超声造影在肺外周良恶性肿块鉴别诊断中的应用

Application of contrast-enhanced ultrasound to differentiation of benign and malignant pulmonary peripheral masses

摘要:

目的  探讨超声造影技术（CEUS）在肺外周良、恶性肿块临床鉴别的意义及临床应用价值。方法  收集该院因肺部肿块住院患者，按增强CT扫描结果，选取肺外周肿块患者45例，行常规超声和CEUS检查，并以病理活检结果为金标准，评价CEUS在肺外周良、恶性肿块鉴别诊断中的临床价值。结果  良性肿块造影剂开始增强时间为（8.48±1.45）s；恶性肿块开始增强时间为（10.89±2.70）s；恶性肿块开始增强时间慢于良性肿块（P <0.05）。造影剂开始廓清时间恶性肿块为（100.63±13.63）s，良性肿块廓清时间为（137.57±12.61）s，造影剂消退时间慢于恶性肿块（P <0.05）。增强CT与CEUS诊断正确率分别为73.3%和77.8%，两者相结合诊断正确率为93.3%。增强CT联合CEUS诊断符合率显著高于单纯增强CT或CEUS诊断符合率（P <0.05）。增强CT联合CEUS诊断敏感性为95%，特异性为92%，经Kappa检验评估增强CT联合CEUS诊断肺外周肿块，具有极好的一致性。结论  超声造影对肺部良、恶性肿块的临床鉴别有重要作用，联合增强CT扫描可以更高地提高诊断正确率。

Abstract:

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant peripheral lung tumor lesions. Methods According to the result of enhanced CT scans, 45 patients with peripheral lung tumor and pleural adhesion of the lungs were collected. Conventional ultrasound scanning, CEUS and pathological biopsy were used. Pathological biopsy results were gold standard to evaluate the clinical value of CEUS in the differential diagnosis of benign and malignant peripheral lung tumors. Results The enhancement time of the benign masses [(8.48 ± 1.45) s] was significantly shorter than that of the malignant tumors [(10.89 ± 2.70) s, P < 0.05]. The clearance time of the malignant tumors [(100.63 ± 13.63) s] was significantly shorter than that of benign masses [(137.57 ± 12.61) s, P < 0.05]. The diagnostic accuracy of enhanced CT and CEUS was 73.3% and 77.8% respectively; when used in combination, the diagnostic accuracy was 93.3% in differential diagnosis of benign and malignant peripheral lung tumor lesions. The diagnostic accuracy rate of CT combined with CEUS was obviously higher than that of CT or CEUS alone (P < 0.05). When pathological biopsy was taken as the gold standard, the diagnostic sensitivity of enhanced CT combined with CEUS was 95% and the specificity was 92%, Kappa test indicated an excellent consistency. Conclusions CEUS is important in the clinical differential diagnosis of benign and malignant lung tumors. CEUS combined with enhanced CT scan can improve the diagnostic accuracy.