Purpose
There is a wide variety of soft tissue masses that includes non neoplastic lesions,
benign and malignant tumours (fig 1).
In this field the imaging characterization remains problematic,
despite advances.
A systematic interdisciplinary approach can identify quiescent,
active and aggressive lesions,
achieve histological diagnosis based on the World Health Organization (WHO) classification system for tissue tumors [1],
allows a rapid clinical decision and optimises resources,
limiting errors,
delayed diagnosis,
excessive costs both financial and human.
Several imaging modalities have been used to assess soft-tissue tumors...
Methods and Materials
A retrospective cohort series of 207 patients from January 2009 to December 2010 (range 18-83) with soft tissue masses of limbs and trunk were studied by US,
PD and CEUS: the intravenous contrast agent was SonoVue® (Bracco,
Milano,
Italy).
We used a Teknos MPX and MyLab 70 equipment (Esaote,
Genova,
Italy) equipped with a wideband (5-10 MHz) linear array transducer.
Each study consisted of conventional grey-scale sonography to visualize the lesion,
followed by contrast- enhanced low-mechanical index (MI: 0.08,
40 Kp) real time examination,
after...
Results
All patients tollerated the sonographical examination well without side effects related to ultrasound contrast agent.
Eighty-eight benign and 117 malignant lesions were diagnosed by histology.
In all masses,
seven different CEUS patterns and three different vascular timing were observed.
90% of the malignant lesions (105/117) show a rapid early time of vascularisation (arterial phase) and 60% (70/117) an inhomogenous enhancement pattern with avascular areas.
Only 20% of benign lesions (11/88) show a pattern similar to malignant lesions and 50% (44/88) showed a rapid time vascularization:...
Conclusion
The inhomogenous CEUS enhancement pattern with avascular areas and the rapid vascular flow can be related with malignancy (Fig.
7,
8).
Also in our experience the absence of the contrast uptake is a good negative predictor for malignancy (Fig.
9) [4].
Other CEUS patterns are more frequent in benign lesions; rapid arterial flow in benign masses is present when hemangioma or artero-venous malformation are present.
These preliminary results suggest that CEUS can facilitate a rapid and easy identification of masses potentially malignant,
therefore CEUS could...
References
[1] Fletcher CD,Unni KK,
Mertens F,
eds.
WHO classification of tumors of soft tissue and bone.
Lion France.
IARC 2002
[2] Kransdorf MJ ,
Murphy MD.
Radiologic evaluation of soft tissue masses: a current perspective.
AJR American J Roentgenol ; 175: 575-587.2000
[3] Cosgrove D,
Lassau N.
Evaluation de l’angiogenese tumorale a l’aide de l’echographie de contraste.
J Radiol 2009;90:156-64
[4] Gay F,
Pierucci F,
Zimmermann V et al Contrast- enhanced ultrasonography of peripheral soft-tissue tumors: feasibility study and preliminary results.
Diagnostic and international imaging...