床旁对比增强超声（CEUS）在老年患者肺炎诊断中的临床应用：与临床、放射学及超声诊断的比较

Clinical utility of bedside Contrast-Enhanced Ultrasound (CEUS) in the diagnosis of pneumonia in elderly patients: Comparison with clinical, -radiological and ultrasound diagnosis.

作者信息

Giangregorio Francesco, Mosconi Emilio, Debellis Maria Grazia, Provini Stella, Esposito Ciro, Mendozza Manuela, Raccanelli Rita, Maresca Luigi, Cinquini Sara, Tursi Francesco

机构信息

Internal Medicine Department, Codogno Hospital, Lodi, Italy.

Cardiac and Pneumological Rehabilitation Medicine, Codogno Hospital, Lodi, Italy.

出版信息

Multidiscip Respir Med. 2024 Oct 1;19(1):967. doi: 10.5826/mrm.2024.967.

AIMS

to measure the clinical impact of contrast-enhanced ultrasound (CEUS) in the diagnosis of -community-acquired pneumonia (CAP), compared to clinical, radiological and ultrasound diagnosis.

METHODS

84 patients (47/37 males/females, mean age:78,57±11,7 Y) with clinical suspicion of pneumonia and with ultrasound findings of peripheral lung lesions, were investigated with CEUS for a better characterization. Final diagnosis of 65 cap was obtained with complete disappearance of symptoms and pulmonary nodule(s); 19 neoplasms: 16 patients performed histologically with bronchoscopy; 3 refused (non-invasive diagnosis with basal CT-scan and positron emission tomography (PET) with fluorodeoxyglucose (FDG)). Sensitivity, specificity, overall diagnostic accuracy (ODA) (and corresponding AUROC) of clinical-data (CD), chest X-ray(CXR), Lung-ultrasound(LUS), CEUS were calculated with SPSS 26.0 software.

RESULTS

Final diagnosis: 65 CAP, and 19 chest cancers. 9/65 (13%) patients died, of these 7/9 with older age and heart disease as comorbidity. CD: True-Positive (TP):23, True-negative (TN): 17; False-Positive (FP):2; False-negative (FN):42 (sens:35,4% spec:89,5% ODA10%: PPV:92%, NPV:28,8%) (AUROC±SEauc:0,46±0,076); CXR: TP: 36, TN:14; FP:5, FN:29; (sens: 55,4%; spec: 73,7%; ODA: 32%; PPV:87,5%, NPV:32,66%) (AUROC±SEauc:0,645±0,068). US: TP:59; TN: 14; FP:5, FN:6 (sens: 90,8%, spec: 73,7%, ODA: 84,9%, PPV:92,2%, NPV:70%) (AUROC±SEauc:0,9417±0,024); CEUS: TP: 63; TN: 19; FP:0; FN:2 (sens: 96,9%; spec: 100% ODA: 97,5%; PPV: 100%, NPV:90,5%) (AUROC±SEauc:0,98±0,01).

CONCLUSIONS

Clinical-data and chest X-RAYS are insufficient to obtain a correct diagnosis of CAP in elderly population; US demonstrated a good accuracy to establish CAP, but with a relatively low specificity; in these cases, CEUS is able to give a correct characterization, allowing you to save the need for a chest contrast-enhanced-CT (CECT).

目的

与临床、放射学及超声诊断相比，评估超声造影（CEUS）在社区获得性肺炎（CAP）诊断中的临床影响。

方法

84例临床怀疑肺炎且超声发现外周肺病变的患者（47例男性/37例女性，平均年龄：78.57±11.7岁）接受CEUS检查以进行更好的特征描述。65例CAP通过症状和肺结节完全消失获得最终诊断；19例为肿瘤：16例患者通过支气管镜进行组织学检查；3例拒绝（通过基础CT扫描和氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）进行非侵入性诊断）。使用SPSS 26.0软件计算临床数据（CD）、胸部X线（CXR）、肺部超声（LUS）、CEUS的敏感性、特异性、总体诊断准确性（ODA）（及相应的受试者工作特征曲线下面积（AUROC））。

结果

最终诊断：65例CAP，19例胸段癌症。65例中有9例（13%）患者死亡，其中7/9例年龄较大且合并心脏病。CD：真阳性（TP）：23，真阴性（TN）：17；假阳性（FP）：2；假阴性（FN）：42（敏感性：35.4%，特异性：89.5%，ODA：10%：阳性预测值：92%，阴性预测值：28.8%）（AUROC±标准误：0.46±0.076）；CXR：TP：36，TN：14；FP：5，FN：29；（敏感性：55.4%；特异性：73.7%；ODA：32%；阳性预测值：87.5%，阴性预测值：32.66%）（AUROC±标准误：0.645±0.068）。超声：TP：59；TN：14；FP：5，FN：6（敏感性：90.8%，特异性：73.7%，ODA：84.9%，阳性预测值：92.2%，阴性预测值：70%）（AUROC±标准误：0.9417±0.024）；CEUS：TP：63；TN：19；FP：0；FN：2（敏感性：96.9%；特异性：100%，ODA：97.5%；阳性预测值：100%，阴性预测值：90.5%）（AUROC±标准误：0.98±0.01）。