Zusammenfassung
Ziel: Die diagnostische Treffsicherheit des kontrastmittelverstärkten Ultraschalls (KFU)
von traumatischen Milzverletzungen nach Embolisation der Milzarterie wurde in früher
und später Verlaufskontrolle ermittelt. Als Standardreferenz diente die kontrastverstärkte
CT. Material und Methoden: 22 Patienten mit einem mittleren Altern von 32 Jahren (15 – 57, 23 % weiblich) wurden
nach Embolisation der Milzarterie mit konventionellem Ultraschall (US), KFU und CT
untersucht. 23 Kontrollen wurden in der frühen posttraumatischen Phase 5 Tage (0 – 12)
nach Embolisation durchgeführt, und 17 Untersuchungen wurden in einer späteren Phase
69 Tage (52 – 189) nach Embolisation durchgeführt. Folgende Parameter wurden registriert:
Flüssigkeitsansammlung im Milzbett, subkapsuläre und intraparenchymale Hämatome, Lazerationen,
Infarkte und Narben. Zusätzlich wurde der Verletzungsgrad ermittelt. US und KFU wurden
getrennt von 2 Radiologen ohne Kenntnis der CT-Ergebnisse befundet. Ergebnisse: Sensitivität und Spezifität für KFU in der frühen Kontrolluntersuchung waren 85 %
und 70 % für Flüssigkeitsansammlungen im Milzbett, 80 % und 94 % für subkapsuläre
Hämatome, 83 % und 73 % für Lazerationen und 75 % und 87 % für Infarkte. Bei der Spätkontrolle
waren Sensitivität und Spezifität 60 % und 100 % für subkapsuläre Hämatome, 91 % und
67 % für intraparenchymale Hämatome, 100 % und 93 % für Lazerationen und 89 % und
100 % für Narben. Gesamtsensitivität und -spezifität für alle Läsionen lagen bei 85 %
und 95 %. Verglichen mit den CT-Befunden wurde der Verletzungsgrad bei 2 / 40 Fällen
unterbewertet und bei 3 / 40 Fällen überbewertet. Schlussfolgerung: KFU ist nützlich bei der Beurteilung posttraumatischen Milzverletzungen. Seine Treffsicherheit
bei Milzverletzungen ist mit der von CT-Untersuchungen vergleichbar. KFU kann möglicherweise
die Anwendung von CT bei Verlaufskontrollen reduzieren.
Abstract
Purpose: The aim of this study was to compare the diagnostic performance of contrast-enhanced
ultrasound (CEUS) to computed tomography (CT) in trauma patients after splenic embolization.
Materials and Methods: 22 patients (17 male and 5 female) with a mean age of 32 (15 – 57 years) were studied
with ultrasound (US), CEUS and CT in 23 early follow-up examinations 5 days (range:
0 – 12 days) after intervention and 17 late follow-up examinations 69 days (range:
52 – 189 days) after intervention. Perisplenic fluid, hematoma, laceration, infarction,
scars and injury grade were evaluated. US and CEUS readings were performed independently
by two radiologist, blinded to the CT results. Results: The sensitivity and specificity for CEUS at early follow-up were 85 % and 70 % for
perisplenic fluid, 80 % and 94 % for subcapsular hematomas, 83 % and 73 % or lacerations
and 75 % and 87 % for infarctions, respectively. The sensitivity and specificity at
late follow-up were 60 % and 100 % for subcapsular hematomas, 91 % and 67 % for intrasplenic
hematomas, 100 % and 93 % for lacerations and 89 % and 100 % for scars, respectively.
The overall sensitivity and specificity for all lesions were 87 % and 88 % at early
follow-up (n = 138) and 85 % and 95 % at late follow-up (n = 102), respectively. Compared
to CT, CEUS underestimated the injury grade in 2 / 40 cases and overestimated the
injury grade in 3 / 40 cases. Conclusion: CEUS is a useful tool for the detection of post-traumatic lesions. It is comparable
to CT in follow-up after splenic embolization and may replace CT in follow-up studies.
Key words
abdomen - trauma - embolization - CEUS - spleen
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Dr. Johann Baptist Dormagen
Radiology, Oslo University Hospital
Kirkeveien 166
0407 Oslo
Norway
Phone: + 47 2 21 18 08 0
Fax: + 47 2 21 18 08 0
Email: johannd@medisin.uio.no