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

Abstract

Objective To determine inter-and intra-reader reproducibility of shear wave elastography measurements for musculoskeletal soft tissue masses. Materials and methods In all, 64 patients with musculoskeletal soft tissue masses were scanned by two readers prior to biopsy; each taking five measurements of shear wave velocity (m/s) and stiffness (kPa). A single lesion per patient was scanned in transverse and cranio-caudal planes. Depth measurements (cm) and volume (cm 3) were recorded for each lesion, for each reader. Linear mixed modelling was performed to assess limits of agreement (LOA), inter-and intra-reader repeatability, including analyses for measured depth and volume. Results Of the 64 lesions scanned, 24 (38%) were malignant. Bland-Altman plots demonstrated negligible bias with wide LOA for all measurements. Transverse velocity was the most reliable measure-intraclass correlation (95% CI) = 0.917 (0.886, 1)though reader 1 measures could be between 38% lower and 57% higher than reader 2 [ratio-scale bias (95% LOA) = 0.99 (0.64, 1.55)]. Repeatability coefficients indicated most disagreement resulted from poor within-reader reproducibility. LOA between readers calculated from means of five repeated measurements were narrower-transverse velocity ratio-scale bias (95% LOA) = 1.00 (0.74, 1.35). Depth affected both estimated velocity and repeatability; volume also affected repeatability. Conclusion This study found poor repeatability of measurements with wide LOA due mostly to intra-reader variability. Transverse velocity was the most reliable measure; variability may be affected by lesion depth. At least five measurements should be reported with LOA to assist future comparability between shear wave elastography systems in evaluating soft tissue masses.

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

“…Our preliminary findings suggest that there are changes in the physical properties of affected muscles in these forms of IIM, but these require further investigation in larger patient cohorts in which correlations with parameters of disease severity and duration can be investigated. SWE findings of reduced muscle stiffness in IIM compared to healthy controls has been demonstrated in a previous study, by Alfuraih et al[ 6 , 19 ], but the study did not include patients with NAM or IBM.…”

“…These two muscles were chosen because they are commonly involved in IIM [ 27 ]. SWS was recorded both at rest and with the muscle passively stretched [ 6 ]. For the deltoid, rest was defined as the position in which the elbow was flexed and rested on a pillow, and passive stretch was defined as the position in which the arm hung freely with the elbow extended [ 6 ].…”

“…SWS was recorded both at rest and with the muscle passively stretched [ 6 ]. For the deltoid, rest was defined as the position in which the elbow was flexed and rested on a pillow, and passive stretch was defined as the position in which the arm hung freely with the elbow extended [ 6 ]. In the vastus lateralis, rest was defined as the position in which the knee was extended with the patient supine on a bed [ 6 ], while passive stretch was defined as when the knee was flexed to 45 degrees (Supplementary Figs.…”

“…However, delayed or misdirected biopsies contribute to the 10–45 % false-negative biopsy rate [ 5 ]. Increasingly, magnetic resonance imaging (MRI) is used as a screening procedure for the presence and extent of muscle abnormalities, such as inflammation, oedema, fatty infiltration, and muscle atrophy [ 6 ]; and may help in determining the optimal site to biopsy [ 5 ]. However, the feasibility of MRI is limited by expense, accessibility and patient tolerability.…”

How Accurate Is Semi-quantitative Elastography for Calculating Strain Ratios? A Validity and Reliability Study

“…After extensive literature search, we found several studies published recently assessing reliability estimates for elastography in different soft tissues structures [14] including nerves [15], muscles [16], tendons [17,18], and arteries [19]. Features were assessed with quantitative elastography (including transverse velocity; transverse stiffness; cranio-caudal velocity; and cranio-caudal stiffness, showing a poor repeatability of measurements with wide limits of agreement) and semi-quantitative elastography assessing SRs [8,9].…”