超声造影在前纵隔神经内分泌肿瘤穿刺活检中的应用价值  

Application value of contrast-enhanced ultrasound in puncture biopsy of anterior mediastinal neuroendocrine tumor

作　　者：王希 王文平 李超伦[1,3] 韩红 季正标 徐本华 闻捷先[1] WANG Xi;WANG Wenping;LI Chaolun;HAN Hong;JI Zhengbiao;XU Benhua;WEN Jiexian(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Institute of Ultrasound Medicine and Engineering,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院超声科,上海200032 [2]复旦大学超声医学与工程研究所,上海200032 [3]上海市影像医学研究所,上海200032

出　　处：《肿瘤影像学》2022年第1期50-56,共7页Oncoradiology

基　　金：上海市自然科学基金(19ZR1450700,20ZR1452800,22ZR1400100);上海市临床重点专科项目经费资(shslczdzk03501);上海申康中心三年行动计划重大临床研究项目(SHDC2020CR1031B)。

摘　　要：目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)在前纵隔神经内分泌肿瘤(neuroendocrine tumor,NET)穿刺活检中的应用价值。方法:对157例前纵隔占位性病变患者行CEUS并选择增强区域超声引导下穿刺活检,选取穿刺病理学诊断为NET的患者13例(类癌2例,不典型类癌5例,小细胞NET 6例),总结其特征并评估安全性。结果:肿块均位于前上纵隔,平均最大径为(82.2±29.8)mm,平均穿刺(2.08±0.49)条。病灶呈低回声11例,高回声1例,中等回声1例;含囊性成分3例;含点状钙化3例;均紧贴纵隔大血管。CEUS病灶呈整体增强9例,向心性增强4例,达峰时呈不均匀增强6例。对比常规超声(3/13,23.1%),CEUS显示7例存在片状坏死(53.8%)。CEUS在4例(30.8%)病灶中识别出滋养血管,彩色多普勒超声在1例(7.7%)病灶中识别出滋养血管。2例患者出现轻微胸痛,其余未出现并发症。结论:CEUS在纵隔NET的初步诊断和引导穿刺中具有重要价值,较常规超声更能准确地把握穿刺区及避让滋养血管,显著提高安全性,是影像学评估和引导穿刺活检的重要工具。Objective:To investigate the value of contrast-enhanced ultrasound(CEUS)in the application of anterior mediastinal neuroendocrine tumor(NET)puncture biopsy.Methods:CEUS was performed in 157 patients with anterior mediastinal mass and ultrasound-guided puncture biopsy was performed in selected enhanced areas.A total of 13 patients with pathology of NET(2 carcinoid tumors,5 atypical carcinoid tumors,and 6 small cell NETs)were selected.Results:The masses were all located in the anterosuperior mediastinum,with a mean diameter of(82.2±29.8)mm and a mean puncture of(2.08±0.49)strips.The lesions were hypoechoic in 11 cases,hyperechoic in 1 case,and moderately echogenic in 1 case;contained cystic components in 3 cases;contained calcification in 3 cases;all were in close proximity to the large mediastinal vessels.The CEUS showed overall enhancement in 9 cases,centripetal enhancement in 4 cases,and inhomogeneity at the peak in 6 cases.In contrast to conventional ultrasound(3/13,23.1%),CEUS showed the presence of necrosis in 7 cases(53.8%).CEUS identified trophoblastic vessels in 4 cases(30.8%)of lesions and color Doppler ultrasound in 1 case(7.7%).And 2 patients had mild chest pain and the rest had no complications.Conclusion:CEUS is of great value in the initial diagnosis and guided puncture of NET.It is more accurate than conventional ultrasound in grasping the puncture zone and avoidance of trophoblastic vessels,significantly improving safety,and is an important tool for imaging evaluation and biopsy guidance.

关 键 词：纵隔肿瘤 神经内分泌肿瘤 超声造影 介入超声 

分 类 号：R734.5[医药卫生—肿瘤] R445.1[医药卫生—临床医学]