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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (08) : 754 -760. doi: 10.3877/cma.j.issn.1672-6448.2022.08.005

浅表器官超声影像学

常规超声及超声造影鉴别诊断局灶性机化性肺炎与非特异性肺炎的初步研究
付颖1, 崔立刚1,(), 杜婷婷1, 谭石1, 王淑敏1, 孙彦1, 马久祎1   
  1. 1. 100191 北京大学第三医院超声科
  • 收稿日期:2022-05-18 出版日期:2022-08-01
  • 通信作者: 崔立刚

Differential diagnosis of focal organizing pneumonia and subpleural focal chronic nonspecific inflammation by conventional ultrasound and contrast-enhanced ultrasound: a preliminary study

Ying Fu1, Ligang Cui1,(), Tingting Du1, Shi Tan1, Shumin Wang1, Yan Sun1, Jiuyi Ma1   

  1. 1. Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-05-18 Published:2022-08-01
  • Corresponding author: Ligang Cui
引用本文:

付颖, 崔立刚, 杜婷婷, 谭石, 王淑敏, 孙彦, 马久祎. 常规超声及超声造影鉴别诊断局灶性机化性肺炎与非特异性肺炎的初步研究[J/OL]. 中华医学超声杂志(电子版), 2022, 19(08): 754-760.

Ying Fu, Ligang Cui, Tingting Du, Shi Tan, Shumin Wang, Yan Sun, Jiuyi Ma. Differential diagnosis of focal organizing pneumonia and subpleural focal chronic nonspecific inflammation by conventional ultrasound and contrast-enhanced ultrasound: a preliminary study[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(08): 754-760.

目的

探讨局灶性机化性肺炎(FOP)的常规超声及超声造影特征,并与局灶性慢性非特异性肺炎进行对比,以期为二者鉴别诊断提供依据。

方法

回顾性收集2017年1月至2022年4月于北京大学第三医院确诊并在超声科行常规超声及超声造影检查的胸膜下FOP患者24例(FOP组),选取同期确诊的40例局灶性慢性非特异性肺炎患者(非特异性肺炎组)为对照组。对2组患者的常规超声特征以及造影剂到达病灶时间、造影增强时相、造影增强模式、病变内造影剂增强程度、增强均匀程度、有无未增强区等超声造影特征进行比较分析。

结果

常规二维超声图像上FOP组出现空气支气管征的比例(62.5%,15/24)高于非特异性肺炎组(35%,14/40),二者比较差异有统计学意义(P=0.032)。相较于非特异性肺炎组,FOP以均匀增强为主(20/24,83.3%),而非特异性肺炎中55%为不均匀增强(22/40),二者比较差异有统计学意义(P=0.003)。FOP组仅2例(2/24,8.3%)出现造影无灌注区,与非特异性肺炎组(15/40,37.5%)比较,差异有统计学意义(P=0.011)。

结论

FOP更常见空气支气管征,超声造影常表现为动脉期均匀增强、较少出现灌注缺损区。这些特征有助于FOP与慢性非特异性肺炎的鉴别诊断。

Objective

To compare the gray-scale and contrast-enhanced ultrasound features between focal organizing pneumonia (FOP) and subpleural focal chronic nonspecific inflammation.

Methods

Twenty-four patients with FOP and 40 patients with focal chronic nonspecific inflammation pathologically diagnosed at Peking University Third Hospital from January 2017 to April 2022 were analyzed retrospectively. The conventional ultrasonic features of the two groups, as well as the arrival time of contrast agent, the phase of enhancement, the enhance mode, the degree of enhancement, the degree of uniformity of enhancement, and the presence or absence of non-enhanced areas were compared between the two groups.

Results

On ultrasound images, the proportion of patients with air bronchogram sign (62.5%, 15/24) was significantly higher in the FOP group than in the focal chronic nonspecific inflammation group (14/40, 35%, P=0.032). The results of contrast-enhanced ultrasound showed that the two groups were supplied by the pulmonary artery. Compared with the focal chronic nonspecific inflammation group, FOP was mainly uniformly enhanced (20/24, 83.3%), while 55% of cases in the focal chronic nonspecific inflammation group was unevenly enhanced (22/40, 55.0%); the difference between the two groups was statistically different (P=0.003). Non-enhanced areas within the lesions were more common in the chronic nonspecific inflammation group (15/40, 37.5% vs 2/24, 8.3%, P=0.011).

Conclusion

FOP is more common with air bronchogram sign. Contrast-enhanced ultrasound shows homogeneous and diffuse enhancement, and few perfusion defects. These features may be helpful to the differential diagnosis of FOP and focal chronic nonspecific inflammation.

表1 局灶性机化性肺炎组与非特异性肺炎组二维及彩色多普勒超声特征比较[例(%)]
表2 局灶性机化性肺炎组与非特异性肺炎组超声造影特征比较[例(%)]
图1 局灶性机化性肺炎患者常规超声及超声造影图像。图a为常规二维超声显示胸膜下一楔形低回声病变(箭头所示),大小约5.5 cm×2.4 cm,边界清晰,内部可见空气支气管征;图b示彩色多普勒超声可见血流信号,为单相动脉频谱;图c为超声造影显示病变4 s开始增强,为自基底部向外周的树枝样强化;图d为超声造影显示增强达峰时病变呈均匀增强,未见无灌注区(箭头所示)
图2 肺部非特异性炎症患者常规超声及超声造影图像。图a为常规二维超声示左肺胸膜下病变(箭头所示),大小约4.5 cm×3.0 cm,类圆形病变,未见明显空气支气管征;图b为彩色多普勒超声可探及低阻单相动脉频谱;图c为超声造影示造影剂增强时相为肺动脉相,增强方式为周边向中心增强(箭头所示);图d为超声造影示增强达峰时为不均匀增强(箭头所示),内部可见造影剂无灌注区(病变中部)
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