Elastosonography in malignant rectal disease: preliminary data

 

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Elastography is an ultrasound technique that allowed to obtain images from the mechanical properties of soft tissue. It is well known that some diseases, such as cancer, lead to changes in tissue hardness. Elasticity imaging is a technique that reveals the physical properties of tissue and can determine changes in tissue hardness caused by disease [1] [2] [3] [4] [5].

We evaluated 20 consecutive patients (10 males, 10 females; mean age 61.15 years, range 29-84 years) with histologically confirmed distal rectal cancer for disease staging. Informed consent was given by all of subjects. All patients underwent rectal endoscopic ultrasound, which was performed using a flexible echo endoscope (an oblique-viewing instrument [fiber obtic or electronic video image] [Pentax, Hamburg, Germany]). The echoendoscope was inserted and advanced beyond the lesion, under direct vision, to the rectosigmoid junction. Tumors were targeted to determine the depth of infiltration into or through the rectal wall. Frequencies commonly used for T-staging range from 7.5 MHz to 9 MHz. The endoscopic ultrasound elastography score was subdivided into five types on the basis of the echopattern distortion of the examined area, from 1 (normal) to 5 (advanced malignant neoplasia) ([Figure 1]). Rectal staging was performed according to Tumor-Node-Metastasis staging system (TNM).

Figure 1 Elastosonographic images in a patient with a T3 rectal malignancy.

It was our experience that the elastography images showed a discreet correlation in the staging of advanced lesions (T3, 65 %); and post-radiotherapy disease persistence has been correctly confirmed by elastography score (T3, 100 %). These preliminary data have shown that elastography, performed during endoscopic ultrasound, is a method that can differentiate between benign and malignant rectal lesions, although further studies, in particular regarding the follow-up of neoadjuvant chemoradiation therapy and in benign lesions, are necessary.

Competing interests: None

References

• 1 Frey H. Realtime elastography: a new ultrasound procedure for the reconstruction of tissue elasticity (in German, English abstract).  Radiologe. 2003;  43 850-855
  CrossrefPubMedGoogle Scholar
• 2 Lorenzen J, Sinkus R, Adam G. Elastography: quantitative imaging modality of the elastic tissue properties [in German, English abstract].  Rofo. 2003;  175 623-630
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Cochlin D L, Ganatra R H, Griffiths DF. Elastography in the detection of prostatic cancer.  Clin Radiol. 2002;  57 1014-1020
  CrossrefPubMedGoogle Scholar
• 4 Saftoiu A, Vilman P. Endoscopic ultrasound elastography: a new imaging technique for the visualization of tissue elasticity distribution.  J Gastrointest Liver Dis. 2006;  15 161-165
  PubMedGoogle Scholar
• 5 Giovannini M, Hookey L C, Bories E. et al . Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients.  Endoscopy. 2006;  38 344-348
  Article in Thieme ConnectPubMedGoogle Scholar

G. Mezzi

Department of Gastroenterology and Gastrointestinal Endoscopy

IRCCS Vita-Salute University

San Raffaele Scientific Institute of Milan

Via Olgettina 60

20132 Milan

Italy

Fax: +39-02-26432504

Email: mezzi.gianni@hsr.it