Novel ultrasound techniques in the study of soft-tissue masses, with special consideration of the pediatric population – a scoping review

This scoping review aimed to evaluate the feasibility and diagnostic accuracy of contrast-enhanced ultrasound, shear-wave elastography, and strain elastography in the assessment of pediatric soft-tissue masses. Across the existing literature, the diagnostic performance of these advanced ultrasound techniques remains inconsistent. Substantial methodological heterogeneity was identified, including variability in reporting standards, differences in preset elasticity color scales, divergent shear-wave velocity thresholds, and inconsistent interpretation of strain ratios, all of which significantly limit inter-study comparability. Importantly, the applicability of the current evidence base to pediatric practice is limited, as studies including exclusively pediatric cohorts are scarce, with most investigations conducted in adult or mixed-age populations. Furthermore, few studies provided a detailed evaluation of real-world feasibility, such as acquisition time, patient compliance, or failure rates, which are critical considerations in children. Among the included studies, contrast-enhanced ultrasound and strain elastography demonstrated more consistent diagnostic trends, whereas shear-wave elastography yielded heterogeneous and often conflicting results. In particular, strain elastography showed a recurring association between increased tissue stiffness and malignant lesions, suggesting potential clinical utility. Overall, the findings support a multiparametric ultrasound approach that integrates contrast-enhanced ultrasound and elastography with conventional B-mode and Doppler imaging as the most promising strategy for improving diagnostic confidence and potentially reducing reliance on invasive diagnostic procedures in the pediatric population.