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Evaluation of Virtual Touch Tissue Imaging Quantification (VTIQ), a new Shear Wave Velocity Imaging
Purpose: To prospectively evaluate Virtual Touch Tissue Imaging Quantification (VTIQ) as
a new elastography method concerning its intra- and inter-examiner reliability, its ability to
differentiate benign from malignant lesions in comparison to and in combination with B-mode
BIRADS® assessment.
Materials and Methods: B-mode ultrasound and VTIQ were performed by an experienced
and an inexperienced examiner in 103 women with 104 breast lesions before biopsy. The
study was approved by an independent ethics committee. All participants gave informed
consent. Intra- and inter-examiner reliability of VTIQ was assessed. BIRADS® assessment
was applied prior to five VTIQ measurements. The area under the receiver operating curve
(AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value
(PNV) of BIRADS®, VTIQ and combined data were compared.
Results: Fifty-four of 104 lesions were malignant (51.9%). Intra-examiner reliability was
consistent and inter-examiner agreement showed a strong positive correlation assessed with
orthogonal regression (intercept=-0.91, slope=1.07, r=0.93). The mean VTIQ values in
malignant lesions were significantly higher than in benign (7.73 m/s ± 1.02 versus 4.46 m/s ±
1.87; p<0.0001). The optimal cut-off for clinical decision making was 5.18 m/s, yielding a
sensitivity of 98%, a specificity of 68%, a PPV of 77% and a NPV of 97%. The combination
of BIRADS® (AUC=0.96) and VTIQ (AUC=0.94) led to improved test validity (AUC=0.98,
Conclusion: VTIQ is a highly reliable method. There is a significant difference regarding the
mean maximum velocity of benign and malignant lesions. Adding VTIQ to BIRADS®
assessment improves the specificity.