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Objective: To quantify the diagnostic utility of imaging features in soft tissue masses (STMs) and to provide a ranked list of predictors for malignancy.Subjects and Methods: Imaging features in 260 cases of STMs with verified histology were assessed. Diagnostic properties including sensitivity, specificity, positive and negative predictive values, likelihood/odds ratios (OR) and normalized variance (NV) via random forest analysis were calculated. The diagnostic utility of an 8-item checklist consisting of the highest-ranked features was evaluated through a receiver-operating-characteristics (ROC) curve.Results: The most predictive features (NV/OR in parentheses) were heterogeneous contrast-enhancement in ultrasound (297.9/15.1) and MRI (197.3/11.9), lesion roundness (209.8/5.5), diffusion restriction (175.8/9.3), cystic/necrotic intralesional areas (167.1/8.3), higher patient age (159.0/2.6), surrounding oedema (155.4/6.5) and intralesional Doppler hypervascularity (134.4/5.1). A simple 8-item checklist was highly predictive of malignancy in cases with at least 75% positive features (0.90 area under the ROC curve, 87.0% sensitivity, 84.5% specificity, 59.5% positive and 96.1% negative predictive value, 36.5 odds ratio) even in cases with only partial feature availability.Conclusion: Features vary widely in their diagnostic value in STMs; an 8-item checklist based on the eight most decisive features can be a simple tool to assess the likelihood for malignancy in unknown soft tissue masses, even though a stratified approach is certainly still advisable when first confronted with an STM. [ABSTRACT FROM AUTHOR]

Abstract: Although the diagnosis of “idiopathic trigger finger” (stenosing tenovaginitis) is normally based on clinical examination alone, to date there is no reliable evaluation defining this idiopathic disease beyond an exclusion of secondary causes or an unnecessary sonographic certification of high-grade impairment. By standardized assessment of 32 patients who retrospectively fulfilled the study inclusion criteria and their comparison to a matched group of volunteers, we defined the diagnostic efficiency of the here newly proposed sonographic dark tendon sign (DTS) alone, of impaired tendon gliding alone and the combination of these two features. Pulley thickness in patients and volunteers was significantly different. The combination of clinically impaired tendon gliding plus the DTS reached a sensitivity and diagnostic efficiency of 100%. We propose this diagnostic combination as the new first line assessment features for the quick definition of idiopathic stenosing tendovaginitis during daily routine.(E-mail: hannes.gruber@i-med.ac.at) [Copyright &y& Elsevier]

Abstract: Diagnosis of a typical idiopathic cubital tunnel syndrome (CuTS) is straight forward but the work-up of mild forms is clinically challenging. The diagnostic value of high-resolution ultrasound (HRUS) relying solely on nerve measurements is doubtful. Additional textural analysis of the nerve may possibly overcome this drawback. Thirty-eight prospectively enrolled patients with idiopathic CuTS and 23 healthy volunteers underwent standardized HRUS. A cubital-to-humeral nerve area ratio (CHR) was calculated and the texture of the most swollen nerve segment assessed. CHR was significantly different among patients and volunteers (p <0.001) but with a marked overlap. Combination of at least partial inner fascicular masking plus a CHR>1.4 showed a positive linear coherence with idiopathic CuTS at a specificity>95% and a PPV>90%. Thus, the combined textural analysis and CHR calculation seems a powerful tool for the sonographic diagnosis of idiopathic CuTS. (E-mail: hannes.gruber@i-med.ac.at) [Copyright &y& Elsevier]

Purpose: In this retrospective study we examined whether size is a viable marker of tumour malignancy in soft tissue masses (STM) and if the ratio of width and length (RALD) of an STM reflects tumour biology more accurately.Methods: Measurements of maximal lesion size and perpendicular diameter were performed in available MRI and ultrasonography studies of 212 patients (mean age 54.4 ± 17.2 years, male:female 1:1.12) with a histologically verified diagnosis.Results: Overall, 28.2 % of lesions were malignant, 11.1 % intermediate, and 58.8 % benign. Size alone was a weak predictor of malignancy in STMs (sensitivity 68.8 %, specificity 50.3 %, positive predictive value [PPV] 44.0 %, negative predictive value [NPV] 80.4 %). RALD showed better discriminatory power with greater separation between benign and malignant entities and higher values for sensitivity (83.6 %), specificity (53.6 %), and NPV (89.0 %). A weighted combination of size, age and RALD improved diagnostic power, demonstrating higher values for sensitivity (77.0 %), specificity (80.1 %), PPV (61.0 %), and NPV (89.6 %).Conclusions: Size should not be used alone to estimate an STM's malignancy. RALD better reflects a lesion's growth pattern and a combination of age, size, and RALD helps to discriminate more accurately between benign, intermediate, and malignant entities. These findings should help to estimate easily whether a newly found STM is benign or malignant prior to further workup.Key Points: •Size does not reliably differentiate between benign, intermediate, and malignant tumours •The R ALD (ratio of lateral to axial diameter) improves diagnostic confidence •When combined with age and size, STM differentiation was further enhanced •These measurements can aid in earlier detection of sarcomas. [ABSTRACT FROM AUTHOR]