Normal Sonographic Appearance

<2mm

Parenchymal Tissue (Mammy Layer): Homogeneous and Hyperechoic to surrounding fat tissue. Normal ducts (<___mm) may be seen within. Varies w/ Age, Pregnancy, Hormone levels, Menopause.

From Mid Sternum and Mid Clavicle to the Humeral Tubercle

Pectoralis Muscle: Appears Hypoechoic w/ striations. The pectoralis major stretches from the mid _______ and mid _______ to the Humeral Tubercle.

Skin and Mammary layer Blood vessels, Nerves, Lymphatics

Subcutaneous Fat Layer: Between ______ and _______ layer. - Fat layer contains (3) Fat layer is also used to establish Gain settings across the image. (HYPO / MED GREY)

Shear Wave Elastography Strain Elastography

Types of Elastography: (2)

Automated Breast Ultrasound

ABUS Equipment

Increase in glandular tissue, decrease in fat

Adolescent Breast

Increased fat in all layers

Adult Multiparous and Increased age Breast

Dense glandular tissue, minimal fat

Adult Nulliparous Breast

Fremitus

Also called Vibrational Doppler Imaging -Vibration of chest tissue during speech (have patient hum) - Important for distinguishing normal tissue from a tumor - Normal softer breast tissue will vibrate and demonstrate color - Can help define borders of a shadowing mass

Strain and Shear Stiffness

Elastography Cont.... - Stiffness measures for both _____ and ______ wave elastography are usually color-coded. - Color map indicates the varied levels of _________ displayed.

<1cm intramammary

Lymph Nodes: Oval shaped with smooth hypoechoic cortex and visible hyperechoic hilum. - <____cm intrmammary - NO posterior enhancement

<2mm thick Inferior

Nipple: Usually homogeneous medium to low level echogenicity and demonstrates posterior shadowing due to dense connective tissue. Skin: Normally _____mm thick. Thicker on the _____ portion of breast. Stand-off pad would be necessary to evaluate.

Involution of the breast occurs w/ parenchymal atrophy and increased fatty replacement; improved visualization of Cooper's Ligaments

Postmenopausal Breast

Glandular tissues expand and engorge w/ milk production; during lactation breast tissue made have a "ground glass" appearance b/c milk particles are reflective

Pregnancy Breast

Very small and fatty; region of glandular tissue posterior to nipple

Prepubertal Breast

Deep and Superficial Fascia Pectoralis Fascia

Retromammary Space: between the ______ and ______ _______ and the superficial layer of the ______ _______.

Elastography

Uses the stiffness of a lesion to predict the likelihood of malignancy. - Meas the stiffness of a lesion compared to the stiffness of subcutaneous fat or fibroglandular tissue around the lesion - The elasticity of tissue enables it to be deformed when it is subject to an external force and it resumes its original shape or size when force is removed.

Skin > Cooper's Ligament > Glandular Tissue > Fat > Pectoralis Muscle > Blood > Cystic Fluid

What is the normal sonographic appearance of the breast listed from most echogenic to least echogenic?

Strain Elastography

operator dependent type of Elastography that measure the change in tissue as a result of compression - Sonographer provides gentle compression to the breast tissue via repetitve motion or the patient's breathing or heartbeat can also provide the repetitive motion. - Longitudinal displacement of the tissue before and after compression is measured to assess strain - This technique provides QUALITATIVE information - The Strain Ratio closer to 1 indicates the mass is similar in stiffness to sounding tissue - A low strain ratio indicates the mass is much stiffer than the surrounding tissue (indicates probable malignancy) - Young's Modulus CANNOT BE CALCULATED IN STRAIN ELASTOGRAPHY -

Echo-palpation

real-time scanning during palpation for direct correlation of clinical and sonographic findings. -Localize mass between two fingers