Percutaneous injection of hemostatic agents for severe blunt hepatic trauma: an experimental study

This study was designed to evaluate whether percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound (CEUS) can stop hemorrhage from severe hepatic trauma. Eighteen dogs were impacted by a miniature impactor to create blunt hepatic trauma. Fourteen with appropriate liver lesions were divided into two groups: the treatment group (n = 7) and the control group (n = 7). In the treatment group, hemocoagulase atrox and α-cyanoacrylate were respectively injected into the injury sites and transected micro-vessels under the guidance of CEUS. In the control group, normal saline was injected into the injury sites. CEUS and CT were performed at 3, 7, 14, and 21 days after the focal injection. Surviving animals were killed on the 21st day for pathologic examination. All animals of the treatment group survived. Three dogs of the control group died in the first 24 h. In the treatment group, CEUS and CT demonstrated that hepatic lesions became smaller gradually from the 3rd to the 21st day after injection. The focal injection of hemostatic agents under the guidance of CEUS can stop hemorrhage from hepatic trauma of grade III~IV or IV. During the period of 3 weeks, no side effect was found.     

超声造影引导下穿刺治疗腹部实质脏器损伤

目的 探讨超声造影指导腹部实质脏器创伤后行经皮穿刺治疗的有效性及安全性.方法12例腹部实质脏器损伤患者行超声造影检查,明确脏器损伤部位、损伤程度及有无活动性出血,生命体征稳定者在超声造影引导下注射止血剂,行局部止血治疗,均于治疗后即刻、1d、3d、1周、2周、1个月行常规超声及超声造影检查. 结果 12例患者均即刻止血,无迟发性再出血. 结论 超声造影显著提高腹部实质性脏器损伤诊断的准确性,准确指导局部介入性止血治疗,效果显著,安全可靠.     

超声增强造影与肝酶水平在肝损伤分级中的意义

目的探讨超声增强造影和血清肝酶在肝损伤检查和分级中的价值和意义。方法 20只健康新西兰大白兔,雌雄不限,体重为(2.15±0.23)kg。随机制作不同级别的肝损伤模型。建模前后抽取静脉血进行血清肝酶检查,建模后分别使用通用16排螺旋CT和Philip公司IU22临床超声仪对实验动物进行增强CT和超声增强造影检查,然后根据美国创伤外科协会(AAST)分级标准对肝脏损伤进行分级,最后将超声造影的分级结果与增强CT分级结果进行Spearman相关性分析,将血清肝酶的结果与CT分级结果进行Pearson相关性分析。结果按照AAST诊断标准,超声增强造影和增强CT检查对肝损伤等级的分类具有很高的一致性,Spearman相关系数为0.888(P0.0001),Kappa值为0.71;天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氨酶(LDH)、AST/ALT比值与肝损伤的等级呈正相关,Pearson相关系数分别为0.664(P=0.0014)、0.704(P=0.0005)、0.503(P=0.024),γ-谷氨酰基转移酶(GGT)水平与肝损伤等级呈负相关(r=-0.467,P=0.038)。结论超声增强造影和血清肝酶检查在对肝损伤的检查与分级上与增强CT检查的结果有较好的一致性,可作为肝损伤诊断及治疗中监测手段。     

比较常规超声与超声增强造影诊断脾钝性创伤的实验研究

 目的 比较常规超声与超声增强造影在脾钝性创伤中的应用价值.方法 8只健康成年杂种犬建立脾钝性创伤的动物模型18处,均行常规超声及超声增强造影检查,分析相应的声像图特点,并以病理结果为标准,比较两种检查方法的诊断准确率.结果 18处创伤常规超声诊断8处,准确率为44.4%;超声造影诊断18处,准确率为100%,二者比较差异具有统计学意义.超声造影图像中脾内创伤区始终无强化,边界清晰,与非创伤区的无强化形成了鲜明对比,破裂处可见造影剂的外渗.结论 超声造影能够清晰地显示脾外伤的范围和程度,对脾钝性创伤的诊断准确率明显高于常规超声.     

脾脏低回声病变的超声造影诊断

目的:探讨超声造影对脾脏低回声病变的诊断价值。材料和方法:经外周静脉团注声诺维(SonoVue),使用对比脉冲序列(CPS)技术,对9例脾脏低回声病变行超声造影检查。结果:2例脾血管瘤造影剂廓清慢于脾组织,实质期回声强于脾实质。5例脾淋巴瘤、1例脾转移癌及1例脾炎性假瘤造影剂廓清均快于脾组织,实质期回声低于脾实质。结论:超声造影对脾脏低回声病变的诊断和鉴别诊断具有一定的价值。     

Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma

Purpose

The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma.

Materials and methods

Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium.

Results

The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable.

Conclusions

CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.     

乏血供肝转移瘤超声造影与CT增强扫描的对比研究

目的:探讨乏血供肝转移瘤超声造影(CEUS)血流灌注特点及其与CT增强扫描的差异。方法:选择CT增强扫描提示为乏血供肝转移瘤的12例(20个病灶)行常规超声及造影检查。二维超声观察病灶的部位、大小、边界、内部回声;CEUS观察病灶各期的强化模式、强化水平,重点观察动脉期(0～25s),并与CT增强扫描进行比较。结果:12例共20个病灶,CT增强扫描动脉期:1个病灶轻度增强(5%),11个环形强化(55%),2个不均匀强化(10%),6个无强化(30%)。CEUS动脉期:11个病灶弥漫性均匀强化(55%),7个环形强化(35%),2个不均匀强化(10%)。结论:CEUS显示乏血供肝转移瘤动脉期血供情况优于CT增强扫描;对于CT增强扫描怀疑为乏血供肝转移瘤患者,尤其是单发转移瘤,CEUS检查对临床诊断和治疗有很大帮助。     

Enhancement pattern of hepatocellular carcinoma: comparison of real-time contrast-enhanced ultrasound and contrast-enhanced computed tomography

We compared the enhancement pattern of 98 hepatocellular carcinoma nodules in 92 patients on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT). Contrast-enhanced ultrasound was performed with SonoVue and a low mechanical index method. In arterial phase, 98 nodules were hyperenhancing on CEUS and 94 on CECT. In portal phase, 82 nodules were hypoenhancing on CEUS and 83 on CECT. Peripheral thin-rim-like enhancement was exhibited in 30 nodules on CEUS and 31 on CECT. Intratumoral vessels were visualized in 94 nodules on CEUS and 36 on CECT.     

超声造影在诊断乳腺癌肝转移中的应用价值

目的:探讨超声造影(CEUS)在诊断乳腺癌肝转移中的应用价值。材料和方法:对89例常规超声疑似乳腺癌肝转移者行CEUS和增强CT(CECT)后,采用穿刺活检、手术病理、影像学随访超过半年临床最后确诊。结果:89例常规超声疑似乳腺癌肝转移经CEUS及相关检查临床最后确诊为良性41例。48例乳腺癌肝转移经CEUS明确诊断47例。CEUS对乳腺癌肝转移诊断的敏感度为97.92%(47/48),假阴性率为2.08%(1/48),特异度为100%(41/41),阳性预测值为100%(47/47),阴性预测值为97.62%(41/42)。经CEUS发现新增转移病灶10例。CEUS从常规超声53.93%(48/89)的诊断准确度提高到98.88%(88/89)。CEUS对乳腺癌肝转移的诊断率与CECT在统计学上无差异(P=0.833)。结论:CEUS能发现乳腺癌较小的肝转移灶,提高了超声诊断乳腺癌肝转移的鉴别能力和准确度。     

钝性肝脾肾损伤的CT平扫与增强扫描比较

目的:比较CT平扫与增强扫描对肝脾肾钝性损伤的诊断能力。方法:回顾性分析临床疑似钝性肝脾肾损伤,并经手术和临床观察证实的CT平扫和增强扫描的患者84例。结果:平扫确定的损伤:肝12例,脾25例,肾5例;平扫可疑损伤:肝22例,脾15例,肾5例。增强确定的损伤:肝32例,脾40例,肾12例(全肾梗塞1例,局限性梗塞3例);对比剂外溢(活动性出血)3例;无可疑损伤。平扫无异常而增强确定有损伤:肝10例,脾5例,肾2例。增强显示的损伤灶比平扫范围明显大、病灶多、界限清楚。结论:CT增强扫描显示肝脾肾损伤明显优于平扫,延时扫描有助于发现活动性出血,应常规增强扫描。     

CT diagnosis of splenic infarction in blunt trauma: imaging features, clinical significance and complications

AIM: The object of this study is to describe the appearance, complications, and outcome of segmental splenic infarctions occurring after blunt trauma using computed tomography (CT). MATERIALS AND METHODS: Thirteen blunt trauma patients were identified with splenic infarction on contrast-enhanced CT. CT images were retrospectively reviewed and the percentage of infarcted splenic tissue and presence of splenic injury separate from the site of infarction were identified. Splenic angiograms were reviewed and follow-up CT images were assessed for interval change in the appearance of the infarcts. RESULTS: The mean age of patients was 32 years and the most common mechanism of injury was road traffic accident. The majority (54%) had 25-50% infarction of the spleen. Splenic angiograms were performed in nine patients and seven demonstrated wedge-shaped regions of decreased perfusion corresponding to the infarction seen on CT with no need for intervention. Eleven patients underwent a follow-up CT that demonstrated the following: no significant change in six, near-complete resolution in two, delayed appearance of infarction in one, abscess formation in one, and delayed splenic rupture in one. CONCLUSION: Segmental splenic infarction is a rare manifestation of blunt splenic trauma. The diagnosis is readily made using contrast-enhanced CT. The majority will decrease in size on follow-up CT and resolve without clinical sequelae. Resolution of infarction is also seen and these cases are best described as temporary perfusion defects. Splenic abscess or delayed rupture are uncommon complications that may necessitate angiographic or surgical intervention.     

Enhancement patterns of intrahepatic cholangiocarcinoma: comparison between contrast-enhanced ultrasound and contrast-enhanced CT

The aim of this study was to compare the enhancement pattern of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) with that on contrast-enhanced computed tomography (CECT). 40 pathologically proven ICC lesions in 40 patients were evaluated retrospectively with both CEUS and CECT. The enhancement level and pattern in the dynamic phases on both CEUS and CECT were analysed. The diagnostic results of CEUS and CECT before pathological examination were also recorded. During arterial phases, the number of lesions that appeared as (i) peripheral irregular rim-like hyperenhancement, (ii) diffuse heterogeneous hyperenhancement, (iii) diffuse homogeneous hyperenhancement and (iv) diffuse heterogeneous hypoenhancement were 19 (47.5%), 9 (22.5%), 5 (12.5%) and 7 (17.5%), respectively, on CEUS, and 22 (55.0%), 3 (7.5%), 2 (5.0%) and 13 (32.5%), respectively, on CECT (p = 0.125). In the portal phase, the number of lesions showing hyperenhancement and hypoenhancement were 1 (2.5%) and 39 (97.5%), respectively, on CEUS, and 15 (37.5%) and 25 (62.5%) on CECT (p = 0.0001). CEUS made a correct diagnosis in 32 (80.0%) lesions before pathological examination; CECT made a correct diagnosis in 27 (67.5%) lesions (p = 0.18). In conclusion, the enhancement patterns of ICC on CEUS were consistent with those on CECT in the arterial phase, whereas in the portal phase ICC faded out more obviously on CEUS than on CECT. CEUS had the same accuracy as CECT in diagnosing ICCs, and so can be used as a new modality for the characterization of ICC.     

超声造影与增强CT对肾癌的诊断分析

目的:本研究旨在比较超声造影(CEUS)和增强CT(CECT)在肾癌病灶中的诊断价值,探讨超声造影在肾癌的诊断价值。方法:对54例患者临床诊断为肾脏内占位性病灶进行CEUS和CECT检查,通过分析病灶CEUS和CECT的特点,比较两种方法的诊断效能。结果:54个病灶中34个为肾脏恶性肿瘤,20个为肾脏良性病灶,CEUS和CECT诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.05%、85.0%、92.59%、91.67%、94.44%与91.18%、80.00%、87.04%、88.57%、84.21%。两种方法诊断差异无统计学意义(P>0.05)。结论:分析比较CEUS和CECT在诊断肾癌过程中,两种方法诊断效能无明显差异,均能为临床诊断提供重要依据,但CEUS对微循环灌注方面及假包膜的观察优于CECT;CEUS定量评价肾肿瘤血管现处于动物实验阶段,临床上特异指标的找寻仍有待于进一步研究。     

Characterization of focal liver lesions with a new ultrasound contrast agent using continuous low acoustic power imaging: comparison with contrast enhanced spiral CT

PURPOSE: To evaluate the concordance of the enhancement patterns of a new ultrasound contrast agent (SonoVue) with those obtained with dual-phase contrast-enhanced spiral CT (CE-CT) in the characterization of focal liver lesions (FLLs). MATERIALS AND METHODS: Sixty-two patients with focal liver lesions discovered at ultrasound and also studied with CECT underwent contrast-enhanced ultrasound using continuous low acoustic power imaging after receiving a 2.4 ml bolus of the new US contrast agent SonoVue, consisting of a dispersion of sulphur hexafluoride microbubbles. The examinations were made using ATL HDI-5000, Acuson SEQUOIA and Aloka 5500 Prosound ultrasound systems with 5.2 MHz curved-array probes. The concordance between US and CE-CT images was evaluated on site by two radiologists blinded to CT RESULTS: The FLLs were assessed in the arterial (20 s after CM injection), portal (after 45-60 s) and late (after 120 s) phases for: 1) presence/absence of enhancement 2) distribution of enhancement (homogenous or target distribution, centripetal or centrifugal flow, and other), 3) qualitative enhancement pattern (hyperechoic, hypoechoic, or isoechoic) versus normal liver parenchyma. RESULTS: The concordance between SonoVue-enhanced US and CE-CT was 85%. Moreover during portal venous phase with CEUS it was possible to differentiate between malignancy or benignity of 91% of lesions. CONCLUSIONS: The preliminary data obtained in this study suggest that continuous low acoustic power imaging and contrast-enhanced US show similar results to CT in contrast distribution and contrast enhancement patterns.     

Differential diagnosis between splenic nodules and peritoneal metastases with contrast-enhanced ultrasound based on signal-intensity characteristics during the late phase

Purpose

This study was done to assess the enhancement characteristics of splenic implants and to evaluate whether contrast-enhanced ultrasound (CEUS) after SonoVue injection allows the differential diagnosis with peritoneal metastases.

Material and Methods

Thirteen consecutive patients with splenosis and 13 consecutive patients with peritoneal metastases were investigated with CEUS after injection of 2.4 ml of SonoVue. Lesion enhancement was evaluated in real time for 240 s. All examinations were recorded digitally and analysed retrospectively. Frames were selected at different time intervals ranging from 0 to 4 min after injection. Average signal intensity was evaluated by measuring the average grey level in a region of interest encompassing the entire nodule. Results were evaluated using the Mann-Whitney test and interobserver variability using the Bland and Altmann method.

Results

Splenic grafts presented with intense enhancement and without significant washout. Metastases presented with variable enhancement and progressive washout. Signal intensity values were significantly higher for splenic grafts, starting from 40 s after microbubble administration. Starting from 90 s after injection, there was no overlapping between enhancement of splenic grafts and peritoneal metastases, and only splenic grafts showed a percent of enhancement higher than 60% of the maximum enhancement.

Conclusions

CEUS after SonoVue injection may be considered a valuable alternative to scintigraphy for characterising peritoneal splenic grafts without radiation.     

Analysis of comparative performance of CEUS and CECT/MR LI-RADS classification: Can CEUS dichotomize LI-RADS indeterminate lesions on CT or MRI?

PurposeTo study the comparative performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT or MRI (CECT/MR) in evaluating liver lesions using the LI-RADS guidelines.MethodsRetrospective analysis of radiology database from July 2010 to April 2017 revealed 228 patients who had CECT/MR and CEUS. Patients at risk of hepatocellular carcinoma (HCC), had contemporaneous CEUS and CECT/CEMR studies within 3 months and adequate follow up were included; reviewed (2 reviewers) and graded according to the 2017 CEUS and 2018 CECT/MR LI-RADS guidelines. Reference standard was multidisciplinary clinical decisions, histology or follow-up imaging.ResultsThe study cohort consisted of 45 patients with 46 lesions. HCC were significantly larger than non-malignant (mean sizes of 2.5 and 1.4 cm, respectively, p<0.001). Intraclass correlation coefficient for CEUS review (0.941) was higher than of CECT/MR review (0.643). Mean area-under-ROC curve (AUC) for CEUS (0.994) was significantly higher than of CECT/MR (0.760) for all lesions (p=0.01). For lesions scored LR-3 by CECT/MR, the AUC was significantly higher for CEUS (0.978) than CECT/MR (0.500) (p<0.001). Twenty-one (of 27) lesions, classified LR-3 or LR-4 by CECT/MR were upgraded by CEUS and 20 were found to be HCC. Six lesions that were LR-3 on both CECT/MR and CEUS were found to be non-malignant. There was good concordance for LR-5 lesions between both techniques.ConclusionCEUS is useful for reassessment of lesions with intermediate probability (LR-3) or probable for HCC (LR-4) on CECT/MR. Lesions upgraded by CEUS tend to be HCC. Lesions that remain LR-3 on CEUS tend to be non-malignant.     

Management of hepatocellular carcinoma: The role of contrast-enhanced Tultrasound简

Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third cause of cancer death worldwide. Contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. On the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver-update 2012 and related literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC, including HCC surveillance, diagnosis, CEUS-guided treatment, treatment response evaluation and follow-up. The diagnostic algorithm for HCC is also suggested. Meanwhile, the comparisons between CEUS and contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in these areas are made. Although CEUS is subject to the same limitation as ordinary US and is inferior to CECT/CEMRI in some aspects, CEUS has proved to be of great value in the management of HCC with inherent advantages, such as sufficient high safety profile making it suitable for patients with renal failure or allergic to iodine, absence of radiation, easy reproducibility and high temporal resolution. The tremendous application of CEUS to the diagnosis and treatment of HCC provides more opportunities for patients with HCC diagnosed at different stages.     

超声造影引导下联合止血剂注射治疗肾挫裂伤的实验研究

目的 探讨超声造影引导下联合止血剂注射治疗肾挫裂伤的可行性.方法 18只新西兰大白兔开腹建立Ⅲ～Ⅳ级模拟钝性挫裂伤,随机数字表法分成三组:在超声造影引导下分别注射血凝酶(A组)、血凝酶联合α-氰基丙烯酸酯止血(B组)和等渗盐水(C组),观察止血时间、止血效果、肾周血肿等情况.结果 治疗后1 h,A、B、C组的肾周积液宽度分别为(0.200±0.012)cm,(0.050±0.002)cm和(0.400±0.009)cm,A、B组与C组比较,差异有统计学意义(P＜0.05).治疗后7,14 d复查,A组病灶长径分别为(1.107±0.143)cm和(0.433±0.163)cm,B组分别为(0.567±0.082)cm和(0.160±0.078)cm,C组分别为(0.980±0.203)cm和(0.686±0.157)cm,治疗后14 d,A、B组与C组间比较,差异有统计学意义(P＜0.01).A组病灶较B组大(P＜0.01).但B组治疗1个月后出现轻度肾积水的情况.结论 单纯注射血凝酶与联合注射血凝酶和α-氰基丙烯酸酯均能够达到止血效果,但后者的止血效果更加迅速、可靠.     

Percutaneous treatment of blunt hepatic and splenic trauma under contrast-enhanced ultrasound guidance

The objective of this study was to evaluate the clinical application of hemostatic percutaneous therapy of liver and spleen trauma under contrast-enhanced ultrasound (CEUS) guidance. A total of 83 patients with 88 traumatic organ lesions were included in this study. Liver or spleen lesions were treated by percutaneous injection of haemocoagulase atrox and α-cyanoacrylate under CEUS guidance. The results showed that one treatment was sufficient to successfully control hemorrhaging in 86 of 88 traumatic organ lesions. In 2 of 88 traumas, a second percutaneous hemostatic treatment was necessary. Percutaneous treatment of blunt hemorrhagic trauma under CEUS guidance is a feasible and safe adjunct to observation in the nonoperative management.     

超声造影与增强CT在胆囊疾病诊断中的对比分析

目的:比较超声造影(contrast-enhanced ultrasound,CEUS)和CT增强(contrast-enhanced helicalcomputedtomography,CECT)检查在胆囊占位性病变诊断中血流灌注过程中的的特点,探讨其在胆囊占位性病变诊断中的价值。方法:对比分析78例胆囊占位性病变的超声造影和增强CT在不同时相的增强及灌注特征。结果:超声造影和增强CT具有相似的表现。但对于小于5 mm的病变,超声造影的检出率高于增强CT,78例胆囊占位性病变中,胆囊癌35例,胆囊息肉29例,局限性胆囊腺肌增生症14例,增强CT准确率分别为84.35%,89.63%和80.13%,超声造影准确率分别为83.12%,93.79%和79.72%。结论:增强CT和超声造影检查均有助于胆囊疾病诊断,两者结合可提高胆囊疾病的诊断符合率。