常规超声联合超声造影对胸膜下肺结核、细菌性肺炎的检查影像特征分析

Analysis of Imaging Features of Subpleural Pulmonary Tuberculosis and Bacterial Pneumonia by Conventional Ultrasound Combined with Contrast-enhanced Ultrasound

目的分析常规超声联合超声造影对胸膜下肺结核、细菌性肺炎的检查影像特征。方法选择于本院确诊的胸膜下肺结核或细菌性肺炎患者115例,其中确诊为胸膜下肺结核的患者有78例,将其作为肺结核组;而确诊为细菌性肺炎的患者有37例,将其作为肺炎组。所有患者均行常规超声、超声造影检查,分析采用常规超声、超声造影检查的影像学表现。结果肺结核组78例患者中52例呈楔形,占比66.67%;21例呈类圆形,占比26.92%;5例为不规则形,占比6.41%。肺炎组37例患者中23例为楔形,占比62.16%;14例为类圆形,占比37.84%,将两组患者形态进行对比,无明显统计学差异(P>0.05);肺结核组中出现碎片征的患者有24例,占比30.77%,在肺炎组中有30例,占比81.08%,肺炎组患者中碎片征的占比相较于肺结核组升高(P<0.05);边缘较为规整,后方出现彗星尾征的高回声为瀑布征,肺结核组患者中瀑布征的占比为62.82%,相较于肺炎组患者中的占比16.22%上升(P<0.05);肺炎组患者中有34例患者的病灶为离心型增强模式,占比91.89%,而其余3例则为局部向整体的增强模式;肺结核组患者中有55例为离心型增强模式,占比70.51%,13例患者为向心型增强模式,占比16.67%;10例患者表现为离心型、向心型均存在的增强模式,占比12.82%,将两组患者增强模式占比进行对比,差异有统计学意义(P<0.05);肺结核组患者中共有64例出现坏死区,占比82.05%,肺炎组患者中共有11例出现坏死区,占比29.73%,经比较,肺结核组患者的坏死区占比相较于肺炎组升高(P<0.05);肺结核组患者中有33例呈现为病灶内有许多间断的筛孔样坏死,占比51.56%,而24例则呈现为形态较为规整的大片状坏死,占比37.50%,7例则呈现为病灶内几乎完全坏死,占比10.94%;肺炎组患者中有2例为形态较为规整的大片状坏死,占比18.18%,9例呈现为形态较为规整的小片状坏死,占比81.82%,经对比,两组间有统计学差异(P<0.05);两组患者超声造影下正常肺组织开始增强时间、病灶开始增强时间等指标进行对比,均无明显差异(均P>0.05)。结论肺结核病灶经常规超声检查为“瀑布征”,超声造影检查显示坏死区面积较大,且多为大片状坏死;而常规超声检查细菌性肺炎病灶为“碎片征”,坏死区面积较小,且形态较为规整,以上特点可作为鉴别两种疾病的标志。

Objective To analyze the imaging features of conventional ultrasound combined with contrast-enhanced ultrasound in subpleural pulmonary tuberculosis and bacterial pneumonia.Methods 115 patients diagnosed with subpleural pulmonary tuberculosis or bacterial pneumonia in our hospital were selected,of which 78 were diagnosed as subpleural pulmonary tuberculosis.37 patients diagnosed with bacterial pneumonia were included in the pneumonia group.All patients underwent conventional ultrasound and contrast-enhanced ultrasound,and the imaging findings of conventional ultrasound and contrast-enhanced ultrasound were analyzed.Results 52 of 78 patients in pulmonary tuberculosis group were wedge-shaped,accounting for 66.67%.21 cases were quasi-circular,accounting for 26.92%;5 cases were irregular,accounting for 6.41%.In the pneumonia group,23 of 37 patients were wedge-shaped,accounting for 62.16%;14 cases were circular,accounting for 37.84%.There was no significant difference between the two groups(P>0.05);in the pulmonary tuberculosis group,there were 24 patients with fragmentation,accounting for 30.77%,and in the pneumonia group,there were 30 patients,accounting for 81.08%.The proportion of fragmentation in the pneumonia group was higher than that in the pulmonary tuberculosis group(P<0.05);the high echo of comet tail sign was waterfall sign,the proportion of waterfall sign in pulmonary tuberculosis group was 62.82%,which was higher than 16.22%in pneumonia group(P<0.05);in the pneumonia group,34 cases(91.89%)had centrifugal enhancement mode,while the other 3 cases had local to whole enhancement mode;in the pulmonary tuberculosis group,55 cases were centrifugal enhancement mode,accounting for 70.51%,13 cases were centripetal enhancement mode,accounting for 16.67%,10 patients showed both centrifugal and centripetal enhancement patterns,accounting for 12.82%.The proportion of enhancement patterns between the two groups was compared,and the difference was statistically significant(P<0.05);a total of 64 patients in the pulmonary tuberculosis group had necrotic areas,accounting for 82.05%,and 11 patients in the pneumonia group had necrotic areas,accounting for 29.73%,the proportion of necrotic areas in the pulmonary tuberculosis group was higher than that in the pneumonia group(P<0.05);in the pulmonary tuberculosis group,33 cases showed many intermittent ethmoidal necrosis in the lesion,accounting for 51.56%,while 24 cases showed large and orderly morphology of necrosis,accounting for 37.50%,and 7 cases showed almost complete necrosis in the lesion,accounting for 10.94%.In the pneumonia group,2 cases showed large flake necrosis with relatively regular shape,accounting for 18.18%,and 9 cases showed small flake necrosis with relatively regular shape,accounting for 81.82%,there was statistical difference between the two groups(P<0.05);there was no significant difference between the two groups in the time of beginning enhancement of normal lung tissue and the time of beginning enhancement of lesion under CEUS(P>0.05).Conclusion The conventional ultrasound examination of pulmonary tuberculosis lesions showed"waterfall sign",and contrast-enhanced ultrasound examination showed that the necrotic area was large,and most of them were large flaky necrotic,conventional ultrasound examination of bacterial pneumonia lesions is"fragmentation",the necrotic area is small,and the shape is more regular,the above characteristics can be used as a sign to distinguish the two diseases.