Qualitative and Quantitative Contrast-Enhanced Ultrasound Combined with Conventional Ultrasound for Predicting the Malignancy of Soft Tissue Tumors

Abstract

This study was aimed at evaluating the performance of perfusion patterns and the quantitative parameters of contrast-enhanced ultrasound (CEUS) in the detection of soft tissue tumors (STTs) and establishing a US workflow for STTs to improve patient management. Conventional ultrasound (US) and CEUS data were retrospectively collected from 156 soft tissue masses. Six perfusion patterns (P1-P6) were applied for CEUS qualitative analysis. Multivariate logistic regression was used to evaluate the performance of conventional US and qualitative and quantitative CEUS in distinguishing benign and malignant STTs. The malignancy rates of P1-P6 in STTs were 0%, 50.0%, 9.1%, 33.3%, 73.4% and 61.0%, respectively. For "non-P1" STTs, the predictive model combining quantitative CEUS parameters with conventional US features, including margin (odds ratio [OR] = 4.490, p = 0.000), vascular density (OR = 2.307, p = 0.013), 50% wash-out intensity (OR = 1.904, p = 0.032) and 50% wash-out time (OR = 1.031, p = 0.019), performed favorably in predicting malignancy, with an accuracy of 81.0% and an area under the receiver operating characteristic curve of 0.868. Furthermore, a US workflow for the detection of STTs based on conventional US and CEUS was established. CEUS with qualitative and quantitative analyses could be an effective tool for STT diagnosis. The US workflow in this study may improve the management of STT patients.

Keywords: Contrast-enhanced ultrasound; Malignancy; Qualitative and quantitative analyses; Soft tissue tumor.