Role of ultrasound and diffusion weighted MRI in characterization of soft tissue masses of the wrist and hand

Background: The wrist and hand are prone to various pathologies. Swelling is a common sign, and understanding its nature helps in diagnosis. Aim: To assess the ability of ultrasound (US) and diffusion-weighted magnetic resonance imaging (DWI-MRI) in the characterization and detection of soft tissue masses in the hand and wrist region, and in determining whether they are benign or malignant. Patients and methods: This Prospective observational research was performed on 50 cases with soft tissue masses of the hand and wrist. They have been referred mainly to the radiology department at the Bab El-shaarya (Sayed Galal) University. The study was conducted from December 2023 to December 2024. Results: Swelling was the most common clinical presentation (100%), followed by pain (88%), limited movement (72%), and tingling (54%). The most frequent pathology was a ganglion cyst (42%), followed by a giant cell tumor (18%). Histopathology confirmed 94% benign and 6% malignant lesions. Ultrasound (US) diagnosed 84% as benign and 16% as malignant, with 61.3% sensitivity and 80% specificity. Magnetic resonance imaging (MRI) identified 88% as benign and 12% as malignant, with 82.9% sensitivity and 90.5% specificity. Diffusion-weighted imaging (DWI) showed the highest diagnostic accuracy, with 90% benign and 10% malignant, and 88.8% sensitivity and 94.4% specificity. Conclusion: Ultrasound is useful for initial evaluation. MRI provides more detail but may not always distinguish benign from malignant lesions.