超声造影定量分析在胸膜下肺病灶良恶性鉴别中的诊断价值

Diagnostic value of contrast-enhanced ultrasound quantitative analysis in differentiating benign and malignant subpleural lung lesions

目的探讨超声造影定量分析在胸膜下肺病灶良恶性鉴别中的诊断价值。方法选择2019年1~6月在同济大学附属上海市肺科医院就诊并行超声引导下经皮肺穿刺术的胸膜下肺病灶患者299例,回顾分析该组病例肺穿刺术前的超声造影资料,对照病理结果分析良恶性病灶的超声造影始增时间、始增强度、病灶的达峰时间及达峰强度、病灶的净增强度、病灶的减半强度及强度减半时间、病灶-肺组织始增时间差、胸壁-病灶始增时间差、时间比例等参数,绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),计算曲线下面积及最佳截断点。结果超声造影定量参数中,病灶始增强度及时间、病灶达峰时间、病灶减半强度及强度减半时间、病灶-肺始增时间差、胸壁-病灶始增时间差、时间比例在良恶性组间差异均有统计学意义(P<0.05),而病灶达峰强度、病灶净增强度在良恶性组间差异无统计学意义(P>0.05);时间比例的曲线下面积最大(0.845),且当时间比例≥51.89%时,诊断胸膜下恶性病灶的敏感度为86.2%,特异度为79.3%,准确度为84.3%,阳性预测值为92%,阴性预测值为68%。结论超声造影定量分析的多项参数在胸膜下肺病灶的良恶性鉴别中差异明显,特别是时间比例参数,可为临床鉴别诊断提供依据。

Objective To discuss the diagnostic value of the quantitative analysis of contrast-enhanced ultrasound(CEUS)in differentiating benign and malignant subpleural lung lesions.Methods A total of 299 cases of ultrasound-guided percutaneous lung puncture in Shanghai Pulmonary Hospital Affiliated to Tongji University from January 2019 to June 2019 were selected and divided into benign group and malignant group.The time-intensity curve(TIC)parameters of CEUS before puncture in both groups were reviewed and compared with the corresponding pathological results,including the arrival time(AT),the AT intensity,the time to peak intensity(TTP),and maximum intensity(IMAX)of the lesions,the net enhancement of intensity of the lesions,the reduced-by-half intensity and the reduced-by-half time of the lesions,the AT difference between the lesions and the lung tissues,the AT difference between the chest wall and the lesions,and the time ratio.The receiver operating characteristic(ROC)curves were drawn,and the area under the curve(AUC)and the optimal cut-off point were calculated.Results Among the quantitative parameters of CEUS,there were statistically significant differences between the benign group and malignant group in terms of the AT,AT intensity,TTP,the reduced-by-half intensity and time of the lesions,the AT difference between the lesions and the lung tissues,the AT difference between the chest wall and the lesions,and the time ratio(P<0.05);while there was no statistically significant difference between the benign group and malignant group in terms of the IMAX and the net enhancement of intensity of the lesions(P>0.05).The AUC of time ratio was the largest(0.845);the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value were 86.2%,79.3%,84.3%,92%,and 68%,respectively,when the time ratio was at or above 51.89%.Conclusion Multiple TIC parameters of CEUS quantitative analysis have shown significant differences in differentiating benign and malignant subpleural lung lesions,especially,the parameter of time ratio can provide a basis for clinical differential diagnosis.