Kontrastmittelgestützte Sonographie (CEUS) bei Patienten/Patientinnen mit Hyposplenie: eine retrospektive Analyse

There are a range of different diseases which may impact the spleen functionality negatively. Especially if a spleen is described as “small” on ultrasound, computer tomography or magnet resonance imaging, a functional examination should be carried out to exclude a possible underlying splenic dysfunction resulting in immune deficiency. If such a condition exists, preventative vaccination is paramount to protect the patient from life threatening illness. An analysis of retrospective collected data was performed to investigate if “contrast enhanced ultrasonography” has a role in the functional diagnostic workup of the small spleen. Method: The data of n = 66 subjects with a reduced spleen size (hyposplenia) was analysed for the presence of underlying diseases, occurrence of Howell-Jolly-Bodies and splenic function using nuclear radioisotope scan (scintigraphy). Each spleen was examined using standardised B-mode sonography followed by contrast enhanced ultrasound (CEUS). Results: 26 patients (39,4 %) demonstrated a striking contrast agent behaviour (arterial and/or parenchymal). Of all patients who underwent functional diagnostic testing (34 persons), 27 indeed had a proven functional hyposplenia/asplenia. In 16 of these cases, striking contrast enhancement was found. The number of patients showing no signs of underlying splenic dysfunction was seven. All these demonstrated inconspicuous enhancement on CEUS. Sensitivity was calculated as 59,3 %, specificity as 100 %. The positive predictive value was also 100 % and the negative predictive value was 38,9 % (The results of the radioisotope scan (scintigraphy) and the presence of Howell- Jolly-Bodies were used as reference). Conclusion: Judging by the results of this analysis, CEUS could represent a suitable new method to detect possible splenic malfunctions. However splenic dysfunction cannot be reliably excluded if the contrast uptake pattern proves to be inconspicuous. In these cases, other diagnostic tools should be used. Conventional Howell-Jolly bodies or pitted erythrocytes were determined. If necessary, the diagnostic workup can be completed using radioisotope scanning.