# Analysis of Conventional Ultrasound and Contrast-Enhanced Ultrasound Features of Pseudoangiomatous Stromal Hyperplasia

## TL;DR

This study examines ultrasound and contrast-enhanced ultrasound features of a rare breast condition called pseudoangiomatous stromal hyperplasia to improve its diagnosis.

## Contribution

The study identifies specific ultrasound features and contrast-enhanced ultrasound patterns that improve diagnostic accuracy for pseudoangiomatous stromal hyperplasia.

## Key findings

- Linear/cystic hypoechoic areas on conventional ultrasound are common in PASH lesions.
- Contrast-enhanced ultrasound shows patchy perfusion defects that correspond to hypoechoic regions seen in conventional ultrasound.
- CEUS increases diagnostic specificity for PASH from 35.7% to 64.3%.

## Abstract

Purpose: To investigate the conventional ultrasound and contrast-enhanced ultrasound (CEUS) imaging features of pseudoangiomatous stromal hyperplasia (PASH).

Methods: Retrospective analysis of clinical and imaging data of 29 patients diagnosed with PASH from June 2014 to June 2023.

Results: The median age of the patients was 39 years. Linear/cystic hypoechoic areas could be detected within the lesion in 12 cases (41.4%), and in 17 cases, the lesions had extensive conventional ultrasound findings with no significant features. The ultrasound-measured lesion diameters were smaller than those measured in surgically resected lesions, and the statistical difference was highly significant (p < 0.01). Fifteen cases underwent CEUS examination, with 7 lesions (46.7%) demonstrating uniform enhancement and 8 lesions (53.3%) exhibiting nonuniform enhancement. Within the enhanced regions, perfusion defects were observed, all of which were of the patchy type. The areas of patchy perfusion defects corresponded to the linear/cystic hypoechoic regions observed in the conventional sonographic images of the lesions. The use of CEUS provided additional diagnostic clarity compared with conventional ultrasound. Specifically, the specificity for identifying PASH lesions increased from 35.7% with conventional ultrasound to 64.3% with CEUS, highlighting the value of CEUS in enhancing the diagnostic accuracy for PASH lesions.

Conclusion: This study suggests that linear/cystic hypoechoic areas on sonography may serve as crucial clues for the ultrasound diagnosis of PASH. The presence of diffuse patchy perfusion defects in CEUS contributes to the accurate diagnosis of PASH.