Stellenwert der kontrastunterstützten Sonografie im Vergleich zur B-Bild-Sonografie in der Charakterisierung fokaler Leberläsionen bei zugrunde liegender maligner hämatologischer Erkrankung: Eine retrospektive Studie mit n = 61 Patienten

Zusammenfassung

Ziel: Ziel der retrospektiven Studie ist es, den Stellenwert der kontrastunterstützten Sonografie (CEUS) in der Dignitätsbeurteilung von fokalen Leberherden im Vergleich zur B-Bild-Sonografie (US) bei Patienten mit malignen hämatologischen Systemerkrankungen (MHS) zu untersuchen.

Patienten und Methoden: Zwischen November 2005 und Februar 2009 wurden bei n = 61 Patienten (24 weiblich, 37 männlich) mit MHS im US fokale Leberläsionen diagnostiziert. Bei Vorliegen einer nicht eindeutig zystischen Läsion (n = 48) wurde neben dem US, eine CEUS durchgeführt und dokumentiert. Die zugrunde liegenden Diagnosen waren Stammzellerkrankungen (n = 31) und maligne Lymphome (n = 30). Bei n = 17 Patienten wurde der Leberherd im Rahmen der Primärdiagnose dokumentiert, n = 13 Patienten befanden sich im Rezidiv und n = 31 in kompletter Remission (CR). Die Diagnosesicherung der Leberpathologie erfolgte durch klinisch-sonografische Verlaufsuntersuchungen (n = 22), CT bzw. MRT (n = 18) und Histologie (n = 21).

Ergebnisse: Insgesamt wurden in 67 % der Fälle benigne und in 33 % maligne Läsionen diagnostiziert. In Bezug auf den therapeutischen Status wiesen benigne Herde eine andere prozentuale Verteilung auf als maligne: Primärdiagnose 53 vs. 47 %, Rezidiv 31 vs. 70 %, CR 90 vs. 10 %. Die Häufigkeitsverteilung benigner versus maligner Leberherde war bei Stammzellerkrankungen 94 vs. 6 % und bei malignen Lymphomen 40 vs. 60 %. In der Dignitätsbeurteilung fokaler Leberläsionen zeigte CEUS im Vergleich zum US eine Sensitivität von 90 vs. 45 % und eine Spezifität von 96 vs. 18 % (p < 0,0001).

Schlussfolgerung: CEUS besitzt einen hohen diagnostischen Stellenwert bei der Charakterisierung fokaler Leberläsionen und sollte im Rahmen der Stagingprozeduren bei Patienten mit MHS durchgeführt werden.

Abstract

Purpose: The aim of the retrospective study is to illustrate the role of contrast-enhanced ultrasound (CEUS) in the dignity assessment of focal liver lesions compared to B-mode ultrasound (US) in patients with malignant haematological diseases (MHD).

Patients and Methods: Focal liver lesions were diagnosed in n = 61 patients (24 female, 37 male) with MHD via US within the period from November 2005 to February 2009. After the presentation of a not clearly cystic liver lesion (n = 48), CEUS was performed and documented in addition to US. The underlying diagnoses were stem cell diseases (n = 31) and malignant lymphomas (n = 30). The detection of a lesion was documented in n = 17 patients with at this time point primary diagnosed haematological disease, n = 13 patients were in relapse and n = 31 in complete remission (CR). The diagnoses of the liver pathology were confirmed through sonographic follow-up studies and clinical courses (n = 22), CT/MRI (n = 18) and histology (n = 21).

Results: In total 67 % of the cases were diagnosed as benign and 33 % as malignant liver lesions. Regarding the therapeutic state, the numbers of benign lesions differ from those of malignant lesions: primary diagnosis 53 vs. 47 %, relapse 69 vs. 31 %, CR 90 vs. 10 %. The frequency distributions of benign versus malignant lesions were 94 vs. 6 % in patients with stem cell diseases and 40 vs. 60 % in patients with malignant lymphomas. Regarding dignity assessment of focal liver lesions, CEUS showed a sensitivity of 90 vs. 45 % and specificity of 96 vs. 18 % (p < 0.0001) compared to US. 

Conclusion: CEUS possesses a significant diagnostic value in the characterization of focal liver lesions and should be used in the context of staging procedures in patients with MHD.

Schlüsselwörter

Leber - Lymphom - CEUS - fokale Leberläsionen - Kontrastmittel

Key words

Liver - Lymphoma - CEUS - focal liver lesions - contrast media

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