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Characterization of soft tissue tumours with ultrasound, shear wave elastography and MRI

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Abstract

Objective

To predict accurately whether a soft tissue mass was benign or malignant and to characterize its type using ultrasound, shear wave elastography and MRI. We hypothesized that with the addition of shear wave elastography, it would be possible to determine a threshold velocity value to classify a lesion as benign or malignant.

Materials and methods

A total of 151 consecutive, consenting adult patients were prospectively recruited to this study in a tertiary referral musculoskeletal oncology centre. All lesions were assessed with ultrasound, including B mode, Doppler and shear wave elastography measurements. One hundred thirty-eight patients also underwent MRI of the lesion. A histological diagnosis was obtained for all lesions.

Results

Malignant lesions were larger than benign lesions and had a greater Doppler activity.

There was no useful threshold shear wave velocity to differentiate between benign and malignant lesions. Longitudinal and transverse shear wave velocities were strongly positively correlated with each other. An inverse correlation was shown with lesion size and depth, regardless of whether it was benign or malignant.

A logistic regression model combining the ultrasound and MRI characteristics did not confidently classify a lesion as benign or malignant and was inferior to expert opinion.

Conclusion

The strongest predictors of malignancy are large lesion size and high vascularity. The combination of all ultrasound characteristics (including shear wave elastography) and MRI features does not confidently classify a lesion as benign or malignant, and histological diagnosis remains the gold standard.

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Acknowledgements

I would like to thank my colleagues, Oswestry Radiologists and Miss Cribb, Consultant Orthopaedic Surgeon, for enabling this study. Thank you to Dr. Y Berkowitz, Dr. S Greenwood, Dr. R Moutinho, Dr. L Connell, Dr. Y Arlachov and Mrs. D Sissons for their assistance in the repeatability measurements. Thank you to the pathologists at the Royal National Orthopaedic Hospital in Stanmore for their histological diagnosis.

Funding

This study was funded by a grant from the British Society of Skeletal Radiologists.

Author information

Authors and Affiliations

  1. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK

    N. Winn, J. Baldwin, V. Cassar-Pullicino, P. Cool, M. Ockendon & B. Tins

  2. Keele University, Keele, Staffordshire, ST5 5BG, UK

    P. Cool

  3. University of Alberta Hospital, Edmonton, T6G 2B7, Canada

    J. L. Jaremko

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  1. N. Winn
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Correspondence to N. Winn.

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All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written and informed consent was obtained from all individual participants included in the study.

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Winn, N., Baldwin, J., Cassar-Pullicino, V. et al. Characterization of soft tissue tumours with ultrasound, shear wave elastography and MRI. Skeletal Radiol 49, 869–881 (2020). https://doi.org/10.1007/s00256-019-03363-1

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  • DOI: https://doi.org/10.1007/s00256-019-03363-1

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