超声造影在经皮肺穿刺活检肺周围型病变中的临床研究

目的探讨超声造影（CEUS）在经皮肺活检肺周围型病变中的临床价值。方法对38例肺周围型病变行彩色多普勒超声和CEUS检查，观察其彩色多普勒和声学造影特征，并选择肿块内造影不同增强区域，在超声引导下行经皮肺穿刺活检。结果38例肺周围型病变彩色多普勒与CEUS血流分级比较，乏血供组与富血供组Х^2=28．33，P〈0．001，差异具有统计学意义。38例肺周围型病变中，彩色多普勒超声可显示全部病灶内部血流19例，超声造影均能显示病灶内部血流状态。造影剂分布特征均匀增强型9例，不均匀增强型29例（Fisher检验，P=0．005）。经病理证实，29例为恶性病变，其超声造影均表现为病灶局部高增强改变（100％，29／29）。9例为良性病变，其造影模式表现为较多样化，其中2例病灶呈高增强，5例等增强，2例低／无增强。CEUS引导下在高增强区域穿刺能获得恶性病变准确病理诊断，且无严重穿刺并发症发生。结论超声造影可提高周围型肺癌的活检成功率，降低操作风险，是经皮肺穿刺活检重要的辅助方法。

Clinical study on contrast-enhanced ultrasonography in percutaneous lung biopsy of peripheral lung lesions

Objective To explore the clinical value of contrast-enhanced ultrasound （CEUS） in percutaneous lung biopsy of peripheral lung lesions. Methods A total of 38 peripheral lung lesions were included in the study. All the lesions were checked by color Doppler ultrasound and CEUS. All lesions were having the uhrasound-guided percutaneous lung biopsy in different contrast enhanced areas on the basis of CEUS. Reeults Comparing blood flow grades of 38 peripheral lung lesions with contrast-enhanced ultrasonography. There was statistically significant difference between less blood supply group and rich blood supply group,Х^2 =28.33 ,P 〈0. 001. The perfusion of all 38 lesions can be observed by CEUS, while only 19 of 38 lesions can be detected by color Doppler ultrasound. A total 9 cases of contrast agent distribution were homogeneous enhancement, 29 cases were nonhomegeneous enhancement （ Fisher test, P = 0. 005）. Pathology confirmed 29 cases of malignant lesions and 9 cases of benign lesions. 29 malignant lesions （ 100%, 29 of 29） had a definite local high-enhanced pattern on CEUS. Two benign lesions had high-enhanced pattern, five benign lesions had equal-enhanced pattern and two benign lesions had low/none-enhanced pattern on CEUS. CEUS-guided puncture in the high enhanced-areas access to accurate pathological diagnosis. There was no severe complications after biopsy. Conclusions CEUS can provide more information about the extent and the perfusion of pulmonary peripheral lesions, which can improve biopsy accuracy and reduce operational risk effectively. It is great benefited in percutaneous lung biopsy of peripheral pulmonanry lesions.