Zusammenfassung
Einleitung: Im Unterschied zur transabdominellen Sonographie sind kontrastverstärkte Realtime-Techniken
mit niedrigem mechanischen Index für die höherfrequente Endosonographie bisher nicht
verfügbar gewesen. Wir berichten über die erstmalige Anwendung eines endosonographischen
Prototypen zur kontrastverstärkten Realtime-Technik (CELMI-EUS). Patienten und Methoden: Elektronisches Echoendoskop Hitachi/Pentax EG-3830UT mit adaptierter dynamischer
„contrast harmonic wideband pulsed inversion” Software mit niedrigem mechanischen
Index (MI = 0,09 - 0,25) vor und nach Applikation von SonoVue® 4,8 ml bis zu 3 Minuten
nach Injektion bei 6 konsekutiven Patienten zur Pankreas- und Leberpfortendarstellung.
Ergebnisse: Die arteriellen und portalvenösen Gefäße sowie das Pankreas konnten bei allen Patienten
adäquat kontrastiert werden. Das einsehbare Leberparenchym des linken Leberlappens
zeigte eine ausreichende Kontrastierung bei 4 von 6 Patienten, wogegen bei 2 Patienten
mit zirrhotischem Umbau die Leberparenchymkontrastierung unzureichend war. Diskussion: Erstmalig wird an einem Prototyp die kontrastverstärkte EUS-Technik mit niedrigem
mechanischen Index beschrieben. Eine adäquate Kontrastierung arterieller und portalvenöser
Gefäße sowie des Pankreas und gesunden Leberparenchyms ist möglich.
Abstract
Aim: Recent advances in technology have supported the development of new endoscopic ultrasound
systems making it possible to use low MI contrast-enhanced imaging techniques (wide
band harmonic imaging done with endoscopic ultrasound is currently at a preliminary
stage). We now report on the first use of contrast-enhanced, low mechanical index,
real-time endoscopic ultrasound (CELMI-EUS) in six patients using prototype technology.
Materials and Methods: CELMI-EUS was performed using an electronic echo-endoscope HITACHI/Pentax EG-3830UT
and adapted dynamic contrast harmonic wide-band pulsed inversion software with low
mechanical index (MI = 0.09 - 0.25) before and up to 180 seconds after injection of
SonoVue® (4.8 mL) in six patients. Results: Adequate visualisation of the arterial and portal venous phases was achieved in
all patients. The pancreas and liver were studied thereafter. In contrast to the satisfactory
visualisation of these vessels, enhancement of the left liver lobe was sufficient
only in 4 patients. In the remaining 2 patients with liver cirrhosis, the enhancement
was less pronounced in contrast to the strong enhancement of the hepatic artery and
portal vein. Conclusion: Recent advances in technology have supported the development of new echo-endoscopic
systems making it possible to use real-time, low mechanical index, contrast-enhanced
imaging techniques with endoscopic ultrasound. We have preliminarily shown that arterial,
portal venous and parenchymal contrast enhancement is possible.
Schlüsselwörter
Endosonographie - Ultraschallkontrastmittel - Sonovue® - Pankreas - Pfortaderthrombose
Key words
Endosonography - ultrasound contrast agent - Sonovue® - pancreas - portal vein thrombosis
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Prof. Dr. med. Christoph F. Dietrich
Innere Medizin 2, Caritaskrankenhaus Bad Mergentheim
Uhlandstraße 7
97980 Bad Mergentheim
Germany
Telefon: ++ 49/79 31/58-22 01/22 00
Fax: ++ 49/79 31/58-22 90
eMail: Christoph.dietrich@ckbm.de