超声造影与CT引导经皮穿刺活检纵隔肿瘤诊断效能的对比分析

Percutaneous biopsy of mediastinal tumors guided by contrast-enhanced ultrasound vs CT:A comparative study of diagnostic efficiency

目的通过对比分析超声造影(CEUS)与电子计算机断层扫描(CT)引导经皮穿刺纵隔肿瘤的诊断效能及影响因素, 探讨CEUS引导穿刺纵隔肿瘤的应用价值。方法回顾性分析129例经皮穿刺活检纵隔肿瘤患者的临床资料, CEUS引导穿刺组54例、CT引导穿刺组75例, 对比分析两种方法对纵膈肿瘤的诊断价值。结果 CEUS组的取材有效率98.1%高于CT组86.7%, 差异有统计学意义(P<0.05);CT引导组的取材有效率与坏死面积占比(A%)呈负相关(相关系数r=-0.56, P<0.001)、与肿瘤的有效厚径(T)呈正相关(相关系数r=0.44, P=0.002), 临界值分别为A%=46.7%, P=0.001, T=20.5 mm, P=0.002。CEUS引导组并发症发生率1.9%, CT引导组17.3%, 差异有统计学意义(P<0.05);其中气胸发生率:CT引导组中经皮穿刺途径为2.1%, 经皮-肺穿刺途径为29.6%(8/27), 差异有统计学意义(P<0.05)。结论对超声可探及的纵隔肿瘤, 尤其是其中坏死程度较广泛的肿瘤, 超声造影能够有效引导穿刺肿瘤活性区域, 可作为CT引导穿刺活检的有效补充。

Objective To compare the diagnostic efficiency of percutaneous biopsy of mediastinal tumors guided by contrast-enhanced ultrasound(CEUS)vs computed tomography(CT),to investigate the influential factors,and to determine the value of CEUS-guided percutaneous biopsy in diagnosing mediastinal tumors.Methods The clinical data of 129 patients with mediastinal tumors who underwent percutaneous biopsy were reviewed.The biopsy was guided by CEUS in 54 patients(CEUS group)and by CT in 75 others(CT group).The diagnostic efficiency for mediastinal tumors was compared between the two methods.Results The rate of effective tissue sampling in the CEUS group(98.1%)was higher than that in the CT group(86.7%),with statistically significant difference(P<0.05).In the CT group,the rate of effective tissue sampling was negatively correlated with the percentage of necrotic area(A%)(correlation coefficient r=-0.56,P<0.001),and was positively correlated with the effective thickness(T)of the tumor(correlation coefficient r=0.44,P=0.002);the cut-off values were 46.7%for A%(P=0.001)and 20.5 mm for T(P=0.002).The incidence of complications was 1.9%in the CEUS group and 17.3%in the CT group,with statistically significant difference(P<0.05).In the CT group,the incidence of pneumothorax was 2.1%via total percutaneous approach,and 29.6%(8/27)via percutaneous transpulmonary approach,with statistically significant difference(P<0.05).Conclusion For ultrasound-detectable mediastinal tumors,particulary those with extensive necrosis,CEUS can effectively guide puncture of the active area of tumor,and can be a useful complement to CT-guided puncture biopsy.