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Ultraschall Med 2010; 31(3): 264-269
DOI: 10.1055/s-0028-1109812
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Contrast-Enhanced Ultrasound Pattern of Splenic Metastases – a Retrospective Study in 32 Patients

Kontrastunterstützte sonografische Befunde bei Milzmetastasen – eine restrospektive Studie an 32 PatientenA. Neesse1 , J. Huth1 , S. Kunsch1 , P. Michl1 , T. Bert2 , J. J. Tebbe3 , T. M. Gress1 , C. Görg4
  • 1Gastroenterology, Endocrinology and Metabolism, University of Marburg
  • 2Department of Internal Medicine, Gastroenterology, Oncology and Endocrinology, Zentralklinikum Bad Berka
  • 3Department of Internal Medicine and Gastroenterology, Klinikum Lippe
  • 4Hematology, Oncology and Immunology, University of Marburg
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Publikationsverlauf

received: 16.5.2009

accepted: 3.9.2009

Publikationsdatum:
06. November 2009 (online)

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Zusammenfassung

Ziel: Ziel ist die Charakterisierung von Milzmetastasen in der kontrastmittelunterstützten Sonografie (CEUS) und die Evaluation der diagnostischen Wertigkeit im Vergleich zur konventionellen B-Bild-Sonografie. Material und Methoden: Von Januar 2004 März 2009 wurde bei ca. 50 000 abdominellen B-Bild-Sonografien n = 279 Fällen (< 0,6 %) eine fokale Milzläsion detektiert. Bei n = 32 (11,5 %) bestand der hochgradige Verdacht auf Milzmetastasierung von unterschiedlichen soliden Tumoren. Die Läsionen wurden im B-Bild hinsichtlich Anzahl, Größe, Echogenität, Häufigkeiten von Halozeichen und Nekrosebildung untersucht. In der CEUS wurde das Ausmaß der Kontrastmittelanreicherung im Vergleich zum umgebenden Milzgewebe während der arteriellen (5 – 30 s) und parenchymatösen Phase (3 – 5 min) bestimmt. Alle Daten wurden retrospektiv ausgewertet. Ergebnisse: Im B-Bild waren die Läsionen solitär n = 18 (56 %), multiple n = 14 (44 %), < 2 cm n = 11 (34 %), ≥ 2 cm n = 21 (66 %), echoarm n = 14 (44 %), isoechogen n = 12 (38 %), echoreich n = 6 (19 %), glatt begrenzt n = 27 (84 %) irregulär begrenzt n = 5 (16 %). In der arteriellen Phase der CEUS waren die Läsionen hypoechogen n = 21 (66 %), isoechogen n = 3 (6 %), hyperechogen n = 1(3 %) und komplex n = 8 (25 %). In der parenchymatösen Phase waren die Läsionen hypoechogen n = 24 (75 %) und komplex n = 8 (25 %). In n = 12 (38 %) Fällen konnte mittels CEUS eine bessere Darstellung der Milzmetastasen erzielt werden. Schlussfolgerung: Milzmetastasen zeigen sowohl in der arteriellen als auch parenchymalen Phase der CEUS eine verminderte Kontrastmittelanreicherung. CEUS kann bei ca. 40 % der Patienten die Darstellung der Milzmetastasen im Vergleich zur B-Bild-Sonografie verbessern.

Abstract

Purpose: To characterize the pattern of contrast-enhanced ultrasonography (CEUS) in splenic metastases compared to standard B-mode ultrasonography. Materials and Methods: Between January 2004 and March 2009, about 50,000 abdominal ultrasound examinations were performed, and n = 279 (< 0.6 %) of focal splenic lesions were detected of which n = 32 (11.5 %) were highly suggestive for splenic metastases of various solid tumors. The number of lesions, size, echogenicity, rim appearance, presence of halo sign and necrosis were recorded via B-mode sonography. Contrast enhancement was determined in the arterial phase (5 – 30 sec) and parenchymal phase (3 – 5 min). B-mode sonography and CEUS were compared in terms of the visibility of splenic metastases. All data was evaluated retrospectively. Results: On B-mode sonography lesions were solitary n = 18 (56 %), multiple n = 14 (44 %), < 2 cm n = 11 (34 %), ≥ 2 cm n = 21 (66 %), hypoechoic n = 14 (44 %), isoechoic n = 12 (38 %) and hyperechoic n = 6 (19 %), with regular rim appearance n = 27 (84 %), and with irregular rim appearance n = 5 (16 %). During the arterial phase CEUS lesions were hypoechoic n = 21 (66 %), isoechoic n = 2 (6 %), hyperechoic n = 1 (3 %) and complex n = 8 (25 %). During the parenchymal phase lesions were hypoechoic n = 24 (75 %) and complex n = 8 (25 %). CEUS provided improved visualization of splenic metastases in n = 12 (38 %) cases. Conclusion: CEUS of splenic metastases is characterized by reduced contrast enhancement in both the arterial and the parenchymal phase in most cases. Moreover, CEUS improved the visualization of splenic metastases in about 40 % of cases in comparison to standard B-mode sonography.

Key words

spleen - contrast-enhanced ultrasonography - splenic metastases - focal splenic lesions

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Dr. Albrecht Neesse

Gastroenterology, Endocrinology and Metabolism, University of Marburg

Baldingerstr.

35043 Marburg

Germany

Telefon: ++ 49/64 21/5 86 64 60

Fax: ++ 49/64 21/5 86 89 22

eMail: neesse@med.uni-marburg.de