超声造影提高前中纵隔穿刺活检准确率的应用价值  

Application of Contrast-enhanced Ultrasound to Improve the Diagnostic Accuracy Rate of Biopsy in Anterior and Middle Mediastinum Lesions

作　　者：付静静[1] 王凇[1] 杨薇[1] 白静[1] 王海月[2] 吴薇[1] 严昆[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所超声科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京市100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所病理科,北京市100142

出　　处：《中国超声医学杂志》2016年第7期612-615,共4页Chinese Journal of Ultrasound in Medicine

基　　金：北京市百千万人才工程资助[No.(2015)261];北京市卫生系统高层次卫生技术人才培养计划(No.2013-3-086)

摘　　要：目的探讨超声造影(CEUS)对前中纵隔占位经皮穿刺活检的临床应用价值。方法拟行超声引导下穿刺活检的109例前中纵隔占位为研究对象。其中58例穿刺前行CEUS检查,5例不宜穿刺,余53例为造影组;同期51例未进行CEUS检查,为对照组。比较两组超声图像特点、穿刺活检次数、诊断准确率以及并发症等差异。分析CEUS组的灌注特征,探讨CEUS对提高纵隔穿刺活检成功率的应用价值。结果造影组5例CEUS显示大部分坏死或浅方大血管不宜穿刺。余53例CEUS对病灶内部坏死的显示率为37.7%(20/53),显著高于对照组的11.8%(6/51)(P=0.002)。两组穿刺次数分别为(2.35±0.73)次和(2.21±0.51)次,差异无统计学意义。诊断准确率比较,造影组为98.1%(52/53),显著高于对照组的84.3%(43/51)(P=0.012)。对照组发生2例纵隔出血(3.9%),造影组无严重并发症。结论 CEUS检查可对纵隔病灶浅表血管和内部结构进行有效评估,有助筛选适应证及提高诊断准确率,具有重要临床指导价值。Objective To evaluate the role of contrast enhanced ultrasound（CEUS）in the clinical application of percutaneous biopsy in lesions of anterior and middle mediastinum.Methods A total of 109 patients with anterior or middle mediastinum lesions intend to undergo ultrasound guided percutaneous biopsy.Among them,58 patients received CEUS examinations before biopsy,In the 58 patients,5 cases were excluded from biopsy,the rest 53 cases underwent biopsy（CEUS group）.51 patients received biopsy without CEUS examination（control group）.The ultrasonography characteristics,number of biopsy punctures,diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.Results Majority area of necrosis or superficial large vessels was found in 5 patients.In the 53 cases in CEUS group,Necrosis inside lesion was demonstrated in 37.7% of the patients（20/53）,while only 11.8% of the patients（6/51）in control group.The detection rate of necrosis in CEUS group was statistically higher than that in control group（P=0.002）.The average number of punctures in CEUS group and control group was（2.35±0.73）and（2.21±0.51）times,respectively（P〉0.05）.There was no statistical difference.The diagnostic accuracy rate of CEUS group 98.1%（52/53）was significantly higher than that of control group 84.3%（43/51）（P=0.012）.In control group,2cases suffered from mediastinal bleeding（3.9%）,while no major complications occurred in CEUS group.Conclusions CEUS could identify superficial blood vessels and internal necrosis of the tumor.Thus,it might play an important role in providing valuable information for screening indications,and improving the diagnostic rate of mediastinum biopsy.

关 键 词：穿刺活检 超声造影 纵隔占位 准确率 

分 类 号：R445.1[医药卫生—影像医学与核医学] R734.5[医药卫生—诊断学]