Perfusion-based malignancy assessment of soft-tissue tumors by contrast-enhanced ultrasound (CEUS): a comprehensive analysis of 187 cases

Abstract

Purpose

This study aimed to examine the perfusion characteristics of benign and malignant soft-tissue tumors (STT) using contrast-enhanced ultrasound (CEUS) and to correlate STT micro-perfusion with malignancy. Findings were compared with patient characteristics, clinical presentations, MRI findings, and histopathological outcomes.

Methods

This prospective single-center study involved patients with unclear STTs who were scheduled for STT biopsy. Clinical assessments and preoperative MRI were conducted along with CEUS. Perfusion quantification was performed, and perfusion parameters (peak enhancement [PE], rise time, wash-in perfusion index, and washout rate) were calculated. Perfusion characteristics of different STTs were compared.

Results

187 patients were included in the final analysis. Significant differences in CEUS perfusion between benign and non-benign STTs were demonstrated. Non-benign tumors showed significantly higher tumor perfusion and differences were also significant when comparing semi-malignant, malignant, and metastatic STTs. (PE-benign 107.74 [34.65–345.62]; PE-semi-malignant 166.06 [60.14–374.47]; PE-malignant 1042.24 [358.15–4917.74]; PE-metastasis 2632.37 [2249.46–3788.94]. ROC analysis demonstrated a sensitivity of 80% and a PPV of 69% for malignant tumor detection using a cut-off value for peak enhancement of 137 [a.u.].

Conclusion

CEUS appears to be a promising tool for primary STT evaluation in addition to MRI. Furthermore, it can detect vital areas within the tumor tissue and could be utilized to increase biopsy accuracy.

Zusammenfassung

Ziel

Es erfolgte eine Analyse der Perfusionscharakteristika verschiedener gutartiger und bösartiger Weichteil-Tumoren (WTT) mittels kontrastverstärkten Ultraschalls (CEUS). Die Tumor-Mikroperfusion wurde neben der MRT-Bildgebung auch mit den histopathologischen Befunden nach der Biopsie korreliert, um die prädiktive Qualität des CEUS zur präoperativen Diagnostik unklarer WTT zu untersuchen.

Material und Methoden

Es wurden Patienten mit unklarem WTT und geplanter offener Biopsie inkludiert. Klinische Untersuchungen und präoperative MRT-Bildgebung wurden durch eine CEUS-Untersuchung ergänzt. Die WTT-Mikroperfusion wurde mittels CEUS quantifiziert und Perfusionsparameter (Peak Enhancement [PE], Rise Time, Wash-in Perfusion-Index und Wash-out-Rate) berechnet. Die Perfusionscharakteristika verschiedener WTT wurden miteinander verglichen.

Ergebnisse

187 Patienten wurden inkludiert. Es zeigten sich unter benignen WTT signifikant niedrigere Perfusionsparameter als unter nicht benignen WTT. Auch im Vergleich von benignen, semi-malignen, malignen WTT und Metastasen zeigten sich charakteristische Unterschiede der CEUS-Mikroperfusion (PE-Benigne 107,74 [34,65–345,62]; PE-Semi-Maligne 166,06 [60,14–374,47]; PE-Maligne 1042,24 [358,15–4917,74]; PE-Metastase 2632,37 [2249,46–3788,94]. Für die Detektion eines malignen Tumors ergaben sich eine Sensitivität von 80% und ein PPV von 69%, bei einem Cut-off von PE=137 [a.u.].

Schlussfolgerungen

Der CEUS scheint ein vielversprechendes Instrument zur WTT-Diagnostik in Ergänzung zur MRT zu sein. Darüber hinaus kann er vitale Bereiche innerhalb eines WTT identifizieren und so womöglich in Zukunft die Präzision einer offenen oder ultraschallgestützten Biopsie erhöhen.

Keywords

sarcoma - CEUS - ultrasound - tumor - malignancy

Publication History

Received: 02 May 2024

Accepted after revision: 03 March 2025

Accepted Manuscript online:
03 March 2025

Article published online:
31 March 2025

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