超声造影实时判断周围型肺病变初始强化时间点的价值

Determination of the Initial Time of Peripheral Pulmonary Lesion by Real-time Contrast-enhanced Ultrasound

目的探讨实时超声造影(CEUS)对比观察法判断周围型肺病变初始强化时间点的应用价值,为CEUS诊断周围型肺病变提供一种新方法。资料与方法选取经胸部X线或CT检查发现且超声可见的60例周围型肺病变患者行CEUS检查,实时对比观察病灶及周围肺组织灌注情况。周围型肺病变初始强化时间点的判定采用实时CEUS对比观察法,即观察造影剂到达周围型肺病变的时间,与到达病变周围相对正常含气肺组织的时间进行对比。所有病灶均经手术或超声引导下经皮肺穿刺活检获得病理标本,行病理诊断,根据病理结果分为肺恶性肿瘤组、慢性炎症病变组和肺炎组。结果 60例周围型肺病变中,肺恶性肿瘤38例(鳞癌15例,腺癌9例,大细胞癌2例,小细胞肺癌9例,转移性肺癌3例),慢性炎症病变14例(结核7例,炎性假瘤3例,肺脓肿4例),肺炎8例。实时CEUS对比观察法肺动脉相显示率为100%(60/60),支气管动脉相显示率为85%(51/60)。肺动脉相和支气管动脉相开始时间分别为(6.1±0.9)s和(10.5±1.6)s,肺动脉相开始时间早于动脉相开始时间,差异有统计学意义(P<0.05)。结论实时CEUS对比观察法用于判断周围型肺病变初始强化时间点具有重要的诊断价值,可为周围型肺病变的准确诊断提供一种新方法。

Purpose To evaluate the value of real-time contrast-enhanced ultrasound （CEUS） combined with comparative observation in determining the initial time of peripheral lung lesion, and to provide a new method for the diagnosis of peripheral lung disease by CEUS. Materials and Methods Sixty patients with peripheral lung disease diagnosed by chest X-ray or CT examination were examined by CEUS, and the lesions and perfusion of surrounding lung tissue were observed in real time and comparatively. The time of initial enhancement of peripheral lung lesion was determined by real-time comparative observation method, that is, to compare the time of contrast agent to reach the peripheral lung lesion with the time to reach the adjacent gas-containing lung tissue. All lesion specimens were obtained by surgery or ultrasound-guided percutaneous biopsy, and the pathological diagnosis was performed. According to the pathological results, the peripheral lung lesions were classified into the malignant group, the chronic inflammation group and the pneumonia group. Results Sixty cases of peripheral lung lesions were identified as 38 cases of malignant tumors （including 15 cases of squamous cell carcinomas, 9 cases of adenocarcinorna cell carcinomas, 2 cases of large cell carcinomas, 9 cases of small cell carcinomas and 3 cases of metastatic carcinomas）, 14 cases of chronic inflammation lesions （including 7 cases of tuberculomas, 3 cases of inflanqmatory pscudoturnors and 4 cases of lung abscess） and 8 cases of pneumonia. The detection rates of pulmonary arterial phase and bronchial artery phase using the real-time comparative observation method were 100% （60/60） and 85% （51/60）. respectively. The initial time of pulnlonary arterial phase and bronchial artery phase were （6.1 ±0.9） s and （10.5± 1.6） s, respectively. The initial time of pulmonary arterial phase was sooner than bronchial artery phase, the difference was statistical significance （P〈0.05）. Conclusion The real-time CEUS combined with comparative observation method has important diagnostic value in judging the initial enhancement time of peripheral lung lesion and can provide a new method for the accurate diagnosis of peripheral lung disease, which is worth popularizing.