Shear-Wave Elastography of Benign versus Malignant Musculoskeletal Soft-Tissue Masses: Comparison with Conventional US and MRI

Abstract

To examine if shear-wave elastography (SWE) improves the accuracy of diagnosing soft-tissue masses as benign or malignant compared with US alone or in combination with MRI. Materials and Methods: Two hundred six consecutive adult participants (mean age, 57.7 years; range, 18-91 years), including 89 men (median age, 56.0 years; range, 21-91 years) and 117 women (median age, 59.1 years; range, 18-88 years), who were referred for biopsy of a soft-tissue mass were prospectively recruited from December 2015 through March 2017. Participants underwent B-mode US, MRI, and SWE prior to biopsy. hree musculoskeletal radiologists independently reviewed US images alone, followed by US and MRI images together, and classiied lesions as benign, probably benign, probably malignant, or malignant. For SWE, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated for transverse shear-wave velocity (SWV). Multivariable logistic regression was used to investigate the association between SWE and malignancy alongside individual demographic and imaging variables. Results: At histologic examination, 79 of 206 (38%) participants had malignant lesions. SWV showed good diagnostic accuracy for lesions classiied as benign or probably benign by US alone (AUC = 0.87 [95% conidence interval {CI}: 0.79, 0.95]). SWV did not provide substantive diagnostic information for lesions classiied as probably malignant or malignant, whether the classiication was made with or without MRI. However, multivariable modeling indicated that diagnostic accuracy may vary by lesion position (interaction P = .

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

“…Interestingly, the unit of shear wave velocity (m/s) yielded better results across all outcomes in comparison to stiffness (kPa). This is in agreement with two previous studies that reported a lower reliability for kPa as a result of the mathematical conversion, which depends on pixel averaging meaning that pixel heterogenicity can lead to differing stiffness calculations for the same measured velocity [14,22]. We therefore support the use of shear wave velocity as a surrogate for tissue elasticity when imaging soft tissue masses as this should ensure better repeatability as evidenced in our results.…”

“…Adult patients (n = 64) were consecutively referred through local sarcoma services over a 12-month period between March 2016 until March 2017, with no clinical exclusion criteria. The patients in this study were involved in a larger study of imaging characteristics and elastography in benign and malignant masses [22]. Patients were retrospectively selected where five individual elastography readings had been recorded.…”

Can Strain Elastography Predict Malignancy of Soft Tissue Tumors in a Tertiary Sarcoma Center?

“…Still, no guidelines are currently available for the use of elastography in musculoskeletal cancer diagnostics. Furthermore, of the currently published studies, many use quantitative shear wave elastography instead of strain elastography, with methods not directly comparable to those of the current study [20].…”

Quantitative Musculoskeletal Ultrasound

“…39 With regard to soft tissue masses, shear-wave elastography can increase the accuracy of diagnosis in conjunction with gray-scale US. 40 However, no useful threshold in shear-wave velocity was found to differentiate benign from malignant lesions. 40,41 A positive correlation was found between shearwave velocities assessed along the long and short axes of the soft tissue mass.…”

“…40 However, no useful threshold in shear-wave velocity was found to differentiate benign from malignant lesions. 40,41 A positive correlation was found between shearwave velocities assessed along the long and short axes of the soft tissue mass. 41…”