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

These data suggest that shear wave velocity measurement is reproducible and that malignant masses may have slower longitudinal shear wave velocities than benign masses. The sample size of this pilot study precludes adjusted analysis but should form the basis for larger study designs.

No abstract

Cite this article as: Pass B, Robinson P, Hodgson R, Grainger AJ. Can a single isotropic 3D fast spin echo sequence replace three-plane standard proton density fat-saturated knee MRI at 1.5 T? Br J Radiol 2015; 88: 20150189. FULL PAPERCan a single isotropic 3D fast spin echo sequence replace three-plane standard proton density fat-saturated knee MRI at 1. Objective: To assess whether a single isotropic threedimensional (3D) fast spin echo (FSE) proton density fat-saturated (PD FS) sequence reconstructed in three planes could replace the three PD (FS) sequences in our standard protocol at 1.5 T (Siemens Avanto, Erlangen, Germany). Methods: A 3D FSE PD water excitation sequence was included in the protocol for 95 consecutive patients referred for routine knee MRI. This was used to produce offline reconstructions in axial, sagittal and coronal planes. Two radiologists independently assessed each case twice, once using the standard MRI protocol and once replacing the standard PD (FS) sequences with reconstructions from the 3D data set. Following scoring, the observer reviewed the 3D data set and performed multiplanar reformats to see if this altered confidence. The menisci, ligaments and cartilage were assessed, and statistical analysis was performed using the standard sequence as the reference standard. Conclusion:A 3D PD FSE sequence reconstructed in three planes gives reduced accuracy and decreased concordance among readers compared with conventional sequences when evaluating the menisci and cartilage with a 1.5-T MRI scanner. Advances in knowledge: Using the existing 1.5-T MR systems, a 3D FSE sequence should not replace twodimensional sequences.

The detailed anatomy of the rectus femoris and corresponding injury appearances were first described in 1995. Since then, there has been little published to change our understanding of this complex anatomical area. More recent anatomical dissection work in 2004 and 2006 alluded to the presence of an altered configuration of the proximal tendon anatomy. Whilst widely accepted that the proximal rectus femoris muscle has two distinct tendon slips, the authors in 2006 described a third separate tendon slip arising from the anterior femoral capsule and this has been widely termed the ‘capsular head’. We provide evidence that imaging features corroborate this revised anatomical concept. Whilst the clinical relevance of these findings is yet to be established, it remains important that our understanding of the radiological anatomy in this area advances with the forward growth of imaging clarity. In this review, we revisit anatomical concepts and present atypical injury cases that may be explained by the presence of a separate capsular head.

Acute shoulder tendon and intra-articular injuries are common and their imaging well described. However, a subset of patients present with more unusual acute shoulder muscle injury. Of these, pectoralis major muscle injuries are encountered the most often and are increasingly prevalent due to a focus on personal fitness, particularly bench-press exercises. Other muscle injuries around the shoulder are rare. This article reviews the anatomy, mechanism of injury, and the imaging findings in relation to injuries of these muscles around the shoulder. We focus on pectoralis major injury but also review proximal triceps, latissimus dorsi, teres major, and deltoid muscle injuries, providing imaging examples.

Soft tissue lesions are a wide range of tumors of mesenchymal cell origin, occurring anywhere in the body with a vast number of histological subtypes both benign and malignant. These are common in clinical practice and vast majority are benign. This article focuses on soft tissue sarcoma of the trunk and extremities and discusses their imaging guidelines.

Objectives: The objectives of this study were to assess the diagnostic yield, accuracy, and complication rate of the US-guided core-needle biopsy technique for suspected soft-tissue sarcomas (STSs) and review this against other published practices. Material and Methods: A 5-year retrospective study was performed of consecutive US-guided percutaneous biopsy for suspected STSs, with 815 planned procedures in 799 patients (average age 57.8 years, [range 15–95] with 54.7% male). Diagnostic yield was recorded as positive for a sample that allowed differentiation of benign and malignant lesions. Diagnostic accuracy was defined as the correlation between biopsy and surgical specimen when excision was performed. Immediate and late complications were documented. The patient procedural experience was recorded by a departmental questionnaire. Results: Diagnostic yield was positive in 751/778 (96.5%) with no immediate, short- or long-term complications. Of 815 planned biopsies, 778 core biopsies were obtained. Of the 37 biopsy cases, where the tissue was not obtained, nine were not performed due to patient factors and a further 28 could not be obtained for other technical reasons (e.g., the lesion being too hard to penetrate or too painful to the core). 27/778 (3.5%) of biopsies were non-diagnostic (96.5%) and of these 27, nine patients were followed up clinically, 13 biopsies were repeated, and five cases were surgically excised without further biopsy attempts. Conclusion: The described soft-tissue mass US-guided percutaneous core-needle biopsy technique demonstrates a high diagnostic yield and accuracy with a low complication rate. The diagnostic yield appears comparable to data published by other institutions with more invasive techniques.