{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:12:10Z","timestamp":1780402330287,"version":"3.54.1"},"reference-count":33,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Pleura-based pulmonary nodules in soft-tissue sarcoma (STS) patients remain diagnostically challenging, and entity-specific contrast-enhanced ultrasound (CEUS) data are scarce. We aimed to characterize CEUS perfusion patterns of pleura-based STS pulmonary metastases in a pilot cohort. Methods: We investigated a single-center retrospective cohort at a tertiary STS referral center (Dec 2024\u2013Dec 2025). Of 51 consecutive STS patients with suspected pulmonary metastases screened, 32 lacked pleural contact and 6 were excluded for logistical reasons; the remaining 13 underwent standardized CEUS of a pleura-contacting lesion (\u22655 mm) visible on B-mode lung ultrasound (B-LUS), with 1 excluded on biopsy (anaplastic lymphoma). The reference standard combined histology, therapy-related size reduction of the index lesion, and\/or documented distant metastatic STS. Two readers rated all examinations independently, with adjudication by a third senior reader. Wilson 95% confidence intervals (CIs) and Cohen\u2019s \u03ba were computed. Results: In the 12 analyzed patients (mean age 58.8 \u00b1 17.8 years; 7 male), the index lesion was histologically confirmed in 4 (33.3%). On CEUS, bronchial-arterial (BA) enhancement predominated (10\/12; 83.3%, 95% CI 55.2\u201395.3%) and pulmonary-arterial timing occurred in 2\/12 (16.7%). Marked enhancement was present in 9\/12 (75.0%), homogeneous in 8\/12 (66.7%), and rapid washout (&lt;120 s) in all lesions (12\/12; 100%, 95% CI 75.8\u2013100%). Inter-reader agreement was substantial to almost perfect for the diagnostically relevant CEUS perfusion variables (enhancement \u03ba = 0.75; EE \u03ba = 0.80; HE \u03ba = 0.82) and moderate for the descriptive shape variable (Form \u03ba = 0.47). Conclusions: In this selected pilot cohort, pleura-based STS lung metastases most commonly showed BA-dominant enhancement with universal rapid washout. The findings are hypothesis-generating and require validation in larger, prospective multicenter cohorts.<\/jats:p>","DOI":"10.3390\/diagnostics16111706","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:25:31Z","timestamp":1780399531000},"page":"1706","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perfusion Patterns of Pleura-Based Pulmonary Sarcoma Metastases on Contrast-Enhanced Ultrasound (CEUS): A Single-Center Retrospective Pilot Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6774-5469","authenticated-orcid":false,"given":"Felix Ragnar Merlin","family":"Koenig","sequence":"first","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"High Field Magnetic Resonance Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"G\u00f6rg","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center of Ultrasound Diagnostics, Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstra\u00dfe, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6119-6364","authenticated-orcid":false,"given":"Helmut","family":"Prosch","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1639-6829","authenticated-orcid":false,"given":"Veronika","family":"Vetchy","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3575-2007","authenticated-orcid":false,"given":"Anna","family":"Hohensteiner","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6649-6762","authenticated-orcid":false,"given":"Nikolai A.","family":"Gantner","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8087-4303","authenticated-orcid":false,"given":"Daria","family":"Kifjak","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0232-1639","authenticated-orcid":false,"given":"Florian","family":"Lindenlaub","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp Theodor","family":"Funovics","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris-Melanie","family":"Noebauer-Huhmann","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9775-3989","authenticated-orcid":false,"given":"Ehsan","family":"Safai Zadeh","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4103\/atm.ATM_110_19","article-title":"Lung nodules: A comprehensive review on current approach and management","volume":"14","author":"Loverdos","year":"2019","journal-title":"Ann. 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