Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58 Zhongshan Er Road, 510080, PR China.
Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The Seventh Affiliated Hospital, Sun-yat Sen University, No.628, Zhenyuan Road, Xinhu Street, Guangming New District, Shenzhen, 200090, PR China.
Clin Radiol. 2020 Jan;75(1):79.e19-79.e24. doi: 10.1016/j.crad.2019.10.003. Epub 2019 Nov 6.
To evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in differentiating malignant from benign peripheral pulmonary lesions, and to evaluate the feasibility, accuracy, and utility of CEUS-guided biopsy for peripheral pulmonary lesions.
Thirty-three patients with histopathologically confirmed peripheral pulmonary lesions (22 malignant, 11 benign) were enrolled in this retrospective study. Conventional ultrasound (US) was first performed and then CEUS with a contrast-specific mode and sulfur hexafluoride-filled microbubble contrast agent. CEUS indices-time of enhancement (TE), time to peak (TP), extent of peak (EP), mean transit time (MTT), area under curve (AUC), and slope-were recorded and compared between the groups. The ability of CEUS and US to detect necrotic areas within lesions was also compared and the accuracy of CEUS-guided biopsy was calculated.
On CEUS, TE was significantly shorter in acute pneumonia lesions than in other types of lesions (p=0.03). Other indices were not significantly different between benign and malignant lesions. Detection of necrosis within lesions was significantly higher with CEUS than with US (51.5% versus 27.3%; p=0.04). The accuracy of CEUS-guided biopsy was 96.9% (32/33).
The study findings suggest that CEUS can identify necrotic areas within lesions, and thereby, play a useful role in imaging-guided biopsy. The present pilot study indicates that CEUS may help to identify acute pneumonia lesions from other types of pulmonary lesions. CEUS might be a useful additional technique for the diagnosis of lung lesions.
评估超声造影（CEUS）在鉴别肺外周良恶性病变中的作用，探讨 CEUS 引导下经皮肺外周病变穿刺活检的可行性、准确性和应用价值。
回顾性分析经病理证实的 33 例肺外周病变患者（恶性 22 例，良性 11 例），术前均行常规超声及对比脉冲序列实时超声造影检查，观察并记录时间-强度曲线的增强时间（TE）、达峰时间（TP）、增强幅度（EP）、平均渡越时间（MTT）、曲线下面积（AUC）和斜率。比较两组患者各参数间的差异，分析超声造影与常规超声对病变内坏死区的检出能力，并计算 CEUS 引导下穿刺活检的准确性。
急性肺炎的 TE 值显著短于其他类型病变（p=0.03），其他参数在良恶性病变之间差异无统计学意义。CEUS 较常规超声对病变内坏死区的检出率更高（51.5%比 27.3%，p=0.04）。CEUS 引导下穿刺活检的准确率为 96.9%（32/33）。
CEUS 能识别病变内的坏死区，有助于指导经皮肺外周病变穿刺活检。本研究初步结果提示，CEUS 有助于鉴别急性肺炎与其他类型的肺外周病变，CEUS 可能是一种有助于肺部病变诊断的有用的附加技术。
