Mesenteric Masses on 2D Mode and Contrast-Enhanced Ultrasound: A Retrospective Study in 69 Patients

Abstract

Purpose Detection of mesenteric masses (MM) by 2 D ultrasound often causes a diagnostic dilemma, and histological confirmation is required for definite diagnosis. The value of contrast-enhanced ultrasound (CEUS) for the diagnosis of MMs has not been investigated before. Here, we retrospectively evaluate 2D-mode and CEUS patterns of 69 patients with histologically confirmed MMs.

Materials and Methods Between January 2006 and January 2016, n = 69 patients were included in the study. Histopathological data, clinical data, 2D-mode ultrasound and CEUS enhancement were retrospectively analyzed.

Results More than half of the MMs (n = 47/69, 68 %) revealed a malignant histology. The size of the MM, inflammation markers and clinical symptoms did not correlate with the histological outcome. 2 D mode revealed n = 46 (67 %) lesions as hypoechoic, n = 14 (20 %) as hyperechoic, and n = 9 (13 %) with a complex echo pattern. Hypoechogenicity and complex echo patterns as well as regular borders of MMs were significantly associated with malignancy (p < 0.05). On CEUS, malignant MMs showed arterial hyperenhancement (n = 11/47, 23 %), isoenhancement (n = 25/47, 52 %) and hypoenhancement (n = 7/47, 15 %). The majority of malignant MMs (n = 42/47, 89 %) revealed parenchymal hypoenhancement. Benign masses revealed arterial hyperenhancement in n = 1/22 (5 %), isoenhancement in n = 8/22 (36 %), and hypoenhancement in n = 10/22 (45 %). The majority of lesions showed parenchymal hypoenhancement (n = 19/22, 86 %).

Conclusion Hypoechogenicity and complex echogenicity in 2 D mode, irregular borders, and parenchymal wash-out were more often associated with malignancy. However, CEUS did not help to subclassify malignant MMs according to their histological entity.

Zusammenfassung

Ziel Der Stellenwert der kontrastunterstützten Sonografie (KUS) zur Beurteilung von mesenterialen Raumforderungen (mRF) ist bisher nicht systematisch untersucht worden. In dieser Arbeit werden 69 Patienten mittels B-Bild Sonografie und KUS retrospektiv analysiert.

Material und Methode Die histopathologischen Befunde, klinische Daten, B-Bild- und KUS Daten von n = 69 Patienten mit mRF wurden über den Zeitraum von 10 Jahren (Januar 2006-Januar 2016) ausgewertet.

Ergebnisse Maligne mRF wurden in n = 47/69 (68 %) gefunden. Weder die Größe, Laborwerte, noch die klinische Symptomatik korrelierte mit der Dignität. In der B-Bild Sonografie zeigten sich n = 46 (67 %) mRF echoarm, n = 14 (20 %) echoreich und n = 9 (13 %) mit einem komplexen Echomuster. Echoarmes und komplexes Echomuster, als auch scharfe Begrenzung der mRF waren signifikant häufiger mit Malignität assoziiert (p < 005). In der KUS zeigten maligne mRF ein arterielles Hyperenhancement (n = 11/47, 24 %), ein Isoenhancement (n = 25/47, 52 %) und ein Hypoenhancement (n = 7/47, 15 %). Ein Großteil der malignen mRF waren durch ein parenchymales Hypoenhancement gekennzeichnet (n = 42/47, 89 %). Gutartige mRF zeigten ein Hyperenhancement in n = 1/22 (5 %), ein Isoenhancement in n = 8/22 (36 %) und ein Hypoenhancement in n = 10/22 (45 %). Die Mehrzahl der benignen mRF wiesen ein parenchymales Hypoenhancement (n = 19/22, 86 %) auf.

Schlussfolgerung Echoarme und komplexe mRF, scharfe Begrenzung und parenchymales wash out sind signifikant häufiger mit Malignität assoziiert. Die KUS scheint jedoch keine Subklassifizierung der histologischen Entitäten zu erlauben.

Key Words

CEUS - mesentery - mesenteric mass

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