The feasibility of shear wave elastography for diagnosing superficial benign soft tissue masses

Hyun Jung Yeoh, Tae-Yoon Kim, Jeong Ah Ryu, Hyun Jung Yeoh, Tae-Yoon Kim, Jeong Ah Ryu

Abstract

Purpose: The purpose of this study was to investigate the feasibility of shear wave ultrasound elastography for differentiating superficial benign soft tissue masses through a comparison of their shear moduli.

Methods: We retrospectively analyzed 48 masses from 46 patients from February 2014 to May 2016. Surgical excision, fine-needle aspiration, and clinical findings were used for the differential diagnosis. The ultrasonographic examinations were conducted by a single musculoskeletal radiologist, and the ultrasonographic findings were reviewed by two other radiologists who were blinded to the final diagnosis. Conventional ultrasonographic features and the median shear modulus were evaluated. We compared the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors using the Kruskal-Wallis test. Additionally, the Mann-Whitney U test was used to compare two distinct groups.

Results: Significant differences were found in the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors (23.7, 5.8, and 9.2 kPa, respectively; P=0.019). Epidermoid cysts showed a greater median shear modulus than ganglion cysts (P=0.014) and lipomatous tumors (P=0.049).

Conclusion: Shear wave elastography may contribute to the differential diagnosis of superficial benign soft tissue masses through a direct quantitative analysis.

Keywords: Elastic modulus; Elasticity imaging techniques; Epidermal cyst; Ganglion cysts; Lipoma; Shear strength.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.. Epidermoid cyst in the forefoot…
Fig. 1.. Epidermoid cyst in the forefoot of a 17-year-old man.
Grayscale ultrasonography (upper) shows a well-circumscribed hypoechoic nodule (arrows) in the subcutaneous layer. Shear wave elastography (lower) shows that the mean shear modulus corresponding to the region of interest was 23.2 kPa.
Fig. 2.. A ganglion cyst in the…
Fig. 2.. A ganglion cyst in the third proximal phalanx of a 74-year-old woman.
Grayscale ultrasonography (upper) shows a well-circumscribed hypoechoic nodule (arrows) connected to the flexor tendon (arrowhead). Shear wave elastography (lower) shows that the mean shear moduli corres-ponding to the regions of interest were 3.3 and 6.8 kPa.
Fig. 3.. Lipoma in the mid-back of…
Fig. 3.. Lipoma in the mid-back of a 48-year-old woman.
Grayscale ultrasonography (upper) shows a well-circumscribed isoechoic mass (arrows) below the dermis. Shear wave elastography (lower) shows that the mean shear moduli corresponding to the regions of interest were 9.1, 12.9, and 8.4 kPa.
Fig. 4.. Neurofibroma in the dorsal aspect…
Fig. 4.. Neurofibroma in the dorsal aspect of the tibiotalar joint in a 70-year-old woman.
Grayscale ultrasonography (upper) shows a well-circumscribed hypoechoic nodule (arrows) in the subcutaneous layer. Shear wave elastography (lower) shows that the mean shear moduli corresponding to the regions of interest were 15.3, 13.8, and 20.0 kPa.
Fig. 5.. Differences of the median shear…
Fig. 5.. Differences of the median shear modulus according to the diagnosis.
The box plot shows the median shear modulus values of epidermoid cysts, ganglion cysts, and lipomatous tumors (P=0.019, Kruskal-Wallis test). The open dot represents an outlier.

References

    1. Jacobson JA, Wilson TJ, Yang LJ. Sonography of common peripheral nerve disorders with clinical correlation. J Ultrasound Med. 2016;35:683–693.
    1. Ryu JA, Lee SH, Cha EY, Kim TY, Kim SM, Shin MJ. Sonographic differentiation between schwannomas and neurofibromas in the musculoskeletal system. J Ultrasound Med. 2015;34:2253–2260.
    1. Drakonaki EE, Allen GM, Wilson DJ. Ultrasound elastography for musculoskeletal applications. Br J Radiol. 2012;85:1435–1445.
    1. Taljanovic MS, Gimber LH, Becker GW, Latt LD, Klauser AS, Melville DM, et al. Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics. 2017;37:855–870.
    1. Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR. Sonoelastography: musculoskeletal applications. Radiology. 2014;272:622–633.
    1. Ryu J, Jeong WK. Current status of musculoskeletal application of shear wave elastography. Ultrasonography. 2017;36:185–197.
    1. Lima K, Costa Junior JF, Pereira WC, Oliveira LF. Assessment of the mechanical properties of the muscle-tendon unit by supersonic shear wave imaging elastography: a review. Ultrasonography. 2018;37:3–15.
    1. Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 2013;34:169–184.
    1. Lee YH, Song HT, Suh JS. Use of strain ratio in evaluating superficial soft tissue tumors on ultrasonic elastography. J Med Ultrason (2001) 2014;41:319–323.
    1. Kim SJ, Park HJ, Lee SY. Usefulness of strain elastography of the musculoskeletal system. Ultrasonography. 2016;35:104–109.
    1. Park HJ, Lee SY, Lee SM, Kim WT, Lee S, Ahn KS. Strain elastography features of epidermoid tumours in superficial soft tissue: differences from other benign soft-tissue tumours and malignant tumours. Br J Radiol. 2015;88:20140797.
    1. Magarelli N, Carducci C, Bucalo C, Filograna L, Rapisarda S, De Waure C, et al. Sonoelastography for qualitative and quantitative evaluation of superficial soft tissue lesions: a feasibility study. Eur Radiol. 2014;24:566–573.
    1. Pass B, Jafari M, Rowbotham E, Hensor EM, Gupta H, Robinson P. Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses? Eur Radiol. 2017;27:723–731.
    1. Pass B, Johnson M, Hensor EM, Gupta H, Robinson P. Sonoelastography of musculoskeletal soft tissue masses: a pilot study of quantitative evaluation. J Ultrasound Med. 2016;35:2209–2216.
    1. Behan M, Kazam E. The echographic characteristics of fatty tissues and tumors. Radiology. 1978;129:143–151.
    1. Gritzmann N, Schratter M, Traxler M, Helmer M. Sonography and computed tomography in deep cervical lipomas and lipomatosis of the neck. J Ultrasound Med. 1988;7:451–456.
    1. Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:396–409.
    1. Slapa RZ, Kasperlik-Zaluska AA, Migda B, Jakubowski WS. Shear wave elastography of adrenal masses is feasible and may help to differentiate between solid and cystic lesions: an initial report. Endokrynol Pol. 2014;65:119–124.
    1. Bhatia KS, Yuen EH, Cho CC, Tong CS, Lee YY, Ahuja AT. A pilot study evaluating real-time shear wave ultrasound elastography of miscellaneous non-nodal neck masses in a routine head and neck ultrasound clinic. Ultrasound Med Biol. 2012;38:933–942.
    1. Bercoff J, Tanter M, Muller M, Fink M. The role of viscosity in the impulse diffraction field of elastic waves induced by the acoustic radiation force. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:1523–1536.
    1. Bhatia KS, Rasalkar DD, Lee YP, Wong KT, King AD, Yuen YH, et al. Real-time qualitative ultrasound elastography of miscellaneous non-nodal neck masses: applications and limitations. Ultrasound Med Biol. 2010;36:1644–1652.
    1. Damron TA, Beauchamp CP, Rougraff BT, Ward WG Sr. Soft-tissue lumps and bumps. Instr Course Lect. 2004;53:625–637.
    1. Choi JY, Hong SH, Yoo HJ, Kim SJ. Musculoskeletal application of ultrasound elastography: soft tissue lipoma. J Korean Soc Ultrasound Med. 2010;29:241–245.

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