Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions

Abstract

Background Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively.

Purpose The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity.

Methods 6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue^®, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single radiologist with experience since 2000 (EFSUMB Level 3).

Results CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy.

Conclusion Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.

Zusammenfassung

Hintergrund Ultraschall ist ein unentbehrliches bildgebendes Verfahren, um den physiologischen und pathologischen Zustand bei Mutter und Fötus in der Schwangerschaft zu beurteilen. Die Publikationen bezüglich des Einsatzes von CEUS in der Schwangerschaft sind begrenzt. Eine sichere Anwendung von CEUS erfolgte bereits, um den uteroplazentaren Blutfluss, die „Cesearen Scar Pregnancy“ und die invasive Plazenta percreta zu beurteilen. CT- und MRT-Aufnahmen in der Schwangerschaft müssen aufgrund der schädlichen ionisierenden Strahlung und wegen der Anreicherung von Gadolinium im Gehirn sorgfältig abgeschätzt werden.

Ziel Ziel dieser retrospektiven Single-Center-Studie ist die Bewertung der diagnostischen Leistung und Sicherheit von CEUS in der Schwangerschaft im Hinblick auf die Beurteilung von Leberläsionen unbekannter Entität.

Methoden In diese Studie wurden 6 Schwangere (Durchschnittsalter: 32 Jahre; mittlere SSW: 28 Wochen), bei denen von 2005 bis 2014 CEUS durchgeführt wurde, eingeschlossen. Das verabreichte Kontrastmittel war ein Blutpool-Kontrastmittel der zweiten Generation (SonoVue^®, Bracco, Mailand, Italien). Die CEUS-Untersuchungen wurden von einem seit dem Jahr 2000 erfahrenen Radiologen (EFSUMB Level 3) durchgeführt und interpretiert.

Ergebnisse CEUS wurde bei allen schwangeren Frauen sicher durchgeführt, ohne dass unerwünschte fetale oder maternale Nebenwirkungen auftraten. Im Rahmen der vorliegenden Studie diente CEUS der sicheren Differenzierung von Lebermetastasen, fokaler nodulärer Hyperplasie, atypischem Hämangiom, arteriovenöser Malformation und zystischer Echinokokkose. Bei 2 Patientinnen bewirkte CEUS eine sofortige Therapie.

Schlussfolgerung Obwohl CEUS in der Geburtshilfe bisher nicht klinisch zugelassen ist, handelt es sich um eine sichere Bildgebungsmethode, die in der Schwangerschaft bei weiteren medizinischen Indikationen zusätzlich zur nativen B-Mode Sonographie und Farbdoppler-Sonographie nützliche Informationen liefern kann.

Key words

pregnancy - placenta - fetus - liver - CEUS

^* Co-Letztautorenschaft.

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