Karaciğer kitlelerinin ayırıcı tanısında renkli doppler ultrasonografi ve eko kontrast madde kullanımının etkinliği

Amaç: Karaciğerde kitle lezyonu saptanan olguların renkli Doppler ultrasonografi bulguları ile eko kontrast madde kullanılarak yapılan renkli Doppler ultrasonografik incelemenin kitle karakterizasyonuna katkısının literatür eşliğinde araştırılması amaçlanmıştır. Gereç ve Yöntem: Rutin radyolojik tetkikleri sırasında karaciğerde kitle saptanan 35 olguya ait kontrastsız ve eko kontrastlı renkli Doppler bulguları retrospektif olarak değerlendirildi. Kitlede kanlanma saptanan olgularda vasküler yapılardan spektral analizler yapılarak maksimum sistolik hız (Vmax) ve rezistif indeks (Rİ) değerleri ile kanlanma paternleri kaydedilmiştir. Maksimum sistolik hızların en yüksek değeri ve ona karşılık gelen Rİ değerleri incelenen lezyon için belirleyici kabul edilmiştir. Lezyon tanıları biyopsi (n=15) gri skala US, BT (n=30), MRG (n=27) ve klinik bulgular eşliğinde değerlendirilerek elde edillmiştir. Kontrast madde öncesi ve sonrası lezyonların kanlanma paternleri ile, spektral analiz değerleri (Vmax ve Rİ) istatistiksel olarak değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen yedi olgu hemanjiom, yedi olgu hepatosellüler karsinom, yirmi olgu metastaz ve bir olgu fokal nodüler hiperplazi tanılı olgulardı. Bu lezyonların rutin renkli Doppler ultrasonografi ile kontrastlı renkli Doppler ultrasonografik değerlendirmede kanlanma paternleri grublarının istatistiksel olarak karşılaştırılmasında anlamlı ilişki bulundu. Rİ değerleri arasında iki grupta istatistiksel anlamlı farklılık saptanmadı (p< 0,05). Vmax değerleri lezyon tanılarına göre sınıflandırıldığında her iki grup arasında istatistiksel olarak anlamlı farklılık izlenmemiştir (p< 0,05). Sonuç: Olguların %77’sinde renkli Doppler ultrasonografi tek başına tümöral lezyonların akım paternlerinin ortaya konmasında yeterli ve tatminkar sonuçların elde edilmesini sağladı. Eko kontrastlı renkli Doppler ultrasonografik değerlendirme kalan olguların %17’sinde kanlanma paterninin dinamik olarak gösterilmesi ile ayırıcı tanıya katkıda bulunmuştur.

The effectiveness of color doppler ultrasonography and echo contrast agents in the differential diagnosis of liver masses

Aim: The aim of this study is to investigate the contribution of color Doppler ultrasonographic findings and echo enhanced color Doppler ultrasonographic evaluation to the mass characterization of patients with liver mass lesions. Materials and Methods: Routine and echo-contrast colored Doppler findings of 35 cases with a mass in the liver during their radiological examinations were evaluated retrospectively. In cases in which blood was detected in the mass, the maximum systolic velocity (Vmax) and resistive index (RI) values and blooding patterns were recorded by performing spectral analyzes from vascular structures. The maximum value of the maximum systolic velocities and the corresponding RI values were considered determinative for the lesion examined. Lesion diagnoses were obtained by evaluating biopsy (n = 15) gray scale US, CT (n = 30), MRI (n = 27) and clinical findings. The blood flow patterns of the lesions before and after the contrast medium, spectral analysis values (Vmax and RI) were statistically evaluated. Results: Seven patients with hemangioma, seven patients with hepatocellular carcinoma, twenty patients with metastasis and one patient with focal nodular hyperplasia were included in the study. A statistically significant correlation was found between routine color Doppler ultrasonography and echo enhanced color Doppler ultrasonographic evaluation of these lesions. There was no statistically significant difference between RI values in two groups (p

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