B-Bild-Sonographie und kontrastunterstützte Sonographie in der Beurteilung von Milzmetastasen solider Tumore: Zwei Untersuchungsreihen der Jahre 1988-2002 und 2004-2006

Aim: To describe B-mode sonographic patterns of splenic metastases and to evaluate clinical data regarding tumor staging, kind of tumor and survival of patient with splenic metastases. Aim of the pilot study on 13 patients is to describe the addiditional value of the new method of contrast enhanced ultrasound in identifying splenic metastases. Methods: From 1988 till October 2002 in an internal ultrasound laboratory about 168 000 abdominal examinations were performed. During this time n=59 patients with splenic metastases were detected which qualified for the retrospective study design. The following data were evaluated: echomorphology of splenic metastases, tumor staging, kind of underlying tumor, and survival rates of patients with splenic metastases. 13 patients fulfilled the inclusion criteria for the pilot study of the years 2004-2006. Metastases had been described in conventional B-Mode sonography as well as with the new method of contrast enhanced sonography. Results: The median age of patients was 61.8 years (SD +/-10.9). Lesions were hypoechoic n=19 (32%), isoechoic n=15 (25.5%), hyperechoic n=10 (17%) und complex n=15 (25.5%). An hypoechoic rim was found in n=18 patientens (31%). An additional organ metastazation was seen in 56 cases (95%). Underlying cancers were carcinoma of unknown primary (CUP) n=12 (20.3%), lung cancer n=11 (18.6%), ovarian cancer n=7 (11.9%), colorectal cancer n=6 (10.2%), breast cancer n=6 (10.2%), malignant melanoma n=5 (8.4%), and others n=12 (20.3%). The median survival time for all patients was 8.7 months. The worst prognosis within the subgroup analysis had the patients with CUP-syndrome with a median survival time of 2.7 months. The conducted pilot study had showed no additional value of CES in the characterisation of Metastases to the spleen. Conclusion: The sonographic pattern of splenic metastases is unspecific. Metastazion to the spleen indicates an end stage cancer disease and is associated with an extreme short survival time. 20% of underlying cancer were CUP-syndromes with the worst prognosis of all subgroups. The new method of contrast enhanced sonography seems to be of low additional value for the detection and identification of splenica metastases.