Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses?

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

Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications

“…The authors concluded that although there may be some evidence of an association between lower shear-wave velocity and soft-tissue malignancy, particularly in the transverse plane, this did not result in a substantive improvement in the ability to detect malignancy over B-mode consensus classification (50). Another similar SWE study from the same institution on 50 soft-tissue tumors, 15 of which were malignant and 35 benign, showed more encouraging results.…”

“…SWE also allowed characterization of thyroid nodules (with the majority of malignant lesions being stiffer than benign nodules [47]) and various benign and malignant liver lesions (48,49). To our knowledge, currently there are two studies on the utility of SWE in evaluation of musculoskeletal soft-tissue masses (50,51). In one, Pass and collaborators (50) conducted a Bmode and SWE study of 105 biopsy-proven musculoskeletal soft-tissue tumors, 39 of which were malignant and 66 benign.…”

Inter- and intra-reader reproducibility of shear wave elastography measurements for musculoskeletal soft tissue masses

“…The technique provides a noninvasive, relatively inexpensive, quantitative measure of local tissue elasticity. To date, only a few feasibility studies have investigated its practical use in delineating benign versus malignant disease, so far showing mixed results [1][2][3][4]. Traditional (strain) elastography requires external compression to determine the mechanical properties of tissues [5].…”

“…almost perfect SWE repeatability in resting [13][14][15][16] and stretched [17,18] normal skeletal tissue. Multiple previous studies have investigated the diagnostic value of sonoelastography for soft tissue lesions [1,3,4,19,20]. Despite this, there is only limited published data on the reproducibility and repeatability of SWE and how it may be affected by tumour characteristics such as depth and location.…”

Sonoelastography in the musculoskeletal system: Current role and future directions

“…Malignant lesions have been shown to be stiffer on strain elastography compared with benign lesions on a semi-quantitative scale, similar to lesions outside of the musculoskeletal system[50]. However, a recently published study by the group in Leeds assessing the role of shear wave elastography in musculoskeletal tumours has been unable to replicate these early findings, with the authors concluding that there is currently no additional role for shear wave elastography in soft tissue tumours compared with B mode imaging[51]. The authors found no statistically significant association between shear wave velocity and malignancy.…”