Safai Zadeh Ehsan, Weide Johanna, Dietrich Christoph Frank, Trenker Corinna, Koczulla Andreas Rembert, Görg Christian
Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany.
Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland.
Diagnostics (Basel). 2021 Jul 19;11(7):1293. doi: 10.3390/diagnostics11071293.
To evaluate the value of CEUS in differentiating malignant from benign pleural effusions (PEs).
From 2008 to 2017, 83 patients with PEs of unknown cause were examined using B-mode thoracic ultrasound (B-TUS), CEUS, and cytological examination. The extent of enhancement of the pleural thickening, the presence of enhancement of septa or a solid mass within the PE, and the homogeneity of the enhancement in the associated lung consolidation, were examined. Subsequently, the diagnostic value of cytology, B-TUS, and CEUS in differentiating malignant from benign PEs was determined.
With CEUS, markedly enhanced pleural thickening and inhomogeneous enhanced lung consolidation were significantly more frequently associated with malignancy ( < 0.05). In the subgroup analysis, the use of CEUS increased the sensitivity from 69.2 to 92.3 in patients with initial negative cytology but clinical suspicion of malignant PE; it also increased the specificity from 63.0 to 90.0, the positive predictive value from 69.2 to 92.3, the negative predictive value from 63.0 to 90.0, and the diagnostic accuracy from 66.7 to 87.5, in the evaluation of PE malignancy.
The use of clinically based B-TUS and CEUS as a complementary method to cytological evaluation may be beneficial for evaluating a PE of unknown cause. CEUS patterns of enhanced pleural thickening and inhomogeneous enhanced lung consolidation may suggest a malignant PE.
评估超声造影（CEUS）在鉴别恶性与良性胸腔积液（PEs）中的价值。
2008年至2017年，对83例病因不明的胸腔积液患者进行了B型胸部超声（B-TUS）、CEUS及细胞学检查。观察胸膜增厚的强化程度、胸腔积液内分隔或实性肿块的强化情况以及相关肺实变强化的均匀性。随后，确定细胞学、B-TUS及CEUS在鉴别恶性与良性胸腔积液中的诊断价值。
CEUS检查显示，明显强化的胸膜增厚及不均匀强化的肺实变与恶性病变显著相关（<0.05）。在亚组分析中，对于初始细胞学检查阴性但临床怀疑为恶性胸腔积液的患者，使用CEUS可使敏感性从69.2%提高至92.3%；在评估胸腔积液恶性程度时，还可使特异性从63.0%提高至90.0%，阳性预测值从69.2%提高至92.3%，阴性预测值从63.0%提高至90.0%，诊断准确性从66.7%提高至87.5%。
将基于临床的B-TUS和CEUS作为细胞学评估的补充方法，可能有助于评估病因不明的胸腔积液。胸膜增厚强化及肺实变不均匀强化的CEUS表现可能提示恶性胸腔积液。
