Barr RG. Elastography: A Practical Approach. Thieme; 2016; 200 pp; 400 ill; $119.00
This comprehensive book encompasses the principles and techniques used in performing elastography under ultrasound guidance. The stiffness or softness of tissue measured by this innovative technique aids radiologists and clinicians in diagnosing various disease conditions, including cancer and inflammation. The changes (including desmoplastic reaction) induced in tissues due to these pathologic processes alter the compressibility and deformation of the surrounding stroma, which are what elastography measures. Given that stiff lesions are more likely to be malignant, the implications of this application can be huge in terms of lesion characterization and management.
The book begins with an introduction to elastography, including shear-wave and strain; the former provides a quantitative assessment and the latter a qualitative assessment of elastography. The physics and technical background are explained in simple and reader-friendly terms. The techniques required to obtain optimal images with the various methods are discussed in a language that is easy to understand. The text is accurate and concise. Case studies that demonstrate the targeted use of elastographic findings by specific pathologic processes are discussed. Important points, such as precompression, descriptions of the imaging patterns, limitations, and artifacts, are covered for ultrasound machines provided by common vendors in the market. There are many illustrations and diagrams to enhance and enrich readers’ experience. The images are appropriately labeled, helpful, and easily interpretable. The references are comprehensive, current, accurate, and obtained from scholarly publications. Two of the unique features of this book are the “tips and tricks” and the “artifacts and pitfalls” sections at the end of each chapter.
The chapters are written by leading authorities around the world on the subject of elastography and its applications in various organ systems of the body. The chapters include step-by-step descriptions of the applications of this technique in various parts of the body, including the liver, breast, thyroid gland, prostate, lymph nodes, spleen, pancreas, kidneys, musculoskeletal system, salivary glands, and testis. The chapter on elastography of diffuse and focal liver disease and how it aids in the determination of fibrosis to direct therapy is very interesting. This is followed by a chapter on breast elastography, which is beautifully illustrated. The author goes into significant detail about precise transducer techniques to reduce operator error, dependence, and resultant artifacts in order to obtain more objective results. Breast tissue has very unique elastic properties not seen in other organs, and breast cancers appear larger on elastography than on B-mode imaging. This difference in size has a high predictive value in identifying cancers.
Thyroid elastography techniques for differentiating benign from malignant lesions and determining treatment and management decisions, including the need to biopsy, are explained in the next chapter. The book concludes with a chapter on MR elastography primarily for liver disease and future applications of elastography.
The applications in this book will be useful to members of all specialties who employ the routine use of ultrasound in their practice, including radiologists, sonographers, and imaging technicians. I recommend this book to the neuroradiology audience, especially head and neck specialists, body imagers, breast imagers, and MSK radiologists, residents-in-training, and faculty members.