Validation of intra- and interobserver reproducibility of shearwave elastography: Phantom study

PurposeTo assess intra- and interobserver reproducibility of quantitative ultrasound (US) elastography for breast masses using shearwave elastography (SWE).Materials and methodsThe US elastography phantom was used. This training phantom contained 12 masses with dimensions from 6 to 11 mm and varying B-mode (hypo- iso- and hyperechoic) characteristics and viscoelastic properties varying from about 50 to 250 kPa. Four attending radiologists participated as operators and used Supersonic Imaging 15–4 MHz array to acquire images. In each session, B-mode US features were assessed once and US elastography values were assessed twice in a consecutive and distinct manner. A total of three identical sessions of data acquisition were performed at 2-week intervals. For categorical variables such as BI-RADS features of mass on B-mode image and qualitative SWE features, kappa (k) values were calculated by the generalized linear mixed model. For continuous variables, kPa, and ratio, intraclass correlation coefficients (ICCs) were calculated.ResultsInterobserver agreement for SWE image similarity was moderate (k = 0.57). With respect to quantitative SWE values, intraobserver ICCs were 0.65, 0.77, 0.92, and 0.91 for maximum elasticity; 0.70, 0.83, 0.94, and 0.94 for mean elasticity; and 0.67, 0.83, 0.92, and 0.92 for elasticity ratio for operators 1, 2, 3, and 4, respectively. Interobserver reproducibility showed good agreement with ICC values of 0.77 for maximum elasticity, 0.82 for mean elasticity, and 0.79 for elasticity ratio.ConclusionQuantitative US elastography for breast masses was highly reproducible with good agreement across operators. With respect to intraobserver reproducibility, ICC values varied but three out of four operators showed good agreement.

► Breast phantom for objective and repetitive elastography evaluation.
► In shearwave elastography, acoustic pressure wave induces slow-moving lateral waves.
► The speed of propagation is proportional to the square root of the tissue’s elastic modulus.
► Ultrasound elastography was highly reproducible with good agreement across operators.
► With respect to intraobserver reproducibility, three out of four operators showed good agreement.