超声造影区分肺动脉相和支气管动脉相的价值

Value of contrast-enhanced ultrasound in distinguishing pulmonary artery phase and bronchial artery phase

目的探讨使用超声造影(CEUS)进行实时对比观察法在鉴别肺部疾病的肺动脉相和支气管动脉相中的价值。方法选择经病理诊断证实胸部病变患者49例(50个病灶),其中男性31例,女性18例;年龄25~76岁,平均年龄64.8岁。对49例患者行CEUS检查,比较肺周围病变与邻近正常肺组织的造影剂灌注情况,对比造影参数始增时间(AT)、达峰时间(TP)、峰值强度(PI)的差异。在超声引导下行经皮肺穿刺活检,并对50个病变的标本进行病理检查。结果50个病变中良性病变14个(肺结核5个,肺炎5个,炎性假瘤4个),恶性病变36个(鳞状细胞癌13个,腺癌9个,支气管肺泡癌4个,小细胞癌4个,转移性癌3个,低分化癌2个,恶性间皮瘤1个);CEUS实时比较观察法肺动脉相的检出率为100%(50/50),支气管动脉相的检出率为88%(44/50);肺炎患者的AT明显早于恶性肿瘤和慢性炎症的患者[(6.0±0.7)s vs(10.9±1.6)s vs(10.6±1.8)s;P<0.01],而恶性肿瘤与慢性炎症的患者之间差异无统计学意义(P>0.05)。在良恶性病变患者中,TP及PI差异无统计学意义(P>0.05)。结论与正常含气肺组织的AT作为参考,实时比较观察法可以减少各种客观因素对动脉期的影响来准确确定病变的增强阶段。该方法操作简便并提供实时动态显示,可提高诊断准确率并减少肺部疾病的误诊。

Objective To explore the value of contrast-enhanced ultrasound(CEUS)real-time comparative observation method in distinguishing pulmonary arterial phase and bronchial arterial phase of lung diseases.Methods A total of 49 patients(50 lesions)with chest lesions confirmed by pathological diagnosis were enrolled,which included 31 males and 18 female,aged 25-76 years old with mean age of 64.8 years old.All of the patients were examined by CEUS.Contrast agent perfusion,contrast parameter arrival time(AT),peak time(TP),peak intensity(PI)differences between the lung lesions and adjacent normal lung tissues were compared.The ultrasound guided percutaneous lung biopsy were performed to pathologically examine 50 lesion specimens.Results Among the 50 lesions,14 were benign lesions(5 of tuberculosis,5 of pneumonia and 4 of inflammatory pseudotumor),36 were malignant lesions(13 of squamous cell carcinoma,9 of adenocarcinoma,4 of bronchoalveolar carcinoma,4 of small cell carcinoma,3 of metastatic cancer,2 of poorly differentiated cancer and 1 of malignant mesothelioma).The detection rate of CEUS real-time comparative observation method of pulmonary artery phase was 100%(50/50),and the detection rate of bronchial artery phase was 88%(44/50).AT of pneumonia patients were significantly earlier than that of patients with malignant tumors and chronic inflammation[(6.0±0.7)seconds vs(10.9±1.6)seconds vs(10.6±1.8)seconds;P<0.01],while there was no statistically significant difference between patients with malignant tumors and chronic inflammation(P>0.05).There was no significant difference in TP and PI between patients with benign and malignant diseases(P>0.05).Conclusion It is demonstrated that with the AT of normal air-bearing lung tissue as reference,real-time comparison observation method could reduce influence of various objective factors on arterial phase,and accurately determine the enhancement phase of lesion.The method is simple with real-time dynamic displaying,which can improve diagnostic accuracy and reduce misdiagnosis of lung diseases.