Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, Halle (Saale), Germany.
Clin Hemorheol Microcirc. 2020;76(2):161-170. doi: 10.3233/CH-209215.
Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue.
In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant.
In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07).
All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.
经皮硬化疗法是静脉畸形（VM）的一种成熟的治疗选择。最近出现的一种硬化剂是乙醇凝胶。本研究旨在确定对比增强超声（CEUS）结合灌注分析是否可区分未经治疗的 VM、健康组织和用乙醇凝胶处理的畸形组织。
在这项经机构审查委员会批准的前瞻性研究中，症状性 VM 患者在接受乙醇凝胶硬化治疗前后在同一位置进行 CEUS。两名经验丰富的超声医师在使用高端超声仪的 6-9MHz 多频探头在静脉内推注微泡后进行所有检查。在 VM 中心和周围健康组织中应用灌注分析。对两个区域的峰值增强（峰值）、达峰时间（TTP）、曲线下面积（AUC）和平均通过时间（MTT）进行评估。执行 Wilcoxon 符号秩检验；p 值 <0.05 被认为具有统计学意义。
在 23 名包括儿童在内的患者（平均年龄 25.3 岁，19 名女性）中，治疗前 VM 中心的所有识别参数均明显高于健康组织（峰值：p <0.01；TTP：p <0.01；AUC：p <0.01；MTT：p <0.01）。比较治疗前后 VM 中心，硬化治疗后 TTP（p <0.02）和 MTT（p <0.01）明显降低。与治疗前相比，周围组织仅在治疗后峰值发生变化（p = 0.04）。比较硬化治疗后 VM 中心和周围组织的数据，峰值（p <0.01）、TTP（p <0.01）和 AUC（p <0.01）仍有显著差异，但 MTT（p = 0.07）差异不显著。
CEUS 确定的所有参数似乎都是区分 VM 和健康组织的极好工具。TTP 和 MTT 可区分乙醇凝胶硬化的 VM 部分和未经治疗的畸形部分，从而可能有助于监测乙醇凝胶硬化治疗。
