Abstract
ObjectivesTo determine if quantitative and qualitative shear wave elastography have roles in evaluating musculoskeletal masses.Methods105 consecutive patients, prospectively referred for biopsy within a specialist sarcoma centre, underwent B-mode, quantitative (m/s) and qualitative (colour map) shear wave elastography. Reference was histology from subsequent biopsy or excision where possible. Statistical modelling was performed to test elastography data and/or B-mode imaging in predicting malignancy.ResultsOf 105 masses, 39 were malignant and 6 had no histology but benign characteristics at 12 months. Radiologist agreement for B-mode and elastography was moderate to excellent Kw 0.52-0.64; PABAKw 0.85-0.90). B-Mode imaging had 78.8% specificity, 76.9% sensitivity for malignancy. Quantitatively, adjusting for age, B-mode and lesion volume there was no statistically significant association between longitudinal velocity and malignancy (OR [95% CI] 0.40[0.10, 1.60], p=0.193), but some evidence that higher transverse velocity was associated with decreased odds of malignancy (0.28[0.06, 1.28], p=0.101). Qualitatively malignant masses tended to be towards the blue spectrum (lower velocities); 39.5% (17/43) of predominantly blue masses were malignant, compared to 14.3% (1/7) of red lesions.ConclusionsQuantitatively and qualitatively there is no statistically significant association between shear wave velocity and malignancy. There is no clear additional role to B-mode imaging currently.Key Points• Correlation between shear wave velocity and soft tissue malignancy was statistically insignificant• B-mode ultrasound is 76.9 % sensitive and 78.8 % specific• Statistical models show elastography does not significantly add to lesion assessment
Highlights
Introduction[1] Soft tissue masses have a benign to malignant ratio of over 100:1 [2, 3], meaning that a large number of lesions that are benign will undergo imaging investigation and biopsy
Soft tissue sarcomas constitute less than 1 % of all malignancies. [1] Soft tissue masses have a benign to malignant ratio of over 100:1 [2, 3], meaning that a large number of lesions that are benign will undergo imaging investigation and biopsy.Elastography uses external compression to determine tissue strain and lesion stiffness [4]
The role of shear wave elastography in musculoskeletal imaging has been largely limited to the evaluation of tendon disorders [13,14,15]
Summary
[1] Soft tissue masses have a benign to malignant ratio of over 100:1 [2, 3], meaning that a large number of lesions that are benign will undergo imaging investigation and biopsy. Elastography uses external compression to determine tissue strain and lesion stiffness [4]. The more recent development of acoustic radiation force impulse (ARFI) imaging does not require operator external compression, and should give less variability. [5] It has been established that benign breast and prostate masses tend to be soft and malignant masses tend to be stiff. The role of shear wave elastography in musculoskeletal imaging has been largely limited to the evaluation of tendon disorders [13,14,15]
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