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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (01) : 84 -89. doi: 10.3877/cma.j.issn.1672-6448.2023.01.014

胸部超声影像学

超声造影定量参数联合对肺周围型病变良恶性的诊断价值
王瑞1, 王金萍1,(), 陈炜2, 李保启1   
  1. 1. 230031 合肥,安徽中医药大学第一附属医院超声医学科
    2. 230031 合肥,安徽中医药大学第一附属医院呼吸内科
  • 收稿日期:2021-07-17 出版日期:2023-01-01
  • 通信作者: 王金萍
  • 基金资助:
    国家青年岐黄学者支持项目、国家自然科学基金青年科学基金项目(81704060); 安徽中医药大学2020年度科学研究项目(2020yfyzc49)

Value of combined quantitative parameters of contrast-enhanced ultrasound in diagnosis of benign and malignant peripheral pulmonary lesions

Rui Wang1, Jinping Wang1,(), Wei Chen2, Baoqi Li1   

  1. 1. Department of Ultrasound, First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei 230031, China
    2. Department of Respiratory Medicine, First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei 230031, China
  • Received:2021-07-17 Published:2023-01-01
  • Corresponding author: Jinping Wang
引用本文:

王瑞, 王金萍, 陈炜, 李保启. 超声造影定量参数联合对肺周围型病变良恶性的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2023, 20(01): 84-89.

Rui Wang, Jinping Wang, Wei Chen, Baoqi Li. Value of combined quantitative parameters of contrast-enhanced ultrasound in diagnosis of benign and malignant peripheral pulmonary lesions[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(01): 84-89.

目的

探索超声造影定量参数联合运用在肺周围型病变良恶性鉴别中的价值。

方法

选取2018年8月至2021年10月在安徽中医药大学第一附属医院可被超声探查的61例肺周围型病变患者,先行常规二维超声检查,记录病灶最长径线及内部回声情况。再行超声造影检查,获取病灶达峰时增强模式及造影定量参数。按照病理结果分为良性组(24例)和恶性组(37例)。先应用单因素分析对比2组间性别、年龄、病灶最长径线、二维超声(病灶内部回声)、超声造影增强模式及超声造影定量参数的差异,再将单因素分析中差异有统计学意义的各因素纳入二元Logistic回归模型进行分析并计算回归方程式,最后绘制预测肺周围型病变良恶性的受试者操作特征(ROC)曲线检验其诊断效能。

结果

单因素分析:2组患者性别、年龄、病灶最长径线、二维超声及超声造影增强模式方面比较,差异均无统计学意义(P均>0.05);超声造影定量参数:与良性组比较,恶性组病灶初始增强时间增多[AT2:(13.78±2.30)s vs(11.17±1.79)s]、病灶与周围肺组织初始增强时间差大[TAT:(4.51±1.63)s vs(2.04±1.09)s]以及上升斜率大[(3.06±0.55)vs(2.77±0.40)],差异均具有统计学意义(t=4.724、6.118、2.151,P<0.001、<0.001、=0.036),周围肺组织初始增强时间、达峰时间以及下降斜率比较,差异均无统计学意义(P均>0.05)。Logistic回归模型显示,AT2、TAT与肺周围型病变的良恶性密切相关,Logit(P)=-12.224+0.542

XAT2
+1.005
XTAT
。绘制单因素AT2、TAT以及二者联合预测模型的ROC曲线,曲线下面积分别为0.825、0.880、0.919,其95%CI分别为0.719~0.931、0.782~0.978、0.848~0.990,其中多因素联合预测模型的曲线下面积最大。

结论

超声造影定量参数中AT2和TAT在肺周围型病变良恶性的鉴别方面具有一定的应用价值,二者联合应用诊断效能更高。

Objective

To assess the value of combined quantitative parameters of contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant peripheral pulmonary lesions.

Methods

A total of 61 patients with peripheral pulmonary lesions that could be assessed by ultrasound from August 2018 to October 2021 were selected at the First Affiliated Hospital of Anhui University of Chinese Medicine. The longest diameter and internal echo of the lesions were recorded via conventional two-dimensional ultrasound examination. CEUS was used to obtain the contrast-enhanced pattern and quantitative parameters of the lesions at peak. According to pathological results, the patients were divided into two groups: benign group (n=24) and malignant group (n=37). Univariate analysis was conducted to compare the differences between the two groups in terms of gender, age, the longest diameter of the lesion, two-dimensional ultrasound results (lesion internal echo), contrast-enhanced pattern, and CEUS quantitative parameters. The parameters with statistical significance in the univariate analysis were incorporated into the binary logistic regression model for analysis, and the regression equation was calculated. Receiver operating characteristic (ROC) curve analysis was performed to test diagnostic efficiency.

Results

Univariate analysis demonstrated that gender, age, the longest diameter of the lesion, two-dimensional ultrasound results (lesion internal echo), and contrast-enhanced pattern had no statistical difference (P>0.05), while CEUS quantitative parameters including contrast agent arrival time [AT2: (11.17±1.79) s vs (13.78±2.30) s], the difference of arrival time between the lesion and the surrounding lung tissue [TAT: (2.04±1.09) s vs (4.51±1.63) s],and rising slope [(2.77±0.40) vs (3.06±0.55)] (t=4.724, 6.118, and 2.151; P<0.001, <0.001, and=0.036, respectively) had significant differences between benign group and malignant group, though there were no statistically significant differences in the arrival time of peripheral lung tissue, time to peak, or descending slope (P>0.05). Logistic regression analysis showed that AT2 and TAT were closely related with whether the lesions are benign or malignant. The regression equation is Logit(P) =-12.224+0.542

XAT2
+1.005
XTAT
. ROC curves of AT2 and TAT alone or in combination were drawn. The areas under the ROC curves were 0.825 (95%CI: 0.719-0.931), 0.880 (95%CI: 0.782-0.978), 0.919 (95%CI: 0.848-0.990), respectively. The combined prediction model had the largest area under the curve.

Conclusion

The two CEUS quantitative parameters, AT2 and TAT, are of significant value in the diagnosis of benign and malignant peripheral pulmonary lesion, and their combination proves more effective.

表1 肺周围型病变患者二维超声、超声造影图像情况比较
图1 浸润性肺腺癌(低分化)超声造影表现。图a:对比剂注入2 s,病灶及周围肺组织未见对比剂进入;图b:对比剂注入9 s,周围肺组织见对比剂进入(箭头所示);图c:对比剂注入14 s,病灶内见对比剂进入(箭头所示);图d:病灶时间-强度曲线,造影剂于14 s开始增强
图2 肺孤立性纤维瘤超声造影表现。图a:对比剂注入2 s,病灶及周围肺组织未见对比剂进入;图b:对比剂注入8 s,周围肺组织见对比剂进入(箭头所示);图c:对比剂注入9 s,病灶内见对比剂进入(箭头所示);图d:病灶时间-强度曲线,造影剂于9 s开始增强
表2 肺周围型病变患者超声定量参数分析(
xˉ
±s
表3 肺周围型病变超声造影参数Logistic回归分析结果
图3 Logistic回归模型预测肺周围型病变良恶性的受试者操作特征曲线
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