REAL TIME STRAIN ELASTOGRAPHY: APPLICATIONS IN HEAD AND NECK REGION: PICTORIAL ESSAY.

Dr.Suresh V.Phatak; Dr.Gaurav Mishra; Dr.Nipun Gupta; Dr. Shishir Rawekar; Dr.Sakshi Daga; Ms.Pallavi Phatak

Volume : VII, Issue : I, January - 2018

REAL TIME STRAIN ELASTOGRAPHY: APPLICATIONS IN HEAD AND NECK REGION: PICTORIAL ESSAY.

Dr. Suresh V. Phatak, Dr. Gaurav Mishra, Dr. Nipun Gupta, Dr. Shishir Rawekar, Dr. Sakshi Daga, Ms. Pallavi Phatak

Abstract :

Elastography is an ultrasound based recent technique currently used for evaluation of east and liver pathology. It is also being evaluated in other areas. We are presenting a pictorial essay of our initial experience of its evaluation in head and neck region in various cases seen in our hospital.

Introduction: – Elastography is based on the principle of tissue deformity due to application of pressure. Different tissues behave in different ways depending on its molecular makeup as external pressure is applied on it. Soft tissues are deformed more when external pressure is applied and hard tissues will deform much less. This information is registered on the monitor in the form of spectrum of colours. Dark Blue colour represents hard areas, red soft areas and green firm areas which have intermediate consistency. The tissue contrast seen on elastography is caused by differential tissue stiffness.^[1] Elastography is a recent imaging modality used for the evaluation of tissue stiffness of superficial organs. It is a sensitive imaging modality for the detection of thyroid nodules, cervical lymph nodes, salivary masses, assessing stiffness of the masseter muscle, and other superficial neck masses.

Tsukuba scoring system: – Itoh et al described a scoring system in 2006.A score of 1 indicated even strain for the entire hypoechoic lesion (i.e., the entire lesion was evenly shaded in green). A score of 2 means strain in most of the hypoechoic lesion, with some areas of no strain (i.e., the hypoechoic lesion had a mosaic pattern of green and blue), A score of 3 implies that strain at the periphery of the hypoechoic lesion, with sp� of the center of the lesion (i.e., the peripheral part of lesion was green, and the central part was blue). A score of 4 shows no strain in the entire hypoechoic lesion (i.e., the entire lesion was blue, but its surrounding area was not included. A score of 5 indicated no strain in the entire hypoechoic lesion or in the surrounding area (i.e., both the entire hypoechoic lesion and its surrounding area were blue). BGR represents typical artifactual three layered aspect (blue–green–red) encountered with cystic lesions. In strain patterns, score 1, 2 and 3 emphasized benign features whereas masses with scores of 4 and 5 were considered as malignant. [2]