Contrast-enhanced ultrasound (CEUS) is helpful for the characterization of solitary fibrous tumors of the pleura

Abstract

Purpose

To describe the perfusion patterns of solitary fibrous tumors of the pleura (SFTP) using contrast-enhanced ultrasound (CEUS).

Materials and Methods

Between November 2012 and 2024, six patients with histologically confirmed SFTP underwent B-mode ultrasound (B-US) and CEUS. Parameters from the arterial phase, including flow-in pattern, extent of enhancement (EE; marked or reduced/absent), and homogeneity of enhancement (HE; homogeneous or inhomogeneous) were retrospectively analyzed.

Results

All 6 lesions displayed a flow-in perfusion pattern that originated from a peripheral point. Five lesions (83.3%) exhibited arterial hyperenhancement and 1 (16.7%) showed hypoenhancement. HE was inhomogeneous in 5 lesions (83.3%) and homogeneous in 1 (16.7%).

Conclusion

On CEUS, all cases showed an arterial flow-in perfusion that originated from a peripheral point in an SFT, which could be a diagnostic clue for the non-invasive diagnosis of SFTPs. Given the risk of tumor seeding, direct surgical resection may be preferable to biopsy in these cases.

Zusammenfassung

Ziel

Beschreibung der Perfusionsmuster solitärer fibröser Tumoren der Pleura (SFTP) mittels kontrastverstärkter Ultraschall-Untersuchung (CEUS).

Materialien und Methoden

Zwischen November 2012 und 2024 wurden 6 Patienten mit histologisch bestätigtem SFTP einer B-Modus-Ultraschall-Untersuchung (B-US) und einer CEUS unterzogen. Retrospektiv wurden Parameter der arteriellen Phase, einschließlich Flow-in-Muster, Ausmaß des Enhancements (EE; ausgeprägt oder reduziert/abwesend) und Homogenität des Enhancements (HE; homogen oder inhomogen), analysiert.

Ergebnisse

Alle 6 Läsionen zeigten ein Flow-in-Perfusionsmuster, das von einem peripheren Punkt ausging. Fünf Läsionen (83,3%) wiesen ein arterielles Hyperenhancement auf, eine Läsion (16,7%) zeigte ein Hypoenhancement. Das HE war in 5 Läsionen (83,3%) inhomogen und in einer (16,7%) homogen.

Schlussfolgerung

Bei der CEUS zeigte sich in allen Fällen ein arterielles Flow-in-Perfusionsmuster, das von einem peripheren Punkt ausging, was ein diagnostischer Hinweis auf die nicht invasive Diagnostik von SFTPs sein könnte. Aufgrund des Risikos eines Tumor-Seedings ist in diesen Fällen eine direkte chirurgische Resektion der Biopsie vorzuziehen.

Keywords

solitary fibrous tumors of the pleura - CEUS - ultrasound - SFT - diagnosis

Publication History

Received: 21 March 2025

Accepted after revision: 03 June 2025

Accepted Manuscript online:
04 June 2025

Article published online:
17 September 2025

• References

• 1 Yeom YK, Kim MY, Lee HJ. et al. Solitary Fibrous Tumors of the Pleura of the Thorax: CT and FDG PET Characteristics in a Tertiary Referral Center. Medicine (Baltimore) 2015; 94: e1548
• 2 Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control 2006; 13: 264-269
• 3 Mercer RM, Wigston C, Banka R. et al. Management of solitary fibrous tumours of the pleura: a systematic review and meta-analysis. ERJ Open Res 2020; 6
• 4 Dango S, Kirschbaum B, Passlick B. Solitary fibroma of the pleura – clinical findings and prognosis. Zentralbl Chir 2008; 133: 227-230
• 5 Chick JF, Chauhan NR, Madan R. Solitary fibrous tumors of the thorax: nomenclature, epidemiology, radiologic and pathologic findings, differential diagnoses, and management. AJR Am J Roentgenol 2013; 200: W238-248
• 6 Cardillo G, Carbone L, Carleo F. et al. Solitary fibrous tumors of the pleura: an analysis of 110 patients treated in a single institution. Ann Thorac Surg 2009; 88: 1632-1637
• 7 Lahon B, Mercier O, Fadel E. et al. Solitary fibrous tumor of the pleura: outcomes of 157 complete resections in a single center. Ann Thorac Surg 2012; 94: 394-400
• 8 Boddaert G, Guiraudet P, Grand B. et al. Solitary fibrous tumors of the pleura: a poorly defined malignancy profile. Ann Thorac Surg 2015; 99: 1025-1031
• 9 Alvarado-Cabrero I, Hernández S, Kelly GJ. et al. Pleura’s solitary fibrous tumor. Clinical pathology analysis of 17 cases. Rev Med Inst Mex Seguro Soc 2006; 44: 397-402
• 10 Bellini A, Marulli G, Breda C. et al. Predictors of behaviour in solitary fibrous tumours of the pleura surgically resected: Analysis of 107 patients. J Surg Oncol 2019; 120: 761-767
• 11 Kovacs T, Waxman J. Recurrence of a malignant solitary fibrous tumor of the pleura 17 years after primary tumor resection – A case report. Respir Med Case Rep 2019; 28: 100895
• 12 Luciano C, Francesco A, Giovanni V. et al. CT signs, patterns and differential diagnosis of solitary fibrous tumors of the pleura. J Thorac Dis 2010; 2: 21-25
• 13 Rosado-de-Christenson ML, Abbott GF, McAdams HP. et al. From the archives of the AFIP: Localized fibrous tumor of the pleura. Radiographics 2003; 23: 759-783
• 14 Ginat DT, Bokhari A, Bhatt S. et al. Imaging features of solitary fibrous tumors. AJR Am J Roentgenol 2011; 196: 487-495
• 15 Wignall OJ, Moskovic EC, Thway K. et al. Solitary fibrous tumors of the soft tissues: review of the imaging and clinical features with histopathologic correlation. AJR Am J Roentgenol 2010; 195: W55-62
• 16 Doyle LA, Vivero M, Fletcher CDM. et al. Nuclear expression of STAT6 distinguishes solitary fibrous tumor from histologic mimics. Modern Pathology 2014; 27: 390-395
• 17 Scarsbrook AF, Evans AL, Slade M. et al. Recurrent solitary fibrous tumour of the pleura due to tumour seeding following ultrasound-guided transthoracic biopsy. Clin Radiol 2005; 60: 130-132
• 18 Yang H, Zhang Y, Wei D. et al. Utility of high-frequency B-mode and contrast-enhanced ultrasound for the differential diagnosis of benign and malignant pleural diseases: a prospective study. J Thorac Dis 2022; 14: 3695-3705
• 19 Findeisen H, Görg C, Hartbrich R. et al. Contrast‐enhanced ultrasound is helpful for differentiating benign from malignant parietal pleural lesions. Journal of Clinical Ultrasound 2021;
• 20 Sidhu P, Cantisani V, Dietrich C. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in Med 2018; 39: e2-e44
• 21 Ajouz H, Sohail AH, Hashmi H. et al. Surgical considerations in the resection of solitary fibrous tumors of the pleura. J Cardiothorac Surg 2023; 18: 79
• 22 de Perrot M, Fischer S, Bründler MA. et al. Solitary fibrous tumors of the pleura. Ann Thorac Surg 2002; 74: 285-293
• 23 Li Y, Lu Z, Hu W. et al. Resection of pleural solitary fibrous tumors with distinct feeding vessels arising from the descending aorta: a case report. J Cardiothorac Surg 2024; 19: 371
• 24 Leng XF, Xian L, Qin JJ. et al. Malignant solitary fibrous tumor of pleura accompanied with first symptoms of chest pain and hemoptysis: a case report. Ann Thorac Cardiovasc Surg 2012; 18: 251-255
• 25 Horn R, Görg C, Prosch H. et al. Sonography of the pleura. Ultraschall in Med 2024; 45: 118-146