Shehata Samah M, Almalki Yassir Edrees, Basha Mohammad Abd Alkhalik, Hendy Rasha Mohamed, Mahmoud Eman M, Abd Elhamed Marwa Elsayed, Alduraibi Sharifa Khalid, Aboualkheir Mervat, Almushayti Ziyad A, Alduraibi Alaa K, Basha Ahmed M Abdelkhalik, Alsadik Maha E
Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt.
Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia.
Diagnostics (Basel). 2024 May 17;14(10):1041. doi: 10.3390/diagnostics14101041.
Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, < 0.001) and nodularity (45.5% vs. 3%, < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.
恶性胸腔积液（MPE）是晚期癌症的一种表现，需要及时、准确的诊断。超声检查（US）和计算机断层扫描（CT）是评估胸腔积液的重要影像学技术；然而，它们对恶性起源的相对预测能力仍存在争议。这项前瞻性研究旨在比较胸部超声与CT检查结果，作为未确诊的渗出性胸腔积液患者恶性肿瘤的预测指标。54例未确诊的渗出性胸腔积液成人患者接受了包括胸部超声、CT和组织病理学活检在内的全面临床评估。不知情的放射科医生根据预先定义的标准评估超声和CT图像中提示恶性肿瘤的特征。以组织病理学作为参考标准计算诊断性能指标。54例患者中，33例（61.1%）经活检确诊为MPE。在检测胸膜壁层异常、肺部病变、胸壁侵犯或肝转移方面，超声和CT之间未发现显著差异。在识别膈胸膜增厚≥10mm（33.3%对6.1%，<0.001）和结节状方面，超声优于CT（45.5%对3%，<0.001），而CT在检测纵隔增厚方面更具优势（48.5%对15.2%，=0.002）。对于诊断MPE，超声检测到的膈结节状具有45.5%的敏感性和100%的特异性，而CT纵隔增厚具有48.5%的敏感性和90.5%的特异性。超声和CT在检测MPE方面均显示出合理的诊断性能，特定的影像学表现提示为恶性起源。超声在评估膈胸膜受累方面可能具有优势，而CT对纵隔异常更敏感。
