School of Medicine, Virginia Tech Carilion, Roanoke, Virginia, USA.
J Trauma Acute Care Surg. 2012 Nov;73(5):1100-5. doi: 10.1097/TA.0b013e31825a74b5.
The evaluation and management of blunt abdominal trauma is primarily nonoperative. Previous attempts to identify parenchymal solid-organ injury with sonography have been unsatisfactory. The use of Perflutren Lipid Microsphere (Definity) contrast-enhanced ultrasound (DUS) may provide an additional modality for evaluation of solid-organ injury with decreased risk of radiation exposure and contrast-related complications.
Injured patients admitted to a state-designated Level I trauma center (January 2008 to July 2009), who showed evidence of solid-organ injury after blunt abdominal trauma on initial computed tomography (CT) were eligible for entry into the study. Patients underwent DUS examinations within 12 hours of initial CT. Ultrasound images were then compared with findings of CT for organ location, size, and grade of injury.
Twenty patients with evidence of solid-organ injury on CT were evaluated with DUS. DUS correctly identified five of eight liver lesions, with a sensitivity of 62.5%. DUS correctly identified all nine splenic lesions demonstrating a sensitivity of 100%. DUS correctly identified one of two kidney injuries, demonstrating a sensitivity of 50%. Overall, the positive predictive value for all solid-organ injuries was 100%, with negative predictive value of 20%. The overall sensitivity for DUS was 79% (15 of 19 patients), and specificity was 100% (15 of 15 patients).
Contrast-enhanced sonography is a potential new modality for the evaluation of solid-organ injury for patients with blunt abdominal trauma. With further research, DUS may provide a safe and accurate alternative to CT.
Diagnostic study, level IV.
钝性腹部创伤的评估和管理主要是非手术的。以前，人们尝试使用超声来评估实质脏器损伤，但效果并不理想。使用 Perflutren Lipid Microsphere（Definity）造影超声（DUS）可能为评估实质脏器损伤提供一种新的方法，同时还可以降低辐射暴露和造影剂相关并发症的风险。
本研究纳入了 2008 年 1 月至 2009 年 7 月期间在州指定的一级创伤中心接受治疗、受伤后立即行 CT 检查显示有实质脏器损伤的患者。在 CT 检查后 12 小时内行 DUS 检查。然后，将超声图像与 CT 检查的结果进行比较，比较内容包括脏器位置、大小和损伤分级。
在 20 名 CT 检查显示有实质脏器损伤的患者中，有 20 名接受了 DUS 检查。DUS 正确识别了 8 个肝脏病变中的 5 个，敏感性为 62.5%。DUS 正确识别了 9 个脾脏病变中的 9 个，敏感性为 100%。DUS 正确识别了 2 个肾脏损伤中的 1 个，敏感性为 50%。总的来说，所有实质脏器损伤的阳性预测值为 100%，阴性预测值为 20%。DUS 的总体敏感性为 79%（15/19 例患者），特异性为 100%（15/15 例患者）。
对比增强超声是评估钝性腹部创伤患者实质脏器损伤的一种潜在的新方法。随着进一步的研究，DUS 可能为 CT 检查提供一种安全、准确的替代方法。
诊断研究，IV 级。
