CAJ | 학술논문

目的探讨新型超声造影微血管灌注模式鉴别诊断周围型肺占位的应用价值.方法采用盲法读片,回顾性分析72例周围型肺占位的超声造影微血管灌注模式特点,并进行分类,比较良恶性病变的差异,Kappa检验评价观察者之间的一致性.比较两名医师结合微血灌注模式的超声造影诊断率,以及造影前后诊断评分差异.结果良性16例,微血管灌注模式主要表现为树枝状强化(43.8％、31.3％)、点片状强化(18.8％、25.0％)及环状强化(18.8％、18.8％);恶性56例,微血管灌注模式主要表现为血管状强化(46.4％、57.1％)、棉花状强化(26.8％、25.0％)及枯枝状强化(19.6％、8.9％).良、恶性微血管灌注模式差异具有统计学意义.2名医师对微血管灌注模式判断具有较好的一致性(Kappa-0.759).结合微血管灌注模式特点,2名医师的超声造影诊断敏感性、特异性及准确性分别为92.9％、91.1％,81.3％、75.0％和90.3％、87.5％.超声造影前,59.7％和68.1％的肺占位诊断评分为3分;超声造影后诊断3分者仅分别占1.4％和6.9％.进一步分析显示鳞癌与腺癌、鳞癌与小细胞癌之间的微血管灌注模式差异具有统计学意义.结论超声造影可显著提高周围型肺占位的诊断率,利用新型微血管显像技术可显示周围型肺占位内的血管灌注模式,为鉴别诊断提供新的诊断依据.
목적 탐토신형초성조영미혈관관주모식감별진단주위형폐점위적응용개치.방법 채용맹법독편,회고성분석72례주위형폐점위적초성조영미혈관관주모식특점,병진행분류,비교량악성병변적차이,Kappa검험평개관찰자지간적일치성.비교량명의사결합미혈관주모식적초성조영진단솔,이급조영전후진단평분차이.결과 량성16례,미혈관관주모식주요표현위수지상강화(43.8％、31.3％)、점편상강화(18.8％、25.0％)급배상강화(18.8％、18.8％);악성56례,미혈관관주모식주요표현위혈관상강화(46.4％、57.1％)、면화상강화(26.8％、25.0％)급고지상강화(19.6％、8.9％).량、악성미혈관관주모식차이구유통계학의의.2명의사대미혈관관주모식판단구유교호적일치성(Kappa-0.759).결합미혈관관주모식특점,2명의사적초성조영진단민감성、특이성급준학성분별위92.9％、91.1％,81.3％、75.0％화90.3％、87.5％.초성조영전,59.7％화68.1％적폐점위진단평분위3분;초성조영후진단3분자부분별점1.4％화6.9％.진일보분석현시린암여선암、린암여소세포암지간적미혈관관주모식차이구유통계학의의.결론 초성조영가현저제고주위형폐점위적진단솔,이용신형미혈관현상기술가현시주위형폐점위내적혈관관주모식,위감별진단제공신적진단의거.
Objective To investigate the value of new microvascular pattern of contrast-enhanced ultrasonography (CEUS) in the diagnosis of peripheral lung lesion.Methods A total of 72 peripheral lung lesions which had been proved by clinical and pathology results underwent conventional ultrasound,CEUS and new microvascular pattern examination.Two independent readers (Reader 1 and Reader 2) blindly and retrospectively analysised and classified the characteristic of microvascular patterns respectively,and Kappa test was used for evaluating the concordance between the two readers.The diagnosis accuracy of CEUS was calculated,and the CEUS diagnostic scores were compared with conventional ultrasound.Results 16 benign lesions and 56 malignant lesions were enrolled in this study.The microvascular patterns in benign lesions included branch enhancement(43.8 ％,31.3％),point and patchy enhancement (18.8％,25.0％) and rim-like enhancement (18.8％,18.8％).The microvascular patterns in malignant lesions included vascular enhancement (46.4％,57.1％),cotton enhancement (26.8％,25.0％) and dead wood enhancement (19.6％,8.9％).There was significant difference between benign and malignant lesions.Kappa result showed that the two readers had a good diagnosis concordance(Kappa=0.759,P =0.000).According to the different types of microvascular pattern,the diagnostic accuracy,sensitivity,and specificity rates of two readers were 92.9％,91.1％;81.3％,75.0％ and 90.3％,87.5％,respectively.Before CEUS,59.7％ and 68.1％ of lesions were diagnosed as 3 by two readers respectively,while only 1.4％ and 6.9％ of lesions were diagnosed as 3 after CEUS.Further analysis demonstrated that there was significant difference in the microvascular pattern between squamous carcinoma and adenocarcinoma,and also between squamous carcinoma and small cell lung carcinoma.Conclusions Contrast-enhanced ultrasound could significantly increase the differential diagnosis of peripheral lung lesions.New microvascular pattern helped to display patterns of vascular perfusion.of peripheral lung lesions,and provide new diagnostic clue for differential diagnosis.