Gültekin Serap, Yücel Cem, Ozdemir Hakan, Celik Halil, Oktar Suna Ozhan, Araç Mehmet
Gazi Universitesi Tip Fakültesi, Radyoloji Anabilim Dali, 06510 Besevler-Ankara, Turkey.
J Ultrasound Med. 2006 Sep;25(9):1139-45. doi: 10.7863/jum.2006.25.9.1139.
The purpose of this study was to investigate the efficacy of late-phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal.
Thirty-two patients (21 women and 11 men; age range, 20-87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir-enhanced magnetic resonance imaging was performed as part of the clinical workup.
After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow-up and CT. Conclusions. Late-phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.
本研究旨在探讨晚期脉冲反转谐波成像（PIHI）在检测隐匿性转移瘤方面的疗效，并将结果与螺旋计算机断层扫描（CT）在一组肝脏基础超声检查结果正常的患者中进行比较。
32例已知原发性恶性肿瘤的患者（21例女性，11例男性；年龄范围20 - 87岁）纳入本研究。对患者进行常规超声、未增强的PIHI以及注射Levovist（SH U 508A；德国柏林先灵公司）3分钟后的PIHI检查。所有患者在超声检查后1周内还接受了三相螺旋CT检查。1例患者进行了锰福地匹增强磁共振成像作为临床检查的一部分。
注射Levovist后，32例患者中有4例（12.5%）通过PIHI检测到至少1个低回声病变；1例患者显示为多个病变。新检测到病变的平均直径为12毫米。三相螺旋CT也显示了所有通过PIHI检测到的病变。2例患者通过活检和CT结果确诊，1例患者通过典型的CT和磁共振成像结果确诊。第4例患者通过随访和CT确诊。结论。晚期PIHI在检测隐匿性肝转移瘤方面与螺旋CT相当，但它可使患者免受辐射和碘化造影剂潜在的有害影响。需要进一步纳入更多患者的系列研究来确定其在癌症分期评估和治疗计划中的地位。
