Contrast-Enhanced Ultrasound and Strain Elastography for Differentiating Benign and Malignant Parotid Tumors

Abstract

Objectives Preoperative differentiation between benign parotid tumors (BPT) and malignant parotid tumors (MPT) is crucial for treatment decisions. The purpose of this study was to investigate the benefits of combining contrast-enhanced ultrasound (CEUS) and strain elastography (SE) for preoperative differentiation between BPT and MPT.

Methods A total of 115 patients with BPT (n=72) or MPT (n=43) who underwent ultrasound (US), SE, and CEUS were enrolled. US and CEUS features and the elasticity score were evaluated. Receiver operating characteristic curve (ROC) analysis was used to assess the diagnostic performance of SE, CEUS, and SE + CEUS with respect to identifying MPT from BPT.

Results Solitary presentation, larger diameter, irregular shape, ill-defined margin, heterogeneous echogenicity, and calcification on US and higher elasticity score on SE had a significant association with malignancy. MPT also presented an unclear margin, larger size after enhancement, and “fast-in and fast-out” pattern on CEUS. The combination of SE and CEUS was effective for differentiating MPT from BPT (AUC: 0.88, 0.80–0.95), with a sensitivity of 86.0%, specificity of 88.9%, and accuracy of 87.8%, which were significantly higher than the values for SE (AUC: 0.75, 0.66–0.85) and CEUS (AUC: 0.82, 0.73–0.91) alone.

Conclusion The combination of CEUS and SE is valuable for distinguishing MPT from BPT.

Zusammenfassung

Ziel Die präoperative Differenzierung zwischen benignen Parotistumoren (BPT) und malignen Parotistumoren (MPT) ist maßgeblich für die Behandlungsentscheidung. Ziel dieser Studie war es, den Nutzen einer Kombination aus kontrastverstärktem Ultraschall (CEUS) und Strain-Elastografie (SE) zur präoperativen Differenzierung von BPT und MPT zu untersuchen.

Methoden Insgesamt wurden 115 Patienten mit BPT (n=72) oder MPT (n=43) eingeschlossen, die sich einer Ultraschalluntersuchung (US), SE und CEUS unterzogen. US- und CEUS-Merkmale sowie der Elastizitäts-Score wurden ausgewertet. Mit Hilfe der ROC-Analyse (Receiver Operating Characteristic Curve) wurde die diagnostische Leistung von SE, CEUS und SE + CEUS im Hinblick auf die Differenzierung von MPT und BPT bewertet.

Ergebnisse Solitäres Auftreten, größerer Durchmesser, unregelmäßige Form, schlecht definierter Rand, heterogene Echogenität und Verkalkung auf US und ein höherer Elastizitätswert in der SE standen in einem signifikanten Zusammenhang mit Malignität. MPT zeigen auch einen unklaren Rand, einen größeren Umfang nach dem Enhancement und ein „Fast-in und Fast-out“-Muster im CEUS. Die Kombination von SE und CEUS war effektiv, um MPT und BPT zu differenzieren (AUC: 0,88; 0,80–0,95), mit einer Sensitivität von 86,0%, einer Spezifität von 88,9% und einer Genauigkeit von 87,8% – diese Werte waren signifikant höher als die für SE (AUC: 0,75; 0,66–0,85) und CEUS (AUC: 0,82; 0,73–0,91) allein.

Schlussfolgerung Die Kombination von CEUS und SE ist wertvoll, um MPT von BPT zu differenzieren.

Keywords

contrast-enhanced ultrasound - strain elastography - benign parotid tumors - malignant parotid tumors

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