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Jiménez-Serrano S, Páez-Carpio A, Doménech-Ximenos B, Cornellas L, Sánchez M, Revzin MV, Vollmer I. Conventional and Contrast-enhanced US of the Lung: From Performance to Diagnosis. Radiographics 2024; 44:e230171. [PMID: 38935548 DOI: 10.1148/rg.230171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
In recent years, lung US has evolved from a marginal tool to an integral component of diagnostic chest imaging. Contrast-enhanced US (CEUS) can improve routine gray-scale imaging of the lung and chest, particularly in diagnosis of peripheral lung diseases (PLDs). Although an underused tool in many centers, and despite inherent limitations in evaluation of central lung disease caused by high acoustic impedance between air and soft tissues, lung CEUS has emerged as a valuable tool in diagnosis of PLDs. Owing to the dual arterial supply to the lungs via pulmonary and bronchial (systemic) arteries, different enhancement patterns can be observed at lung CEUS, thereby enabling accurate differential diagnoses in various PLDs. Lung CEUS also assists in identifying patients who may benefit from complementary diagnostic tests, including image-guided percutaneous biopsy. Moreover, lung CEUS-guided percutaneous biopsy has shown feasibility in accessible subpleural lesions, enabling higher histopathologic performance without significantly increasing either imaging time or expenses compared with conventional US. The authors discuss the technique of and basic normal and pathologic findings at conventional lung US, followed by a more detailed discussion of lung CEUS applications, emphasizing specific aspects of pulmonary physiology, basic concepts in lung US enhancement, and the most commonly encountered enhancement patterns of different PLDs. Finally, they discuss the benefits of lung CEUS in planning and guidance of US-guided lung biopsy. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Sergio Jiménez-Serrano
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Alfredo Páez-Carpio
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Blanca Doménech-Ximenos
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Lluria Cornellas
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Marcelo Sánchez
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Margarita V Revzin
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Ivan Vollmer
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
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Wang XY, Yuan ZF, Gan KH, Zhong Y, Huang JX, Huang WJ, Xie YH, Pei XQ. Contrast-enhanced Imaging in Peripheral Pulmonary Lesions: The Role in US-guided Biopsies. Radiol Cardiothorac Imaging 2024; 6:e230234. [PMID: 38695742 PMCID: PMC11211938 DOI: 10.1148/ryct.230234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/07/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
Purpose To compare the tissue adequacy and diagnostic accuracy of US-guided biopsies of peripheral pulmonary lesions (PPLs) with and without contrast agents. Materials and Methods A retrospective study was conducted at four medical centers in patients with PPLs who underwent US-guided percutaneous transthoracic needle biopsy (PTNB) between January 2017 and October 2022. The patients were divided into contrast-enhanced US (CEUS) and US groups based on whether prebiopsy CEUS evaluation was performed. Tissue adequacy and the diagnostic accuracy of PTNB, stratified by lesion size, were analyzed and compared between groups. A propensity score matching (PSM) analysis was conducted using the nearest-neighbor matching method. Results A total of 1027 lesions were analyzed, with 634 patients (mean age, 59.4 years ± 13.0 [SD]; 413 male) in the US group and 393 patients (mean age, 61.2 years ± 12.5; 270 male) in the CEUS group. The CEUS group produced more acceptable samples than the US group (98.2% vs 95.7%; P = .03) and achieved higher diagnostic accuracy (96.9% vs 94.2%; P = .04), with no evidence of a difference in sensitivity (96.7% vs 94.0%; P = .06). PSM and stratified analyses (n = 358 per group) indicated higher tissue adequacy (99.0% vs 95.7%; P = .04) and diagnostic accuracy (98.5% vs 92.9%; P = .006) in the CEUS group compared with the US group for 2-7-cm PPLs but not for lesions larger than 7 cm. Conclusion PTNB with prebiopsy CEUS evaluation demonstrated significantly better tissue adequacy and diagnostic accuracy compared with US guidance alone for PPLs ranging from 2 to 7 cm, with similar biopsy performance achieved between groups for lesions larger than 7 cm. Keywords: Contrast Material, Thoracic Diseases, Ultrasonography, Image-Guided Biopsy © RSNA, 2024.
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Affiliation(s)
| | | | - Ke-Hong Gan
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Yuan Zhong
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Jia-Xin Huang
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Wei-Jun Huang
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Yu-Huan Xie
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Xiao-Qing Pei
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
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Panou V, Bhatnagar R, Rahman N, Christensen TD, Pietersen PI, Arshad A, Laursen CB. Advances in the diagnosis and follow-up of pleural lesions: a scoping review. Expert Rev Respir Med 2024; 18:423-434. [PMID: 38995221 DOI: 10.1080/17476348.2024.2375421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Pleural lesions may have heterogeneous presentation and causes. In recent years, there have been significant advances in pleural lesions diagnostics. The aim of this review is to provide an overview of the state-of-the-art, and recent updates for diagnostic modalities and monitoring regimes for pleural lesions. AREAS COVERED A literature search was conducted through PubMed and Web of Science for relevant articles published from 1 January 2000- 1 March 2023. This article critically appraises the radiological modalities and biopsy techniques that are employed in pleural lesions diagnostics, including chest radiography, thoracic ultrasound, computed tomography, F-fluorodeoxyglycose positron emission tomography, magnetic resonance imaging, percutaneous, and thoracoscopic pleural biopsies with reference to their strengths, limitations, and clinical use. The review asserts also the available literature regarding monitoring algorithms. EXPERT OPINION Despite the recent advances in the field, there are several key areas for improvement, including the development and validation of minimal invasive methods and tools for risk stratification, the integration of multi-omics technologies, the implementation of standardized, evidence-based diagnostic and monitoring guidelines and increased focus on research and patient-centric approaches. The broad establishment of dedicated pleural clinics may significantly assist toward this direction.
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Affiliation(s)
- Vasiliki Panou
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Respiratory Medicine Department, North Bristol National Health Service Trust, Southmead Hospital, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Pleural Unit, Churchill Hospital, Oxford, UK
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery & Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Arman Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bai J, Du YQ, Yang W, Bai XM, Wang S, Wu W, Yan K, Chen MH. The Role of Contrast-Enhanced Ultrasound Plus Color Parametric Imaging in the Differential Diagnosis of Subpleural Pulmonary Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2777-2789. [PMID: 37594990 DOI: 10.1002/jum.16316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To distinguish benign and malignant subpleural pulmonary lesions (SPLs) with contrast-enhanced ultrasound (CEUS) and color parametric imaging (CPI), and evaluate the role of CEUS plus CPI in the differential diagnosis of pathological types of SPLs. METHODS One hundred and thirty-six patients underwent CEUS with a Logiq E9 XD Clear ultrasonic machine equipped with a 3.5- to 5.0-MHz C5-1 transducer in our center were enrolled in our study, including 27 cases of benign lesions and 109 cases of malignant lesions. The ultrasound contrast agent used in this study was SonoVue. CEUS images and CPI of all cases were reviewed and analyzed by the resident and staff radiologist groups separately. RESULTS With CEUS alone, by both the two groups, the main enhancement pattern of benign SPLs was arborization (P < .001), while centripetal enhancement pattern occurred more frequently in malignant SPLs (P < .001). With CEUS plus CPI, by both the two groups, the main enhancement pattern of benign SPLs was arborization (P < .001), while those of malignant SPLs were centripetal (P < .001) and eccentric (P < .05). The diagnosis performance of CEUS plus CPI was significantly higher than that of CEUS alone in both the resident (area under the curve [AUC] = 0.857 vs 0.677, P < .001) and staff (AUC = 0.866 vs 0.681, P < .001) groups. Moreover, CPI offered remarkable inter-consistency improvements in the enhancement pattern determination between the two groups. CONCLUSION The CEUS enhancement patterns would provide information of blood perfusion patterns in the differential diagnosis of benign and malignant SPLs. The diagnosis performance could be significantly improved by CEUS plus CPI compared with CEUS alone.
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Affiliation(s)
- Jing Bai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yu-Qing Du
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiu-Mei Bai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Min-Hua Chen
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Contrast-Enhanced Ultrasound in Distinguishing between Malignant and Benign Peripheral Pulmonary Consolidations: The Debated Utility of the Contrast Enhancement Arrival Time. Diagnostics (Basel) 2023; 13:diagnostics13040666. [PMID: 36832153 PMCID: PMC9955590 DOI: 10.3390/diagnostics13040666] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Background. Limited studies and observations conducted on a too small number of patients prevent determining the actual clinical utility of pulmonary contrast-enhanced ultrasound (CEUS). The aim of the present study was to examine the efficacy of contrast enhancement (CE) arrival time (AT) and other dynamic CEUS findings for differentiating between malignant and benign peripheral lung lesions. Methods. 317 inpatients and outpatients (215 men, 102 women; mean age: 52 years) with peripheral pulmonary lesions were included in the study and underwent pulmonary CEUS. Patients were examined in a sitting position after receiving an intravenous injection of 4.8 mL of sulfur hexafluoride microbubbles stabilized by a phospholipid shell as ultrasound contrast agent (SonoVue-Bracco; Milan, Italy). Each lesion was observed for at least 5 min in real-time and the following temporal characteristics of enhancement were detected: the arrival time (AT) of microbubbles in the target lesion; the enhancement pattern; the wash-out time (WOT) of microbubbles. Results were then compared in light of the definitive diagnosis of community acquired pneumonia (CAP) or malignancies, which was not known at the time of CEUS examination. All malignant cases were diagnosed by histological results, while pneumonia was diagnosed on the basis of clinical and radiological follow-up, laboratory findings and, in some cases, histology. Results. CE AT has not been shown to differ between benign and malignant peripheral pulmonary lesions. The overall diagnostic accuracy and sensibility of a CE AT cut-off value < 10 s in discriminating benign lesions were low (diagnostic accuracy: 47.6%; sensibility: 5.3%). Poor results were also obtained in the sub-analysis of small (mean diameter < 3 cm) and large (mean diameter > 3 cm) lesions. No differences were recorded in the type of CE pattern showed between benign and malignant peripheral pulmonary lesions. In benign lesions we observed a higher frequency of delayed CE wash-out time (WOT) > 300 s. Anyhow, a CE WOT cut-off value > 300 s showed low diagnostic accuracy (53.6%) and sensibility (16.5%) in discriminating between pneumonias and malignancies. Similar results were also obtained in the sub-analysis by lesion size. Squamous cell carcinomas showed a more delayed CE AT compared to other histopathology subtypes. However, such a difference was statistically significant with undifferentiated lung carcinomas. Conclusions. Due to an overlap of CEUS timings and patterns, dynamic CEUS parameters cannot effectively differentiate between benign and malignant peripheral pulmonary lesions. Chest CT remains the gold standard for lesion characterization and the eventual identification of other pneumonic non-subpleural localizations. Furthermore, in the case of malignancy, a chest CT is always needed for staging purposes.
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Ye F, Yang Y, Liu J. Comparison of High-Frequency Contrast-Enhanced Ultrasound With Conventional High-Frequency Ultrasound in Guiding Pleural Lesion Biopsy. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1420-1428. [PMID: 35504789 DOI: 10.1016/j.ultrasmedbio.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
The goal of the work described here was to compare high-frequency contrast-enhanced ultrasound (HF-CEUS) and conventional high-frequency ultrasound (HFU) with respect to performance and safety during ultrasound-guided biopsy of pleural lesions. We performed a retrospective study on patients with pleural lesions who received the puncture biopsy under the guidance of conventional HFU or HF-CEUS between August 2018 and August 2021. These patients received either a conventional HF-U (HF-U group) or HF-CEUS (HF-CEUS group) examination. Clinical characteristics, pathological results, ultrasonic images and complications were compared between these two groups. A total of 144 patients were enrolled, with 70 in the HFU group and 74 in the HF-ECUS group. Except for the time required for ultrasonic localization (p < 0.05), there were no significant differences in clinical characteristics between the two groups. The success rate of biopsy in the HF-CEUS group was higher than that in the HFU group (93.2% vs. 81.4%, p < 0.05). There were significant differences between the two groups in terms of measurements of pleural thickness, necrotic areas, large blood vessels and lesion boundaries (p < 0.05). The complication rates were 2.7% and 12.9% in the HF-CEUS and HFU groups, respectively, with a significant difference (p < 0.05). Compared with conventional HFU, the HF-CEUS-guided pleural biopsy had a better success rate and fewer complications. HF-CEUS could facilitate the biopsy in patients with pleural lesions.
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Affiliation(s)
- Fuyong Ye
- First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Medical Ultrasound, Gaozhou People's Hospital, Gaozhou, Guangdong, China
| | - Yuwen Yang
- First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Medical Ultrasound, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jianhua Liu
- First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Medical Ultrasound, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
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Walter U. Ultrasound-guided medical procedures: a growing field with new opportunities. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:327-331. [PMID: 35961295 DOI: 10.1055/a-1856-8797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Quarato CMI, Venuti M, Sperandeo M. Letter to the Editor on the Article: "Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review" by Jacobsen N et al. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:306-307. [PMID: 32736399 DOI: 10.1055/a-1219-7606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Italy
| | - Mariapia Venuti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Italy
| | - Marco Sperandeo
- Department of Internal Medicine, Diagnostic and Interventional Ultrasound Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
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Safai Zadeh E, Westhoff CC, Keber CU, Trenker C, Dietrich CF, Alhyari A, Mohr CGL, Görg C. Perfusion Patterns of Peripheral Organizing Pneumonia (POP) Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns. Diagnostics (Basel) 2021; 11:1601. [PMID: 34573943 PMCID: PMC8468045 DOI: 10.3390/diagnostics11091601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To describe the perfusion patterns of peripheral organizing pneumonia (POP) by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical CD34 endothelial staining. Methods: From October 2006 until December 2020, 38 consecutive patients with histologically confirmed POPs were standardized-examined by CEUS. The time to enhancement (TE; classified as an early pulmonary-arterial [PA] pattern of enhancement vs. delayed bronchial-arterial [BA] pattern of enhancement), the extent of enhancement (EE; classified as marked or reduced), the homogeneity of enhancement (HE; classified as homogeneous or inhomogeneous), and the decrease of enhancement (DE; classified as rapid washout [<120s] or late washout [≥120s]) were evaluated retrospectively. Furthermore, tissue samples from the study patients were immunohistochemically stained with CD34 antibody. The presence of avascular areas (AAs) and the VPs were evaluated in all tissue samples. Results: The majority of POPs showed a BA pattern of enhancement (71.1%), an isoechoic marked enhancement (76.3%), and an inhomogeneous enhancement (81.6%). A rapid DE was observed in 50.0% of cases. On CD34 staining, all POPs had a chaotic VP, indicating BA neoangiogenesis. AAs (abscess, necrosis, hemorrhage) were identified in (41.9%) cases with an inhomogeneous enhancement on CEUS. Conclusion: On CEUS, POPs predominantly revealed a marked inhomogeneous BA pattern of enhancement with a rapid washout in 50% of cases. Furthermore, we demonstrated that the presence of a PA pattern of enhancement, found in 28.9% of POPs, did not exclude a BA neoangiogenesis as an important feature of chronic inflammatory and malignant processes.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (C.G.L.M.)
| | - Christina Carolin Westhoff
- Institute of Pathology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (C.C.W.); (C.U.K.)
| | - Corinna Ulrike Keber
- Institute of Pathology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (C.C.W.); (C.U.K.)
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany;
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany;
| | - Charlotte Gabriele Luise Mohr
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (C.G.L.M.)
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (C.G.L.M.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany;
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10
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Bi K, Xia DM, Fan L, Ye XF, Zhang Y, Shen MJ, Chen HW, Cong Y, Zhu HM, Tang CH, Yuan J, Wang Y. Development and Prospective Validation of an Ultrasound Prediction Model for the Differential Diagnosis of Benign and Malignant Subpleural Pulmonary Lesions: A Large Ambispective Cohort Study. Front Oncol 2021; 11:656060. [PMID: 34026629 PMCID: PMC8132998 DOI: 10.3389/fonc.2021.656060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To develop and prospective validate an ultrasound (US) prediction model to differentiate between benign and malignant subpleural pulmonary lesions (SPLs). METHODS This study was conducted retrospectively from July 2017 to December 2018 (development cohort [DC], n = 592) and prospectively from January to April 2019 (validation cohort [VC], n = 220). A total of 18 parameters of B-mode US and contrast-enhanced US (CEUS) were acquired. Based on the DC, a model was developed using binary logistic regression. Then its discrimination and calibration were verified internally in the DC and externally in the VC, and its diagnostic performance was compared with those of the existing US diagnostic criteria in the two cohorts. The reference criteria were from the comprehensive diagnosis of clinical-radiological-pathological made by two senior respiratory physicians. RESULTS The model was eventually constructed with 6 parameters: the angle between lesion border and thoracic wall, basic intensity, lung-lesion arrival time difference, ratio of arrival time difference, vascular sign, and non-enhancing region type. In both internal and external validation, the model provided excellent discrimination of benign and malignant SPLs (C-statistic: 0.974 and 0.980 respectively), which is higher than that of "lesion-lung AT difference ≥ 2.5 s" (C-statistic: 0.842 and 0.777 respectively, P <0.001) and "AT ≥ 10 s" (C-statistic: 0.688 and 0.641 respectively, P <0.001) and the calibration curves of the model showed good agreement between actual and predictive malignancy probabilities. As for the diagnosis performance, the sensitivity and specificity of the model [sensitivity: 94.82% (DC) and 92.86% (VC); specificity: 92.42% (DC) and 92.59% (VC)] were higher than those of "lesion-lung AT difference ≥ 2.5 s" [sensitivity: 88.11% (DC) and 80.36% (VC); specificity: 80.30% (DC) and 75.00% (VC)] and "AT ≥ 10 s" [sensitivity: 64.94% (DC) and 61.61% (VC); specificity: 72.73% (DC) and 66.67% (VC)]. CONCLUSION The prediction model integrating multiple parameters of B-mode US and CEUS can accurately predict the malignancy probability, so as to effectively differentiate between benign and malignant SPLs, and has better diagnostic performance than the existing US diagnostic criteria. CLINICAL TRIAL REGISTRATION www.chictr.org.cn, identifier ChiCTR1800019828.
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Affiliation(s)
- Ke Bi
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - De-meng Xia
- Department of Emergency, Changhai Hospital, The Naval Medical University, Shanghai, China
- Department of Orthopaedics, The Naval Hospital of Eastern Theater Command of People’s Liberation Army of China (PLA), Zhoushan, China
| | - Lin Fan
- Shanghai Clinic and Research Center of Tuberculosis, Department of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-fei Ye
- Department of Health Statistics, The Naval Medical University, Shanghai, China
| | - Yi Zhang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meng-jun Shen
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong-wei Chen
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Cong
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-ming Zhu
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun-hong Tang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Yuan
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Wang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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11
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Marini TJ, Rubens DJ, Zhao YT, Weis J, O’Connor TP, Novak WH, Kaproth-Joslin KA. Lung Ultrasound: The Essentials. Radiol Cardiothorac Imaging 2021; 3:e200564. [PMID: 33969313 PMCID: PMC8098095 DOI: 10.1148/ryct.2021200564] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/16/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
Although US of the lungs is increasingly used clinically, diagnostic radiologists are not routinely trained in its use and interpretation. Lung US is a highly sensitive and specific modality that aids in the evaluation of the lungs for many different abnormalities, including pneumonia, pleural effusion, pulmonary edema, and pneumothorax. This review provides an overview of lung US to equip the diagnostic radiologist with knowledge needed to interpret this increasingly used modality. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Thomas J. Marini
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Deborah J. Rubens
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Yu T. Zhao
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Justin Weis
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Timothy P. O’Connor
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - William H. Novak
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Katherine A. Kaproth-Joslin
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
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