Splenic trauma: Evaluation with contrast-specific sonography and a second-generation contrast medium - Preliminary experience
Splenic trauma: Evaluation with contrast-specific sonography and a second-generation contrast medium - Preliminary experience
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DOI：
10.7863/jum.2003.22.5.467
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发表时间：
2003-05-01
影响因子：
2.3
通讯作者：
Siani, A
中科院分区：
文献类型：
--
作者：
Catalano, O;Lobianco, R;Siani, A
Objective.报告我们的经验，在评估脾外伤的对比编码超声和第二代造影剂。方法.从2002年1月至5月，120例患者进行了研究，超声检查可疑脾外伤。选择25例患者进行进一步成像，因为超声检查结果为脾损伤阳性，仅腹腔液阳性，不确定结果，以及临床或实验室高度怀疑的阴性结果。这些患者接受了对比增强谐波超声和对比增强螺旋计算机断层扫描。结果在研究的25例患者中，6例在初始和随访评估时没有脾损伤。1例患者脾灌注不足，无实质损伤，18例脾损伤;这19例患者被认为是阳性。在19例阳性病例中，74%的患者通过超声检查、超声造影和计算机断层扫描发现腹腔积血。58%的病例通过计算机断层扫描和42%的病例通过基线和增强超声检查识别出脾周凝块。通过对比增强超声和计算机断层扫描发现11%的病例有脾梗死;通过非增强超声没有发现脾梗死。在18例脾损伤患者中，12例通过非增强超声检查，17例通过对比增强超声检查，所有18例通过对比增强计算机断层扫描发现了实质性创伤性病变。在一个具有假阴性对比增强超声检查结果的患者中发现了最小的脾病变。超声造影在检测损伤和估计损伤程度方面明显优于非超声造影。在非增强超声检查中也发现了无法检测到的结果：在对比增强超声检查和对比增强计算机断层扫描中，11%的阳性病例中存在脾脏灌注不足，在对比增强超声检查和计算机断层扫描中，21%的病例中存在造影剂池，在计算机断层扫描中，11%的病例中存在造影剂外渗，在对比增强超声检查中，5%的病例中存在造影剂外渗。结论.超声造影是一种很有前途的工具，在评估脾外伤。在超声检查被用作初始程序的机构中，这种技术可能会增加其有效性。
Objective. To report our experience in the assessment of splenic trauma with contrast-coded sonography and a second-generation contrast medium. Methods. From January to May 2002, 120 patients were studied with sonography for suspected splenic trauma. Twenty-five were selected for further imaging because of sonographic findings positive for splenic injury, findings positive for peritoneal fluid only, indeterminate findings, and negative findings with high clinical or laboratory suspicion. These patients underwent contrast-enhanced harmonic sonography and contrast-enhanced helical computed tomography. Results. Among the 25 patients studied, 6 had no spleen trauma at initial and follow-up evaluation. One patient had a hypoperfused spleen without parenchymal damage, and 18 had splenic injuries; these 19 patients were considered positive. Hemoperitoneum was identified by sonography, contrast-enhanced sonography, and contrast-enhanced computed tomography in 74% of the 19 positive cases. Perisplenic clots were recognized in 58% of the cases by computed tomography and in 42% by baseline and enhanced sonography. Splenic infarctions were found in 11% of cases by contrast-enhanced sonography and computed tomography; none was found by unenhanced sonography. Parenchymal traumatic lesions were identified in 12 of 18 patients with splenic injuries by unenhanced sonography, in 17 cases by contrast-enhanced sonography, and in all 18 cases by contrast-enhanced computed tomography A minimal splenic lesion was found in the single patient with a false-negative contrast-enhanced sonographic finding. Contrast-enhanced sonography correlated appreciably better than unenhanced sonography in detecting injuries and in estimating their extent. Findings undetectable on unenhanced sonography were also noted: splenic hypoperfusion in 11% of positive cases on both contrast-enhanced sonography and contrast-enhanced computed tomography, contrast medium pooling in 21% of cases on both contrast-enhanced sonography and computed tomography, and contrast extravasation in 11% of cases on computed tomography and 5% on contrast-enhanced sonography. Conclusions. Contrast-enhanced sonography is a promising tool in the assessment of splenic trauma. In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness.