Advances in the clinical application of ultrasound elastography in uterine imaging

Abstract

Changes in tissue stiffness by physiological or pathological factors in tissue structure are identified earlier than their clinical features. Pathological processes such as uterine fibrosis, adenomyosis, endometrial lesions, infertility, and premature birth can manifest as tissue elasticity changes. In clinical settings, elastography techniques based on ultrasonography, optical coherence tomography, and magnetic resonance imaging are widely used for noninvasive measurement of mechanical properties in patients, providing valuable tool and information for diagnosis and treatment. Ultrasound elastography (USE) plays a critical role in obstetrics and gynecology clinical work because of its simplicity, non-invasiveness, and repeatability. This article reviews the recent progress of USE in uterine tumor diagnosis (especially early diagnosis and treatment effect evaluation), prediction of preterm birth, and intrauterine insemination. We believe that USE, especially shear wave elastography, may serve as a potential means to assess tissue stiffness, thereby improving the diagnosis and treatment of adenomyosis, fibroids, endometrial lesions, cervical cancer, and precise management of preterm birth and intrauterine insemination monitoring.

The Role of Elastography in Diagnosing Endometrial Pathology

“…[1][2][3] The strain ratio is measured by targeting a region of interest and comparing it to adjacent normal tissue before and after freehand transducer compression. 2,4 In strain elastography, compressive strain is lower in stiffer tissue. 2 Strain wave elastography results are reported as strain ratios, the ratio of the sampled tissue to normal adjacent tissue.…”

“…3,4 Strain imaging is also limited in imaging deep tissue with respect to the transducer that cannot be manually compressed. 4 This makes strain elastography considerably more userdependent than shear wave elastography. 3,4 Shear wave elastography displaces tissue using dynamic, acoustic forces generated by the ultrasound system and is less user-dependent than strain imaging.…”

“…4 This makes strain elastography considerably more userdependent than shear wave elastography. 3,4 Shear wave elastography displaces tissue using dynamic, acoustic forces generated by the ultrasound system and is less user-dependent than strain imaging. 3,4 The shear wave velocity can qualitatively and quantitatively estimate tissue stiffness.…”

“…3,4 Shear wave elastography displaces tissue using dynamic, acoustic forces generated by the ultrasound system and is less user-dependent than strain imaging. 3,4 The shear wave velocity can qualitatively and quantitatively estimate tissue stiffness. 4 The velocity of the shear wave in the region of interest is converted, and the stiffness of the tissue is reported as E mean and E max values measured in kilopascals (kPa).…”

“…4 The velocity of the shear wave in the region of interest is converted, and the stiffness of the tissue is reported as E mean and E max values measured in kilopascals (kPa). 4,6 Shear wave imaging has the benefit of being able to access and image deeper tissues, up to 8 cm from the transducer, making it more suitable for obstetrics and gynecologic (OB/Gyn) imaging. 4 For the past 2 decades, elastography has gained ground in the detection and diagnosis of disease in other organs.…”