain ratio assessment. Methods The MEDLINE, EMBASE, PubMed, and Cochrane Library databases up to January 31, 2013, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random-effects model. The extent and sources of heterogeneity were explored. Results A total of 5481 nodules in 4468 patients for elasticity score studies and 1063 nodules in 983 patients for strain ratio studies were analyzed. The overall mean sensitivity and specificity of ultrasound elastography for differentiation of thyroid nodules were 0.79 (95% confidence interval [CI], 0.77-0.81) and 0.77 (95% CI, 0.76-0.79) for elasticity score assessment and 0.85 (95% CI, 0.81-0.89) and 0.80 (95% CI, 0.77-0.83) for strain ratio assessment, respectively. The areas under the curve for the elasticity score and strain ratio were 0.8941 and 0.9285. Conclusions These results confirmed those obtained in the previous meta-analysis. Ultrasound elastography has high sensitivity and specificity for identification of thyroid nodules. It is a promising tool for reducing unnecessary fine-needle-aspiration biopsy.

Ultrasound in chronic liver disease

Abstract: With the high prevalence of diffuse liver disease there is a strong clinical need for noninvasive detection and grading of fibrosis and steatosis as well as detection of complications. B-mode ultrasound supplemented by portal system Doppler and contrast-enhanced ultrasound are the principal techniques in the assessment of liver parenchyma and portal venous hypertension and in hepatocellular carcinoma surveillance. Fibrosis can be detected and staged with reasonable accuracy using Transient Elastography and Acoustic Radiation Force Imaging. Newer elastography techniques are emerging that are undergoing validation and may further improve accuracy. Ultrasound grading of hepatic steatosis currently is predominantly qualitative. A summary of methods including B-mode, Doppler, contrast-enhanced ultrasound and various elastography techniques, and their current performance in assessing the liver, is provided. • Diffuse liver disease is becoming more prevalent and there is a strong clinical need for noninvasive detection. • Portal hypertension can be best diagnosed by demonstrating portosystemic collateral venous flow. • B-mode US is the principal US technique supplemented by portal system Doppler. • B-mode US is relied upon in HCC surveillance, and CEUS is useful in the evaluation of possible HCC. • Fibrosis can be detected and staged with reasonable accuracy using TE and ARFI. • US detection of steatosis is currently reasonably accurate but grading of severity is of limited accuracy.

Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments.

Abstract: Our aim was to compare the diagnostic performance of strain elastography (SE) and shear-wave elastography (SWE), combined with B-mode ultrasonography (US), in breast cancer. For 79 breast lesions that underwent SE and SWE, two radiologists reviewed five data sets (B-mode US, SWE, SE and two combined sets). Qualitative and quantitative elastographic data and Breast Imaging Reporting and Data System (BI-RADS) categories were recorded. The area under the receiver operating characteristic curve (AUC) was evaluated. No significant difference in the AUC between the two elastography methods was noted. After subjective assessment by reviewers, the AUC for the combined sets was improved (SWE, 0.987; SE, 0.982; B-mode US, 0.970; p < 0.05). When SE and SWE were added, 38% and 56% of benign BI-RADS category 4a lesions with a low suspicion of cancer were downgraded without false-negative results, respectively. SE and SWE performed similarly. Therefore, addition of SE or SWE improved the diagnostic performance of B-mode US, potentially reducing unnecessary biopsies.