Differentiation of Benign From Malignant Focal Splenic Lesions Using Sulfur Hexafluoride-Filled Microbubble Contrast-Enhanced Pulse-Inversion Sonography

被引:58
作者
Stang, Axel [1 ]
Keles, Handan [1 ]
Hentschke, Suna [1 ]
von Seydewitz, Cay Uwe [1 ]
Dahlke, Joachim [2 ]
Malzfeldt, Ernst [2 ]
Braumann, Dietrich [1 ]
机构
[1] Asklepios Klin Altona, Dept Hematol & Oncol, D-22763 Hamburg, Germany
[2] Asklepios Klin Altona, Dept Radiol, D-22763 Hamburg, Germany
关键词
contrast agents; diagnosis; focal lesions; sonography; spleen; RADIOLOGIC-PATHOLOGICAL CORRELATION; OPERATING CHARACTERISTIC CURVES; CT FINDINGS; SPLEEN; DIAGNOSIS; ULTRASOUND; ABNORMALITIES; LYMPHANGIOMA; MASSES; AGENT;
D O I
10.2214/AJR.07.3988
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
OBJECTIVE. The purpose of our study was to evaluate whether sonographic characterization of focal splenic lesions could be improved by using low mechanical index pulse-inversion sonography after sulfur hexafluoride-filled microbubble injection. MATERIALS AND METHODS. One hundred forty-seven splenic lesions (68 benign, 79 malignant) in 147 patients (81 men, 66 women; mean age, 51 years) underwent baseline gray-scale sonography and sulfur hexafluoride-enhanced low-acoustic-power pulse-inversion sonography (mechanical index < 0.1). Two site investigators assessed in consensus lesion and splenic enhancement during arterial and parenchymal phases. Four readers (readers I and 2, blinded; and readers 3 and 4, unblinded to clinical data) independently reviewed baseline and contrast-enhanced sonograms and provided confidence rating for diagnosis of malignancy or benignancy. Accuracy, sensitivity, specificity, positive and negative predictive values, and areas under the receiver operating characteristic curves (A(z)) were calculated by considering biopsy results or splenectomy (51 patients) or CT or MR images followed by serial sonography 6-12 months apart (96 patients) as reference standards. RESULTS. Benign lesions appeared predominately non- or isoenhancing relative to splenic parenchyma, whereas malignant lesions appeared predominately progressively hypoenhancing. For correct diagnosis of benignancy or malignancy, review of contrast-enhanced sonography after baseline sonography yielded significantly improved diagnostic performance (overall accuracy, 51%, 43%, 70%, and 74% before vs 83%, 81%, 92%, and 91% after contrast-enhanced sonography for readers 1, 2, 3, and 4; p < 0.05: respectively) and significantly improved diagnostic confidence (A(z), 0.770, 0.678, 0.900, and 0.917 before vs 0.935, 0.917, 0.984, and 0.959 after contrast-enhanced sonography for readers 1, 2, 3, and 4; p < 0.05 respectively). CONCLUSION. Sulfur hexafluoride-filled microbubble-enhanced sonography improves characterization of focal splenic lesions with and without the availability of clinical data.
引用
收藏
页码:709 / 721
页数:13
相关论文
共 39 条
[1]   Primary vascular neoplasms of the spleen: Radiologic-pathologic correlation [J].
Abbott, RM ;
Levy, AD ;
Aguilera, NS ;
Gorospe, L ;
Thompson, WM .
RADIOGRAPHICS, 2004, 24 (04) :1137-1163
[2]   The value of B-Mode and colour Doppler sonography in the diagnosis of focal splenic lesions [J].
Bachmann, C ;
Görg, C .
ULTRASCHALL IN DER MEDIZIN, 2004, 25 (06) :444-447
[3]   Concurrent focal hepatic and splenic lesions - A pictorial guide to differential diagnosis [J].
Bean, MJ ;
Horton, KM ;
Fishman, EK .
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY, 2004, 28 (05) :605-612
[4]   Pulse inversion imaging of liver blood flow - Improved method for characterizing focal masses with microbubble contrast [J].
Burns, PN ;
Wilson, SR ;
Simpson, DH .
INVESTIGATIVE RADIOLOGY, 2000, 35 (01) :58-71
[5]   Abdominal and pelvic CT in the HIV-positive population [J].
Carucci, LR ;
Halvorsen, RA .
ABDOMINAL IMAGING, 2004, 29 (06) :631-642
[6]   Contrast-enhanced sonography of the spleen [J].
Catalano, O ;
Sandomenico, F ;
Matarazzo, L ;
Siani, A .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2005, 184 (04) :1150-1156
[7]   Contrast-enhanced sonography of the spleen [J].
Catalano, Orlando ;
Sandomenico, Fabio ;
Vallone, Paolo ;
d'Errico, Adolfo Gallipoli ;
Siani, Alfredo .
SEMINARS IN ULTRASOUND CT AND MRI, 2006, 27 (05) :426-433
[8]  
Catalano Orlando, 2003, Radiol Med, V106, P338
[9]   Splenic hamartoma: Presentation on contrast-enhanced sonography [J].
Chou, YH ;
Chiou, HJ ;
Tiu, CM ;
Chiou, SY ;
Hsia, CY ;
Tsay, SH .
JOURNAL OF CLINICAL ULTRASOUND, 2004, 32 (08) :425-428
[10]   Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) -: Update 2008 [J].
Claudon, M. ;
Cosgrove, D. ;
Albrecht, T. ;
Bolondi, L. ;
Bosio, M. ;
Calliada, F. ;
Correas, J. -M. ;
Darge, K. ;
Dietrich, C. ;
D'Onofrio, M. ;
Evans, D. H. ;
Filice, C. ;
Greiner, L. ;
Jaeger, K. ;
de Jong, N. ;
Leen, E. ;
Lencioni, R. ;
Lindsell, D. ;
Martegani, A. ;
Meairs, S. ;
Nolsoe, C. ;
Piscaglia, F. ;
Ricci, P. ;
Seidel, G. ;
Skjoldbye, B. ;
Solbiati, L. ;
Thorelius, L. ;
Tranquart, F. ;
Weskott, H. P. ;
Whittingham, T. .
ULTRASCHALL IN DER MEDIZIN, 2008, 29 (01) :28-44