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

• Published in: European radiology 2017-02, Vol.27 (2), p.723-731
• Main Authors: Pass, B., Jafari, M., Rowbotham, E., Hensor, E. M. A., Gupta, H., Robinson, P.
• Format: Article
• Language: English
• Subjects: Acoustics; Adult; Aged; Aged, 80 and over; Biopsy; Diagnostic Radiology; Elasticity Imaging Techniques - methods; Female; Glomus Tumor - diagnostic imaging; Histology; Humans; Imaging; Internal Medicine; Interventional Radiology; Liposarcoma - diagnostic imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Molecular Weight; Neuroradiology; Patients; Radiation; Radiology; Reproducibility of Results; Sarcoma; Sarcoma - diagnostic imaging; Sensitivity and Specificity; Soft Tissue Neoplasms - diagnostic imaging; Software; Ultrasonic imaging; Ultrasonography; Ultrasonography, Doppler, Color - methods; Ultrasound; Velocity; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4427-y

Objectives To determine if quantitative and qualitative shear wave elastography have roles in evaluating musculoskeletal masses. Methods 105 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. Results Of 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. Conclusions Quantitatively 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