Mediastinal Masses in Contrast‐Enhanced Ultrasound ‐ Retrospective Analysis of 58 Cases

Abstract

Objectives To determine contrast enhancing features of mediastinal masses (ML) using transcutaneous contrast‐enhanced ultrasound (CEUS). Methods Retrospective analysis of n = 58 patients with histologically confirmed ML, which were examined in the period from October 2005 to February 2018 using transcutaneous B‐mode ultrasound and CEUS. In n = 29 (50%) histological confirmation was performed by ultrasound guided core‐needle biopsy. The lesions were evaluated using CEUS in regard to the enhancement pattern (hyper‐, iso‐, hypoenhancement, non‐enhancement, homogenous, inhomogenous) compared to enhancement of the spleen as an in vivo reference. Results N = 53 (91.4%) of ML were malignant (m) (lymphoma n = 36, metastasis n = 11, thymoma n = 2, teratoma n = 1, sarcoma n = 2, seminoma n = 1). In n = 5 (8.6%) cases there was a benign (b) histology (thyroid tissue n = 2, thymus residue n = 1, ganglioneurinoma n = 1, scar tissue: n = 1). In ultrasound, n = 53 (91.4%; (48 = m, 5 = b)) were hypoechoic, n = 5 (8.6%, (5 = m,0 = b)) hyperechoic. In CEUS, n = 35 lesions presented an arterial isoenhancement (60.3%; 33 = m, 2 = b). An arterial hypoenhancement had n = 21 (36.2%, (20 = m,1 = b)), and no enhancement showed n = 2 (3.5%, (0 = m, 2 = b) of the ML. A parenchymal isoenhancement was observed in n = 1 (1.7%, (1 = m, 0 = b)), a hypoenhancement in n = 54 (93.1%; 51 = m, 3 = b) of the patients and almost no enhancement in n = 3 ML (5.2%, (1 = m, 2 = b).) The enhancement was homogeneous in n = 26 (44.8%, (25 = m,1 = b)) cases, in n = 31 (53.5%, (28 = m,3 = b)) inhomogeneous and n = 1 (1.7%) benign lesion was exclusively cystic. Conclusion In CEUS, mediastinal tumor formations showed variable arterial enhancement, followed by parenchymal hypoenhancement (wash‐out).

Transcutaneous B-mode ultrasound (TUS) and contrast-enhanced ultrasound (CEUS) pattern of mediastinal tumors: a pictorial essay

“…The CEUS examinations were carried out with a Siemens ACUSON SEQUOIA 512 GI ultrasound scanner (Siemens, Erlangen, Germany) and a 4C1 curved array transducer in 1.5 MHz contrast-specific mode, and a bolus injection of 2.4 ml of SonoVue® (Bracco Imaging S.p.A., Milan) CM via a peripheral (anechoic, echogenic, complex), and homogeneity (homogeneous, inhomogeneous) should be performed (1,7) . Contrastenhanced ultrasound allows the assessment of contrast enhancement in terms of extent and homogeneity (homogenous, inhomogeneous), and perfused and nonperfused tissue can be reliably differentiated based on the strictly intravascular localized ultrasound contrast medium (CM) (8) . In the knowledge that a histology assessment that is relevant for therapy must be performed in the majority of MTs, US-guided biopsy based on the CEUS findings represents a supporting pillar for the evaluation of MTs (8) .…”

“…Contrastenhanced ultrasound allows the assessment of contrast enhancement in terms of extent and homogeneity (homogenous, inhomogeneous), and perfused and nonperfused tissue can be reliably differentiated based on the strictly intravascular localized ultrasound contrast medium (CM) (8) . In the knowledge that a histology assessment that is relevant for therapy must be performed in the majority of MTs, US-guided biopsy based on the CEUS findings represents a supporting pillar for the evaluation of MTs (8) .…”