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


CONCLUSIONS
• 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.
Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK.
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Pass
Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK.
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Jafari
Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK.
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Rowbotham
Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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Hensor
Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK.
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Gupta
Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK. Philip.robinson10@nhs.net.|Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK. Philip.robinson10@nhs.net.
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Robinson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005918:Glomus Tumor / Q000000981:diagnostic imaging; D006801:Humans; D008080:Liposarcoma / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D015203:Reproducibility of Results; D012509:Sarcoma / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
Elasticity imaging techniques; Imaging; Sarcoma; Soft tissue neoplasms; Ultrasound