Presentation of histologically confirmed mesenteric masses in B-mode imaging and contrast enhanced ultrasound (CEUS): a 10 year retrospective study in 69 patients

Purpose: Analysis of mesenteric masses in B-mode imaging and contrast enhanced ultrasound (CEUS).

Patients/Methods: from January 2006 to January 2016, n = 69 patients with mesenteric masses were examined by B-mode imaging, followed by CEUS. The contrast enhancement of the lesions was evaluated in comparison to the enhancement of the parenchymal organs. Histological diagnosis was available for all cases. Malignant diagnoses included lymphoma, GIST, NET, sarcoma and metastases, whereas benign cases consisted of mesenteritis, lymph nodes, adipose tissue, panniculitis and others.

Results: In B-mode imaging the lesions presented hypoechoic in n = 46 (67%), hyperechoic in n = 14 (20%), and with a complex echo pattern in n = 9 (13%). Histopathology revealed n = 45 (65%) malignant lesions and n = 24 cases (35%) with benign diagnoses. Malignant mesenteric lesions presented with arterial hyperenhancement in n = 10 (22%), isoenhancement in n = 24 (53%), a hypoenhancement in n = 7 (16%), a complex enhancement in n = 3 (7%) and n = 1 (2%) were anechoic. In the parenchymal phase, 40 cases (89%) of mesenteric lesions showed a hypoenhancement. The enhancement pattern was homogeneous in n = 29 (64%). In benign mesenteric masses arterial hyperenhancement was observed in n = 2 (8%), an isoenhancement in n = 9 (38%), a hypoenhancement in n = 10 (42%) and lesions were anechoic in n = 3 (13%) of the cases, followed by a hypoenhacement (n = 21, 88%) in the late phase. The enhancement was homogeneous in n = 16 (67%) benign lesions.

Conclusion: Mesenteric masses were predominantly (65%) malignant. In B-mode sonography and CEUS, malignant and benign masses show a similar contrast behavior with a predominant parenchymal hypoenhancement. Therefore, histology must be obtained in order to correctly diagnose unclear mesenteric masses.