Journal of Medical Ultrasonics

, Volume 41, Issue 3, pp 319–323 | Cite as

Use of strain ratio in evaluating superficial soft tissue tumors on ultrasonic elastography

  • Young Han Lee
  • Ho-Taek Song
  • Jin-Suck SuhEmail author
Original Article



The aim of this study was to describe the strain ratio in histopathologically confirmed superficial soft tissue tumors using ultrasonic elastography (USE).


From March to August 2012, 94 soft tissue tumors in 79 consecutive patients (age range 19–70 years) were examined using USE for palpable masses. Among them, 39 lesions in 36 patients were histopathologically confirmed. Thirty-four lesions in 31 patients with lipoma, ganglion, epidermal inclusion cyst, and pilomatricoma were included: 34 histopathologically confirmed mature lipomas (n = 19), ganglia (n = 6), epidermal inclusion cysts (n = 5), and pilomatricomas (n = 4). Ultrasonographic features of margins, echogenicity, walls, ultrasonic transmission, and vascular flow via Doppler ultrasonography were evaluated. The strain ratios were calculated from the USE strain measured within the lesion and in adjacent tissue. Intraclass correlation (ICC) with Cohen’s kappa was used to determine intraobserver agreement, and the strain ratios of the three groups were compared using Mann–Whitney U tests. All statistical analyses were performed using R package statistical software, and p values <0.05 were considered to be statistically significant.


On USE, repeated measurements of the strain ratios showed excellent intraobserver agreement [ICC value = 0.952 (CI 0.905–0.977), p < 0.05]. The strain ratios of lipomas (median ± standard error 0.83 ± 0.18) were statistically different (p < 0.05) from those of ganglia, epidermal inclusion cysts, and pilomatricomas. The strain ratios of ganglia (2.78 ± 0.48) were also statistically different (p < 0.05) from those of epidermal inclusion cysts and pilomatricomas. The strain ratios of epidermal inclusion cysts (0.17 ± 0.21) were not statistically different (p > 0.05) from that of pilomatricomas (0.13 ± 0.02).


Strain ratios determined by USE help to differentiate lipomas and ganglia from other superficial soft tissue tumors. Our results suggest that USE could be used in addition to traditional ultrasound techniques to obtain diagnostic clues in the evaluation of superficial soft tissue tumors.


Strain ratio Ultrasound Ultrasound elastography Soft tissue tumor 


Conflict of interest

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012R1A1A2042165).

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Oral informed consent was obtained from all patients. This retrospective study protocol was approved by the institutional review board.


  1. 1.
    Garra BS, Cespedes EI, Ophir J, et al. Elastography of breast lesions: initial clinical results. Radiology. 1997;202:79–86.PubMedCrossRefGoogle Scholar
  2. 2.
    Hall TJ, Zhu Y, Spalding CS. In vivo real-time freehand palpation imaging. Ultrasound Med Biol. 2003;29:427–35.PubMedCrossRefGoogle Scholar
  3. 3.
    Havre RF, Waage JR, Gilja OH, et al. Real-time elastography: strain ratio measurements are influenced by the position of the reference area. Ultraschall Med. 2011 [Epub ahead of print].Google Scholar
  4. 4.
    Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Park GY, Kwon DR. Application of real-time sonoelastography in musculoskeletal diseases related to physical medicine and rehabilitation. Am J Phys Med Rehabil. 2011;90:875–86. doi: 10.1097/PHM.0b013e31821a6f8d.
  6. 6.
    Patel K, Sellars ME, Clarke JL, et al. Features of testicular epidermoid cysts on contrast-enhanced sonography and real-time tissue elastography. J Ultrasound Med. 2012;31:115–22.PubMedGoogle Scholar
  7. 7.
    Lee JH, Kim SH, Kang BJ, et al. Role and clinical usefulness of elastography in small breast masses. Acad Radiol. 2011;18:74–80.PubMedCrossRefGoogle Scholar
  8. 8.
    Chiou HJ, Chou YH, Chiu SY, et al. Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color Doppler ultrasonography. J Chin Med Assoc. 2009;72:307–15.PubMedCrossRefGoogle Scholar
  9. 9.
    Lagalla R, Iovane A, Caruso G, et al. Color Doppler ultrasonography of soft-tissue masses. Acta Radiol. 1998;39:421–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Arda K, Ciledag N, Aktas E, et al. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR Am J Roentgenol. 2011;197:532–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Park SH, Kim SJ, Kim EK, et al. Interobserver agreement in assessing the sonographic and elastographic features of malignant thyroid nodules. AJR Am J Roentgenol. 2009;193:W416–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Wang Y, Dan HJ, Dan HY, et al. Differential diagnosis of small single solid thyroid nodules using real-time ultrasound elastography. J Int Med Res. 2010;38:466–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Ning CP, Jiang SQ, Zhang T, et al. The value of strain ratio in differential diagnosis of thyroid solid nodules. Eur J Radiol. 2012;81:286–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee JY, Kim SM, Fessell DP, et al. Sonography of benign palpable masses of the elbow. J Ultrasound Med. 2011;30:1113–9.PubMedGoogle Scholar
  15. 15.
    Widmann G, Riedl A, Schoepf D, et al. State-of-the-art HR-US imaging findings of the most frequent musculoskeletal soft-tissue tumors. Skelet Radiol. 2009;38:637–49.CrossRefGoogle Scholar
  16. 16.
    Sarvazyan A, Hall TJ, Urban MW, et al. An overview of elastography—an emerging branch of medical imaging. Curr Med Imaging Rev. 2011;7:255–82.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2014

Authors and Affiliations

  1. 1.Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science InstituteYonsei University College of MedicineSeoulRepublic of Korea

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