Value of contrast-enhanced ultrasound for vascular diseases of the liver – current indications and open questions

Abstract

Contrast-enhanced ultrasonography (CEUS) is a widely available and well-tolerated technique that can expand the diagnosis of a variety of vascular liver diseases. This paper presents an overview of the current possibilities of the use of CEUS in vascular liver diseases. Particularly where Doppler sonography has technical limitations, CEUS provides additional opportunities to visualize vascular thrombosis and other obstructions restricting blood flow. When CT or MRI contrast agents cannot be used because of severe allergy or renal insufficiency, CEUS can be a valuable diagnostic alternative and has demonstrated comparable diagnostic performance in at least some vascular liver diseases, such as portal vein thrombosis. In addition, CEUS works without radiation and, therefore, might be particularly suitable for young patients and children. This may be useful, for example, in congenital disorders such as persistent umbilical vein or preduodenal portal vein. Vascular liver disease is rare and comprehensive data are still lacking, but the available literature provides promising insights into potential new ways to study vascular liver disease. Although most studies are based on small sample sizes or even case reports, the high diagnostic utility is undisputed.

Zusammenfassung

Kontrastmittelunterstützte Sonografie (CEUS) ist eine weithin verfügbare und gut verträgliche Technik, die die Diagnostik für eine Vielzahl von vaskulären Lebererkrankungen erweitern kann. Diese Arbeit stellt einen Überblick über die aktuellen Möglichkeiten der Diagnostik vaskulärer Lebererkrankungen mithilfe von CEUS dar. Besonders dort, wo die Doppler-Sonografie technische Grenzen hat, bietet CEUS zusätzliche Möglichkeiten, um Gefäßthrombosen und andere den Blutfluss einschränkende Obstruktionen darzustellen. Wenn CT- oder MRT-Kontrastmittel wegen schwerer Allergie oder Niereninsuffizienz nicht eingesetzt werden können, kann CEUS eine wertvolle diagnostische Alternative sein und hat zumindest bei einigen vaskulären Lebererkrankungen, z.B. der Pfortaderthrombose, eine vergleichbare diagnostische Leistung bewiesen. Darüber hinaus funktioniert CEUS ohne Strahlung und könnte daher besonders für junge Patienten und Kinder geeignet sein. Dies kann z. B. bei angeborenen Störungen wie persistierender Nabelvene oder präduodenaler Pfortader sinnvoll sein. Vaskuläre Lebererkrankungen sind seltene Erkrankungen und es fehlen noch umfassende Daten, aber die vorliegende Literatur gibt vielversprechende Einblicke in mögliche neue Wege zur Untersuchung vaskulärer Lebererkrankungen. Obwohl die meisten Studien auf kleinen Stichprobengrößen oder sogar Fallberichten beruhen, ist der hohe diagnostische Nutzen unbestritten.

Keywords

guideline - liver portal vein thrombosis - Budd Chiari - pseudoaneurysm - liver tumor

Schlüsselwörter

Leitlinie - Pfortaderthrombose - Budd Chiari - Pseudoaneurysma - Lebertumor

Publikationsverlauf

Eingereicht: 22. Juli 2022

Angenommen nach Revision: 06. November 2022

Artikel online veröffentlicht:
15. Dezember 2022

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