Diagnostic Performance of Point Shear Wave Elastography (pSWE) Using Acoustic Radiation Force Impulse (ARFI) Technology in Mesenteric Masses: A Feasibility Study

Abstract

Purpose: To evaluate the diagnostic performance of ultrasound point shear wave elastography (pSWE) using acoustic radiation force impulse (ARFI) technology in different benign and malignant mesenteric masses (MMs).

Methods: A total of 69 patients with MMs diagnosed from September 2018 to November 2021 were included retrospectively in the study. The inclusion criteria were (1) an MM over 1 cm; (2) valid ARFI measurements; and (3) confirmation of the diagnosis of an MM by histological examination and/or clinical and radiological follow-up. To examine the mean ARFI velocities (MAVs) for potential cut-off values between benign and malignant MMs, a receiver operating characteristics analysis was implemented.

Results: In total, 37/69 of the MMs were benign (53.6%) and 32/69 malignant (46.4%). Benign MMs demonstrated significantly lower MAVs than mMMs (1.59 ± 0.93 vs. 2.76 ± 1.01 m/s; p < 0.001). Selecting 2.05 m/s as a cut-off value yielded a sensitivity and specificity of 75.0% and 70.3%, respectively, in diagnosing malignant MMs (area under the curve = 0.802, 95% confidence interval 0.699-0.904).

Conclusion: ARFI elastography may represent an additional non-invasive tool for differentiating benign from malignant MMs. However, to validate the results of this study, further prospective randomized studies are required.

Keywords: ARFI elastography; mesenteric mass; mesentery; sclerosing mesenteritis; ultrasound.

Figure 1

Benign mesenteric mass. An 80-year-old male patient with a known history of type 1 autoimmune pancreatitis under immunosuppressive treatment. (A) Magnetic resonance imaging appearance of a mass-like “misty mesentery” in the right upper portion of the umbilical region (arrow) (courtesy of Prof. Dr. Mahnken, Department of Radiology, University Hospital Marburg); (B) the ultrasound appearance of an ill-defined, slightly inhomogeneous, echogenic mesenteric mass (arrows); (C) the final acoustic radiation force impulse (ARFI) report of the same mass, showing a mean ARFI velocity (MW) of 1.29 m/s. The mesenteric histology showed an IgG−4-positive sclerosing mesenteritis. Läsion 1: lesion 1; Vs (m/s): velocity in meter per second; Tiefe (cm): depth in centimeter; MW = mean value (Mittelwert); Std-Abw.: standard deviation (Standard Abweichung); IQB: interquartile range (Interquartilbereich).

Figure 2

Malignant mesenteric mass. A 67-year-old male patient with a known history of malignant lymphoma and suspected recurrence on staging. (A) Computed tomography showing a hypointense round mass in the left upper quadrant (arrow) (courtesy of Prof. Dr. Mahnken, Department of Radiology, University Hospital Marburg); (B) B-mode ultrasound showing a hypoechoic mesenteric mass (arrows); (C) the final acoustic radiation force impulse (ARFI) report of the same mass, showing a mean ARFI velocity (MW) of 2.72 m/s. The mesenteric histology showed a high-grade malignant lymphoma. Läsion 1: lesion 1; Vs (m/s): velocity in meter per second; Tiefe (cm): depth in centimeter; MW = mean value (Mittelwert); Std-Abw.: standard deviation (Standard Abweichung); IQB = interquartile range (Interquartilbereich).

Figure 3

Malignant mesenteric mass. A 76-year-old female patient with a known history of ovarian cancer and suspected recurrence on staging. (A) Computed tomography image (left) shows a hypointense mesenteric mass (arrow) (courtesy of Prof. Dr. Mahnken, Department of Radiology, University Hospital Marburg); (B) positron emission tomography–computed tomography reveals a high intensity of fluorodeoxyglucose uptake within the mass (arrow)), indicating mesenteric metastasis (courtesy of Prof. Dr. Luster, Department of Nuclear Medicine, University Hospital Marburg); (C) B-mode ultrasound showing a hypoechoic mesenteric mass; (D) the final acoustic radiation force impulse (ARFI) report of the same mass, showing a mean ARFI velocity (MW) of 4.05 m/s. Läsion 1: lesion 1; Vs (m/s): velocity in meter per second; Tiefe (cm): depth in centimeter; MW = mean value (Mittelwert); Std-Abw.: standard deviation (Standard Abweichung); IQB = interquartile range (Interquartilbereich); E: elasticity in Kilopaskal (kPa).

Figure 4

Differences in mean acoustic radiation force impulse (ARFI) velocities between benign and malignant mesenteric masses in the study. The mean ARFI velocity (MAV) in m/s is represented with an “X” in each box, and the median ARFI velocity in subgroups is shown as a horizontal line within each box. bMM: benign mesenteric mass (MAV = 1.59 ± 0.90 m/s), mMM: malignant mesenteric mass (MAV = 2.76 ± 1.01 m/s) (p < 0.001).

Figure 5

Receiver operator characteristic curve for the differences in mean acoustic radiation force impulse velocities between benign and malignant mesenteric masses.