超声对肺胸膜小彗星尾征的研究及临床意义

Clinical value of small comet tail artifact of visceral pleura by ultrasonography

目的 探讨超声所显示肺胸膜后方小彗星尾征伪像 (SCTA)的声像图特征、形成原因及临床意义。方法 181例进行随机肺胸膜超声检查 ,有胸部CT或X线检查结果及临床资料者作为本研究对象 ,并将受检者分为两组 ,CT、X线检查结果阴性者为正常组 ,阳性者为异常组。根据超声显示的SCTA形态、数量和分布状况分为三种类型 :SCTA呈细强回声带 ,自胸膜拖曳而下 ,形态排列较一致者为I型 ;类似I型 ,但数量较多 ,形态宽窄不等 ,分布杂乱者为Ⅱ型 ;SCTA前方伴有直径数毫米弱回声小结节者为Ⅲ型。结果 正常组 10 8例 ,显示SCTA的占 62 .1% (67例 ) ,其中 97.0 % (65 /67)为I型 ,70 .1% (4 7例 )局限在近肋膈角或肋纵隔隐窝。异常组73例中 ,94.5 % (69例 )显示SCTA ,Ⅱ型占 46.4% (3 2 /69)。两组间差异有显著性意义 (P <0 .0 1)。对比胸部CT或X线检查结果 ,Ⅱ型伪像多局限在CT相对应的部位 ,常见于肺局部或弥漫性病变 ;而Ⅲ型伪像则常见于肺表面或胸膜下多发结节。结论 多发或大量弥漫分布的伪像与肺部弥漫性病变密切相关 ;超声所见SCTA的不同类型可能与增厚的小叶间隔的不同表现形式有关 ;

Objective To investigate the sono morphological characteristics,inducing factors and clinical value of the small comet tail artifact (SCTA)of visceral pleura.Methods One hundred and eighty one cases undergone conventional ultrasonographic examination were included.The shape,quantity and distribution of SCTA were recorded and the artifact was sorted according to them.The SCTA trailing down from the visceral pleura,with homogenous shape and regular distribution was classified as typeⅠ; typeⅡ SCTA which looked like typeⅠ,but distributes more disorderly and the amount was larger; typeⅢ which SCTA had a tiny sub pleura hypo echo nodular at the initial point of each artifact.The results were compared with CT, X ray or clinical diagnosis and analyzed.Results All cases were divided into two groups on the basis of CT,X ray and clinical results.The first group included 108 healthy ones,41 cases ( 37.9% ) of which reveal no artifact.SCTA were detected in 67 cases (62.1%),while only 3 cases have more than 6 artifacts detected.The second group consisted of 73 cases having abnormal radiologic diagnosis.SCTA was found in 69 cases ( 94.5% ) with 49 cases revealing more than 6 artifacts.There was significant difference between these two groups.Compared with their own CT or X ray,most artifacts were found in the relevant anatomy regions.In first group, 97.0% (65/67 cases ) revealed typeⅠ SCTA.The typeⅡ artifacts were always found in diffuse pulmonary diseases.When CT reveals multiple nodulars in the lungs,type Ⅲ artifacts were often detected.Those different types of SCTA have some relation to variform of thickening of the septa interlobulare.Conclusions Multiple or diffuse SCTA is correlated with diffuse pulmonary disease and typeⅢ artifact has important referenc value for detecting small pulmonary nodules.