目的:脂肪性软组织肿瘤(STT),从良性脂肪瘤到恶性脂肪肉瘤,需要准确的鉴别才能及时治疗。作为MRI的补充,超声造影(CEUS)正在成为一种有前途的工具,实时提供对肿瘤微灌注的洞察。本研究旨在探讨术前CEUS在鉴别良性脂肪瘤和恶性脂肪肉瘤亚型中的潜力。
方法:纳入87例计划手术的脂肪性STT患者。进行临床和MRI评估以获得一般肿瘤特征。CEUS用于标准化的肿瘤灌注评估。灌注分析包括峰值增强,上升时间,洗入灌注指数,和冲洗率,反映了灌注动力学。获得每个STT的组织病理学结果,并与灌注特征进行比较。
结果:总计,48脂肪瘤,鉴定出23例ALT和11例脂肪肉瘤。证明了肿瘤微灌注的显着差异,具有较高的灌注水平,表明恶性程度较高(脂肪瘤的峰值增强[a.u.]:145±238;ALT:268±368;脂肪肉瘤:3256±4333;p(ALT与脂肪肉瘤)<0.001)。良性脂肪瘤或ALT与肉瘤的基于灌注的鉴定导致93%的阳性预测值。患者相关因素(年龄,性别,BMI,ASA得分,吸烟状态)对基于CEUS的灌注参数没有显着影响。
结论:我们的研究表明,CEUS是一种有效的非侵入性工具,可改善脂肪瘤性STT的术前评估。它可以帮助区分良性和恶性STT,加速治疗决策并提高患者预后。CEUS衍生参数与恶性肿瘤之间的显着相关性突出了其风险评估潜力。
OBJECTIVE: Lipomatous soft tissue tumors (STT), ranging from benign lipomas to malignant liposarcomas, require accurate differentiation for timely treatment. Complementary to MRI, Contrast-enhanced ultrasound (CEUS) is emerging as a promising tool, providing insight into tumor microperfusion in real-time. This study aims to explore the potential of preoperative CEUS in differentiating benign lipomatous tumors from malignant liposarcoma subtypes.
METHODS: Eighty-seven patients with lipomatous STT scheduled for surgery were enrolled. Clinical and MRI assessments were conducted to obtain general tumor characteristics. CEUS was used for a standardized tumor perfusion evaluation. Perfusion analysis included peak enhancement, rise time, wash-in perfusion index, and wash-out rate, reflecting the perfusion kinetics. Histopathological results were obtained for every STT and compared to perfusion characteristics.
RESULTS: In total, 48
lipoma, 23 ALT and 11 liposarcoma were identified. Significant differences in tumor microperfusion were demonstrated, with higher perfusion levels indicating higher malignancy (Peak enhancement [a.u.] of
Lipoma: 145 ± 238; ALT: 268 ± 368; Liposarcoma: 3256 ± 4333; p (ALT vs. Liposarcoma) < 0.001). A perfusion-based identification of a benign
lipoma or ALT versus sarcoma resulted in a positive predictive value of 93%. Patient-related factors (age, gender, BMI, ASA score, smoking status) had no significant impact on the CEUS-based perfusion parameters.
CONCLUSIONS: Our study suggests CEUS as a capable non-invasive tool for improving preoperative assessment of lipomatous STT. It can assist in the distinction between benign and malignant STT, accelerating treatment decisions and enhancing patient outcomes. Significant correlations between CEUS-derived parameters and malignancy highlight its risk assessment potential.