Karaciğer kitlelerinin ayırıcı tanısında renkli doppler ultrasonografi ve eko kontrast madde kullanımının etkinliği
Öz
Amaç: Karaciğerde kitle lezyonu saptanan olguların renkli Doppler ultrasonografi bulguları ile eko kontrast madde kullanılarak yapılan renkli Doppler ultrasonografik incelemenin kitle karakterizasyonuna katkısının literatür eşliğinde araştırılması amaçlanmıştır.
Gereç ve Yöntem: Rutin radyolojik tetkikleri sırasında karaciğerde kitle saptanan 35 olguya ait kontrastsız ve eko kontrastlı renkli Doppler bulguları retrospektif olarak değerlendirildi. Kitlede kanlanma saptanan olgularda vasküler yapılardan spektral analizler yapılarak maksimum sistolik hız (Vmax) ve rezistif indeks (Rİ) değerleri ile kanlanma paternleri kaydedilmiştir. Maksimum sistolik hızların en yüksek değeri ve ona karşılık gelen Rİ değerleri incelenen lezyon için belirleyici kabul edilmiştir. Lezyon tanıları biyopsi (n=15) gri skala US, BT (n=30), MRG (n=27) ve klinik bulgular eşliğinde değerlendirilerek elde edillmiştir.
Kontrast madde öncesi ve sonrası lezyonların kanlanma paternleri ile, spektral analiz değerleri (Vmax ve Rİ) istatistiksel olarak değerlendirilmiştir.
Bulgular: Çalışmaya dahil edilen yedi olgu hemanjiom, yedi olgu hepatosellüler karsinom, yirmi olgu metastaz ve bir olgu fokal nodüler hiperplazi tanılı olgulardı. Bu lezyonların rutin renkli Doppler ultrasonografi ile kontrastlı renkli Doppler ultrasonografik değerlendirmede kanlanma paternleri grublarının istatistiksel olarak karşılaştırılmasında anlamlı ilişki bulundu. Rİ değerleri arasında iki grupta istatistiksel anlamlı farklılık saptanmadı (p< 0,05). Vmax değerleri lezyon tanılarına göre sınıflandırıldığında her iki grup arasında istatistiksel olarak anlamlı farklılık izlenmemiştir (p< 0,05).
Sonuç: Olguların %77’sinde renkli Doppler ultrasonografi tek başına tümöral lezyonların akım paternlerinin ortaya konmasında yeterli ve tatminkar sonuçların elde edilmesini sağladı. Eko kontrastlı renkli Doppler ultrasonografik değerlendirme kalan olguların %17’sinde kanlanma paterninin dinamik olarak gösterilmesi ile ayırıcı tanıya katkıda bulunmuştur.
Anahtar Kelimeler
karaciğer kitlesi eko kontrast madde renkli Doppler ultrasonografi
Kaynakça
- Leen E, Goldberg JA, Robertson J, et al. Detection of hepatik metastasis using duplex/ color Doppler sonography. Ann Surg. 1991; 214 (5): 599–604.
- Leen E, Goldberg JA, Robertson J, et al. Image directed Doppler sonography; a novel technique for diagnosis of colorectal liver metastasis. J Clin Ultrasound 1993; 21: 221-30.
- Paintner A, Bayer C, Böttcher B, Wenk H, Swobodnik W. Doppler and color Doppler ultrasound diagnosis in differentiation of focal liver lesions. Bildgebung. 1996; 63 (1): 22-6.
- Nino-Murcia M, Ralls PW, Jeffrey RB Jr, Johnson M. Color flow Doppler characterization of focal hepatic lesions. AJR Am J Roentgenol. 1992; 159 (6): 1195-7.
- Tanaka S, Kitamura T, Fujita M, Nakanishi K, Okuda S. Color Doppler flow imaging of liver tumors. AJR Am J Roentgenol. 1990; 154 (3): 509-14.
- Goldberg BB, Liu JB, Forsberg F. Ultrasound contrast agents: A review. Ultrasound Med Biol. 1994; 20 (4): 319-33.
- Killi RM. Doppler sonography of the native liver. Eur J Radiology 1999; 32 (1): 21-35.
- Ernst H, Hahn EG, Balzer T, Schlief R, Heyder N. Color doppler ultrasound of liver lesions: signal enhancement after intravenous injection of the ultrasound contrast agent Levovist. J Clin Ultrasound. 1996; 24 (1): 31-5.
- Claudon M, Dietrich CF, Choi BI, D O Cosgrove, M Kudo, C P Nolsøe, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver–update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34 (1):11–29.
- Nicolau C, Vilana R, Catala V, Bianchi L, Gilabert R, García A, et al. Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions. AJR Am J Roentgenol 2006; 186 (1): 158–67.
- Harvey CJ, Blomley MJK, Eckersley RJ, Cosgrove DO. Developments in ultrasound contrast media. Eur Radiol 2001; 11 (4): 675-89.
- Tanaka S, Ioka T, Oshikawa O, Hamada Y, Yoshioka F. Dynamic sonography of hepatic tumors. AJR Am J Reontgenol 2001; 177 (4): 799-805.
- Chami L, Lassau N, Malka D, Ducreux M, Bidault S, Roche A, et al. Benefits of contrastenhanced sonography for the detection of liver lesions: comparison with histologic findings. AJR Am J Roentgenol 2008; 190: 683-90.
- Pennisi F, Farina R, Politi G, Lombardo R, Puleo S. Hepatic focal lesions: role of color Doppler ultrasonography with contrast media. Radiol Med. 1998; 96 (6): 579-87.
- Tanaka S, Kitamra T, Fujita M, Yoshioka F. Value of contrast-enhanced color Doppler sonography in diagnosing hepatocellular carcinoma with special attention to the "color-filled pattern". J Clin Ultrasound. 1998; 26 (4): 207-12.
- Sandulescu L, Saftoiu A, Dumitrescu D, Ciurea T. The Role of Real-time contrast-enhanced and real-time virtual sonography in the assessment of malignant liver lesions. J Gastrointestin Liver Dis 2009: 18 (1): 103-8.
- Fujimoto M, Moriyasu F, Nishikawa K, Nada T, Okuma M. Color Doppler sonography of hepatic tumors with a galactose-based contrast agent: correlation with angiographic findings. AJR Am J Roentgenol. 1994; 163 (5): 1099-104.
- Wachsberg RH1, Jilani M. Duplex Doppler sonography of small (<3 cm diameter) liver tumours: intralesional arterial flow does not exclude cavernous haemangioma. Clin Radiol. 1999; 54(2): 103-6.
- Naganuma H, Ishida H, Konno K, et al. Hepatic hemangioma with arterioportal shunts. Abdominal Imaging 1999; 24, 42–6.
- Nishigaki Y, Tomita E, Matsuno Y, et al. Usefulness of novel imaging modalities in diagnosis of focal nodular hyperplasia of the liver. Journal of Gastroenterology 1997; 32, 677–83.
- Wang LY1, Wang JH, Lin ZY, et al. Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound. Abdom Imaging. 1997; 22 (2): 178-81.
- Reinhold C, Hammers L, Taylor CR, Quedens-Case CL, Holland CK, Taylor KJ. Characterization of focal hepatic lesions with duplex sonography: findings in 198 patients. AJR Am J Roentgenol. 1995; 164 (5): 1131-5.
- Numata K, Tanaka K, Kiba T, et al. Use of hepatic tumor index on color Doppler sonography for differentiating large hepatic tumors. AJR 1997; 168 (4): 991-5.
- Trillaud H, Bruel J-M, Valette P-J, Vilgrain V, Schmutz G, Oyen R, et al. Characterization of focal liver lesions with SonoVue-enhanced sonography: International multicenter-study in comparison to CT and MRI. World J Gastroenterol 2009; 15 (30): 3748-56.
- D'Onofrio M, Crosara S, De Robertis R, Canestrini S, Mucelli RP. Contrast-Enhanced Ultrasound of Focal Liver Lesions. AJR Am J Roentgenol 2015; 205 (1), 56-66.
- Zarzour JG, Porter KK, Tchelepi H, Robbin ML. Contrast-enhanced ultrasound of benign liver lesions. Abdominal Radiology 2018; 43, 848–60.
The effectiveness of color doppler ultrasonography and echo contrast agents in the differential diagnosis of liver masses
Öz
Aim: The aim of this study is to investigate the contribution of color Doppler ultrasonographic findings and echo enhanced color Doppler ultrasonographic evaluation to the mass characterization of patients with liver mass lesions.
Materials and Methods: Routine and echo-contrast colored Doppler findings of 35 cases with a mass in the liver during their radiological examinations were evaluated retrospectively. In cases in which blood was detected in the mass, the maximum systolic velocity (Vmax) and resistive index (RI) values and blooding patterns were recorded by performing spectral analyzes from vascular structures.
The maximum value of the maximum systolic velocities and the corresponding RI values were considered determinative for the lesion examined. Lesion diagnoses were obtained by evaluating biopsy (n = 15) gray scale US, CT (n = 30), MRI (n = 27) and clinical findings. The blood flow patterns of the lesions before and after the contrast medium, spectral analysis values (Vmax and RI) were statistically evaluated.
Results: Seven patients with hemangioma, seven patients with hepatocellular carcinoma, twenty patients with metastasis and one patient with focal nodular hyperplasia were included in the study. A statistically significant correlation was found between routine color Doppler ultrasonography and echo enhanced color Doppler ultrasonographic evaluation of these lesions. There was no statistically significant difference between RI values in two groups (p <0.05). When Vmax values were classified according to lesion diagnoses, no statistically significant difference was observed between the two groups (p <0.05).
Conclusion: Color Doppler ultrasonography in 77% of cases alone provided sufficient and satisfactory results in revealing the flow patterns of tumoral lesions. Echo-contrast colored Doppler ultrasonographic evaluation contributed to differential diagnosis by dynamically showing blood pattern in 17% of the remaining patients.
Anahtar Kelimeler
Kaynakça
- Leen E, Goldberg JA, Robertson J, et al. Detection of hepatik metastasis using duplex/ color Doppler sonography. Ann Surg. 1991; 214 (5): 599–604.
- Leen E, Goldberg JA, Robertson J, et al. Image directed Doppler sonography; a novel technique for diagnosis of colorectal liver metastasis. J Clin Ultrasound 1993; 21: 221-30.
- Paintner A, Bayer C, Böttcher B, Wenk H, Swobodnik W. Doppler and color Doppler ultrasound diagnosis in differentiation of focal liver lesions. Bildgebung. 1996; 63 (1): 22-6.
- Nino-Murcia M, Ralls PW, Jeffrey RB Jr, Johnson M. Color flow Doppler characterization of focal hepatic lesions. AJR Am J Roentgenol. 1992; 159 (6): 1195-7.
- Tanaka S, Kitamura T, Fujita M, Nakanishi K, Okuda S. Color Doppler flow imaging of liver tumors. AJR Am J Roentgenol. 1990; 154 (3): 509-14.
- Goldberg BB, Liu JB, Forsberg F. Ultrasound contrast agents: A review. Ultrasound Med Biol. 1994; 20 (4): 319-33.
- Killi RM. Doppler sonography of the native liver. Eur J Radiology 1999; 32 (1): 21-35.
- Ernst H, Hahn EG, Balzer T, Schlief R, Heyder N. Color doppler ultrasound of liver lesions: signal enhancement after intravenous injection of the ultrasound contrast agent Levovist. J Clin Ultrasound. 1996; 24 (1): 31-5.
- Claudon M, Dietrich CF, Choi BI, D O Cosgrove, M Kudo, C P Nolsøe, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver–update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34 (1):11–29.
- Nicolau C, Vilana R, Catala V, Bianchi L, Gilabert R, García A, et al. Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions. AJR Am J Roentgenol 2006; 186 (1): 158–67.
- Harvey CJ, Blomley MJK, Eckersley RJ, Cosgrove DO. Developments in ultrasound contrast media. Eur Radiol 2001; 11 (4): 675-89.
- Tanaka S, Ioka T, Oshikawa O, Hamada Y, Yoshioka F. Dynamic sonography of hepatic tumors. AJR Am J Reontgenol 2001; 177 (4): 799-805.
- Chami L, Lassau N, Malka D, Ducreux M, Bidault S, Roche A, et al. Benefits of contrastenhanced sonography for the detection of liver lesions: comparison with histologic findings. AJR Am J Roentgenol 2008; 190: 683-90.
- Pennisi F, Farina R, Politi G, Lombardo R, Puleo S. Hepatic focal lesions: role of color Doppler ultrasonography with contrast media. Radiol Med. 1998; 96 (6): 579-87.
- Tanaka S, Kitamra T, Fujita M, Yoshioka F. Value of contrast-enhanced color Doppler sonography in diagnosing hepatocellular carcinoma with special attention to the "color-filled pattern". J Clin Ultrasound. 1998; 26 (4): 207-12.
- Sandulescu L, Saftoiu A, Dumitrescu D, Ciurea T. The Role of Real-time contrast-enhanced and real-time virtual sonography in the assessment of malignant liver lesions. J Gastrointestin Liver Dis 2009: 18 (1): 103-8.
- Fujimoto M, Moriyasu F, Nishikawa K, Nada T, Okuma M. Color Doppler sonography of hepatic tumors with a galactose-based contrast agent: correlation with angiographic findings. AJR Am J Roentgenol. 1994; 163 (5): 1099-104.
- Wachsberg RH1, Jilani M. Duplex Doppler sonography of small (<3 cm diameter) liver tumours: intralesional arterial flow does not exclude cavernous haemangioma. Clin Radiol. 1999; 54(2): 103-6.
- Naganuma H, Ishida H, Konno K, et al. Hepatic hemangioma with arterioportal shunts. Abdominal Imaging 1999; 24, 42–6.
- Nishigaki Y, Tomita E, Matsuno Y, et al. Usefulness of novel imaging modalities in diagnosis of focal nodular hyperplasia of the liver. Journal of Gastroenterology 1997; 32, 677–83.
- Wang LY1, Wang JH, Lin ZY, et al. Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound. Abdom Imaging. 1997; 22 (2): 178-81.
- Reinhold C, Hammers L, Taylor CR, Quedens-Case CL, Holland CK, Taylor KJ. Characterization of focal hepatic lesions with duplex sonography: findings in 198 patients. AJR Am J Roentgenol. 1995; 164 (5): 1131-5.
- Numata K, Tanaka K, Kiba T, et al. Use of hepatic tumor index on color Doppler sonography for differentiating large hepatic tumors. AJR 1997; 168 (4): 991-5.
- Trillaud H, Bruel J-M, Valette P-J, Vilgrain V, Schmutz G, Oyen R, et al. Characterization of focal liver lesions with SonoVue-enhanced sonography: International multicenter-study in comparison to CT and MRI. World J Gastroenterol 2009; 15 (30): 3748-56.
- D'Onofrio M, Crosara S, De Robertis R, Canestrini S, Mucelli RP. Contrast-Enhanced Ultrasound of Focal Liver Lesions. AJR Am J Roentgenol 2015; 205 (1), 56-66.
- Zarzour JG, Porter KK, Tchelepi H, Robbin ML. Contrast-enhanced ultrasound of benign liver lesions. Abdominal Radiology 2018; 43, 848–60.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2020 |
| Gönderilme Tarihi | 23 Aralık 2019 |
| Yayımlandığı Sayı | Yıl 2020 |