Trenker Corinna, Dietrich Christoph F, Ziegler Elena, Neesse Albrecht, Görg Christian
Hämatologie/Onkologie/Immunologie, UKGM Standort Marburg Zentrum für Innere Medizin, Marburg, Germany.
Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Germany.
Z Gastroenterol. 2019 Aug;57(8):945-951. doi: 10.1055/a-0893-6872. Epub 2019 Aug 9.
Little is known about the imaging of omental pathologies. The aim of the current study was to determine the value of B-mode ultrasound (B-US), contrast-enhanced ultrasound (CEUS), and ultrasound-guided core needle biopsy for the differential diagnosis of benign and malignant omental pathologies.
A retrospective evaluation (2008-2017) was performed in 44 patients (median 65,5 years, mean 64 years [47-83], 27 male, 17 female) with histological (40/44 [91 %]) or cytological (4/44 [9 %]) proven omental lesions. Clinical signs and final diagnosis, size, B-US and CEUS findings, and complications were analyzed.
Omental thickening was in n = 36 (81.8 %) of the cases malignant (mOL) and in n = 8 (18.2 %) benign (bOL). Twenty-six (59.1 %) patients had ascites (n = 24 [66.7 %] mOL, n = 2 [25 %] bOL). The average tumor thickness was 23 mm (24 mm in mOL, 20 mm in bOL). Interventional complications were not observed.
The majority of omental lesions are malignant. The differentiation between a malignant or benign cause of thickening is not possible by any imaging method. CEUS is helpful to determine vital tissue before biopsy. Ultrasound-guided core-needle biopsy allows final diagnosis of omental thickening if > 10 mm and should be performed prior to the more invasive and complicative diagnostic laparoscopy.
关于网膜病变的影像学表现，人们了解甚少。本研究的目的是确定B型超声（B-US）、超声造影（CEUS）以及超声引导下粗针活检在网膜良恶性病变鉴别诊断中的价值。
对44例经组织学（40/44 [91%]）或细胞学（4/44 [9%]）证实的网膜病变患者（年龄中位数65.5岁，平均64岁[47 - 83岁]，男性27例，女性17例）进行回顾性评估（2008 - 2017年）。分析临床体征、最终诊断、大小、B-US和CEUS检查结果以及并发症。
36例（81.8%）病例的网膜增厚为恶性（mOL），8例（18.2%）为良性（bOL）。26例（59.1%）患者有腹水（mOL组24例[66.7%]，bOL组2例[25%]）。肿瘤平均厚度为23mm（mOL组24mm，bOL组20mm）。未观察到介入相关并发症。
大多数网膜病变为恶性。任何影像学方法都无法区分增厚的原因是恶性还是良性。CEUS有助于在活检前确定有活力的组织。超声引导下粗针活检可对厚度>10mm的网膜增厚进行最终诊断，且应在更具侵入性和复杂性的诊断性腹腔镜检查之前进行。
