UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA
FACULTY OF MEDICINE
The role of ultrasound
elastography in diagnosis breast
focal lesions
-ABSTRACT-
Scientific coordinator,
Professor Andrei Bondari, MD, PhD
PhD Student,
Ioana Andreea Gheonea
CRAIOVA
2011
1
Contents
Background ---------------------------------------------------------------------- 3
Material and methods --------------------------------------------------------- 3
Results and discussions ------------------------------------------------------- 7
 Elastography study --------------------------------------------------------- 7

Qualitative analysis ------------------------------------------------- 7

Quantitative analysis ------------------------------------------------ 8
Conclusions --------------------------------------------------------------------- 10
References ---------------------------------------------------------------------- 12
Curriculum vitae --------------------------------------------------------------- 13
Key words
Ultrasound elastography, mammography, ultrasound, magnetic
resonance imaging, immunohistochemistry, breast focal lesions, breast cancer
2
BACKGROUND
Breast cancer is an important cause of morbidity and mortality,
representing the second cause of death by cancer in women. A study
made in 2005 by the Society for Women's Health Research indicated
breast cancer as the most important disease among women. According
to World Health Organization more than 1.2 million people are annually
diagnosed breast cancer and over 500.000 die from this disease.
However, breast cancer mortality rate has declined since 1990 due to
early diagnosis and treatment methods improvement.
Ultrasound elastography has recently been developed for clinical
applications, allowing reconstruction of tissue elasticity distribution and
directly revealing tissue physical properties. Ultrasound elastography
estimates axial strength of tissues along the ultrasound. The method
reveals physical tissue properties, characterizing the difference in
hardness between pathological and normal tissue. Sonoelastography
is a complementary method for breast nodules, increasing
two-dimensional ultrasound specificity. This could reduce the number
of benign biopsy results for non-suspect lesions, as well as following
examinations. The validation of the elastography could probably
represent the initial step to tactile imaging, visualizing and
reconstructing tissue elasticity distribution on breast covered surface.
Magnetic resonance imaging is a complementary technique for
mammography and ultrasound. Malignant lesions can be identified by
studying the behavior after intravenous paramagnetic contrast.
Recently, new MRI techniques have improved, with possible
applications in breast cancer diagnosis, techniques that are still being
evaluated (MR spectroscopy, diffusion-weighted images, perfusion,
bold).
This paper is divided into two parts: a general part – state of
knowledge and a personal part – with personal contributions.
In the first part, we tried to present the latest theoretical data from
specialized literature on the topic. In the special part we presented the
material and methods used and results and discussions arising from
the study of the groups of patients.
MATERIAL AND METHOD
The study was conducted at the University of Medicine and
Pharmacy Craiova, Department of Radiology and Medical Imaging,
Center for Research in Gastroenterology and Hepatology and Medical
3
Center Camen in Craiova during November 2006 and August 2011 with
prospective data. The total number of patients with breast pathology
included in the study was 345 at who were added 17 cases with normal
breast, of which two men evaluated for other conditions. Mammary
pathology was: breast cancer (n=95), fibroadenoma (n=87), fibrocystic
mastopathy (n=79), breast cysts (n=60), lipomas (n= 14), papillomas
(n=4), breast abscess (n=6).
More studies were conducted on the group of patients evaluated:
• Demographic study
• Imaging study
• Cytological and immunohistochemical study
• Elastography study
All patients included were suspected of breast tumors by at least
one of the following: detection of self palpation lesions, palpation by the
physician, evidence of suspicious injuries in females examined by
mammography within breast cancer screening program, highlighting
suspicious imaging mass (ultrasound, mammography, CT, MRI),
breast pain and inflammatory phenomena. Data were collected through
a structured form.
Imaging examinations included the performance of breast ductal
ultrasound and elastography in all cases and selectively
mammography and/or magnetic resonance, with an interval between
examinations of up to 7 days. In cases with suspected breast cancer
imaging was performed cytological examination or surgery with
histopathology exam.
Before imaging explorations or minimally invasive and sampling
of biological materials, all patients signed an informed consent after
explaining the details and clarify any arising ambiguities.
Breast ultrasound and elastography were performed using a
Hitachi 8500 EUB, Hitachi Preirus and Siemens Acuson Antares
Preirus with multifrequency transducers (7-15 MHz), allowing
adaptation to breast thickness, thus achieving optimization of spatial
resolution and contrast, all breast plans being examined with maximum
accuracy.
Conventional ultrasound examinations were performed with the
patient supine or oblique, ipsilateral arm raised above his head to clear
upper-outer quadrant, axillary extension and submammary groove.
Longitudinal and transverse sections were made. Good contact
between probe and skin and an even distribution of gel were aimed.
Examination of axillary lymph node groups, subclavian and internal
mammary artery by axial and transverse sections on vascular tracks
4
was also present.
The examination included vascular ultrasound Doppler study,
given that malignant lesions have multipolar, centripetal, distortional
blood supply, neovascularization appearing even in tumor sized less
than 5 mm.
Similar to the Power Doppler mode examination, examination by
elastography interface presents on the right side of the screen gray
mode image and to the left the elastography images. Elastography
images were obtained by conventional ultrasound lesions evaluation.
Next a region of interest (ROI) was manually set that included both
breast lesions and subcutaneous tissue and pectoral muscles without
coastal springs. ROI areas involved the inclusion of a sufficiently large
area of surrounding tissues because elastography values are tightly
related to all ROI structures compressibility.
The pressure applied was set between 1 and 6 score (score 1
indicating the lowest pressure and the 6 the highest). We applied a
maximum pressure of 3 or 4, because too much pressure can cause
compression even in hard lesions, which can lead to false information.
Elastography images were evaluated according to the Tsukuba score
of elasticity developed by Itoh and Ueno.
Hitachi elastography system is set so that very hard areas appear
dark blue and still, with the decrease in hardness, the colors go through
shades of green, yellow and red. Regarding the Siemens system,
tissue elasticity was visualized in color and monochrome mode, hard
areas being displayed in red or black and elastic areas in blue or white.
Lesions were classified using a five grade score: score 1 for
lesions with identical elasticity with surrounding breast tissue, score 2
for lesions with alternating hard and elastic areas. Score 3 was used for
lesions with peripheral elasticity and central hardness. Score 4 was
used in entirely hard lesions, but with surrounding elastic tissue and
score 5 for entirely non-compressible injuries as well as for adjacent
tissue areas. Scores 1 to 3 are used for benign lesions, while malignant
lesions are characterized by scores 4-5. Also, regarding ultrasound
performed with Hitachi module, we calculated the fat-to-lesion-ratio
(FLR).
Ductal ultrasound was added to elastography examination. The
latter were performed with the patient in sitting position, facing the
examiner, with hands on hips to examine the upper part of the breast
and with hands on their hands the inferior region.
The probe was positioned perpendicular to the skin and radial on
the breast, with one edge placed near the areola, and the other to the
5
periphery. Transducer was oriented so that the areola to appear to the
left of the image.
This was rotated around the areola, and when a ductal image was
identified rotation was stopped and we performed lateral movement
back and forth to assess the entire duct and its branches. A second
movement was made for the analysis of peripheral described areas.
So, clockwise and anti-clockwise lobe movements assured lobe
analysis, with tracking and highlighting all ducts pathological changes.
Computed analysis of the images
Each elastography film was analyzed using a computerized
image processing java tool (ImageJ) developed at the National
Institutes of Health, Bethesda, Maryland for which a special plug-in
dynamic analysis was created in the IT Department of UMF Craiova.
To minimize bias induced by the examining physician, all digital
post-processing analysis were performed without knowledge of clinical
and laboratory data of patients. For each US elastography film of 10
seconds each (about 125 personnel) have automatically been selected
only color frames (containing information elastography) for which the
histograms were calculated.
Final numerical value assigned to each examination is composed
of the average individual values of the histograms of each elastography
frame.
Statistic analysis
Statistic analysis was performed using MedCalc Software 9, 2008,
Mariakerke, Belgium.
For each imaging method were calculated sensibility, specificity,
positive predictive value (VPP) and negative predictive value (VPN).
Our study also included the calculation of correlation Spearman
and Kendall Tau index.
6
RESULTS AND DISCUSSION
ELASTOGRAPHY STUDY
 Qualitative analysis
Lesions were classified using a five grade score: score 1 for
lesions with identical elasticity with surrounding breast tissue, score 2
for lesions with alternating hard and elastic zones. Score 3 was used for
lesions with peripheral elasticity and central hard area. Score 4 was
used in entirely hard lesions, but with surrounding elastic tissue and
score 5 for entirely non-compressible lesions, as well as adjacent tissue
areas.
The analysis was conducted separately for patients to whom
elastography was performed using Siemens and Hitachi EUB 8500
devices.
In order to estimate elastography score value using Hitachi EUB
8500 ultrasound in the differential diagnosis of focal lesions of the
breast we realized the ROC analysis that revealed a value of 0.918
(95%, 0.874 - 0.950) (P<0.0001) for the area under the curve. The
optimal cutoff value to use as a diagnostic test method was considered
>3. Thus, for this value the sensitivity and specificity obtained were
81.5% and 92.5%.
For estimating elastography score value using Siemens Acuson
Antares ultrasound in the differential diagnosis of focal breast lesions
we realized the ROC analysis that revealed a value of 0.934 (95%, from
0.874 to 0.971) (P<0.0001) for the area under the curve. The optimal
cutoff value considered to use as a diagnostic test method was >3.
Thus, for this value the sensitivity and specificity obtained were 83.3%
and 91.1%.
Also, for estimating the elastography score value on an even
larger number of patients we developed statistical analysis across the
entire group consisting of patients examined with both ultrasound
systems. Thus, ROC analysis revealed a value of 0.923 (95%, 0.890 to
0.949) (P <0.0001) for the area under the curve. The optimal cutoff
value considered to use as a diagnostic test method was > 3. Thus, for
this value the sensitivity and specificity obtained were 82.1% and
92.0%. Out of the total of malignant lesions evaluated by the two
elastography systems, one lesion had score 1, six lesions had score 2
and ten lesions had score 3.
7
 Quantitative analysis
o Fat-to-lesion-ratio (FLR)
Quantitative FLR analysis using ultrasound Hitachi 8500 and
Hitachi EUB Preirus systems was performed on a number of 224
patients with benign and malignant focal breast lesions. The average
FLR value for benign lesions was 2.28 and 7.49 for malignant ones.
For estimating FLR value used in the differential diagnosis of
focal lesions of the breast we realized the ROC analysis that revealed a
value of 0.922 (95%, 0.879 to 0.954) (P <0.0001) for the area under the
curve. The optimal cutoff value to use as a diagnostic test method was
> 4.25. Thus, for this value the sensitivity and specificity obtained were
75.4% and 93.1%.
o Qualitative analysis (elastography score) - quantitative
analysis (FLR) correlation
Correlation between qualitative analysis methods (elastography
score) and static quantitative (FLR) analysis was performed using
Spearman and Kendall’s Tau coefficients. Spearman correlation
coefficient between the FLR values and elastography score was 0.827
(95% CI 0.781 to 0.864, p <0.0001), suggesting a very good correlation
between the two methods. Kendall’s Tau coefficient also showed a
satisfactory correlation between the two methods 0.686 (95% CI 0.632
to 0.735, p <0.0001).
o Color histograms analysis
Due to the inherent bias determined by the still images selection,
different authors have reported the need for a computerized medical
diagnostic by transforming histograms data from a dynamic
elastography sequence in a number matrix, converted into a vector
format.
 Computer analysis
Computer analysis was performed using a Hitachi EUB 8500
ultrasound system with built-in elastography module (Hitachi Medical
Systems Europe Holding AG, Zug, Switzerland) and a 6.5 MHz linear
transducer. The same ultrasound parameters (brightness, contrast,
intensity, gain) were used in all examinations. However, since
elastography numerical information is displayed using a color coded
scale with values from 1 to 256, changes of the parameters system do
not affect the results after computer analysis.
8
Tissue elasticity is restored within the region of interest and
translated into a color signal that overlaps the image in grayscale. To
visualize tissue elasticity, elastography different values are marked with
different colors on a scale of 1 to 256.
The system is organized in a gradation color map
(red-green-blue) so hard tissues are represented with dark blue, the
ones with average hardness with light blue, the intermediate elastic with
green, soft intermediate tissue with yellow and the soft ones with red.
Complete encoding of the spectrum of colors from blue to red, is
applied to each elastography record, indicating the gradual relative
elasticity within the region of interest. Qualitative analysis of tissue
compression is indicated on a numerical scale from 1 to 7.
Each elastography film has undergone dynamic computer
analysis using a Java image processing program (Image J) with a
special plugin for dynamic analysis developed by the IT department of
the University of Medicine and Pharmacy of Craiova.
The same plugin has been validated with good results in several
published studies. The plugin was used to dynamically evaluate and
analyze gradual individual histograms of each elastography film frame,
clinical and pathological information not being available to minimize
subjectivity. Each color frame was afterwards numerically transformed,
characterized by a single vector histogram. Each individual vector
value corresponds to the number of pixels of each color or the number
of pixels that correspond to each elasticity level from 1 to 256.
Using computer analysis we obtained average values of
elastography frames from the recorded films. For a cutoff value of 175,
ROC analysis (0.854 [95% CI, 0.804 – 0.894] (P<0.0001)) showed a
sensitivity and specificity of 91.7% and 93.8%.
 Automatic analysis
The development of ultrasound systems has allowed the
incorporation of analysis program by color histograms (Strain
Histogram Measurement, Hitachi, Japan) of selected areas within the
examined region. Thus, a calculation of mean histograms value can be
automatically obtained on several successive color frames. Unlike the
Image J program, the values assigned to visible spectrum colors have
values from 0 to 256, thus hard structures have low average values
while compressible structures have gradually larger histogram values.
The latest Hitachi Preirus system purchased in 2011 was tested
in our study on a limited number of patients (n=10) with breast
malignant (n=2) and benign (n=8) lesions. The obtained values were
similar to those provided by Image J software. The study is ongoing.
9
CONCLUSIONS
 Breast cancer is an important morbidity and mortality factor with a
very high incidence worldwide, leading to high interest in
developing new techniques for early diagnosis. In our study, we
observed a trend of annual growth of breast cancer.
 The origin environment and socio-economic status should be
considered, the incidence of breast cancer in women is higher in
social classes with high economic and educational status, probably
due to factors such as diet, age at first menstruation, estrogen
hormone use, alcohol, coffee, tobacco.
 The average age (59.35 ± 8.54 years) was higher compared to
studies on breast cancer epidemiology. Thus in our study, most
cases are distributed in the fourth decades of age, a significant
number of patients in the seventh decade of age.
 Clinical expression is poor which makes accidental discovery of the
tumor the main way to detect breast cancer.
 Primary tumor topography revealed predominance for the right
breast in the studied group with a predominant distribution in the
upper-outer quadrant.
 Prospective study conducted at the University of Medicine and
Pharmacy Craiova, Department of Radiology and Medical Imaging,
Center for Research in Gastroenterology and Hepatology and
Medical Center in Craiova Camen during November 2006 - August
2011, enabled detailed statistical analysis concerning the new
imaging exploring methods by the large number of patients
introduced in the study. However, new generation explorations
(elastography, immunohistochemistry, computer data analysis)
proved special diagnostic capacities in reference centers.
 Elastography analysis of focal breast lesions was the essence of
this study, with the qualitative and quantitative characterization of
pathological investigated processes. Qualitative analysis using
ductal technique evaluated lesions classifying them into five scores.
Statistical analysis of the entire formed group obtained, for a cutoff
value above 3, the sensitivity and specificity of 82.1% and 92.0%,
these data correlate with recent studies in literature.
Quantitative analysis using FLR was performed on a number of 224
patients with benign and malignant focal lesions of the breast,
examined by ultrasound Hitachi and Hitachi EUB 8500 Preirus
10
systems. The FLR average value for benign lesions was 2.28 and
for malignant lesions 7.49. For the cutoff value of 4.25, we obtained
sensitivity and specificity of 75.4% and 93.1%.
 Statistical analysis showed very good correlation between the
qualitative and quantitative static analysis, with a very high
coincidence rate in the evaluation of elasticity and differentiation of
malignant and benign tumors.
 To remove bias in the analysis of quantitative static elastography of
the elastography images, we performed dynamic computer
analysis using a Java image processing program with a special
plugin developed by IT department of the University of Medicine
and Pharmacy of Craiova. Using computer analysis we obtained for
the cutoff value of 175 a sensitivity and specificity of 91.7% and
93.8%.
 Automatic analysis could be achieved using the latest Hitachi
Preirus system purchased in 2011, which automatically calculates
the average values of histograms obtained on several successive
color frames. This system was tested in our study on a limited
number of patients, the values obtained being similar to those
provided by software Image J.
11
References
 American Cancer Society. Cancer facts & figures 2006. Atlanta, Ga.:
American Cancer Society, 2006. (www.cancer.org)
 Society for Women's Health Research.
(www.womenshealthresearch. org)
 O’Malley MS, Fletcher SW. U.S. Preventive Services Task Force.
Screening for breast cancer with breast self-examination. A critical
review. JAMA 1987;257:2196-2203
 Screening for breast cancer: current recommendations and future
directions. Am Fam Physician. 2007; 75:1660-1666
 Berman CG. Recent advances in breast-specific imaging. Cancer
Control. 2007 14:338-349
 Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of
digital versus film mammography for breast-cancer screening. N Engl
J Med. 2005; 353:1773-1783.
 Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules: use of
sonography to distinguish between benign and malignant lesions.
Radiology 1995;196:123-134
 Rahbar G, Sie AC, Hansen GC, et al. Benign versus malignant solid
breast masses: US differentiation. Radiology 1999; 213: 889-894
 Irwig L, Houssami N, van Vliet C. New technologies in screening for
breast cancer: a systematic review of their accuracy. Br J Cancer
2004; 90: 2118-2122.
 Săftoiu A, Vilmann P, Ciurea T, Popescu GL, Iordache A, Hassan H,
Gorunescu F, Iordache S. Dynamic analysis of EUS used for the
differentiation of benign and malignant lymph nodes. Gastrointest
Endosc. 2007; 66:291-300
 Săftoiu A, Vilmann P, Hassan H, Gorunescu F. Analysis of endoscopic
ultrasound elastography used for characterisation and differentiation
of benign and malignant lymph nodes. Ultraschall Med. 2006;
27:535-542
 Saftoiu A, Vilman P.Endoscopic ultrasound elastography -- a new
imaging technique for the visualization of tissue elasticity distribution. J
Gastrointestin Liver Dis. 2006; 15:161-165.
 Nunes LW, Schnall MD, Orel SG, et al. Breast MR imaging:
interpretation model. Radiology. 1997; 202:833-841
 Kuhl CK, Mielcareck P, Klaschik S, et al. Dynamic breast MR imaging:
are signal intensity time course data useful for differential diagnosis of
enhancing lesions? Radiology. 1999; 211:101-110
12
CURRICULUM VITAE
P E R S O N AL I N F O R M AT I O N

Name:
Ioana Andreea Gheonea

Place of Birth :
July 27th 1980, Caracal, Romania

Marital status:
Married

Telephone:
+4 0751268732

E-mail Address:
iagheonea@gmail.com
P R O F E S S I O N AL AC T I V I T Y
2006 - Present
2011
2006 - 2010
1999 - 2005
1995 - 1999
Teaching Assistant – Radiology and Imaging
Department, Faculty of Medicine, University of
Medicine and Pharmacy, Craiova;
Physician specialist in Radiology and Medical
Imaging;
Fellow in Training in Radiology and Medical
Imaging;
I followed and graduated the courses of Faculty of
Medicine, University of Medicine and Pharmacy
Craiova;
National College Ioniţa Asan, Caracal, Mathematics
and Physics Department;
C O U R S E S AN D D I P L O M AS
June 2011
Graduated the course News in MRI of Prostate And
Feminine Pelvis, Bucharest, Romania;
13
July 2011
March 2011
March 2011
June 2010
June 2010
June 2010
June 2010
Feb. 2009
Nov. 2008
Nov. 2008
July 2008
July 2008
June 2008
Participant at the Third National Congress of
Magnetic Resonance, Bucharest, Romania;
Graduated the exploratory workshop Interventional
Endoscopy and Endoscopic Surgery – Paving the
Way to NOTES State-of-the-art Reviews. Live
Demo. Hands-on Training, Craiova, Romania,
Participant at European Congress of Radiology,
2011, Viena, Austria;
Participant at the Third Conference of PhD Students
in Medicine and Pharmacy, Targu Mures, Romania
Participant at Sectional Imaging Group Reunion,
Bran, România;
Participant at The XXX-lea National Symposium of
Gastroenterology, Hepatology, and Digestive
Endoscopy, Craiova, Romania;
Graduated course Malignant Digestive Disease,
Craiova, Romania;
Graduated
course
Imaging
School
for
Contrast-Enhanced
Ultrasound,
Bucharest,
Romania;
Graduated the musculoskeletal course, The
Ultrasound Diseases of Hand and Foot, Timisoara,
Romania;
Participant at the First National Conference of
Musculoskeletal Society from Romania, Timisoara,
Romania;
Participant at workshop New opportunities in breast
ultrasound, Craiova, Timisoara;
Participant at the First Conference of PhD Students
in Medicine and Pharmacy, Targu Mures, Romania;
Participant at International Summer School on MRI
and MRS, endorsed by International Society for
Magnetic Resonance in Medicine (ISMRM), Sinaia,
Romania;
14
June 2008
June 2008
June 2008
May 2008
October 2007
October 2007
Sept. 2007
June 2007
June 2007
June 2007
May 2007
May 2007
Sept. 2006
Participant at Symposium Digestive Tract Cancers –
Diagnostic and Treatment News, Craiova, Romania;
Graduated the International Course - Breast
Ultrasound under the auspices of European
Federation of Societies for Ultrasound in Medicine
and Biology (EFSUMB), Timisoara, Romania;
Participant at EUROSON 2008 under the auspices
of European Federation of Societies for Ultrasound
in Medicine and Biology (EFSUMB), Timisoara,
Romania;
Participant at Sectional Imaging Group Reunion, Tg.
Jiu, Romania;
Participant at Congress French Days of Radiology,
2007, Paris, France;
Participant at International School of MRI,
Advanced Breast and Pelvis MR Imaging, Madrid,
Spain;
Participant at 17th Session of Balkan Medical Days,
Craiova, Romania;
Participant at Symposium Radiology and Imaging
Diagnose in Cervical, Thorax and Abdomen
Pathology, Craiova, Romania;
Participant at Gastroenterology Symposium,
Craiova, Romania;
Participant at Sectional Imaging Group Reunion,
Sighetu-Marmaţiei, Romania
Participant at 9th National Conference of Ultrasound,
Craiova, Romania;
Graduated the Euroson School – Guidelines in
Gastroenterological Ultrasound, under the auspices
of European Federation of Societies for Ultrasound
in Medicine and Biology (EFSUMB), Craiova,
Romania;
Participant at Francophone Congress of Medical
15
Sept. 2006
May 2006
March 2006
2003 - 2005
Imaging of Central and Eastern European Countries,
Iaşi, Romania
Graduated the International Course – Non invasive
imaging of thorax, under Groupe des Radiologistes
Enseignants
d’Expression
Francaise,
Iaşi,
Romania;
Graduated
the
Euroschool
Course
–
Ultrasonography in emergencies, under auspices of
European Federation of Societies for Ultrasound in
Medicine and Biology (EFSUMB), Oradea,
Romania;
Participant at Symposium Eso-gastro-duodenal
pathology induced by chlorhydro-peptic action,
Craiova, Romania;
Graduated the Psychology and Teaching Module
organized by Department of Teaching Staff Training,
University of Medicine and Pharmacy Craiova,
Romania;
PRISES
October 2011
June 2007
Top Poster Prize 19th United European
Gastroenteroloy Week (UEGW) Stockholm,
Sweden, 2011
Grand prize of Radiology French Society for the
best oral presentation at Sectional Imaging Group
Reunion, Sighetu-Marmaţiei, 2007;
16
F O R E I G N L AN G U AG E S AN D C O M P U T E R S K I L L S
 English – very well
 French – well
 Windows, MS Office, Corel, Dicom
R E S E AR C H P R O J E C T S
 Project director (2008-2012): Evaluation of modern imaging
techniques relative to immunohistochemical and molecular
tehniques in early diagnose of breast cancer, CNCSIS financed
by Scientific Research Scholarships for Young PhD Students (BD
type), 16 700 EURO;
 Member in research programme PN II, financed by CNCSIS
(2008-2011):The impact cuantification of new micromedium
cellular and molecular factors over immune tolerance during
antinflamatory/antitumoral therapy, director of project: Conf. Dr.
Petrică Badea, 1 990 000 RON
 Member in research programme PN II, financed by CNCSIS
(2008-2011): Integrative prediction model of malignant
transformation of regeneration lesion in cirrhotic liver using
noninvasive imaging techniques, immunohistochemical and
molecular genetic methods, director of project: Prof. Univ. Dr. Ion
Rogoveanu, 270 270 EURO;
 2007-2009, Ministry of Education and Research, Comparision
between video capsule endoscopy and push-and-pull
enteroscopy in patients with small bowel pathology
(ENTERODIAG), multicentric grant, 570000 EURO;
17
E X P E R I E N C E I N I N T E R N A T I O N A L P R O G R AM M S
March 2011
October 2007
May 2005
August 2004
2002 – 2003
Invest in Youth program offered by European
Society of Radiology, Vienna, Austria;
Jacques Sauvegrain scholarship offered by French
Society of Radiology, Paris, France;
Participant at International Seminar Introduction in
Concept Problem Based Learning and Teaching Maastricht, Holland, Craiova, Romania;
Program of professional interchange IFMSA SCOPE, Endocrinology, at University Jagiellonski Krakow, Poland;
Erasmus scholarship at University of Maastricht,
The Netherlands;
SCIENTI FIC SOCIETIES M EM BERSHIP
 Member of European Society of Radiology;
 Member of European Society for Magnetic Resonance in
Medicine and Biology;
 Member of Romanian Society of Radiology and Medical
Imaging;
 Member of The European Association for Cancer Research;
 Member of Radiology Society of North-America (RSNA);
 Member of Romanian Society of Magnetic Resonance;
M E D I C AL S T U D E N T S ’ S O C I E T Y AC T I V I T Y
Oct. 1999
July 2000
June 2001
Member of Medical Students Society, SCORE
Department, Craiova;
Participant in the project Rural Health 2000;
Member in the organising committee of the
18
Oct. 2001
Dec. 2001
April 2002
April 2002
May 2002
July 2002
April 2004
July 2004
Dec. 2004
April 2005
Scientific Session for Students and Young
Physicians;
Head of the SCORE department, Craiova (Standing
Committee on Research Exchange), IFMSA,
Romania;
Delegate Member in IFMSA Congress, Romania
(International Federation of Medical Students
Associations) – Băile Herculane,
Participant in TRANSMED 2002 Oradea, Romania;
Participant in the project Weeks of Fight against
Sexually Transmitted Infections;
Member in the Organizing Committee of the
Scientific Session for
Students and Young
Physicians; Craiova, Romania;
Participant in the project Rural Health 2002;
Member in the Organizing Committee of the
Scientific Session for
Students and Young
Physicians; Craiova, Romania;
Participant in the project Rural Health 2004;
Delegat Member in IFMSA Congress (International
Federation of Medical Students Associations) –
Sibiu, Romania;
Member in the Organizing Committee of the
Scientific Session for
Students and Young
Physicians, Craiova, Romania;
S C I E N T I F I C AC T I V I T Y
PUBLISHED PAPERS:
 Ioana A. Gheonea, Simona Bondari, Anamaria Manda, Zoia
Stoica, Andrei Bondari, Differential diagnosis of breast lesions
19
using ultrasound elastography Indian Journal of Radiology and
Imaging, 2011, in press.
 Ioana Andreea Gheonea, Liliana Donoiu, Dragoş Camen,
Carmen Popescu, Simona Bondari, Sonoelastography of brest
lesions: a prospective study of 215 cases with histopathological
correlation, Romanian Journal of Morphology and Embryology,
2011, in press
 Ioana Andreea Gheonea, Raluca Pegza, Luana Lascu, Simona
Bondari, Zoia Stoica, A. Bondari, The role of imaging techniques
in diagnosis of breast cancer, Current Health Sciences Journal,
2011, 37(3):131-139.
 Ioana
Gheonea,
Camelia
Popescu,
A.
Bondari,
Sonoelastography role in differential diagnosis of breast lesions,
Acta Medica Marisiensis, 2010, 57(2):87-89.
 Camelia Popescu, Ioana Gheonea, Alina Capitanescu, Mihaela
Mitroi, A. Bondari, Management of medical treatment of nasal
polyposis, Romanian Journal of Rhinology, 2010, I(1):3-6.
 Zoia Stoica, Daniela Dumitrescu, Mihai Popescu, Ioana
Gheonea, Mihaela Gabor, Nicu Bogdan, Imaging of avascular
necrosis of femoral head: familiar methods and newer trends,
Current Health Sciences Journal, 2009, 35(1):25-30
 Luana Corina Lascu, Ioana Andreea Gheonea, A. Bondari Post
therapeutic imaging aspects in breast cancer, Medicine and
Pharmacy Journal Targu Mures, 2008, 54 (3):313-316.
 Zoia Stoica, Ioana Andreea Gheonea, Adriana Bădulescu,
Experience of Imaging Department of University of Medicine and
Pharmacy Craiova in Gastrointestinal Stromal Tumors (GIST),
Medical Craiova, 2007, 9 (3):199-203.
NATIONAL AND INTERNATIONAL CONGRESSES:
20
 E. Osiac, I. A. Gheonea, D. I. Gheonea, Correlation of the
autofluorescence signal after short pulse laser irradiation and
optical coherence tomography for detection of colorectal cancer,
UEGW, Stockholm, 2011;
 Ioana Andreea Gheonea, Zoia Stoica, Mihaela Burlacu, Carmen
Buce, Cristian Adrian Silosi, Dorin Mercut, Bouveret Syndrom –
case present, Al Treilea Third National Congress of Magnetic
Resonance, Bucharest, 2011;
 Mihaela Burlacu, Ioana Andreea Gheonea, Cornel Tambura, Zoia
Stoica, Daniela Dumitrescu, Mihai Popescu, Role of MRI in
diagnosis of avascular osteonecrosis, Third National Congress of
Magnetic Resonance, Bucharest, 2011;
 Ioana Andreea Gheonea, Zoia Stoica, M.Popescu, Daniela
Dumitrescu, Multicystic nephroma associated with arterial
malformation – case present, Third National Congress of
Magnetic Resonance, Bucharest, 2011;
 I. A. Gheonea, Z. Stoica, A. Bondari, The role of
sonoelastography in the differential diagnosis of breast lesions,
European Congress of Radiology, 2011, Viena, Austria;
 Ioana Gheonea, Camelia Popescu, A. Bondari, The role of
ultrasound elastography in differential diagnosis of breast lesions,
Third Conference of PhD Students in Medicine and Pharmacy,
2010,Targu Mures, Romania;
 Camelia Popescu, Ioana Gheonea, A. Bondari, Medical
Management of nasal polyposis– review, Third Conference of
PhD Students in Medicine and Pharmacy, Targu Mures, 2010,
Romania;
 Gheonea Ioana, Petrişor Iuliana, Donoiu Liliana, Bondari Simona,
Sonoelastography in positive and differential diagnosis of breast
lesions, UMF Days 2011, Craiova, Romania;
21
 Gheonea Ioana, Bondari Simona, Lascu Luana, Stoica Zoia,
Imaging diagnosis of breast cancer metastasis, UMF Days 2011,
Craiova, Romania;
 Bondari Simona, Gheonea Ioana Andreea, Stoica Zoia,
Bistriceanu Iulia, The role of imaging techniques in children bone
tumors, UMF Days 2011, Craiova, Romania;
 Bondari Simona, Gheonea Ioana Andreea, Albulescu Dana,
Imaging diagnosis algorithm of patella instability, UMF Days
2011, Craiova, Romania;
 Bondari Simona, Gheonea Ioana Andreea, Stoica Zoia, The role
of imaging techniques in kidney cancer, UMF Days 2011,
Craiova, Romania;
 Ioana Gheonea, Zoia Stoica, Mihai Popescu, Daniela
Dumitrescu, The role of imaging techniques in diagnosis of brain
infection in AIDS patients, Sectional Imaging Group Reunion,
2010, Bran, Romania;
 Ioana Gheonea, Simona Bondari, Dana Albulescu, Zoia Stoica,
The role of imaging techniques in positive and differential
diagnosis of brain infection with toxocara caniis – case present,
Sectional Imaging Group Reunion, 2010, Bran, Romania;
 Carla Pircă, Ianula Dumitru, Andreea Ciulinca, Ioana Gheonea,
Adriana Iliescu, Simona Bondari, C. Constantin, The role of MRI
in femoral head avascular osteonecrosis, National Conference of
Musculoskeletal Society from Romania, Timisoara, 2009,
Romania;
 Lascu Luana, Dumitrescu Daniela, Popescu M., Gheonea Ioana,
Stoica Zoia, Bondari A., The role of imaging in breast cancer
diagnosis, UMF Days 2009, Craiova, Romania;
 Ianula Dumitru, Ioana Gheonea, M.
Popescu, Daniela
Dumitrescu, Zoia Stoica, MRI aspects in children tumors, UMF
Days 2009, Craiova, Romania;
22
 Carla Pirca, Ioana Gheonea, M. Popescu, Zoia Stoica, Liver
calcification – positive and differential diagnosis, UMF Days 2009,
Craiova, Romania;
 Ioana Andreea Gheonea, Mihai Popescu, Daniela Dumitrescu,
Dana Albulescu, Zoia Stoica, MR imaging findings in pyogenic
and tuberculous spondylitis, National Congress of Radiology and
Medical Imaging, 2009, Bucharest, Romania;
 Ioana Gheonea, Mihai Popescu, Daniela Dumitrescu, Zoia
Stoica, Lower Leg Schwanoma- case present, First National
Conference of Musculoskeletal Society from Romania,
Timisoara, 2008, Romania;
 Luana Corina Lascu, Ioana Andreea Gheonea, A. Bondari, Post
therapeutic imaging aspects in breast cancer, First Conference of
PhD Students in Medicine and Pharmacy, Targu Mures, 2008,
Romania;
 Ioana Gheonea, Zoia Stoica, M. Popescu, Daniela Dumitrescu,
C. Constantin, Simona Bondari, Dana Albulescu, The role of
modern imaging techniques in the diagnosis of chronic
pancreatitis, UMF Days 2008, Craiova, Romania;
 Dan Morosanu, Georgiana Camen, Teodor Sas, Ioana Gheonea,
Rexhep Berisha, Mihai Popescu, Zoia Stoica CT technique in
emergency diagnosis of head trauma, Sectional Imaging Group
Reunion,Tg.Jiu, 2008, Romania;
 Ioana Gheonea, Zoia Stoica, Mihai Popescu, Daniela
Dumitrescu, Cristian Constantin, Simona Bondari, Dana
Albulescu, The role of imaging techniques in differential diagnosis
of chronic pancreatitis and pancreatic cancer, Sectional Imaging
Group Reunion, Tg. Jiu, 2008,Romania;
 Aristida Georgescu, Ioana Gheonea, Zoia Stoica, A. Bondari
Modern Imaging approach in benign hepatic tumors. 17th Session
of Balkan Medical Days, 2007, Craiova, Romania;
23
 Stoica Zoia, Gheonea Ioana, Bădulescu Adriana, Popescu M.,
Dumitrescu Daniela, Constantin C. Computer tomography
features of gastrointestinal stromal tumors. Sectional Imaging
Group Reunion, 2007, Sighetu-Marmaţiei, Romania;
 Gheonea Ioana, Popescu M., Dumitrescu Daniela, Constantin C.,
Bondari Simona, Stoica Zoia MRI in degenerative pathology of
thoracic and lumbar spine. Radiology and Imaging Diagnose in
Cervical, Thorax and Abdomen Pathology Symposium, 2007,
Craiova, Romania
 Gheonea Ioana, Iordache Anca, Dumitrescu Daniela, Constantin
C., Constantin Gabriela, Stoica Zoia MRI in tumoral and
infectious pathology of spine. Radiology and Imaging Diagnose in
Cervical, Thorax and Abdomen Pathology Symposium, 2007,
Craiova, Romania
 Constantin C., Popescu M., Dumitrescu Daniela, Bondari
Simona, Albulescu Dana, Gheonea Ioana, Stoica Zoia The role of
CT exam in thoracic and lumbar grand vessels pathology.
Radiology and Imaging Diagnose in Cervical, Thorax and
Abdomen Pathology Symposium, 2007, Craiova, Romania
 Gheonea DI, Trifu (Gheonea) I.A. News in hepatic steathosis.
Session for Students and Young Physicians, 2004, Craiova,
Romania;
 Trifu (Gheonea) I.A, Gheonea DI, Voican CS. The action of
imipramine on isolated rat gut Session for Students and Young
Physicians, 2004, Craiova, Romania;
 Voican CS, Delcea AS, Trifu (Gheonea) I.A., Rogoz I.
Cytogenetic features in plurimalformed children. Session for
Students and Young Physicians, 2004, Craiova, Romania;
 D.I. Gheonea, Trifu (Gheonea) I.A. Liver Cirrhosis – Modification
of the Portal Venous System. 4th International Medical
24
Conference for Students and Young Doctors, 2003, Sibiu,
Romania;
 Matcas H, Sfredel D, Stan V, Trifu (Gheonea) I.A. - Alterations of
Cerebral Electrogenesis in Digital Intoxication 6th National
Congress for Students and Young Phisicians 2002,Tirgu Mures,
Romania;
25