Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2010;46(2-3):89-99. doi: 10.3233/CH-2010-1336.
Evaluation of high resolution linear ultrasound and intra-operative linear contrast enhanced ultrasound (CEUS) and its benefit for the detection and characterization of tumor lesions.
Twenty patients were investigated preoperatively regarding tumor detection using CT (n = 8) or MRI (n = 12) and image fusion (VNav) (n = 3). All patients had surgery for their hepatic tumor (hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), metastasis, and adenoma). Ultrasound was performed intra-operatively first with B-scan using a convex probe. Than multifrequency linear transmitters (6-9 MHz, 6-15 MHz, LOGIQ E9, GE) were applied for B-scan, coulor coded Doppler sonography (CCDS) and Power Doppler followed by dynamic CEUS with Contrast Harmonic Imaging (CHI) after bolus injection of a maximum of 15 mL SonoVue®.
In 9 cases with the use of intra-operative CEUS additional tumor lesions (diameter 4-15 mm) could be detected and were histologically confirmed after surgical resection (7 cases) or intra-operative biopsy (2 cases). Using intraoperative CEUS 64 tumor lesions could be detected compared to 51 tumor lesions detected by preoperative CT or MRI (p < 0.05). Using the 6-15 MHz multifrequency linear transducer with CHI, arterial perfusion of adenomas, neuroendocrine metastases and HCC lesions was detectable. In 3 cases a resection was not achievable. Two of these cases were treated with radio frequency ablation (RFA). The other case had no curable option due to multifocal tumor manifestation.
The intra-operative use of high-resolution linear transducer techniques with CEUS offers new diagnostic perspectives for an effective liver surgery.
评估高分辨率线性超声和术中线性对比增强超声（CEUS）及其在检测和特征分析肿瘤病变中的作用。
20 例患者术前分别接受 CT（n=8）、MRI（n=12）和图像融合（VNav）（n=3）检查以检测肿瘤。所有患者均因肝肿瘤（肝细胞癌（HCC）、胆管细胞癌（CCC）、转移和腺瘤）接受手术治疗。术中首先使用凸阵探头进行 B 型超声检查，然后使用多频线性发射器（6-9MHz、6-15MHz、LOGIQ E9、GE）进行 B 型超声、彩色编码多普勒超声（CCDS）和功率多普勒检查，随后在经静脉团注 SonoVue®后进行动态 CEUS 检查，采用谐波成像（CHI）技术。
在 9 例使用术中 CEUS 的患者中，可检测到额外的肿瘤病变（直径 4-15mm），并在手术后（7 例）或术中活检（2 例）中得到组织学证实。与术前 CT 或 MRI 检测到的 51 个肿瘤病变相比（p<0.05），术中 CEUS 可检测到 64 个肿瘤病变。使用 6-15MHz 多频线性探头和 CHI 技术，可检测到腺瘤、神经内分泌转移和 HCC 病变的动脉灌注。在 3 例患者中无法进行切除。其中 2 例接受射频消融（RFA）治疗。另 1 例由于多灶性肿瘤表现，没有可行的治疗方案。
术中使用高分辨率线性换能器技术结合 CEUS 为有效的肝切除术提供了新的诊断视角。
