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  • 张怡,毕珂,汤春红,施洪,沈梦君,王茵.超声造影在胸膜下肺结核与肺癌鉴别诊断中的价值[J].第二军医大学学报,2018,39(10):1071-1076    [点击复制]
  • ZHANG Yi,BI Ke,TANG Chun-hong,SHI Hong,SHEN Meng-jun,WANG Yin.Value of contrast-enhanced ultrasound in differential diagnosis of pleural-based pulmonary tuberculosis and lung cancer[J].Acad J Sec Mil Med Univ,2018,39(10):1071-1076   [点击复制]
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超声造影在胸膜下肺结核与肺癌鉴别诊断中的价值
张怡1△,毕珂2△,汤春红1,施洪3,沈梦君1,王茵1*
0
(1. 同济大学附属上海市肺科医院超声科, 上海 200433;
2. 同济大学医学院, 上海 200092;
3. 海军军医大学(第二军医大学)长海医院超声科, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 对比分析胸膜下肺结核与肺癌病灶的超声造影表现特征,为二者的影像学鉴别提供依据。方法 回顾性分析2017年6月至2018年2月我院收治的病理证实为肺结核与肺癌的患者各42例,选择每例患者最大病灶的常规超声及超声造影图像进行分析。归纳总结并分析两组病灶的超声造影始增时间、增强模式、增强强度、增强均匀程度、坏死区表现、增强消退速度等特征。结果 肺结核与肺癌病灶的增强模式均以从外周向中心增强为主,但肺结核组呈规则树枝状血管样增强的病灶多于肺癌组[10例vs 1例,χ2=8.473,P=0.004]。肺结核病灶多为低增强(17例vs 6例,χ2=7.244,P=0.007),肺癌病灶多为高增强(25例vs 6例,χ2=18.456,P<0.001)。与肺癌组相比,肺结核组病灶坏死区多表现为筛孔样(13例vs 0例,χ2=15.380,P<0.001)或形态规则的大片状坏死(11例vs 2例,χ2=7.372,P=0.007);肺癌病灶坏死区形态多不规则,与肺结核组相比差异有统计学意义(16例vs 2例,χ2=13.859,P<0.001)。肺结核病灶始增时间<10 s者多于肺癌(21例vs 9例,χ2=7.467,P=0.006),与正常肺组织的造影始增时间差<2.5 s者多于肺癌(40例vs 3例,χ2=65.227,P<0.001)。结论 肺结核与肺癌病灶的超声造影在始增时间差、增强强度和坏死区表现等方面差异显著,能为二者的临床鉴别诊断提供依据。
关键词:  超声造影检查  肺结核  肺肿瘤  始增时间
DOI:10.16781/j.0258-879x.2018.10.1071
投稿时间:2018-07-06修订日期:2018-09-18
基金项目:上海市科学技术委员会2018年度医学引导类(中、西医)科技支撑项目(18411966700).
Value of contrast-enhanced ultrasound in differential diagnosis of pleural-based pulmonary tuberculosis and lung cancer
ZHANG Yi1△,BI Ke2△,TANG Chun-hong1,SHI Hong3,SHEN Meng-jun1,WANG Yin1*
(1. Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
2. Tongji University School of Medicine, Shanghai 200092, China;
3. Department of Ultrasound, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To compare and analyze the performances of contrast-enhanced ultrasonography in the diagnosis of pleural-based pulmonary tuberculosis and lung cancer lesions, so as to provide basis for imaging identification. Methods A total of 42 patients with pathologically confirmed pleural-based pulmonary tuberculosis and 42 patients with pleural-based lung cancer admitted to Shanghai Pulmonary Hospital from Jun. 2017 to Feb. 2018 were retrospectively enrolled, and the images of conventional ultrasound and contrast-enhanced ultrasound of the largest lesions in each patient were analyzed. The arrival time, enhancement pattern, enhancement intensity, uniformity, images of necrosis, clearance speed and other characteristics by contrast-enhanced ultrasound were analyzed in the two groups. Results The enhancement patterns of pulmonary tuberculosis and lung cancer were both mainly enhanced from the periphery to the center, but the number of lesions with regular dendritic vascular enhancement in the pulmonary tuberculosis group was significantly more than that in the lung cancer group (10 vs 1; χ2=8.473, P=0.004). Low enhancement was more common in pulmonary tuberculosis lesions (17 vs 6; χ2=7.244, P=0.007), and high enhancement was more common in lung cancer lesions (25 vs 6; χ2=18.456, P<0.001). Compared with the lung cancer group, the necrotic areas in the pulmonary tuberculosis group mostly showed a mesh-like appearance (13 vs 0; χ2=15.380, P<0.001) or regular large patchy necrosis (11 vs 2; χ2=7.372, P=0.007). The necrotic areas in the lung cancer group were more irregular compared with the pulmonary tuberculosis group (16 vs 2; χ2=13.859, P<0.001). The proportion of patients with arrival time<10 s in the pulmonary tuberculosis group was significantly higher than that in the lung cancer group (21 vs 9; χ2=7.467, P=0.006), and the proportion of patients with the arrival time difference<2.5 s compared with normal lung tissue in the pulmonary tuberculosis group was significantly higher than that in the lung cancer group (42 vs 3; χ2=65.227, P<0.001). Conclusion The arrival time difference, enhancement intensity and images of necrosis by contrast-enhanced ultrasound in the pulmonary tuberculosis and lung cancer are significantly different, which can provide evidence for the differential diagnosis of pulmonary tuberculosis and lung cancer.
Key words:  contrast-enhanced ultrasound  pulmonary tuberculosis  lung neoplasms  initial enhanced time