title: Effect of Calcifications on Breast Ultrasound Shear Wave Elastography: An Investigational Study.
abstract: OBJECTIVE
  To investigate the effects of macrocalcifications and clustered microcalcifications associated with benign breast masses on shear wave elastography (SWE).
  
  
  METHODS
  SuperSonic Imagine (SSI) and comb-push ultrasound shear elastography (CUSE) were performed on three sets of phantoms to investigate how calcifications of different sizes and distributions influence measured elasticity. To demonstrate the effect in vivo, three female patients with benign breast masses associated with mammographically-identified calcifications were evaluated by CUSE.
  
  
  RESULTS
  Apparent maximum elasticity (Emax) estimates resulting from individual macrocalcifications (with diameters of 2mm, 3mm, 5mm, 6mm, 9mm, 11mm, and 15mm) showed values over 50 kPa for all cases, which represents more than 100% increase over background (~21kPa). We considered a 2cm-diameter circular region of interest for all phantom experiments. Mean elasticity (Emean) values varied from 26 kPa to 73 kPa, depending on the macrocalcification size. Highly dense clusters of microcalcifications showed higher Emax values than clusters of microcalcification with low concentrations, but the difference in Emean values was not significant.
  
  
  CONCLUSIONS
  Our results demonstrate that the presence of large isolated macrocalcifications and highly concentrated clusters of microcalcifications can introduce areas with apparent high elasticity in SWE. Considering that benign breast masses normally have significantly lower elasticity values than malignant tumors, such areas with high elasticity appearing due to presence of calcification in benign breast masses may lead to misdiagnosis.
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Adriana
authors.initials: A
authors.lastname: Gregory
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mehrmohammadi
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Max
authors.initials: M
authors.lastname: Denis
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Bayat
authors.affiliation: Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Daniela L
authors.initials: DL
authors.lastname: Stan
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Fatemi
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America; Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
authors.forename: Azra
authors.initials: A
authors.lastname: Alizad
mesh_terms: D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D002113:Calcification, Physiologic; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods