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Two upgrades to the ordinary ultrasound machine: elastography measures how stiff a lump is (cancers are usually hard), and microbubble contrast shows how blood flows through it in real time, with no radiation and no kidney-toxic dye.
Elastography turns an ultrasound probe into a stiffness meter. Strain elastography compares tissue deformation under gentle pressure; shear-wave elastography sends an acoustic push into the tissue and times the sideways wave it sets off, giving a stiffness value in kilopascals. It is used to grade liver fibrosis before liver cancer surveillance, to raise or lower suspicion of breast and thyroid nodules before biopsy, and to guide prostate biopsies. Contrast-enhanced ultrasound injects a suspension of gas microbubbles a few microns across that stay in the blood; a low-power imaging mode makes them resonate so the scanner shows blood flow through a lesion second by second. It characterises liver nodules found on surveillance (the CEUS LI-RADS system), assesses kidney masses in patients who cannot have iodine or gadolinium, and checks ablation zones for residual tumour.
Endoscopic ultrasound carries the same probe technology into the gut wall to stage oesophageal and gastric tumours and to biopsy pancreatic masses. All these modes depend on the operator and on an acoustic window, and they image one region at a time rather than the whole body.
Shear-wave or strain imaging maps tissue stiffness from ultrasound-tracked deformation; encapsulated gas microbubbles resonate under low-power ultrasound to image blood flow in real time.
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