Abstract
Introduction: MRI is well established to provide excellent spatial and anatomical evaluation of soft tissue masses, however grey scale and Doppler evaluation may provide sufficient information to differentiate benign and malignant soft tissue tumours in good number of cases.
Objective: The objective of the study was to compare the role of grey scale and Doppler USG and MR imaging in soft tissue masses and correlating the diagnosis with final diagnosis based on histopathology for distinguishing benign from malignant soft tissue masses.
Material and Methods: The study was conducted in 25 patients presenting with soft tissue swelling on clinical examination. The patients were first subjected to sonographic evaluation followed by MRI. The results were compared with the final diagnosis established by histopathological / FNAC examination.
Results: For malignant masses, USG had 86% sensitivity, 100% specificity with a positive predictive value of 100% and a negative predictive value of 85%. For benign masses, USG had 100% sensitivity, 86% specificity with a positive predictive value of 85% and a negative predictive value of 100%. For malignant masses, MRI had 93% sensitivity, 100% specificity with a positive predictive value of 100% and a negative predictive value of 92%. For benign masses, MRI had 100% sensitivity, 93% specificity with a positive predictive value of 92% and a negative predictive value of 100%.
Conclusion: Purely cystic & nonvascular masses can be simply followed with serial USG or subjected to surgery without histopathology and further imaging. Large masses with PSV >50 cm/s, RI <0.5, irregular areas of calcification that are suspicious for malignancy may be subjected for MRI for presurgical detailed evaluation and staging. Final diagnosis of many benign masses like lipomas, nerve sheath tumors, haemangiomas, paragangliomas & soft tissue hydatid can also be highly suggested on MR imaging, which was slightly more sensitive than USG for benign as well as malignant masses.
Keywords: Soft tissue masses, Magnetic resonance imaging, Doppler Sonography.
References
- Belli P, Constantini M, Mirk P, Maresca G, Priolo F,Marano P. Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses. J Ultrasound Med. 2000; 19: 823–830.
- Ahuja AT, A. D. King, J. Kew, W. King, and C. Metreweli Head and Neck Lipomas: Sonographic Appearance. AJNR 1998; 19: 505–508.
- Kaushik S, Theodore T. Miller, Levon N. Nazarian and William C. Foster. Spectral Doppler Sonography of Musculoskeletal Soft Tissue J Ultrasound Med. 2003; 22: 1333-1336.
- Ozbek SS, Arkun R,Killi R. Image-directed color Doppler ultrasonography in the evaluation of superficial solid tumors. J Clin Ultrasound 1995; 23: 233-238.
- Bodner G, Michael F. H. Schocke, Franz Rachbauer, Klaus Seppi, Siegfried Peer, Anke Fierlinger, Tarek Sununu, and Werner R. Jaschke. Differentiation of Malignant and Benign Musculoskeletal Tumors: Combined Color and Power Doppler US and Spectral Wave Analysis. Radiology 2002; 223: 410-416.
- G Hermann, IF Abdelwahab, TT Miller, MJ Klein and MM Lewis. Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses. The British Journal of Radiology 1992, 769 :14-20.
- Pang KK, Hughes T. MR imaging of the musculoskeletal softtissue mass: is heterogeneity a sign of malignancy? J Chin Med Assoc2003; 66:655-661.
- Berquist TH, Ehman RL, King BF, Hodgrnan CG, lstrup DM. Value of MR Imaging in Differentiating Benign from Malignant Soft-Tissue Masses: Study of 95 Lesions. AJR 1990;155:1251-1255.
- Jones BC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging findings in 34 patients.AJR1993; 161:827 830.
- Sundaram M, McGuire MH, Schajowicz F. Soft-Tissue Masses: Histologic Basis for Decreased Signal (Short T2) on T2-Weighted MR Images.AJR1987; 48:1247-1250.
- Beltran J, Simon DC, Katz W, Weis LD. Increased MR signal intensity in skeletal muscle adjacent to malignant tumors: pathologic correlation and clinical relevance. Radiology1987; 162: 251–255.
- Kransdorf MJ, Jelinek JS,Moser RP, Utz JA, Browen AC, Hudson TM, Hudson Berry B. Soft-Tissue Masses: Diagnosis Using MR Imaging. AJR 1989;153:541-547.
- Alyas F, Lee J, Ahmed M, Connell D, Saifuddin A. Prevalence and diagnostic significance of fluid-fluid levels in soft-tissue neoplasms. Clinical Radiology 2007;62:769-774.
- Tsai JC, Dalinka MK, Fallon MD. Fluid fluid levels:a non-specific finding in tumours of bone and soft tissue.Radiology 1990;175:779-82.
- Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS, Kathleen H. Emery. MR Imaging of Soft-Tissue Masses: Diagno-stic Efficacy and Value of Distinguishing Between Benign and Malignant Lesions. AJR 1995;164:1191-1199.
- Peabody TD, Simon MA. Principles of staging of soft-tissue sarcomas. Clin Orthop1993; 289:19–31.
- Rijswijk CSPV, Geirnaerdt MJA, Hogendoorn PCW, Taminiau AHM, Coevorden FV, Zwinderman AH, Pope TL, Bloem JL. Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine–enhanced MR imaging in prediction of malignancy.Radiology 2004; 233:493–502.
- Van der Woude HJ, Verstraete KL, Hogendoorn PC, Taminiau AH, Hermans J, Bloem JL. Musculoskeletal tumors: does fast dynamic contrast-enhanced subtraction MR imaging contribute to the characterization?. Radiology 1998; 208:821-828.
- May DA, Good RB, Smith DK, Parsons TW. MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experience with 242 patients. Skeletal Radiol 1997;26: 2–15
Corresponding Author
Dr Dinesh Sharma
Assistant Professor DYSPGMC Nahan (H.P.) India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i5.112
