Shear Wave Ultrasound Elastography and Diffusion-Weighted Magnetic Resonance Imaging Findings of Pleural-Based Masses with Histopathologic Correlation

Abstract

Objective: The study aims to evaluate the usefulness of non-invasive diagnostic methods, shear wave elastography (SWE), and diffusion-weighted magnetic resonance imaging (DWI) to differentiate benign and malignant lesions in the thoracic pleural based masses by comparing them with histopathological findings.
Materials and Methods: Sixty-three patients having a pleural-based peripheral mass on CT, admitted to the interventional radiology department for transthoracic biopsy, were included in the study. All patients underwent DWI, and ADC values of the groups were measured. Transthoracic biopsy was performed with the guidance of US from the area where the highest shear wave velocity (SWV) value was calculated. ADC and SWV values of histopathologically proven benign and malignant lesions were statistically compared.
Results: Fifty-six patients were male, and seven were female. The mean age was 64.68±10.13 years (41-85 years). Fourty-four patients were malignant, and 19 were benign. The maximum SWV was found to be 4.13±0.59 m/s in malignant cases and 3.55±0.71 m/s in benign cases, and the difference was significant (p = 0.001). Mean ADC value was measured as 1.04±0.30 x 10-3 mm2/s in malignant cases and 1.32±0.33 x 10-3 mm2/s in benign cases on DWI and the difference was significant (p = 0.002). In malignant cases, the minimum ADC was 0.73±0.29 x 10-3 mm2/s, and 0.99±0.44 x 10-3 mm2/s in benign cases, the difference was significant (p = 0.024). ROC analysis revealed a cut-off value of ≥4.08 m/s for SWVmax, ≤1.01x10-3 mm2/s for mean ADC, and ≤0.8x10-3 mm2/s for minimum ADC showed a significant performance in distinguishing malignant and benign lesions.
Conclusions: Transthoracic US elastography and DWI are useful in differentiating malignant and benign lesions in appropriate cases. Both SWE and DWI are useful in routine use because they are non-invasive and do not contain radiation. In particular, SWE is suitable for biopsy guidance and may prevent the possibility of insufficient material.

Keywords

• Shear wave elastography
• diffusion-weighted MRI
• biopsy
• mass
• thorax

Plevra Tabanlı Kitlelerde Shear Wave Elastografi Ve Difüzyon Mrg Bulgularının Histopatolojik Bulgular ile Korelasyonu

Abstract

Amaç: Non-invaziv tanısal yöntemler olan shear wave elastografi (SWE) ve difüzyon ağırlıklı magnetik rezonans görüntülemenin (DAG), toraksta plevra tabanlı kitlelerde benign ve malign lezyonların ayırımında kullanılabilirliklerinin histopatolojik bulgular ile karşılaştırılarak değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Mart 2015 ile Mart 2018 tarihleri arasında girişimsel radyoloji ünitesine transtorasik biyopsi amacıyla başvuran, bilgisayarlı tomografide (BT) plevra tabanlı kitle izlenen ve biyopsiye uygun bulunan 63 olgu çalışmaya dahil edilmiştir. Tüm olgulara DAG yapılmış ve kitlelerin ADC değerleri ölçülmüştür. Tüm olgulara SWE uygulanmış ve en yüksek SW hızı ölçülen alandan transtorasik biyopsi yapılmıştır. Histopatolojik olarak benign ve malign olduğu belirlenen lezyonların DAG ve SWE bulguları karşılaştırılmıştır.
Bulgular: Olguların 56’sı erkek, 7’si kadındı. Ortalama yaş 64.68±10.13 idi (41-85). Olguların 44’ü malign, 19’u ise benigndi. Malign olgularda maksimum SW hızı ortalama 4.13±0.59 m/sn, benign olgularda ise 3.55±0.71 m/sn ölçülmüş olup fark anlamlı idi (p=0.001). Malign olgularda mean ADC 1.04±0.30 x 10-3 mm2/sn, benign olgularda ise 1.32±0.33 x 10-3 mm2/sn ölçülmüş olup fark anlamlı idi (p=0.002). Malign olgularda minimum ADC 0.73±0.29 x 10-3 mm2/sn; benign olgularda ise 0.99±0.44 x 10-3 mm2/sn ölçülmüş olup fark yine anlamlı idi (p=0.024). ROC analizi sonucu maksimum SW hızı değeri ≥ 4.08 m/sn, mean ADC değeri ≤1.01x10-3 mm2/sn ve minimum ADC değeri ≤ 0.8x10-3 mm2/sn malign tanısı için cut-off değeri olarak alındığında, başarılı şekilde malign-benign ayrımı yapılabilmekteydi.
Sonuç: Transtorasik US elastografi ve difüzyon MR, uygun olgularda malign-benign lezyon ayrımında yararlıdır. Hem SWE, hem de difüzyon MR incelemesi, radyasyon içermemeleri ve non-invaziv olmaları nedeniyle rutin kullanımda kullanışlı yöntemlerdir. Özellikle SWE, biyopsi kılavuzluğu için uygun olup yetersiz materyal olasılığını engelleyebilir. 

Keywords

• shear wave elastografi
• difüzyon MRG
• biyopsi
• kitle
• toraks

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