Stellenwert farbdopplersonographischer Befunde in der (Differential-)Diagnose fokaler Milzläsionen: eine retrospektive Studie
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Philipps-Universität Marburg
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Abstract
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.
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Dates
Created: 2003Issued: 2003-12-22Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
SpleenColorUltrasonography , Doppler
DFG-subjects
UltraschalldiagnostikMilzkrankheit , B-scan-VerfahrenMilz , Farb-Doppler-SonographieUltraschall
DDC-Numbers
610
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Bachmann, Christian (128619120): Stellenwert farbdopplersonographischer Befunde in der (Differential-)Diagnose fokaler Milzläsionen: eine retrospektive Studie. : Philipps-Universität Marburg 2003-12-22. DOI: https://doi.org/10.17192/z2003.0648.
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This item has been published with the following license: In Copyright