Morita Masahiro, Ogawa Chikara, Omura Akina, Noda Teruyo, Kubo Atsushi, Matsunaka Toshihiro, Tamaki Hiroyuki, Shibatoge Mitsushige, Seno Hiroshi, Minami Yasunori, Ueshima Kazuomi, Sakurai Toshiharu, Nishida Naoshi, Kudo Masatoshi
Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan.
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan.
Intern Med. 2020;59(4):471-477. doi: 10.2169/internalmedicine.2510-18. Epub 2020 Feb 15.
Objective The usefulness of contrast-enhanced ultrasonography (CEUS) for making decisions in the treatment of liver abscess is unknown. Methods We evaluated the internal blood flow in the arterial-predominant phase by CEUS using Sonazoid in 21 patients. The stain area rate was evaluated in maximum parting plane of abscess in CEUS. Patients were divided into two groups: the vascular phase enhancement (VE) group, in which ≥50% of the abscess cavity was enhanced (12 patients), and the vascular phase non-enhancement (VNE) group, in which <50% of the abscess cavity was enhanced (9 patients). The rate of patients who were cured by conservative treatment alone was examined in both groups. The defect rate of all liver abscesses in the post-vascular phase was also evaluated. Results In the VE group, improvement by conservative treatment alone was obtained in 11 out of 12 patients (91.7%), while in the VNE group, improvement by conservative treatment alone was obtained in only 1 out of 9 patients (11.1%), a significant difference (p<0.001). In the VE group, one patient did not improve with conservative treatment alone because the abscess ruptured near the liver surface. In the VE group, the abscess size was smaller than in the VNE group. By examining the defect rate in the post-vascular phase, it was found that 16 out of 21 patients (76.2%) showed 71% or more defects. Conclusion The enhancement rate in the arterial-predominant phase of CEUS was considered useful for determining the treatment approach for liver abscess.
目的 对比增强超声（CEUS）在肝脓肿治疗决策中的实用性尚不清楚。方法 我们使用声诺维通过CEUS评估了21例患者动脉期为主时的内部血流情况。在CEUS脓肿的最大分割平面评估染色面积率。患者分为两组：血管期增强（VE）组，脓肿腔增强≥50%（12例患者）；血管期无增强（VNE）组，脓肿腔增强<50%（9例患者）。两组均检查仅通过保守治疗治愈的患者比例。还评估了所有肝脓肿在血管期后的缺损率。结果 在VE组中，12例患者中有11例（91.7%）仅通过保守治疗得到改善，而在VNE组中，9例患者中仅有1例（11.1%）仅通过保守治疗得到改善，差异有统计学意义（p<0.001）。在VE组中，1例患者仅通过保守治疗未改善，因为脓肿在肝表面附近破裂。在VE组中，脓肿大小小于VNE组。通过检查血管期后的缺损率，发现21例患者中有16例（76.2%）显示缺损率达71%或更高。结论 CEUS动脉期为主时的增强率被认为对确定肝脓肿的治疗方法有用。
