Department of Diagnostic Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa Prefecture 259-1193, Japan.
Eur Radiol. 2013 May;23(5):1429-42. doi: 10.1007/s00330-012-2711-z. Epub 2012 Nov 19.
To evaluate the use of diffusion-weighted imaging (DWI) for estimating infarcted splenic volume during partial splenic embolisation (PSE) using n-butyl cyanoacrylate (NBCA).
Twenty consecutive patients (57.2 ± 11.7 years) with hypersplenism underwent PSE. Intrasplenic branches were embolised using NBCA via a 2.1-French microcatheter aiming at infarction of 50 to 80 % of total splenic volume. Immediately after PSE, signal intensities (SI) of embolised and non-embolised splenic parenchyma were measured on DWI. Semi-automated volumetry (SAV) on DWI was compared with conventional manual volumetry (MV) on contrast-enhanced CT 1 week after PSE. Platelet counts were recorded before and after PSE.
The SI on DWI in the embolised parenchyma decreased significantly (P < 0.01) to 24.7 ± 8.1 % as compared to non-embolised parenchyma. SAV and MV showed a strong correlation (r = 0.913 before PSE, r = 0.935 after PSE, P < 0.01) and significant (P < 0.01) reduction of normal splenic volume was demonstrated on both SAV (71.9 ± 12.4 %) and MV (73.6 ± 9.3 %) after PSE. Based on the initial SAV, three patients (15 %) underwent additional branch embolisation to reach sufficient infarction volume. Platelet counts elevated significantly (522.8 ± 209.1 %, P < 0.01) by 2 weeks after PSE. No serious complication was observed.
Immediate SI changes on DWI after PSE allowed semi-automated splenic volumetry on site.
• Partial splenic embolisation (PSE) is an important interventional technique for hypersplenism • Diffusion-weighted MR reveals an immediate decrease in signal in the embolised parenchyma • Such signal reduction permits semi-automated splenic volumetry on site. • This allows precise quantification of the amount of parenchyma infarcted, avoiding additional PSE.
评估使用 n-丁基氰基丙烯酸酯 (NBCA) 进行部分脾栓塞术 (PSE) 时，弥散加权成像 (DWI) 对估计脾梗死体积的应用。
连续 20 例脾功能亢进患者（57.2 ± 11.7 岁）接受 PSE 治疗。使用 2.1F 微导管将 NBCA 注入脾内分支，目标为 50%至 80%的总脾体积梗死。PSE 后立即在 DWI 上测量栓塞和非栓塞的脾实质的信号强度 (SI)。PSE 后 1 周，DWI 上的半自动容积测量 (SAV) 与常规增强 CT 上的手动容积测量 (MV) 进行比较。记录 PSE 前后的血小板计数。
与非栓塞的脾实质相比，栓塞的脾实质的 DWI 上的 SI 显著降低（P < 0.01），至 24.7 ± 8.1%。SAV 和 MV 之间具有很强的相关性（PSE 前 r = 0.913，PSE 后 r = 0.935，P < 0.01），并且在 SAV（71.9 ± 12.4%）和 MV（73.6 ± 9.3%）上均显示正常脾体积显著减少（P < 0.01）。根据初始 SAV，3 例（15%）患者行额外的分支栓塞以达到足够的梗死体积。PSE 后 2 周，血小板计数显著升高（522.8 ± 209.1%，P < 0.01）。未观察到严重并发症。
PSE 后立即进行 DWI 上的 SI 变化可在现场进行半自动脾容积测量。
