Application of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Retroperitoneal Occupying Lesions_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHENG Yujing ¹ , CHEN Wenwei ¹ , LIU Qin ¹ , ZHANG Yuguo ¹ , HE Jie ² , ZHENG Yongbin ² , SHEN Shiqiang ³

1.Department of Ultrasound;;
2.Department of Gastrointestinal Surgery;;
3.Department of Hepatobiliary Endoscopic Surgery;;
Renmin Hospital of Wuhan University, Wuhan 430060, ChinaCorresponding Author: CHEN Wen-wei, E-mail: wuhancwww@126.com;

Corresponding author：

Keywords：

Ultrasonography; Contrast agent; Retroperitoneal occupying lesion

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　Objective 　To evaluate the real-time contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of retroperitoneal occupying lesions.
　Methods 　Thirty patients with retroperitoneal occupying lesions, including 10 benign and 20 malignant lesions, were performed with CEUS, thus describing the perfusion of contrast agent, the entering style of contrast agent and the vascular morphous. And the entering styles were divided into two patterns: peripheral type or central type while the vascular morphous were divided into 4 levels: level 0, level 1, level 2 and level 3. All of these were compared between benign and malignant lesions. Compared the results of diagnosis malignant lesions by common ultrasonography with CEUS.
　Results　 1/5 case of benign substantive lesions presented as contrast agent perfusion defect, and 11/20 cases of substantive malignant lesions presented as contrast agent perfusion defect. 14/20 of malignant lesions were central type; 9/10 of benign lesions were peripheral type (P=0.005 2). In benign lesions, level 0 had 7/10， level 1 had 2/10 and level 3 had 1/10. In malignant lesions, level 0 had 1/20, level 1 had 3/20, level 2 had 8/20 and level 3 had 8/20, too (P=0.000 5). The rate of missed diagnosis was 40.00% and the accuracy was 66.67% by common ultrasonography, while the rate of missed diagnosis was 10.00% and the accuracy was 86.67% by CEUS combined with the entering style of contrast agent and the vascular morphous.
　Conclusion　 The CEUS applies a new way to discriminate malignant from benign in retroperitoneal occupying lesions.

Citation： SHENG Yujing,CHEN Wenwei,LIU Qin,ZHANG Yuguo,HE Jie,ZHENG Yongbin,SHEN Shiqiang. Application of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Retroperitoneal Occupying Lesions. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(3): 245-249. doi: Copy

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1. 汤钊猷主编. 现代肿瘤学 [M]. 上海: 上海医科大学出版社, 1993:869~912.
2. Bartolotta TV, Midiri M, Quaia E, et al. Benign focal liver lesions: spectrum of findings on SonoVue-enhanced pulse-inversion ultrasonography [Ｊ]. Eur Radiol, 2005; 15(8):1643.
3. Nicolau C, Catalá V, Vilana R, et al . Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation [Ｊ]. Eur Radiol, 2004; 14(6):1092.
4. Park BK, Kim B, Kim SH, et al. Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US [Ｊ]. Eur J Radiol, 2007; 61(2):310.
5. de Groot MC, van Zwieten-Boot BJ, van Grootheest AC. Severe adverse reactions after the use of sulphur hexafluoride (SonoVue) as an ultrasonographic contrast agent [Ｊ]. Ned Tijdschr Geneeskd, 2004; 148(38):1887.
6. Kupesic S, Kurjak A. Contrast-enhanced, three-dimensional power Doppler sonography for differentiation of adnexal masses [Ｊ]. Obstet Gynecol, 2000; 96(3):452.
7. 　顾蔚蓉，丰有吉，张钰华. Levovist 在超声鉴别诊断卵巢良恶性肿瘤中的应用研究 [Ｊ]. 中华超声影像学杂志， 2003； 12（9）:534.
8. 戴晴，姜玉新. 超声造影的临床应用 [Ｊ]. 中国医学科学院学报， 2008；　30(1):1.
9. 李玮，毛赛，张峰，等. 腹膜后间隙的断层解剖学研究进展 [Ｊ]. 白求恩医学院学报， 2008； 6(1):25.
10. 黄斌，赵纪春，马玉奎. 复发性腹膜后肿瘤的诊断和治疗 [Ｊ]. 中国普外基础与临床杂志， 2008； 15(8):607.
11. 王健. 腹膜后纤维化32例临床分析 [Ｊ]. 中国临床医学, 2001；增刊:31.
12. 杜凤山，张辉，金正印. 螺旋ＣＴ对腹膜后原发恶性肿瘤的诊断价值 [Ｊ]. 　临床军医杂志，　2006；　34(4):487.
13. 李捷，张晓兰，魏远，等. 螺旋CT对腹膜后占位性病变的诊断价值 [Ｊ]. 川北医学院学报， 2005； 20(4):451.
14. 舒艳艳，韩志江，赖旭峰，等. 螺旋CT在原发性腹膜后占位性病变鉴别诊断中的价值 [Ｊ].　浙江临床医学， 2007； 9(12):1708.
15. 徐英，陈文卫，石华，等. 超声造影诊断腹膜后占位性病变的临床应用 [Ｊ]. 武汉大学学报(医学版)，　2007；　28(6):747.
16. Burns PN, Wilson SR, Simpson DH. Pulse inversion imaging of liver blood flow: improved method for characterizing focal masses with microbubble contrast [Ｊ]. Invest Radiol, 2000; 35(1):58.
17. Marret H, Sauget S, Giraudeau B, et al. Contrast-enhanced sonography helps in discrimination of benign from malignant adnexal masses [Ｊ]. J Ultrasound Med, 2004; 23(12):1629.
18. Ordén MR, Jurvelin JS, Kirkinen PP. Kinetics of a US contrast agent in benign and malignant adnexal tumors [Ｊ]. Radiology, 2003; 226(2):405.
19. Testa AC, Ferrandina G, Ferrandina E, et al. The use of contrasted transvaginal sonoguaphy in the diagnosis of gynaecology disease: a preliminary study [Ｊ]. Ultrasound Med, 2004; 24(9):1267.
20. D’Arcy TJ, Jayaram V, Lynch M, et al. Ovarian cancer detected non-invasively by contrast-enhanced power Doppler ultrasound [Ｊ]. BJOG, 2004; 111(6):619.
21. Folkman J. What is the evidence that tumors are angiogenesis dependent? [Ｊ]. J Natl Cancer Inst， 1990; 82(1):4.
22. 郑伟，罗成华，晋援朝，等. 原发性腹膜后肿瘤352例术后复发多因素分析 [Ｊ]. 人民军医， 2004； 47(5):261.
23. Albrecht T, Hoffmann CW, Schmitz SA, et al. Phase-inversion sonography during the liver-specific late phase of contrast enhancement: improved detection of liver metastases [Ｊ]. AJR Am J Roentgenol， 2001; 176(5):1191.
24. Bernatik T, Strobel D, Hahn EG, et al. Detection of liver metastases: comparison of contrast-enhanced wide-band harmonic imaging with conventional ultrasonography [Ｊ]. J Ultrasound Med, 2001; 20(5):509.
25. Kckerling F, Schun-Pass C, Weskott HP, et al. malignant hepatobiliary tumors. Surgical requirements concerning preoperative diagnosis [Ｊ]. Zentralbl Chir, 2000； 125(7):616.
26. 丁红，王文平，黄备建，等. 超声造影检测和诊断小肝癌的价值 [Ｊ]. 中国普外基础与临床杂志， 2007；　14(1):30.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Retroperitoneal Occupying Lesions

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