Ist die Kontrastmittelsonographie im klinischen Alltag eine robuste Methode? Eine retrospektive Analyse über 6 Monate

Zusammenfassung

Hintergrund: Die Kontrastmittel-Sonographie als relativ neue Methode erfährt eine zunehmende Verbreitung und Indikationsausweitung. Unter Studienbedingungen ist die Treffsicherheit hervorragend mit hohen negativ und positiv prädiktiven Werten. Daten zur Übertragbarkeit auf den klinischen Alltag sind spärlich.

Patienten und Methodik: Retrospektive Analyse aller konsekutiven Kontrastmittel-Sonographien innerhalb von 6 Monaten (n=238).

Ergebnisse: 68 % der Kontrastmittel-Sonographien betrafen die Leber.  Bei 83 % (n=197) ging es um die Charakterisierung potenziell neoplastischer Raumforderungen, 95 % davon konnten geklärt werden. In 44 % führte die Kontrastmittel-Sonographie zu einer Änderung der Diagnose, in 74 % war sie die abschließende Bildgebung. Eine Konkordanz zu CT oder MRT zeigte sich in 64 %, zur Histologie in 77 %. Die Ergebnisse sind mit prospektiven Studien vergleichbar.

Folgerung: Die Leistung der Kontrastmittelsonographie ist im klinischen Alltag ähnlich gut wie unter kontrollierten Studienbedingungen, es handelt sich also um eine robuste Methode.

Abstract

Background: CEUS is a relatively new imaging method with growing use and broadening applications. It shows excellent accuracy with high negative and positive predictive values under study conditions. It is not well known, whether the study results can be reproduced in daily clinical practice.

Methods: Retrospective analysis of all consecutive CEUS-exams at our institution during a six month period.

Results: 68 % of CEUS-exams were of the liver. 83 % (197 exams) concerned the characterisation of focal lesions. 95 % of focal lesions could be clarified via CEUS. In 44 % of the exams, CEUS changed the diagnosis of B-mode-US, in 74 % of exams, CEUS was the final imaging method. We found a 64 % concordance to cross sectional imaging and a 77 % concordance to histology, when available.

Conclusion: CEUS performance in daily clinical practice is comparable to controlled study conditions. CEUS is therefore a robust imaging method.

Schlüsselwörter

Sonographie - Kontrastmittelsonographie - Leistungsfähigkeit - klinischer Alltag - Indikation - Raumforderung - Leberraumforderung

Keywords

ultrasound - contrast-enhanced ultrasound - performance - daily practice - indication - focal lesion - focal liver lesion

• Literatur

• 1 Albrecht T, Blomley M, Bolondi L et al. Guidelines for the use of contrast agents in ultrasound. Ultraschall in Med 2004; 25: 249-256
• 2 Braden B, Ignee A, Hocke M et al. Diagnostic value and clinical utility of CEUS in intestinal diseases. Dig Liver Dis 2010; 42: 667-674
• 3 Chiavaroli R, Grima P, Tundo P. Characterization of nontraumatic focal splenic lesions using CEUS. J Clin Ultrasound 2011; 39: 310-315
• 4 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008. Ultraschall in Med 2008; 29: 28-44
• 5 D'Onofrio M, Barbi E, Dietrich CF. Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol 2012; 81: 630-638
• 6 D'Onofrio M, Zamboni G, Tognolini A et al. Mass-forming pancreatitis: value of contrast-enhanced ultrasonography. World J Gastroenterol 2006; 12: 4181-4184
• 7 Giesel FL, Delorme S, Sibbel R et al. Contrast-enhanced ultrasound for the characterization of incidental liver lesions – an economical evaluation in comparison with multi-phase computed tomography. Ultraschall in Med 2009; 30: 259-268
• 8 Görg C, Faoro C, Bert T et al. CEUS of splenic lymphoma involvement. Eur J Radiol 2011; 80: 169-174
• 9 Haendl T, Strobel D, Legal W et al. Renal cell cancer does not show a typical perfusion pattern in CEUS. Ultraschall Med 2009; 30: 58-S63
• 10 Hohmann J, Skrok J, Basilico R et al. Characterisation of focal liver lesions with unenhanced and contrast enhanced low MI real time ultrasound: On-site unblinded versus off-site blinded reading. Eur J Radiol 2012; 81: e317-e324
• 11 Ignee A, Straub B, Brix D et al. The value of CEUS in the characterisation of patients with renal masses. Clin Hemorheol Microcirc 2010; 46: 275-290
• 12 Lanka B, Jang H-J, Kim TK et al. Impact of contrast-enhanced ultrasonography in a tertiary clinical practice. J Ultrasound Med 2007; 26: 1703-1714
• 13 Lu Q, Zhong Y, Wen XR et al. Can contrast-enhanced ultrasound evaluate the severity of acute pancreatitis?. Dig Dis Sci 2011; 56: 1578-1584
• 14 Madsen HH, Rasmussen F. CEUS in oncology. Cancer imaging 2011; 11: 167-173
• 15 Moriyasu F, Itho K. Efficacy of perflubutane microbubble-enhanced ultrasound in the characterization and detection of focal liver lesions: phase 3 multicenter clinical trial. Am J Roentgenol 2009; 193: 86-95
• 16 Park BK, Kim B, Kim SH et al. Assessment of cystic renal masses based on Bosniak classifiaction: comparison of CT and CEUS. Eur J Radiol 2007; 61: 310-314
• 17 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall in Med 2012; 33: 33-59
• 18 Quaia E, Calliada F, Bertolotto M et al. Characterization of focal liver lesions with contrast-specific US Modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 2004; 232: 420-430
• 19 Seitz K, Strobel D, Bernatik T. CEUS for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs CT (DEGUM multicenter trial). Ultraschall in Med 2009; 30: 383-389
• 20 Seitz K, Bernatik T, STrobel D. CEUS for the characterization of focal liver lesions in clinical practice (DEGUM multicenter trial): CEUS vs MRI – a prospective comparison in 269 patients. Ultraschall in Med 2010; 31: 492-499
• 21 Sporea I, Badea R, Martie A et al. Contrast Enhanced Ultrasound for the characterization of focal liver lesions. Med Ultrason 2011; 13: 38-44
• 22 Stang A, Keles H, Hentschke S et al. Incidentally detected splenic lesions in ultrasound: does CEUS improve the Differentiation of benign hemangioma/hamartoma from malignant lesions?. Ultraschall in Med 2011; 32: 582-592
• 23 Strobel D, Seitz K, Blank W et al. CEUS for the characterization of focal liver lesions- Diagnostic accuracy in Clinical Practice (DEGUM multicenter trial). Ultraschall in Med 2008; 29: 499-505
• 24 Tranquart F, Correas JM, Ladam Marcus V et al. Real-time CEUS in the evaluation of focal liver lesions: diagnostic efficacy and economical issues form a French multicentric study. J Radiol 2009; 90: 109-122
• 25 Trillaud H, Bruel J-M, Valette P-J et al. Characterization of focal liver lesions with Sonovue-enhanced sonography: International multicenter-study in comparison to CT and MRI. World J Gastroenterol 2009; 15: 3748-3756
• 26 Wang W-P, Wu Y, Luo Y et al. Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions: a prospective multicenter trial. Hepatobiliary Pancreat Dis Int 2009; 8: 370-376
• 27 Wilson S, Jang H-J, Kim TK et al. Diagnosis of Focal Liver Masses on Ultrasonography Comparison of Unenhanced and Contrast-Enhanced Scans. J Ultrasound Med 2007; 26: 7765-787
• 28 Xie L, Guang Y, Ding H et al. Diagnostic value of contrast-enhanced ultrasound, CT und MRI for focal liver lesions: a meta-analysis. Ultrasound Med Biol 2011; 37: 854-861