CAJ | 학술논문

目的探讨超声造影( contrast-enhanced ultrasound,CEUS)在肺良、恶性病变诊断中的价值。方法以经胸部CT和/或X线检查发现、超声能显示的40例患者的40个肺占位病变为研究对象,包括周围型病变38个,中央型病变伴阻塞性肺不张2个；40例患者中,男性25人,女性15人,平均年龄(64.8±12.5)岁(35~84岁)。首先,普通超声观察病变大小、形态、回声、血流信号分布情况, CEUS 观察病变开始增强时间( time to enhancement, TE ),达峰时间( time to peak, TTP )及净增强强度( net enhancement,NE)。之后,在超声引导下避开CEUS显示的无增强坏死区行经皮穿刺活检,全部标本进行病理学检查。结果40例患者接受了经皮穿刺活检,1例(2.5%)发生咳血合并症。40个病变中,34个被确诊为恶性病变,其中1个病变穿刺病理诊断不明确,后经手术病理确诊为恶性肿瘤,其余6个为良性病变,穿刺活检确诊率达97.5%(39/40)。 CEUS显示良性病变的TE稍早于恶性病变,分别为(9.50±1.05)s(6~14 s)及(10.85±1.67)s(8.5~17 s),差异无统计学意义(P>0.05),但当TE明显增快或减慢时对病变鉴别诊断有意义；比较良、恶性组TTP及NE,差异均无统计学意义(P均>0.05)。良、恶性病变组中分别有16例及3例(47.1%和50.0%,P>0.05)显示病变内有无增强坏死区。各种肺占位性病变时间强度曲线( time intensity curve,TIC)具有“快进慢退”特征。结论 CEUS在肺占位病变的定性诊断及指导穿刺活检取材方面有价值,值得推广应用。
목적탐토초성조영( contrast-enhanced ultrasound,CEUS)재폐량、악성병변진단중적개치。방법이경흉부CT화/혹X선검사발현、초성능현시적40례환자적40개폐점위병변위연구대상,포괄주위형병변38개,중앙형병변반조새성폐불장2개；40례환자중,남성25인,녀성15인,평균년령(64.8±12.5)세(35~84세)。수선,보통초성관찰병변대소、형태、회성、혈류신호분포정황, CEUS 관찰병변개시증강시간( time to enhancement, TE ),체봉시간( time to peak, TTP )급정증강강도( net enhancement,NE)。지후,재초성인도하피개CEUS현시적무증강배사구행경피천자활검,전부표본진행병이학검사。결과40례환자접수료경피천자활검,1례(2.5%)발생해혈합병증。40개병변중,34개피학진위악성병변,기중1개병변천자병리진단불명학,후경수술병리학진위악성종류,기여6개위량성병변,천자활검학진솔체97.5%(39/40)。 CEUS현시량성병변적TE초조우악성병변,분별위(9.50±1.05)s(6~14 s)급(10.85±1.67)s(8.5~17 s),차이무통계학의의(P>0.05),단당TE명현증쾌혹감만시대병변감별진단유의의；비교량、악성조TTP급NE,차이균무통계학의의(P균>0.05)。량、악성병변조중분별유16례급3례(47.1%화50.0%,P>0.05)현시병변내유무증강배사구。각충폐점위성병변시간강도곡선( time intensity curve,TIC)구유“쾌진만퇴”특정。결론 CEUS재폐점위병변적정성진단급지도천자활검취재방면유개치,치득추엄응용。
Objective To explore the value of contrast-enhanced ultrasound ( CEUS ) in diagnosis of pulmonary space-occupying lesions. Methods Forty patients with 40 pulmonary space-occupying lesions found by using computed tomography( CT) and/or X ray, visible at US, were enrolled in this study, including 38 peripheral pulmonary lesions and 2 central pulmonary lesions with obstructive atelectasis. Of the 40 patients, 25 were male and 15 female, the mean age was (64. 8±12. 5)years (range from 35 to 84 years). Firstly, the lesions' dimension, shape, echo and blood flow characteristic were recorded by traditional ultrasound, then CEUS was performed, and time to enhancement(TE), time to peak(TTP) and net enhancement(NE) were recorded. Finally, percutaneous puncture biopsy was performed under the guidance of ultrasound, taking care to avoid the no-enhanced necrotic areas displayed by CEUS, and all specimens were examined pathologically. Results All the 40 cases underwent percutaneous puncture biopsy, 1 case developed the complication of hemoptysis. In 40 lesions, 34 were malignant,of which 1 was indefinite by percutaneous puncture biopsy pathology but was confirmed as malignant tumor by pathology of specimen obtained via surgery, the other 6 were benign lesions. So the rate of final diagnosis using percutaneous puncture biopsy was 97. 5%(39/40). TE was slightly shorter in malignant lesion group than in benign lesion group using CEUS〔(9.50±1.05)s & (10.85±1.67)s, respectively〕 and with no significant difference(P>0.05), however, a seriously short or delayed TE may be helpful for different diagnosis in pulmonary space-occupying lesions. There was no significant difference regarding NE and TTP between two groups(P>0. 05 & P>0. 05, respectively); Sixteen(47. 1%) were discovered non-enhanced necrosis areas in 34 malignant lesions, and 3(50. 0%) in 6 benign lesions(P>0. 05). The time intensity curve(TIC) of different pulmonary space-occupying lesions was characterized by "ascending slowly and descending slowly" pattern. Conclusion CEUS is a valuable method for diagnosis and guiding percutaneous puncture biopsy in pulmonary space-occupying lesions.