Dobek Adam, Kobierecki Mateusz, Ciesielski Wojciech, Grząsiak Oliwia, Kosztowny Konrad, Fabisiak Adam, Białek Piotr, Stefańczyk Ludomir
I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland.
Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
Pol J Radiol. 2024 Oct 8;89:e470-e479. doi: 10.5114/pjr/192184. eCollection 2024.
This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in diagnosing and monitoring hepatic abscesses (HA).
This retrospective study included 29 patients (9 females, 20 males) with 64 HA. Computed tomography (CT) served as the diagnostic benchmark, compared with CEUS and B-mode ultrasound (B-mode). Two radiologists assessed the presence, size, and characteristics of the HA.
The contrast enhancement pattern on CEUS matched post-contrast CT. Lesion size detected by CEUS ranged from 1.16 cm to 15.33 cm (median 5.74 cm). CT classified lesions into four types: I (tumor-like) - 2, II (honeycomb) - 5, III (lacunar) - 23, IV (cystic-like) - 34. CEUS fully agreed with these classifications. B-mode missed two type I lesions. For type III abscesses, agreement with CEUS was perfect (κ = 1, 100%), and moderate with B-mode (κ = 0.50, 79.7%). For type IV abscesses, agreement with CEUS was perfect (κ = 1, 100%), and high with B-mode (κ = 0.88, 93.75%). Pus enhancement remained stable (± 15 dB), while the abscess pouch background varied (± 11 dB to ± 6 dB). The Mann-Whitney test confirmed these observations (arterial: = 1.02e-14, portal: = 3.79e-12, late venous: = 4.53e-13). No significant difference in enhancement values was found based on abscess size (> 4 cm vs. < 4 cm).
CEUS is superior to B-mode for diagnosing and monitoring HA, offering clearer views of the abscess pouch, septa, and liver parenchyma. The purulent part lacks contrast, allowing accurate assessment. CEUS can replace CT for monitoring and aid in patient selection for percutaneous intervention.
本研究旨在评估超声造影（CEUS）在肝脓肿（HA）诊断及监测中的诊断价值。
本回顾性研究纳入了29例患者（9例女性，20例男性），共64个肝脓肿。以计算机断层扫描（CT）作为诊断基准，与CEUS及B型超声（B-mode）进行比较。两名放射科医生评估肝脓肿的存在、大小及特征。
CEUS上的造影增强模式与造影后CT相符。CEUS检测到的病变大小范围为1.16 cm至15.33 cm（中位数为5.74 cm）。CT将病变分为四种类型：I型（肿瘤样）-2个，II型（蜂窝状）-5个，III型（腔隙状）-23个，IV型（囊肿样）-3个。CEUS与这些分类完全一致。B型超声漏诊了2个I型病变。对于III型脓肿，与CEUS的一致性极佳（κ = 1，100%），与B型超声的一致性为中等（κ = 0.50，79.7%）。对于IV型脓肿，与CEUS的一致性极佳（κ = 1，100%），与B型超声的一致性较高（κ = 0.88，93.75%）。脓液增强保持稳定（± 15 dB），而脓肿腔背景有所变化（± 11 dB至± 6 dB）。曼-惠特尼检验证实了这些观察结果（动脉期： = 1.02e-14，门脉期： = 3.79e-12，延迟静脉期： = 4.53e-13）。基于脓肿大小（> 4 cm与< 4 cm），增强值未发现显著差异。
CEUS在肝脓肿的诊断及监测方面优于B型超声，能更清晰地显示脓肿腔、分隔及肝实质。脓性部分无造影剂增强，有助于准确评估。CEUS可替代CT进行监测，并有助于选择经皮介入治疗的患者。
