From the Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds LS7 4SA, England (A.N.T., E.A., H.G., P.R.); Leeds Biomedical Research Centre, University of Leeds, Leeds, England (A.M.A., E.M.A.H., P.R.); Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia (A.M.A.); and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, England (A.M.A., E.M.A.H.).
Radiology. 2019 Feb;290(2):410-417. doi: 10.1148/radiol.2018180950. Epub 2018 Nov 27.
Purpose To examine if shear-wave elastography (SWE) improves the accuracy of diagnosing soft-tissue masses as benign or malignant compared with US alone or in combination with MRI. Materials and Methods Two hundred six consecutive adult participants (mean age, 57.7 years; range, 18-91 years), including 89 men (median age, 56.0 years; range, 21-91 years) and 117 women (median age, 59.1 years; range, 18-88 years), who were referred for biopsy of a soft-tissue mass were prospectively recruited from December 2015 through March 2017. Participants underwent B-mode US, MRI, and SWE prior to biopsy. Three musculoskeletal radiologists independently reviewed US images alone, followed by US and MRI images together, and classified lesions as benign, probably benign, probably malignant, or malignant. For SWE, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated for transverse shear-wave velocity (SWV). Multivariable logistic regression was used to investigate the association between SWE and malignancy alongside individual demographic and imaging variables. Results At histologic examination, 79 of 206 (38%) participants had malignant lesions. SWV showed good diagnostic accuracy for lesions classified as benign or probably benign by US alone (AUC = 0.87 [95% confidence interval {CI}: 0.79, 0.95]). SWV did not provide substantive diagnostic information for lesions classified as probably malignant or malignant, whether the classification was made with or without MRI. However, multivariable modeling indicated that diagnostic accuracy may vary by lesion position (interaction P = .02; superficial, odds ratio [OR] = 17.7 [95% CI: 1.50, 207], P = .02; deep/mixed, OR = 0.24 [95% CI: 0.07, 0.86], P = .03) and participant age (interaction P = .01; eg, age 43 years, OR = 0.72 [95% CI: 0.15, 3.5], P = .69; age 72 years, OR = 0.08 [95% CI: 0.02, 0.37], P = .001). Conclusion Shear-wave elastography can increase accuracy of soft-tissue lesion diagnosis in conjunction with US. However, a single cut-off may not be universally applicable with diagnostic accuracy that is affected by lesion position and patient age. © RSNA, 2018 Online supplemental material is available for this article.
目的 探讨剪切波弹性成像（SWE）是否比单独使用超声（US）或联合使用 MRI 能提高诊断软组织肿块良恶性的准确性。
材料与方法 本研究前瞻性纳入 2015 年 12 月至 2017 年 3 月期间因软组织肿块行活检而转诊的 206 例连续成年参与者（平均年龄 57.7 岁，范围：18-91 岁），包括 89 例男性（中位年龄 56.0 岁，范围：21-91 岁）和 117 例女性（中位年龄 59.1 岁，范围：18-88 岁）。所有参与者均在活检前行 B 型 US、MRI 和 SWE 检查。3 名肌肉骨骼放射科医生分别独立分析仅行 US 检查、同时行 US 和 MRI 检查的图像，并将病变分类为良性、可能良性、可能恶性或恶性。对于 SWE，计算横切向剪切波速度（SWV）的受试者工作特征（ROC）曲线下面积（AUC）。采用多变量逻辑回归分析 SWE 与恶性肿瘤以及个体人口统计学和影像学变量之间的相关性。
结果 在组织学检查中，206 例参与者中有 79 例（38%）为恶性病变。SWV 对 US 单独分类为良性或可能良性的病变具有良好的诊断准确性（AUC=0.87 [95%CI：0.79，0.95]）。SWV 对 US 单独分类为可能恶性或恶性的病变并未提供实质性的诊断信息，无论是否联合 MRI 进行分类。然而，多变量模型表明，诊断准确性可能因病变位置（交互 P=.02；表浅病变，优势比[OR] = 17.7 [95%CI：1.50，207]，P=.02；深部/混合病变，OR = 0.24 [95%CI：0.07，0.86]，P=.03）和参与者年龄（交互 P=.01；例如，年龄 43 岁，OR = 0.72 [95%CI：0.15，3.5]，P=.69；年龄 72 岁，OR = 0.08 [95%CI：0.02，0.37]，P=.001）而异。
结论 SWE 与 US 联合使用可提高软组织病变诊断的准确性。然而，单一的截断值可能并不普遍适用，诊断准确性受到病变位置和患者年龄的影响。
© 2018 RSNA，在线补充材料本文内容可供参考。
