Stellenwert farbdopplersonographischer Befunde in der (Differential-)Diagnose fokaler Milzläsionen: eine retrospektive Studie

Fokale Läsionen der Milz sind extrem selten und werden im Patientengut eines internistischen Ultraschall-Labors mit einer Häufigkeit von etwa 0,2 % bis 0,46 % beobachtet. Eine ätiologische Zuordnung ist häufig schwierig und erst in Verbindung mit klinischen Daten und dem sonographisc...

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Bibliographic Details
Main Author: Bachmann, Christian
Contributors: Görg, Christian (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2003
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Focal lesions of the spleen are extremely rare. Among the patients of an internal medicine sonography lab they are found with a frequency of 0,2 % to 0,46 %. Often an etiologic classification is diffidult and becomes possible only in connection with clinical data and sonographic information over the course of time. The value of color doppler sonography in the etiologic classification of focal lesions of the spleen is unknown and seen critically. So far there are no method-comparing studies concerning this question. Also there is no comprehensive data concerning color doppler sonography findings in focal lesions of the spleen. In this study the color doppler sonographic flow patterns of 98 etiologically proven spleen lesions are reported. Furthermore, on the basis of sonographic images of 63 patients the methods of b-mode-sonography vs. color doppler sonography are compared. The results can be summarized as follows: In color doppler sonography 68 % of focal spleen lesions appeared with a lack of flow signal. 15 % appeared hypovascular, 8 % isovascular, 5 % showed a hypervascular and 3 % a arterio-venous "high flow" pattern. In the presentation of the flow pattern there was a difference between the ultrasound machines used in this study: When newer ultrasound technique was used (ACUSON Sequoia), the percentage of lesions presenting as "avascular" decreased from 72,8 % (ACUSON 128) to 63,2 %. Diagnostic marksmanship in the ultrasound diagnosis of focal spleen lesions correlated in b-mode and color doppler sonography with experience of the examiner: More experienced examiners scored better results. Diagnostic marksmanship was 32 %/ 35 % (b-mode/ color doppler) in the least experienced examiner and 72 %/ 75 % in the most experienced one. In contrast to these results, examiners thought color doppler sonography to be necessary for assurance of the diagnosis in 39,7 % to 88,9 % of all cases. It is shown that additional information due to color doppler sonography brought (independent from examiner experience) no significant increase of diagnostic marksmanship (variation range from - 1,6 % to + 4,8 %). Thus the value of color doppler sonography for assurance of diagnosis was overestimated by the examiners. The value of color doppler sonography in (differential-)diagnosis of focal lesions of the spleen has to be assessed as quite low, so routine use of color doppler sonography in sonographic examination of the spleen is not necessary. For special dignostic means (e.g. diagnosis of a-v-aneurysma) color doppler sonography allows a quick and reliable diagnosis. Sonography with contrast media (stimulated acoustic emission) can possibly increase diagnostic marksmanship in focal spleen lesions.Focal lesions of the spleen are extremely rare. Among the patients of an internal medicine sonography lab they are found with a frequency of 0,2 % to 0,46 %. Often an etiologic classification is diffidult and becomes possible only in connection with clinical data and sonographic information over the course of time. The value of color doppler sonography in the etiologic classification of focal lesions of the spleen is unknown and seen critically. So far there are no method-comparing studies concerning this question. Also there is no comprehensive data concerning color doppler sonography findings in focal lesions of the spleen. In this study the color doppler sonographic flow patterns of 98 etiologically proven spleen lesions are reported. Furthermore, on the basis of sonographic images of 63 patients the methods of b-mode-sonography vs. color doppler sonography are compared. The results can be summarized as follows: In color doppler sonography 68 % of focal spleen lesions appeared with a lack of flow signal. 15 % appeared hypovascular, 8 % isovascular, 5 % showed a hypervascular and 3 % a arterio-venous "high flow" pattern. In the presentation of the flow pattern there was a difference between the ultrasound machines used in this study: When newer ultrasound technique was used (ACUSON Sequoia), the percentage of lesions presenting as "avascular" decreased from 72,8 % (ACUSON 128) to 63,2 %. Diagnostic marksmanship in the ultrasound diagnosis of focal spleen lesions correlated in b-mode and color doppler sonography with experience of the examiner: More experienced examiners scored better results. Diagnostic marksmanship was 32 %/ 35 % (b-mode/ color doppler) in the least experienced examiner and 72 %/ 75 % in the most experienced one. In contrast to these results, examiners thought color doppler sonography to be necessary for assurance of the diagnosis in 39,7 % to 88,9 % of all cases. It is shown that additional information due to color doppler sonography brought (independent from examiner experience) no significant increase of diagnostic marksmanship (variation range from - 1,6 % to + 4,8 %). Thus the value of color doppler sonography for assurance of diagnosis was overestimated by the examiners. The value of color doppler sonography in (differential-)diagnosis of focal lesions of the spleen has to be assessed as quite low, so routine use of color doppler sonography in sonographic examination of the spleen is not necessary. For special dignostic means (e.g. diagnosis of a-v-aneurysma) color doppler sonography allows a quick and reliable diagnosis. Sonography with contrast media (stimulated acoustic emission) can possibly increase diagnostic marksmanship in focal spleen lesions.