Studies were heterogeneous, the majority lacking an independent reference standard. Future prospective trials should address these limitations and assess the impact of WBMRI on management.
Ultrasound is the first-line imaging investigation in the evaluation of parotid gland lesions; however, ultrasound alone cannot differentiate between benign and malignant lesions. An imaging technique with this capability would be of great value, as fine needle aspiration cytology (FNAC) is not always accurate and partial/total parotidectomy is associated with facial nerve palsy and Frey's syndrome. Sonoelastography is a novel imaging technique that has been employed in the research setting in the evaluation of tissues including breast, thyroid, prostate and the salivary glands. More recently it has been used as a diagnostic adjunct in the sonographic evaluation of major salivary gland lesions. This review article outlines the current role of sonoelastography in the diagnostic imaging of parotid lesions, with particular reference to the findings of two research papers published in European Radiology. These papers employ slightly different techniques: the first utilises shear wave elastography whilst the second uses real-time sonoelastography. Sonoelastography may have potential as a diagnostic imaging adjunct to conventional ultrasound. However, it seems likely that FNAC/core biopsy will continue to be necessary. Further studies to evaluate the reproducibility of sonoelastographic results across a range of operators and systems are also needed. Key Points • Ultrasound is the initial and often definitive investigation for parotid lesions • Ultrasound-based strain elastography has been attempted but offered little additional information • New shear wave elastographic techniques did not confer much advantage either • However, analysis of elastographic patterns seems to provide advantages over ultrasound alone.
Purpose
Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma.
Methods
Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI.
Results
Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08).
Conclusion
Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.
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