Görg C, Bert T, Kring R, Dempfle A
Department of Internal Medicine, Philipps-University, Baldingerstrasse, Marburg.
Ultraschall Med. 2006 Oct;27(5):437-44. doi: 10.1055/s-2006-927021.
Transcutaneous ultrasound enables visualization of pleural based lesions but with a poor correlation to specific pathology. Ultrasound contrast agents in conjunction with contrast specific imaging techniques are increasingly accepted in clinical use. Up to date there are no data about the use of contrast enhanced sonography (CES) in a large series of pleural based pulmonary lesions.
From August 2004 to August 2005, 137 consecutive patients with pleural based pulmonary lesions on B-mode sonography were studied by CES using a transcapillary second-generation contrast agent (SonoVue(R)). The following CES parameters were retrospectively evaluated. Time to enhancement (TE) of contrast agent after i. v. application was determined and classified as short TE (< = 6 sec) vs. delayed TE (> 6 sec). Extent of enhancement (EE) was evaluated during the arterial phase (2 - 30 sec) and the parenchymal phase (1 - 5 minutes) by using the normal splenic tissue as an in vivo reference, and classified in reduced EE (anechoic/hypoechoic) vs. marked EE (isoechoic/hyperechoic) during both phases. Homogeneity of enhancement (HE) was classified as homogeneous vs. inhomogeneous. 60 patients had histologically confirmed malignant lesions due to central lung cancer (n = 31), and peripheral malignant lesions (n = 29). 77 patients had benign pleural based lesions including pneumonia (n = 32), pulmonary embolism (n = 20), compression atelectasis (17), and other benign pleural based lesions (n = 8).
Malignant and benign lesions did not vary significantly regarding TE, EE, and HE. However, there were highly significant differences in the ratio of short vs. delayed TE and reduced vs. marked EE between the six disease groups. Characteristic patterns were short TE with marked EE in all compression atelectasis cases and in 62 % of patients with pneumonia. Delayed TE and reduced EE was seen in all patients with pulmonary embolism and in 62 % of patients with peripheral malignant lesions. Central lung cancer and benign nodules did not present with such specific patterns. No significant differences in HE were seen between subgroups.
Pulmonary lesions are characterized by different CES-patterns of arterial supply as evidenced by TE and EE which depends on underlying causes, but CES does not allow to distinguish benign from malignant pleural based lesions in general.
经皮超声能够显示胸膜下病变，但与特定病理类型的相关性较差。超声造影剂联合造影特异性成像技术在临床应用中越来越被认可。目前尚无关于在大量胸膜下肺病变中使用超声造影增强检查（CES）的数据。
2004年8月至2005年8月，对137例B超检查发现胸膜下肺病变的连续患者，使用经毛细血管第二代造影剂（声诺维®）进行CES检查。对以下CES参数进行回顾性评估。静脉注射造影剂后的增强时间（TE），分为短TE（≤6秒）和延迟TE（>6秒）。在动脉期（2 - 30秒）和实质期（1 - 5分钟），以正常脾脏组织作为体内对照，评估增强范围（EE），并分为两个阶段均为增强减弱（无回声/低回声）和增强显著（等回声/高回声）。增强均匀性（HE）分为均匀和不均匀。60例患者经组织学证实为恶性病变，其中中央型肺癌31例，周围型恶性病变29例。77例患者为良性胸膜下病变，包括肺炎32例、肺栓塞20例、压迫性肺不张17例及其他良性胸膜下病变8例。
恶性和良性病变在TE、EE和HE方面无显著差异。然而，六个疾病组之间短TE与延迟TE以及增强减弱与增强显著的比例存在高度显著差异。所有压迫性肺不张病例以及62% 的肺炎患者表现为短TE且增强显著。所有肺栓塞患者以及62% 的周围型恶性病变患者表现为延迟TE且增强减弱。中央型肺癌和良性结节无此特定表现。各亚组之间HE无显著差异。
肺病变具有不同的动脉供血CES模式，这通过TE和EE得以证明，其取决于潜在病因，但一般来说，CES无法区分良性和恶性胸膜下病变。
