Clevert D-A, Weckbach S, Minaifar N, Clevert D-A, Stickel M, Reiser M
Department of Clinical Radiology, University Hospitals - Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
Clin Hemorheol Microcirc. 2008;39(1-4):155-69.
To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in the diagnosis and characterization of hepatic, renal and splenic traumatic injuries versus conventional ultrasound (US) and multislice computed tomography (MS-CT). Between January 2005 and January 2007, 78 patients (48 males, 30 females, mean age 56 years) with blunt abdominal trauma were examined by conventional US, CEUS and MS-CT. CEUS employed a low-MI technique using 1.2 to 2.4 ml of SonoVue (Bracco, Italy) i.v. and a multifrequency transducer (2-4 MHz, Siemens, Sequoia, Acuson). CT examinations were performed on a 64 detector CT scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) before and after administration of 120 ml intravenous contrast agent (Solutrast, Bracco, Milan, Italy) followed by 50 ml saline. The presence of hepatic, renal and splenic injuries was analyzed and the conspicuousness of findings was assessed. In 15 of the 78 patients conventional US identified solid organ injuries: 8 hepatic, 2 renal and 5 splenic injuries. CEUS identified 3 more injuries (2 hepatic and 1 splenic) that had been missed by conventional US. CEUS identified traumatic lesions in 18/78 patients. In one of the 18 patients even active bleeding could be identified by CEUS. In CEUS solid organ injuries appeared hypoechoic. MS-CT identified 18 solid organ injuries in 78 patients, corroborating the CEUS results.CEUS greatly improves the visualization and characterization of hepatic, renal and splenic injuries compared to conventional ultrasound and correlates well with MS-CT. The imaging technique detects even minor blood flow and is able to depict vascular structures in detail. At our institution it is used as an additional examination technique which supplements MS-CT in unclear cases. Owing to its bedside availability, CEUS provides a good alternative to MS-CT, especially in patients with contraindications to CT contrast agents (e.g. due to renal failure or severe allergy) and in hemodynamically compromised patients.
评估超声造影（CEUS）在肝脏、肾脏和脾脏创伤性损伤的诊断及特征描述方面与传统超声（US）和多层螺旋计算机断层扫描（MS-CT）相比的有效性。2005年1月至2007年1月期间，对78例腹部钝性创伤患者（48例男性，30例女性，平均年龄56岁）进行了传统超声、CEUS和MS-CT检查。CEUS采用低机械指数技术，静脉注射1.2至2.4 ml声诺维（意大利博莱科公司），并使用多频探头（2-4 MHz，西门子，Sequoia，Acuson）。CT检查在64排CT扫描仪（Somatom Sensation 16或64，德国西门子医疗系统公司，福希海姆）上进行，静脉注射120 ml静脉造影剂（意大利米兰博莱科公司的Solutrast）后再注射50 ml生理盐水，然后进行扫描。分析肝脏、肾脏和脾脏损伤的存在情况，并评估检查结果的明显程度。78例患者中，15例经传统超声检查发现实质性器官损伤：8例肝脏损伤、2例肾脏损伤和5例脾脏损伤。CEUS发现了另外3例传统超声漏诊的损伤（2例肝脏损伤和1例脾脏损伤）。CEUS在78例患者中发现了18例创伤性病变。在这18例患者中的1例，CEUS甚至能够识别出活动性出血。在CEUS检查中，实质性器官损伤表现为低回声。MS-CT在78例患者中发现了18例实质性器官损伤，证实了CEUS的检查结果。与传统超声相比，CEUS大大提高了肝脏、肾脏和脾脏损伤的可视化及特征描述能力，且与MS-CT相关性良好。该成像技术甚至能够检测到微小的血流，并能够详细描绘血管结构。在我们机构，它被用作一种辅助检查技术，在情况不明确时补充MS-CT检查。由于CEUS可在床边进行，它为MS-CT提供了一个很好的替代方法，尤其是对于有CT造影剂禁忌证的患者（如因肾衰竭或严重过敏）以及血流动力学不稳定的患者。
