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Shear wave elastography to distinguish between hard and soft mucin in pseudomyxoma peritonei
Carissa Vici1,2, Nishka Tapaswi1,2, Ashish Vaska1
1Peritonectomy Unit, St George Hospital, South Eastern Sydney Local Health District, Kogarah, NSW, Australia.
Objectives:
Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy characterised by progressive accumulation of mucin within the abdomen. The gold standard of PMP treatment is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). BromAc® is a mucolytic therapy developed for patients with inoperable PMP but its efficacy is reduced with hard mucin. Shear wave elastography (SWE) is an ultrasound technique that quantifies the mechanical and elastic properties of tissues. It was hypothesised that SWE could provide a preoperative, objective assessment of mucin consistency.
Methods:
A retrospective pilot study of patients with PMP who underwent SWE prior to CRS-HIPEC was conducted. All patients underwent elastography at a specialised radiology practice. SWE results across the four quadrants of the abdomen were compared with intraoperative assessment of mucin consistency.
Results:
The study yielded 12 eligible patients between Jan 2020 to Apr 2025. The mean SWE value for hard mucin was 5.9 kPa compared with 4.5 kPa for soft. This difference was not statistically significant (p=0.64).
Conclusions:
There is a clinical need for an objective assessment of mucin consistency in patients with PMP. While limited by its small sample size, this study found that the mean SWE result for hard mucin was slightly higher than for soft.
Insights
Shear wave elastography (SWE) may offer an objective assessment of mucin consistency in patients with pseudomyxoma peritonei (PMP). This pilot study found slightly higher SWE values for hard mucin compared to soft, though not statistically significant.
Area of Science:
- Oncology
- Medical Imaging
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) is a rare abdominal malignancy involving mucin accumulation.
- Current treatment involves cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
- BromAc® efficacy is limited by hard mucin, necessitating better preoperative assessment.
Purpose of the Study:
- To investigate Shear Wave Elastography (SWE) as a preoperative tool for assessing mucin consistency in PMP patients.
- To correlate SWE findings with intraoperative assessments of mucin hardness.
Main Methods:
- Retrospective pilot study of 12 PMP patients undergoing SWE before CRS-HIPEC.
- Elastography performed at a specialized radiology practice.
- SWE values compared between hard and soft mucin based on intraoperative findings.
Main Results:
- Mean SWE for hard mucin was 5.9 kPa versus 4.5 kPa for soft mucin.
- The difference in SWE values between hard and soft mucin was not statistically significant (p=0.64).
- Study included 12 eligible patients between January 2020 and April 2025.
Conclusions:
- An objective method to assess mucin consistency in PMP is clinically needed.
- SWE shows a trend towards higher values for harder mucin, but requires further investigation.
- Larger studies are needed to validate SWE's role in PMP management.
