超声对肺外周及胸膜转移癌的早期诊断

目的 探讨超声对肺外周及胸膜≤2cm转移癌的诊断价值及声像图特征。方法 对中晚期肺、乳腺及消化系等恶性肿瘤患者行肋间及肋缘下肺底扫查,观察肺外周及胸膜下≤2cm小转移癌声像图特征及诊断率。结果 经确诊小转移癌61例中,超声显示56例（91.8%）,其中约半现灶≤1cm。声像图表现多呈类圆形（83.9%）,边界清晰规整（73.2%）,内部呈均匀的弱回声或无回声（78.6%）,局部胸膜不清晰或中断（75％),后方显示典型的长“彗星尾征”（89.3%）。根据以上特征,25例（44.6%）在未知X线、CT、临床诊断结果情况下超声作出诊断,其中6例为超声首诊。超声对检出的病灶定性诊断较X线、CT敏感,但易漏诊,肩胛骨、肋骨、肺气体等为主要影响因素。结论 对于肺周及胸膜下的转移癌,超声检查不受肺气体干扰,显示率较高,声像图典型,尤其后方长“彗星尾征”为敏感的超声指征。超声作为X线、CT的辅助诊断手段,有助于提高肺周转移癌的早期诊断率。

Value of ultrasonography in detecting early stage peripheral pulmonary metastasis

Objective To investigate the diagnostic value of ultrasonography in detecting early stage peripheral pulmonary and visceral pleural metastasis lesions which smaller than 2 cm,and summary the ultrasonic features.Methods Ultrasound scanning was performed through intracostal or acoustic window of liver or spleen to the patients with malignant tumor from lung,breast and digestive tract,etc.The ultrasonic features of peripheral pulmonary and visceral pleural metastasis were observed.Results Ultrasonography demonstrated 56 cases ( 91.8% ) in the 61 cases confirmed.Ultrasonogram usually showed oval ( 83.9% ),clear edge ( 73.2% ),homogeneous hypoechoic or anechoic patterns ( 78.6% ),interruption of local pleura (75%),long "comet tail artifact" was seen in 50 of the 56 patients ( 89.3% ).Based on these features,25 cases of metastasis were founded by ultrasound examination without knowing the results of X ray,CT and clinical diagnosis.Six cases of peripheral pulmonary metastasis had been firstly detected by ultrasound.Ultrasonography was more sensitive for determining the nature of lesions than X ray and CT.However,ultrasound application was still limited in detecting lesions of lung.Obstruction of scapula,lib and aerated pulmonary was the main reason.Conclusions The detection rate of ultrasound examination is high and figure features is typical for metastasis lesions in peripheral pulmonary or pleural,especially the long"comet tail artifact" is shown.So being complementary examination for X ray and CT,ultrasonography is helpful in detecting early stage peripheral pulmonary metastasis.