Contrast‐Enhanced Sonography for Monitoring Neoadjuvant Chemotherapy in Soft Tissue Sarcomas

Abstract

Neoadjuvant chemotherapy is a mainstay in treating soft tissue sarcomas. Soft tissue sarcomas can show an increase in size and central necrosis, with a decrease in the viable tumor, as an initial response to neoadjuvant chemotherapy. Thus, the maximum tumor diameter may not reliably assess the response to this therapy. Contrast-enhanced sonography may address this limitation. We evaluated 4 patients with soft tissue sarcomas by contrast-enhanced sonography, performed concomitantly with conventional imaging (computed tomography, magnetic resonance imaging, or positron emission tomography). Quantitative analysis was also performed on 1 sarcoma. A viable, enhancing tumor versus tumor necrosis was nearly identical on contrast-enhanced sonography and conventional imaging. Preliminary results demonstrate potential for contrast-enhanced sonographic monitoring of soft tissue sarcomas during neoadjuvant chemotherapy.

Use of contrast ultrasound in differentiating thrombosed pseudoaneurysm from sarcoma, prior to surgery

“…If it was incompletely thrombosed, vascular flow within the pseudoaneurysm should be identifiable, similar to endoleak in a grafted abdominal aortic aneurysm [21] , which would be useful preoperative information to the vascular surgeon. If there was focal, soft tissue-type enhancement, it would be targeted for biopsy at the same visit, and would have a higher expected yield than a random FNA biopsy [ 8 , 22 ]. The patient could then be referred to the appropriate surgical specialist.…”

“…Contrast ultrasound is also able to differentiate bland versus tumor thrombus within the portal vein, in the setting of cirrhosis and hepatocellular carcinoma, respectively [7] . It has also proven useful in evaluating extremity sarcoma response to neoadjuvant chemotherapy [8] as well as in guiding percutaneous image-guided biopsies [9] , by identifying viable vascular and necrotic tissue. Acquisition of both viable and necrotic tissue during sarcoma biopsy is important for accurate tumor grading [10] .…”

Radiological investigations in orthopaedic oncology

“…Preliminary results using contrast-enhanced sonography show potential for monitoring soft-tissue sarcomas during neoadjuvant chemotherapy, although it is still in its infancy. 33 …”

Musculoskeletal Imaging: Current Practice and Future Directions

“…95 CEUS also showed promise in the evaluation of early treatment response to antiangiogenic treatment in solid tumors, a potential technique that could be adopted for soft tissue tumors. 96 Although CEUS is widely used in Europe and Asia, to date no contrast agent for US has been approved by the FDA for MSK imaging, limiting its current role to a research tool. Superb microvascular imaging (SMI) was recently developed in an effort to improve the sensitivity of power Doppler and to overcome the limitations of CEUS.…”