Shear wave elastography to distinguish between hard and soft mucin in pseudomyxoma peritonei

Abstract 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.