超声造影定量参数联合对肺周围型病变良恶性的诊断价值

Value of combined quantitative parameters of contrast-enhanced ultrasound in diagnosis of benign and malignant peripheral pulmonary lesions

目的探索超声造影定量参数联合运用在肺周围型病变良恶性鉴别中的价值。方法选取2018年8月至2021年10月在安徽中医药大学第一附属医院可被超声探查的61例肺周围型病变患者,先行常规二维超声检查,记录病灶最长径线及内部回声情况。再行超声造影检查,获取病灶达峰时增强模式及造影定量参数。按照病理结果分为良性组(24例)和恶性组(37例)。先应用单因素分析对比2组间性别、年龄、病灶最长径线、二维超声(病灶内部回声)、超声造影增强模式及超声造影定量参数的差异,再将单因素分析中差异有统计学意义的各因素纳入二元Logistic回归模型进行分析并计算回归方程式,最后绘制预测肺周围型病变良恶性的受试者操作特征(ROC)曲线检验其诊断效能。结果单因素分析:2组患者性别、年龄、病灶最长径线、二维超声及超声造影增强模式方面比较,差异均无统计学意义(P均>0.05);超声造影定量参数:与良性组比较,恶性组病灶初始增强时间增多[AT_(2):(13.78±2.30)s vs(11.17±1.79)s]、病灶与周围肺组织初始增强时间差大[T_(AT):(4.51±1.63)s vs(2.04±1.09)s]以及上升斜率大[(3.06±0.55)vs(2.77±0.40)],差异均具有统计学意义(t=4.724、6.118、2.151,P<0.001、<0.001、=0.036),周围肺组织初始增强时间、达峰时间以及下降斜率比较,差异均无统计学意义(P均>0.05)。Logistic回归模型显示,AT_(2)、T_(AT)与肺周围型病变的良恶性密切相关,Logit(P)=-12.224+0.542 X^(TA_(2))+1.005 X^(T_(AT))。绘制单因素AT_(2)、T_(AT)以及二者联合预测模型的ROC曲线,曲线下面积分别为0.825、0.880、0.919,其95%CI分别为0.719~0.931、0.782~0.978、0.848~0.990,其中多因素联合预测模型的曲线下面积最大。结论超声造影定量参数中AT_(2)和T_(AT)在肺周围型病变良恶性的鉴别方面具有一定的应用价值,二者联合应用诊断效能更高。

Objective To assess the value of combined quantitative parameters of contrast-enhanced ultrasound(CEUS)in the diagnosis of benign and malignant peripheral pulmonary lesions.Methods A total of 61 patients with peripheral pulmonary lesions that could be assessed by ultrasound from August 2018 to October 2021 were selected at the First Affiliated Hospital of Anhui University of Chinese Medicine.The longest diameter and internal echo of the lesions were recorded via conventional two-dimensional ultrasound examination.CEUS was used to obtain the contrast-enhanced pattern and quantitative parameters of the lesions at peak.According to pathological results,the patients were divided into two groups:benign group(n=24)and malignant group(n=37).Univariate analysis was conducted to compare the differences between the two groups in terms of gender,age,the longest diameter of the lesion,two-dimensional ultrasound results(lesion internal echo),contrast-enhanced pattern,and CEUS quantitative parameters.The parameters with statistical significance in the univariate analysis were incorporated into the binary logistic regression model for analysis,and the regression equation was calculated.Receiver operating characteristic(ROC)curve analysis was performed to test diagnostic efficiency.Results Univariate analysis demonstrated that gender,age,the longest diameter of the lesion,two-dimensional ultrasound results(lesion internal echo),and contrast-enhanced pattern had no statistical difference(P>0.05),while CEUS quantitative parameters including contrast agent arrival time[AT_(2):(11.17±1.79)s vs(13.78±2.30)s],the difference of arrival time between the lesion and the surrounding lung tissue[T_(AT):(2.04±1.09)s vs(4.51±1.63)s],and rising slope[(2.77±0.40)vs(3.06±0.55)](t=4.724,6.118,and 2.151;P<0.001,<0.001,and=0.036,respectively)had significant differences between benign group and malignant group,though there were no statistically significant differences in the arrival time of peripheral lung tissue,time to peak,or descending slope(P>0.05).Logistic regression analysis showed that AT_(2)and T_(AT)were closely related with whether the lesions are benign or malignant.The regression equation is Logit(P)=-12.224+0.542 X^(AT_(2))+1.005 X^(T_(AT)).ROC curves of AT_(2)and T_(AT)alone or in combination were drawn.The areas under the ROC curves were 0.825(95%CI:0.719-0.931),0.880(95%CI:0.782-0.978),0.919(95%CI:0.848-0.990),respectively.The combined prediction model had the largest area under the curve.Conclusion The two CEUS quantitative parameters,AT_(2)and T_(AT),are of significant value in the diagnosis of benign and malignant peripheral pulmonary lesion,and their combination proves more effective.