Diagnostic Value of Dynamic Contrast Enhanced Ultrasound (CEUS) with Time Intensity Curve (TIC) Analysis for Differentiating Musculoskeletal Benign and Malignant Soft Tissue Tumors.

PURPOSE: This retrospective study evaluated the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with time-intensity curve (TIC) analysis for differentiating benign from malignant soft tissue lesions.

MATERIALS AND

METHODS

CEUS was performed using a linear transducer (5-18 MHz) after a bolus injection of 1.4 - 2.4 ml sulfur hexafluoride microbubbles. Quantitative perfusion parameters including arrival time (AT), time-to-peak (TTP), and area under the curve (AUC) were obtained by system integrated TIC-analysis using intralesional and perilesional regions of interest. Qualitative wash-in and wash-out dynamics were also assessed. Histology, CT and MRI served as reference standards.

RESULTS

Ninety lesions were included, comprising 51 benign (lipomas, fibromatoses, inflammatory lesions, lymph nodes and schwannomas) and 39 malignant tumors (sarcomas, lymphomas, metastases). Malignant lesions demonstrated significantly shorter TTP (mean: 15.3 ± 6.6 s vs. 29.8 ± 13.3 s) and a higher prevalence of rapid wash-in (mean: 71.2% vs 13.7%). AT tended to be shorter in malignant lesions. AUC were generally higher in malignant lesions. TIC patterns differed characteristically: benign lesions showed gradual, homogeneous enhancement, whereas malignant tumors exhibited steep early enhancement followed by wash-out.

CONCLUSION

CEUS represents a valuable adjunctive imaging modality for the characterization of soft tissue tumors. Shortened TTP and rapid wash-in/wash-out represent the most reliable malignancy indicators. Therefore, CEUS may support clinical decision making and biopsy planning.

KEY POINTS: · CEUS reliably helps to differentiate benign and malignant soft tissue tumors.. · Rapid wash-in and wash-out strongly indicate malignancy.. · Time-to-peak is the most robust quantitative TIC parameter.. · CEUS may improve planning of ultrasound-guided biopsies..

CITATION FORMAT: · Brandenstein MK, Greiner B, Hammer S et al. Diagnostic Value of Dynamic Contrast Enhanced Ultrasound (CEUS) with Time Intensity Curve (TIC) Analysis for Differentiating Musculoskeletal Benign and Malignant Soft Tissue Tumors. Rofo 2026; DOI 10.1055/a-2923-4597.