SONOGRAPHY AS A FIRST LINE TOOL IN SOFT TISSUE MASSES OF WRIST AND HAND: A RADIOPATHOLOGICAL CORRELATION

Abstract

Soft tissue masses of the wrist and hand are frequently encountered in clinical practice and represent a diverse range of pathologies, including tumors, infections, and inflammatory disorders. Accurate preoperative diagnosis is essential for guiding management and avoiding unnecessary surgery. This study aimed to evaluate the sonographic findings of wrist and hand swellings and discuss the comparative roles of ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in their assessment. A prospective study was conducted on 45 patients presenting with wrist and hand lesions. All patients underwent clinical examination, high-resolution ultrasonography (5-13 MHz), and radiography. Contrast-enhanced MRI was performed in 16 cases where USG findings were equivocal. Imaging findings were correlated with final diagnoses obtained through fine-needle aspiration cytology (FNAC), histopathology, or clinical follow-up. The majority of lesions were benign (97.78%), with only one malignant case (Bednar’s tumor) identified. The most common entities were ganglion cysts (26.67%), followed by inflammatory pseudomasses (28.89%) and vascular malformations (13.33%). Sonography was "diagnostic" in 86.67% of cases and proved highly reliable in differentiating cystic from solid lesions, identifying 100% of cystic and mixed lesions correctly. MRI provided a higher prediction rate of 87.5% compared to 75% for USG within the subset of patients who received both scans. USG is an effective first-line modality for initial characterization and differentiating cystic from solid masses due to its accessibility and real-time capability. MRI offers superior tissue characterization and is reserved for complex cases requiring detailed anatomical mapping.