Department of Radiology, Regensburg University School of Medicine, Regensburg, Germany.
Clin Hemorheol Microcirc. 2010;46(2-3):117-26. doi: 10.3233/CH-2010-1338.
To show the feasibility of a combination of the advantages of modern contrast enhanced ultrasound (CEUS) with the technique of arterioportography to achieve the highest sensitivity of all different modalities.
Ten patients (9 m, 1 f, age 52-73 years) with suspected hepatocellular carcinoma (HCC) in liver cirrhosis (8 ethyl toxic, 2 hepatitis) were included before transarterial chemo-embolization (TACE). In all patients during a 6-week period a double enhanced MRI (Gd-DTPA and SPIO) was performed. Before TACE a bolus <2 mL ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy) was injected over a selectively placed catheter in the superior mesenteric artery (SMA) and ultrasound of the liver (2.5-4 MHz, LOGIQ 9; GE Healthcare) was performed in arterioportographic phase (US-AP). Two independent readers evaluate number, size and localisation of detected lesion in MRI and US-AP. Additional diagnostic quality of both modalities was determined using a 4-point scale (1: excellent-4: not diagnostic). Differences were analysed for significance using a t-test. Interobserver variability was calculated (κ-value).
In all 10 patients (100 %) US-AP was feasible. Diagnostic quality was in all cases between 1-2 for both modalities and readers (MRI standard deviation (SD) -0.51, Sono-AP SD -0.421). US-AP detected with 33.5 vs. 24.5 lesions, significant more lesions than double enhanced MRI (p < 0.022). The interobserver variability was κ -0.965 for MRI and κ -0.898 for US-AP.
US-AP for detection of liver lesions is feasible. Using this technique significantly more lesions in patients with hepatocellular carcinoma could be detected in comparison to MRI with liver-specific contrast agent.
展示将现代对比增强超声（CEUS）的优势与动脉造影技术相结合的可行性，以实现所有不同模态中最高的灵敏度。
10 名患者（9 名男性，1 名女性，年龄 52-73 岁），患有肝硬化（8 例乙基中毒，2 例肝炎），疑似肝细胞癌（HCC），在经动脉化疗栓塞（TACE）前纳入研究。所有患者在 6 周内进行双增强 MRI（钆-DTPA 和 SPIO）检查。在 TACE 前，将 <2 毫升超声造影剂（SonoVue®，Bracco，米兰，意大利）经选择性放置在肠系膜上动脉（SMA）的导管中注入，然后进行肝超声造影（AP）（2.5-4 MHz，LOGIQ 9；GE Healthcare）。两名独立的读者评估 MRI 和 US-AP 中检测到的病变的数量、大小和定位。使用 4 分制（1：优秀-4：无法诊断）评估两种模态的附加诊断质量。使用 t 检验分析差异的显著性。计算了观察者间的变异性（κ 值）。
在所有 10 例患者（100%）中，US-AP 是可行的。两种模态和读者的诊断质量均在 1-2 分之间（MRI 标准偏差（SD）-0.51，Sono-AP SD -0.421）。US-AP 检测到 33.5 个病变，明显多于双增强 MRI（p < 0.022）。MRI 的观察者间变异性为 κ -0.965，US-AP 的观察者间变异性为 κ -0.898。
US-AP 检测肝脏病变是可行的。与使用肝脏特异性造影剂的 MRI 相比，使用该技术可以在患有肝细胞癌的患者中检测到更多的病变。
