超声造影在肺占位病变诊断中的价值  

Diagnosis value of contrast-enhanced ultrasound on pulmonary space-occupying lesions

作　　者：张红霞[1] 何文[1] 程令刚[1] 蔡文佳[1] 李铄[1] 李晨[1] 杜丽娟[1] 

机构地区：[1]首都医科大学附属北京天坛医院超声科,北京100050

出　　处：《首都医科大学学报》2014年第2期150-154,共5页Journal of Capital Medical University

基　　金：2012首都卫生发展科研专项项目(2011-2004-02)~~

摘　　要：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。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 ＆amp; （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 ＆amp; 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

关 键 词：超声 超声造影 肺 穿刺活检 

分 类 号：R445.1[医药卫生—影像医学与核医学]