Alhyari Amjad, Görg Christian, Tahat Suhaib, Trenker Corinna, Dietrich Christoph Frank, Westhoff Christina C, Safai Zadeh Ehsan, Findeisen Hajo
Department of Gastroenterology, Endocrinology, Metabolism and Infectious Diseases, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany.
Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany.
Cancers (Basel). 2023 Oct 12;15(20):4964. doi: 10.3390/cancers15204964.
Nontraumatic focal splenic lesions (FSL) are rare, and the need for tissue diagnosis must be weighed against the very high risk of bleeding after a splenic biopsy. The aim of this study was to explore the feasibility and diagnostic potential of acoustic radiation force impulse (ARFI) elastography as a noninvasive method for different benign and malignant FSLs. No human studies on the elastographic characteristics of FSL exist.
This was a retrospective analysis of 34 patients with FSLs, who underwent abdominal B-mode ultrasound (B-US), contrast-enhanced ultrasound (CEUS), and standardized ARFI examinations between October 2021 and December 2022 at our university hospital. The inclusion criteria were: (i) FSL size ≥ 1 cm; (ii) 10 valid ARFI measurements of the FSL, as well as of the normal splenic parenchyma (NSP) as an in vivo reference; and (iii) diagnostic confirmation of FSL etiology based on histological examination (8/34; 23.5%) or clinical evaluation, which included a clinical and sonographic follow-up (FU), CEUS morphology, and/or morphology on cross-sectional imaging (26/34; 76.5%). CEUS was performed on all patients and the FSLs were classified according to the current guidelines; cross-sectional imaging was available for 29/34 (85.3%). The mean FU duration was 25.8 ± 30.5 months. The mean ARFI velocity (MAV) of the FSL (MAV), the NSP (MAV), and the ratio of the MAV to the MAV (MAV) were calculated and compared.
Of the 34 FSLs, 13 (38.2%) were malignant (mFSL) and 21 (61.8%) were benign (bFSL). The MAV of all 34 FSLs (2.74 ± 0.71 m/s) was lower than the MAV (3.20 ± 0.59 m/s), = 0.009, with a mean MAV ratio of 0.90 ± 0.34. No significant differences in the MAV were observed between the mFSL (2.66 ± 0.67 m/s) and bFSL (2.79 ± 0.75 m/s). There were also no significant differences between the MAV in patients with mFSL (3.24 ± 0.68 m/s) as compared to that in the patients with bFSL (3.18 ± 0.55 m/s). Likewise, the MAV ratio did not differ between the mFSL (0.90 ± 0.41 m/s) and bFSL (0.90 ± 0.30 m/s) groups.
ARFI elastography is feasible in evaluating the stiffness of FSLs. The lesions' stiffness was lower than that of the NSP, regardless of the FSL etiology. However, differentiation between benign and malignant FSL with the help of this elastographic method does not appear possible. Larger prospective studies are needed to validate these findings.
非创伤性局灶性脾病变（FSL）较为罕见，脾活检后出血风险极高，因此必须权衡组织诊断的必要性。本研究旨在探讨声辐射力脉冲（ARFI）弹性成像作为一种针对不同良恶性FSL的非侵入性方法的可行性和诊断潜力。目前尚无关于FSL弹性成像特征的人体研究。
这是一项对34例FSL患者的回顾性分析，这些患者于2021年10月至2022年12月在我校医院接受了腹部B型超声（B-US）、超声造影（CEUS）和标准化ARFI检查。纳入标准为：（i）FSL大小≥1 cm；（ii）对FSL以及作为体内参照的正常脾实质（NSP）进行10次有效的ARFI测量；（iii）基于组织学检查（8/34；23.5%）或临床评估确诊FSL病因，临床评估包括临床和超声随访（FU）、CEUS形态以及/或者横断面成像的形态（26/34；76.5%）。对所有患者进行CEUS检查，并根据现行指南对FSL进行分类；34例中有29例（85.3%）可获得横断面成像。平均FU时长为25.8±30.5个月。计算并比较FSL的平均ARFI速度（MAV）、NSP的MAV以及MAV与MAV的比值（MAV）。
34例FSL中，13例（38.2%）为恶性（mFSL），21例（61.8%）为良性（bFSL）。所有34例FSL的MAV（2.74±0.71 m/s）低于NSP的MAV（3.20±0.59 m/s），P = 0.009，平均MAV比值为0.90±0.34。mFSL（2.66±0.67 m/s）和bFSL（2.79±0.75 m/s）之间的MAV未观察到显著差异。mFSL患者（3.24±0.68 m/s）与bFSL患者（3.18±0.55 m/s）的MAV之间也无显著差异。同样，mFSL组（0.90±0.出41 m/s）和bFSL组（0.90±0.30 m/s）之间的MAV比值也无差异。
ARFI弹性成像在评估FSL硬度方面是可行的。无论FSL病因如何，病变的硬度均低于NSP。然而，借助这种弹性成像方法似乎无法区分良恶性FSL。需要更大规模的前瞻性研究来验证这些发现。
