S58 Ultrasound in Medicine and Biology Volume 37, Number 8S, 2011

correlation of ARFI with fibrosis (r 5 0.483 vs. r 5 0.484, p 5 0.12).

ARFI values were not correlated with liver fibrosis in case of amino-

transferases level .3x normal value. ARFI measurements were corre-

lated with fibrosis in patients with no or mild steatosis (Hepburn I, II,

III on LB) (r 5 0.568; p , 0.0001), while in patients with moderate

and severe steatosis (Hepburn IV, V) there was no correlation (r 50.055; p 5 0.86).

Conclusion: Quality technical parameters (IQR and SR) must be intro-

duced to improve the accuracy of ARFI assessment of liver fibrosis.

High levels of aminotransferases and severe steatosis can influence

the accuracy of ARFI measurements.

SS 29.06

Use of Aixplorer� for Detection of Liver Fibrosis or Cirrhosis in

Patients with Hepatitis C

T. Karlas,1 M. Tr€oltzsch,2 J. Wiegand,1 V. Keim2

1Medizinische Klinik fur Gastroenterologie, Universit€atsklinikum

Leipzig, Leipzig/DE, 2Interdisziplin€are Zentrale Ultraschalleinheit,Universit€atsklinikum Leipzig, Leipzig/DE

Purpose: Different elastographic procedures are available. Here, we

explored the usefulness of the Aixplorer�-technique for the detection

of fibrosis/cirrhosis.

Material &Methods: In 33 patients with proven hepatitis C (detectable

load of hepatitis C virus) shear wave velocities was determined with the

following techniques: Fibroscan� (Echosens, XL probe, 10 valid

measurements, right liver lobe), ARFI� (Siemens, 10 valid measure-

ments, right and left liver lobe), Aixplorer� (Supersonic, 4 valid

measurements, right and left liver lobe).

Results: Successful measurements were obtained with Fibroscan� and

ARFI� (right liver lobe) in 100%, ARFI (left liver lobe) in 94%,

Aixplorer� (right liver lobe) in 97% and Aixplorer� (left liver lobe)

in 85%. In the right liver lobe, mean values were as follows. ARFI�:

1,30 m/s, Fibroscan�: 8,57 kPa, Aixplorer�: 10,05 kPa. The means

of left liver lobe were Aixplorer�: 13,21 kPa, ARFI�: 1,73. In the right

liver lobe, there was a significant correlation between ARFI� and both

Fibroscan� and Aixplorer� (r2 5 0,6720, r2 5 0,5408, p , 0,0001).

There was a moderate but still significant correlation between ARFI�and Aixplorer� measurements in the left liver lobe (r2 5 0,35, p ,0,001). The Aixplorer� measurements showed that the homogenicity

of the tissue decreased with increasing shear wave velocity.

Conclusion: Aixplorer� is an interesting alternative to other elasto-

graphic procedures. Increased values in the left liver lobe were found.

Different from other techniques, the inhomogenous structure of liver

tissue is directly visible and increased with higher shear wave velocity.

SS 29.07

ShearWave Elastography for the Evaluation of Diffuse Liver

Disease: Determining Normal and Pathological Values in kPa

P. S. Zoumpoulis,1 E. Mastorakou,2 I. Theotokas,1 A. Plagou,1

E. Vafeiadis3

1Ultrasound, Diagnostic Echotomography SA, Kifissia/GR, 2Onaseio

Hospital, Kallithea/GR, 3Laiko Hospital, Athens/GR

Purpose: To validate the accuracy of SWE in chronic liver disease and

evaluate the normal and abnormal values quantifying liver fibrosis.

Material & Methods: A total of 72 prospectively recruited patients

underwent SWE of the liver with Aixplorer (Ult Im, Aix ,France) and

were grouped into normal (N) fatty liver (FL), chronic liver disease

(CLD) and liver cirrhosis (LC). All patients with FL, CLD and LC

had US-guided liver biopsy and histopathology. SWE and liver function

test results of each group were compared using one-way ANOVA test.

The performance of SWE in diagnosing FL, LCD and LC was evaluated

using ROC analysis.

Results: The 72 patients were composed of 18 N, 12 FL, 22 CLD and 20

LC.MeanSWEwas significantly different among the groups. Normal: 4.1

Kpa, FL: 6.2 Kpa, CLD: 7.9 Kpa, LC: 11.4 kPa. In diagnosing LC, SWE

showed 94% sensitivity and 73,3% specificity at a cutoff value of 8.1 kPa.

Conclusion: The accuracy of SWE is well validated in diagnosing LCD

and LC. SWE performance is better than laboratory test (LFT) and has to

be considered as an accurate diagnostic tool.

SS 29.08

Technical and Software Adjustments for a Reliable ShearWave

Elastography Estimation of Fibrosis in Chronic Liver Disease

P. S. Zoumpoulis,1 I. Theotokas,1 E. Mastorakou,2 A. Plagou,1

E. Vafeiadis3

1Ultrasound, Diagnostic Echotomography SA, Kifissia/GR, 2Onaseio

Hospital, Kallithea/GR, 3Laiko Hospital, Athens/GR

Purpose: To establish the technical and statistical parameters in order to

limit inter- and intra-observer variability using SWE in the liver.

Material&Methods:We studied 72 patients with chronic liver disease.

All patients had US-guided liver biopsy and histopathology with F-stage

for liver fibrosis. We applied two different protocols of examinations

with main equipment presets preserved. The position and the size of

the SWE ROI were different and an additional SW quality indicator

was evaluated.

Results:Mean SWE per F stage in kPa were as follows. For protocol 1,

F1: 6.2/F2: 6.4/F3: 7.5/F4: 9.8. For protocol 2, F1: 5.6/F2: 6.6/F3: 7.9/

F4: 9.6. The two protocols were compared using Bland-Altman charts

and interclass correlation coefficient (ICC). Protocol 2 showed better

accuracy in estimating liver fibrosis with both methods.

Conclusion: Application of a robust examination protocol with prede-

termined parameters concerning the position and the size of the SWE

ROI and an additional SW quality indicator are prerequisites for a reli-

able liver fibrosis estimation using SWE.

SS 29.09

Usefulness of Virtual Touch Tissue Quantification to Diagnose

the Severity of Fibrosis

H. Tanaka,1 H. Iijima,1 M. Yoshida,2 T. Iwai,1 T. Takashima,1 Y. Sakai,1

N. Aizawa,1 N. Ikeda,1 Y. Iwata,1 H. Enomoto,1 M. Saito,1 H. Imanishi,1

S. Hirota,3 J. Fujimoto,4 S. Nishiguchi1

1Division of Hepatobiliary and Pancreatic Disease, Department of

Internal Medicine, Hyogo College of Medicine, Nishinomiya/JP,2Ultrasound Imaging Center, Hyogo College of Medicine,

Nishinomiya/JP, 3Department of Surgical Pathology, Hyogo College of

Medicine, Nishinomiya/JP, 4Division of Hepatobiliary and Pancreatic

Disease, Department of Surgery, Hyogo College of Medicine,

Nishinomiya/JP

Purpose: The diagnosis of liver fibrosis stage is important in predicting

progression of the disease. Virtual touch tissue quantification (VTTQ) is

an implementation of acoustic radiation force impulse imaging (ARFI)

technology that provides numerical measurements using sheer wave

velocity (Vs) value for a noninvasive quantitative assessment of tissue

stiffness. We evaluated the diagnostic usefulness of VTTQ in assessing

liver fibrosis in chronic hepatitis.

Material & Methods: A total of 441 chronic hepatitis and cirrhosis

patients, proven by liver biopsies, and 25 healthy volunteers were

studied (218 male and 248 female; average age 56.0 13.6; 85 hepatitis

B, 251 hepatitis C, 9 hepatitis B + C, 95 hepatitis non-B non-C). The

degree of hepatitis was evaluated by the New Inuyama classification;

staging of fibrosis was F0 (n 5 49), F1 (n 5 174), F2 (n 5 71), F3

(n 5 76), F4 (n 5 9 6). VTTQ using ARFI with Siemens Acuson

S2000 was used for the quantitative analysis.

Results: The Vs values compared with F0-F4 stage of the fibrosis

stage were 1.13 6 0.17, 1.23 6 0.37, 1.35 6 0.36, 1.56 6 0.05 and

Abstracts S59

2.14 6 0.64, respectively, and significant correlations were observed

between F3 and F4 (P , 0.001). The area under the receiver operating

characteristic curve (AUROC) for distinguishing cirrhosis was 0.890.

The cutoff value in predicting cirrhosis was 1.64 (sensitivity 81%, speci-

ficity 88%, positive predicting value 64%, negative predicting value 95%).

Conclusion: VTTQ is simple and useful in diagnosing chronic hepatitis

and cirrhosis.

Mon, Aug 29, 2011

Hall F1

SS 30

14:00-15:30

Breast 2 - Various Breast

SS 30.02

Misinterpretations of Breast Ultrasound Findings in Daily

Practice

T. Tadin

Ultrasound Diagnostic Service, Ultrasound Diagnostic Service, Health

Centre Rijeka, Rijeka/HR

Purpose: The moment of early detection of possibly suspicious breast

ultrasound finding, its initial interpretation and initial classification are

crucial for further assessment. In spite of skill and equipment playing

a decisive role in evaluating the finding, there are findings requiring

extreme precaution and additional efforts in preliminary evaluation. De-

tecting elements of ultrasound image that help in differentiating the

nature of such findings and avoiding their misinterpretations is

important.

Material&Methods: From a sample of 3,015 patients, a selection of 12

pitfall findings was analysed including a case of bizarre repetitive find-

ings in the same patient followed up over a long period of time. Both the

benign-looking malignant changes and the malignant-looking benign

changes were analysed.

Results: Various findings from haematomas, diffuse haemorrhagic

imbibitions and scars to benign tumours were, in certain cases, success-

ful imitators of malignant changes at the moment of early detection. On

the other hand, there were rare findings of malignant tumours with

completely benign appearance at the moment of detection.

Conclusion: Misinterpretations are risk always present in everyday

challenging work of breast ultrasound. Providing appropriate skill and

technical requirements are met. they are expected to be exceptionally

rare, being corrected by other diagnostic tools and later follow-up.

However, evaluating as much as possible the elements of ultrasound

image, particularly in independent ultrasound examination, is expected

to contribute to their further reduction.

SS 30.03

Breast Ultrasound and Ultrasound-Guided Biopsies in

Gynecological Practice

U. Weßling,1 J. Brand,2 R. Edelmann,2 K. Muller-Pitz,2 B. B€oßenecker,2

T. Schutt,3 C. Zulauf,3 K. Riester,4 M. Eheim,4 J. U. Alles5

1Gynecology, Gyn. Practice, Butzbach/DE, 2Gyn. Practice, Bad

Nauheim/DE, 3Gyn. Practice, Friedberg/DE, 4Rad. Practice,

Friedberg/DE, 5Path. Practice, Wetzlar/DE

Purpose:Madjar et al. (2006) published the BI-RADS-analogue criteria

for findings in breast ultrasound. In this study, the role of breast ultra-

sound using these criteria and including ultrasound-guided biopsies in

the gynecological practice is evaluated.

Material & Methods: In our group practice, high-resolution breast

sonography is performed by seven physicians at three locations for

different indications, and also on asymptomatic women on their request.

At one location, a DEGUM II qualification and the ability of biopsy is

available. Seventeen parameters from each woman were evaluated.

Results: From January 2009 to February 2011, 5950 breast ultrasounds

were performed on 4474 women. After 139 biopsies, 64 breast malig-

nancies were registered. The rate of benign/malignant histology was

0.77/1 in 2010. In a group of 2066 asymptomatic women, ten breast

malignancies were detected by ultrasound (4.8 &). The average tumor

size was 13.4 mm; 21.5% of the cancers were smaller than 10 mm. Eigh-

teen (27.7%) ultrasonically noticedmalignancy could not be detected by

mammography. One contralateral mucinous breast cancer was not de-

tected by ultrasound.

Conclusion: In conclusion, our data shows that breast ultrasound is an

effective method for detecting breast cancer in our practice setting.

For the future, the further reduction in biopsies for benign histology is

intended.

SS 30.04

Ultrasonographic Features of Triple-Negative Breast Cancer:

Understanding the Biology Leads to Less False Negative Results

S. Wojcinski,1 A. Farrokh,2 J. Schmidt,2 P. Hillemanns,3 F. Degenhardt2

1Ob/gyn, Franziskus Hospital, Bielefeld/DE, 2Franziskus Hospital,

Bielefeld/DE, 3Ob/gyn, Hannover Medical School, Hannover/DE

Purpose: To describe the ultrasonographic features of triple-negative

breast cancer (TNBC) according to the ACR BI-RADS(R)-US classifi-

cation system and to compare these features with non-TNBC.

Material & Methods: A total of 326 consecutive breast cancer cases

from our Hospital database were systematically reviewed and the digi-

tally recorded ultrasound images were interpreted according to the BI-

RADS(R) system. The ultrasound features of TNBC (n 5 34) and

non-TNBC (n 5 292) as well as the relevant clinical features were

compared.

Results: TNBC was more common in young patients and exhibited

higher tumor grades and more advanced tumor stages. Focusing on

the ultrasound features, TNBC was more likely to exhibit oval shape

(instead of irregular shape) with a parallel orientation (instead of non-

parallel orientation). The margin of TNBC frequently appeared micro-

lobulated or angular, whereas the margin of non-TNBC was more likely

to be spiculated or indistinct. The echogenic halo and architectural

distortions were less often observed in TNBC. There was no difference

regarding the posterior acoustic features of TNBC and non-TNBC. In

Doppler-ultrasound, the vascularization of TNBC tended to be increased

with more irregular vessels.

Conclusion:TNBC is a subtype of breast cancer known to have a typical

molecular profile, aggressive behavior and characteristic pattern of

metastasis. We found that TNBC also exhibits distinct ultrasonographic

features which can be explained by the unique pathology of TNBC.

Being familiar with these features can avoid false-negative classification

of TNBC.

SS 30.05

Is Pleomorphic Invasive Lobular Carcinoma Different from

Conventional Invasive Lobular Carcinoma?

H. N. Jung,1 J. H. Shin,1 B. Han,1 E. Y. Ko,1 E. S. Ko2

1Department of Radiology, Samsung medical center, Sungkyunkwan

University School of Medicine, Seoul/KR, 2Samsung medical center,

Sungkyunkwan University School of Medicine, Seoul/KR

Purpose: To evaluate whether pleomorphic invasive lobular caricinoma

(PILC) is different from conventional invasive lobular carcinoma

(CILC) in radiologic and clinicopathologic features.

Material & Methods: Twenty-one patients with 22 PILCs were surgi-

cally confirmed, which were compared with 47 CILCs of 47 patients in

radiologic and clinicopathological features. Their imaging findings,

medical records and pathological results were reviewed.