Multiparametric Evaluation of Soft Tissue Lesions by Shear Wave Elastography, Diffusion Weighted Imaging and Perfusion MRI

Abstract

We aimed to investigate diagnostic accuracy of shear wave elastography (SWE), diffusion weighted imaging (DWI) and perfusion magnetic resonance imaging (p-MRI) in differentiation of benign and malignant soft tissue masses. SWE, DWI and p-MRI were performed in 23 histopathologically proven (13 benign and 10 malignant) soft tissue lesions (15 female, 8 male; mean age: 46.43 ± 15.79 years).Quantitative evaluation of the masses with SWE in kilopascals, quantitative apparent diffusion coefficient (ADC) measurements of the lesions on DWI were performed.The perfusion curves of the lesions were also drawn on dynamic contrast enhanced MRI images. Malignant lesions were significantly larger compared to the benign lesions (p= 0.008). No significant
difference was found among mean elasticity values (p>0.05) and mean ADC values of benign and malignant lesion groups (p=0.059), but ADC values in the malignant group were in trend to be lower than benign lesions.When a cut-off value for differentiation of benign and malignant lesions was set to 1.06 10–3 mm2/second; the sensitivity, specificity, positive and negative predictive values along with diagnostic accuracy for detection of malignant lesions was found to be 87.5%, 58.3%, 58.3%, 87.5%,
75%, respectively.Type 4 perfusion curve was more commonly seen in malignant lesions (57.1% of malignant lesions (p = 0.045) compared to benign lesions and type 2 curve was commonly encountered in benign lesions (54.5% of benign lesions).
Soft tissue tumors constitute a heterogeneous group with a broad range of elasticity characteristics. In contrast to diffusion and perfusion MRI, the diagnostic accuracy of SWE is not sufficient to differentiate malignant from benign soft tissue tumors in isolation. We demonstrated that p-MRI would provide more accurate results compared to elastography and diffusion weighted MRI examination. Diffusion and perfusion weighted studies would be added to conventional MRI sequences.