Sperandeo Marco, Sperandeo Giuseppe, Varriale Antonio, Filabozzi Paola, Decuzzi Marco, Dimitri Lucia, Vendemiale Gianluigi
Department of Internal Medicine; IRCCS, Casa Sollievo Della Sofferenza, Viale Cappuccini, San Giovanni Rotondo (FG), Italy.
Ultrasound Med Biol. 2006 Oct;32(10):1467-72. doi: 10.1016/j.ultrasmedbio.2006.06.018.
The use of contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions has never been systematically investigated. We evaluated the CEUS patterns of 98 peripheral lung lesions before performing US-guided fine-needle biopsies (FNB). The examinations were done with an Esaote Technos MPX scanner in the harmonic mode with a mechanical index of 0.04 or less. Contrast enhancement was achieved with a 4.8 mL bolus of SonoVue (Bracco) administered via an antecubital vein. All FNBs performed under CEUS guidance were adequate for pathologic diagnosis. Seventy-eight lesions were malignant: 33 (41.9%) were adenocarcinomas, 29 (36.5%) were squamous-cell carcinomas, 13 (17.6%) were undifferentiated large-cell carcinomas and the remaining three (4.1%) were small-cell carcinomas. All presented intralesional enhancement consistent with tumor neovascularization. In some cases, there were unenhanced areas consistent with zones of necrosis and these areas were avoided during FNB. The other 20 lesions were benign (four lipomas, two fibrous lung tumor, two noncaseous granulomas, six abscesses, one rheumatoid nodule, one histiocytosis X, one chondroid hamartoma, one sclerosing hemangioma, two sarcoid nodules) and none presented intralesional enhancement. This initial and admittedly limited experience suggests that CEUS may provide diagnostically useful information on peripheral lung lesions and increase the diagnostic yield of transthoracic FNB by reducing the risk of inadequate tissue sampling.
超声造影（CEUS）用于外周肺病变的研究从未得到系统的调查。我们在进行超声引导下细针穿刺活检（FNB）之前，评估了98例外周肺病变的CEUS模式。检查使用Esaote Technos MPX扫描仪，采用谐波模式，机械指数为0.04或更低。通过肘前静脉注射4.8 mL声诺维（Bracco）实现造影增强。所有在CEUS引导下进行的FNB均足以进行病理诊断。78个病变为恶性：33个（41.9%）为腺癌，29个（36.5%）为鳞状细胞癌，13个（17.6%）为未分化大细胞癌，其余3个（4.1%）为小细胞癌。所有病变均表现为病灶内增强，与肿瘤新生血管形成一致。在某些情况下，存在与坏死区域一致的无增强区域，FNB时避开了这些区域。另外20个病变为良性（4个脂肪瘤、2个肺纤维瘤、2个非干酪样肉芽肿、6个脓肿、1个类风湿结节、1个组织细胞增多症X、1个软骨样错构瘤、1个硬化性血管瘤、2个结节病结节），均无病灶内增强。这一初步且有限的经验表明，CEUS可能为外周肺病变提供诊断有用信息，并通过降低组织采样不足的风险提高经胸FNB的诊断率。
