Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
Department of Pathology, New York University Langone Medical Center, New York, New York, USA.
J Ultrasound Med. 2021 Aug;40(8):1515-1522. doi: 10.1002/jum.15529. Epub 2020 Oct 14.
To evaluate whether a follow-up magnetic resonance imaging (MRI) scan performed after initial ultrasound (US) to evaluate soft tissue mass (STM) lesions of the musculoskeletal system provides additional radiologic diagnostic information and alters clinical management.
A retrospective chart review was performed of patients undergoing initial US evaluations of STMs of the axial or appendicular skeleton between November 2012 and March 2019. Patients who underwent US examinations followed by MRI for the evaluation of STM lesions were identified. For inclusion, the subsequent pathologic correlation was required from either a surgical or image-guided biopsy. Imaging studies with pathologic correlations were then reviewed by 3 musculoskeletal radiologists, who were blinded to the pathologic diagnoses. The diagnostic utility of MRI was then assessed on the basis of a 5-point grading scale, and inter-reader agreements were determined by the Fleiss κ statistic.
Ninety-two patients underwent MRI after US for STM evaluations. Final pathologic results were available in 42 cases. Samples were obtained by surgical excision or open biopsy (n = 34) or US-guided core biopsy (n = 8). The most common pathologic diagnoses were nerve sheath tumors (n = 9), lipomas (n = 5), and leiomyomas (n = 5). Imaging review showed that the subsequent MRI did not change the working diagnosis in 73% of cases, and the subsequent MRI was not considered to narrow the differential diagnosis in 68% of cases. There was slight inter-reader agreement for the diagnostic utility of MRI among individual cases (κ = 0.10) between the 3 readers.
The recommendation of MRI to further evaluate STM lesions seen with US frequently fails to change the working diagnosis or provide significant diagnostic utility.
评估对肌肉骨骼系统软组织肿块（STM）病变进行初始超声（US）检查后进行后续磁共振成像（MRI）扫描是否能提供额外的放射学诊断信息并改变临床管理。
对 2012 年 11 月至 2019 年 3 月间进行初始 US 评估轴向或附肢骨骼 STM 的患者进行回顾性图表审查。确定了接受 US 检查后因 STM 病变行 MRI 检查的患者。纳入标准为需要通过手术或影像引导活检获得后续病理相关性。对具有病理相关性的影像学研究由 3 名肌肉骨骼放射科医生进行回顾，这些医生对病理诊断结果不知情。然后根据 5 分制评分标准评估 MRI 的诊断效用，并通过 Fleiss κ 统计确定读者间的一致性。
92 名患者因 STM 评估而行 US 后行 MRI。42 例有最终病理结果。样本通过手术切除或开放活检（n=34）或 US 引导下核心活检（n=8）获得。最常见的病理诊断是神经鞘瘤（n=9）、脂肪瘤（n=5）和平滑肌瘤（n=5）。影像学复查显示，在 73%的病例中，后续 MRI 并未改变初步诊断，在 68%的病例中，后续 MRI 并未被认为缩小鉴别诊断范围。3 名读者对单个病例 MRI 诊断效用的判断存在轻微的读者间一致性（κ=0.10）。
推荐对 US 检查所见的 STM 病变进行 MRI 进一步评估，这常常不能改变初步诊断或提供显著的诊断效用。
