Abstract
Purpose: To evaluate the diagnostic performance of ultrasound point shear wave elastography (pSWE) using acoustic radiation force impulse (ARFI) technology in different benign and malignant mesenteric masses (MMs). Methods: A total of 69 patients with MMs diagnosed from September 2018 to November 2021 were included retrospectively in the study. The inclusion criteria were (1) an MM over 1 cm; (2) valid ARFI measurements; and (3) confirmation of the diagnosis of an MM by histological examination and/or clinical and radiological follow-up. To examine the mean ARFI velocities (MAVs) for potential cut-off values between benign and malignant MMs, a receiver operating characteristics analysis was implemented. Results: In total, 37/69 of the MMs were benign (53.6%) and 32/69 malignant (46.4%). Benign MMs demonstrated significantly lower MAVs than mMMs (1.59 ± 0.93 vs. 2.76 ± 1.01 m/s; p < 0.001). Selecting 2.05 m/s as a cut-off value yielded a sensitivity and specificity of 75.0% and 70.3%, respectively, in diagnosing malignant MMs (area under the curve = 0.802, 95% confidence interval 0.699–0.904). Conclusion: ARFI elastography may represent an additional non-invasive tool for differentiating benign from malignant MMs. However, to validate the results of this study, further prospective randomized studies are required.
Highlights
The mesentery is a complex, contiguous, membranous peritoneal fold, which starts at the level of the aortic origin of the superior mesenteric artery and extends in a fan-like fashion toward its insertion at the intestinal border, connecting the intestine to the posterior abdominal wall [1]
Acoustic radiation force impulse (ARFI) is a type of point shear wave elastography that depends on the differences of acoustic wave propagation velocity in different tissues, determined by measuring the degree of displacement within a 0.5 to 1.0 cm box on the US screen, known as the “region of interest” (ROI) [27]
Using the area under the ROC curve (AUROC) and in order to maximize sensitivity and specificity, we suggest a value of 2.05 m/s as a cut-off for malignant mesenteric mass (mMM) (AUC = 0.803, 95% confidence interval (CI) 0.702–0.904)
Summary
The mesentery is a complex, contiguous, membranous peritoneal fold, which starts at the level of the aortic origin of the superior mesenteric artery (known as the root of the mesentery) and extends in a fan-like fashion toward its insertion at the intestinal border, connecting the intestine (from the level of the duodenojejunal junction to the rectum) to the posterior abdominal wall [1]. As a new trend in US imaging, contrastenhanced ultrasound (CEUS) is used to assess perfusion patterns of various pathologies, including MMs [11,12,13,14,15,16,17,18,19,20]. Another new trend in US imaging is US elastography, which is a non-invasive tool for assessing tissue stiffness, with guidelines available for hepatic and non-hepatic applications [21,22,23,24,25,26]. To date, no guidance for the use of ARFI elastography in the mesentery is currently available
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