超声造影与增强CT对周围型肺局灶性病变诊断价值的对比研究

Comparative study on the diagnostic value of contrast-enhanced ultrasound and contrast-enhanced CT in peripheral pulmonary focal lesions

目的:对比研究超声造影(CEUS)与增强CT(CECT)对周围型肺局灶性病变良、恶性的鉴别诊断价值。方法:回顾性分析经病理证实的72例周围型肺局灶性病变患者共72个病灶的CEUS与CECT图像特征,以病理结果为金标准统计比较二者对周围型肺局灶性病变的诊断效能,并对CEUS、CECT和病理诊断结果进行一致性分析。结果:72个周围型肺局灶性病变中,恶性病灶44个:包括肺腺癌24个,肺鳞癌9个,肺小细胞癌、神经内分泌癌和肉瘤样癌各2个,转移癌、低分化非小细胞癌、非典型类癌、低分化癌和低度恶性孤立性纤维瘤各1个;良性病灶28个,包括局灶性肺炎12个,肺结核9个,机化性肺炎5个,肺脓肿和淀粉样变性各1个。CEUS、CECT对良恶性周围型肺局灶性病变诊断的灵敏度、特异度及准确度分别为84.1%和93.2%、71.4%和64.3%、79.2%和81.9%,二者诊断效能的差异无统计学意义(P值分别为0.125、0.687和0.754)。CEUS和CECT对于良恶性周围型肺局灶性病变诊断与病理结果一致性检验Kappa值分别为0.559(P<0.001)和0.602(P<0.001)。结论:CEUS和CECT在鉴别诊断周围型肺局灶性病变良、恶性方面均有较高价值,两者结合有助于周围型肺局灶性病变的明确诊断。

Objective:To compare the value of contrast-enhanced ultrasound(CEUS)and contrast-enhanced CT(CECT)in the differential diagnosis of benign and malignant peripheral pulmonary focal lesions.Methods:The CEUS and CECT image features of 72 lesions in 72 patients with peripheral focal pulmonary lesions confirmed by pathology were retrospectively ana-lyzed.Using pathological results as the gold standard,the diagnostic efficacy of the two kinds of examination was statistically compared.The consistency of CEUS,CECT and pathological results was analyzed.Results:Among 72 peripheral pulmonary focal lesions,there were 44 malignant lesions,including 24 lung adenocarcinoma,9 lung squamous carcinoma,2 lung small cell carcinoma,2 neuroendocrine carcinoma,2 sarcomatoid carcinoma,1 metastatic carcinoma,1 poorly differentiated non-small cell carcinoma,1 atypical carcinoid,1 poorly differentiated carcinoma and 1 low grade malignant solitary fibrous tumor.There were 28 benign lesions,including 12 focal pneumonia,9 pulmonary tuberculosis,5 organized pneumonia,1 lung ab-scess and 1 amyloidosis.The sensitivity,specificity and accuracy of CEUS and CECT in the diagnosis of benign and malig-nant peripheral pulmonary focal lesions were 84.1%and 93.2%,71.4%and 64.3%,79.2%and 81.9%,respectively.There was no significant difference in the diagnostic efficacy between the two methods(P value was 0.125,0.687 and 0.754,respectively).The Kappa value between CEUS and pathological results was 0.559(P<0.001),the Kappa value between CECT and pathological results was 0.602(P<0.001).Conclusion:CEUS and CECT are of high value in differentiating benign and malignant peripheral pulmonary focal lesions.The combination of CEUS and CECT is helpful for the definite diagnosis of peripheral pulmonary fo-cal lesions.