Characteristic Analysis And Clinical Application Value Of Contrast-enhanced Ultrasound In Peripheral Pulmonary Lesions

ObjectiveThis paper analyzes the characteristics of routine ultrasound and contrast-enhanced ultrasound of peripheral pulmonary lesions,and preliminarily discusses the value of contrast-enhanced ultrasound in the differential diagnosis of benign and malignant pulmonary peripheral lesions,as well as the application value of guiding ultrasound percutaneous puncture biopsy.Methods167 peripheral pulmonary lesions were selected for clinical observation from January 2019 to August 2021.Both enhanced CT examination and contrast-enhanced ultrasound examination were performed.and a puncture biopsy was carry out under that guidance of ultrasound and a valid sample tissue were obtain.According to the pathological results of needle biopsy and clinical follow-up diagnosis,divided into 33 cases,134 cases were malignant.167 general patients were reviewed,Finally,its imaging characteristics are summarized.Compare the contrast-enhanced ultrasound performance characteristics of benign and malignant groups,such as lesion location,maximum diameter,shape,internal echo,bronchial sign,blood flow signal grade,time of beginning to increase,difference of lung lesion starting time,peak enhancement,etc.From this,the indicators related to peripheral pulmonary malignant lesions were selected.On this basis,Logistic regression analysis was used to analyse the independent risk factors of ultrasound and ultrasound of peripheral malignant lesions.SPSS25.0 maps the recipient operating characteristic curve(ROC curve)to evaluate the value of conventional ultrasound and ultrasound for the differential diagnosis of benign and malignant pulmonary lesions.Compare the differences in the display rate of blood vessels between Colour Doppler ultrasound and Contrast-enhanced ultrasound.Compare the differences in the display rate of blood vessels between conventional Doppler ultrasound and ultrasound,compare the display rate and necrosis area range of ultrasound and scanning CT to enhance CT on lesion lesions,and count the success rate of puncture biopsy guided by ultrasound.ResultsPart 1: General informationIn the benig group,there were 17 males and 16 females,with an average age of(62.35 6.17)years,and the average maximum diameter of the lesion was(4.15 0.56)cm.;In the malignant group,there were 83 males and 51 females,with an average age of(61.20 5.88)years,and the average maximum diameter of the lesion was(4.490.77)cm.There was no significant difference between the two groups in gender examination(χ2=0.242,P>0.05),but there was no significant difference in average age and average maximum diameter of lesions between the two groups by group T examination(t=,0.997,P>0.05),(t =1.344,P>0.05)Part 2: Characterization of ultrasound/contrast-enhanced ultrasound and the value of differential diagnosis of benign and malignant lesions around the lungsThere is no obvious difference between the benign group and the malignant group in terms of position,“location”,“maximum diameter”,“echo”,“Lesion-lung AT difference”,“peak enhancement” and ‘blood supply classification” by K-square test(P>0.05).and there was significant difference in “shape”,“bronchial sign” and“Lesion-lung AT difference” characteristics(p-value was <0.05,<0.001 and <0.001respectively).The shape of lesion: triangular or wedge-shaped in benign groups,while circle/like circle are more common in malignant groups.Bronchial sign: benign group mostly had bronchial sign,while malignant group mostly had no bronchial sign;Lesion-lung AT difference: the Lesion-lung AT difference of malignant group was more than t AT≥2.5s.Prediction of the diagnosis of peripheral malignant lesions in the lungs by contrast-enhancedultrasound: Logistic regression analysis to analyse the signs of ultrasound/contrast-enhancedultrasound,and the “Lesion-lung AT difference”(P<0.001)and “Bronchial sign “(P <0.001)were statistically significant in the model,with p-values < 0.001,respectively.As an independent risk factor for predicting malignant peripheral pulmonary lesions,the predictiver equation was obtained as follows: Logit(P)=-0.021+2.48 × Lesion-lung AT difference-1.81 × bronchial sign.The diagnostic value of contrast-enhanced ultrasound in peripheral pulmonary malignant lesions was as follows: area under ROC curve(AUC)of 0.853,P=0.000,Jordan index of 0.838,and 95% CI of 0.785–0.928,indicating a high diagnostic value.Part 3:Comparison of contrast-enhanced ultrasound characteristics of adenocarcinoma and squamous carcinoma in pulmonary malignant lesionsThere were no significant differences in “initial increase time”,“Lesion-lung AT difference”or “peak intensity ”between adenocarcinoma and squamous cell carcinoma(P>0.05).Part 4:Comparison of contrast-enhanced ultrasound with CDFI,CT and contrast-enhanced CT in the detection of lesion blood vessels and necrosis in percutaneous ultrasound biopsyAccording to the Alder semi-quantitative method,the blood supply score of the lesion is graded,and the vascular display rate of the lesion is compared with that of colour Doppler.Contrast-enhanced ultrasound is significantly better than CDFI(P<0.05).By comparing the lesion necrosis display rate and the area range of necrosis,contrast-enhanced ultrasound detected that 44.9% of the lesion had necrosis,enhancing the display rate of CT necrosis lesions by 47.3%.The difference between the two was not statistically significant(P>0.05).The difference between the display rate of necrosis and scanning CT 35.3% is statistically significant(P>0.05).The results of contrast-enhanced ultrasound and enhanced CT show similar results on the range of necrosis areas in the lesion.The difference is not statistically significant(P>0.05),and the range is wider than that of flat-scan CT,and the difference between the two is significant(P<0.05).Conclusion(1)Ultrasound/contrast-enhanced ultrasound performance characteristics and benign and malignant identification: “shape” is triangular or wedge-shaped in the benign group,while “circular” is more common in the malignant group;most benign group has “bronchial sign”,and most malignant group has no “bronchial sign”;“Lesion-lung AT difference”: the Lesion-lung AT difference in the malignant group has more t AT≥2.5s.(2)“Bronchial signs” and “Lesion-lung AT difference” are independent risk factors for predicting peripheral lung malignant lesions.The obtained prediction equations are: logit(p)=-0.021+2.48 ×Lesion-lung AT difference-1.81× bronchial signs,which is of certain value for the diagnosis of benign and malignant peripheral lesions;however,the comparative differences in adenocarcinoma and squamous lesions in lung malignant lesions have no statistical significance.(3)Contrast-enhanced ultrasound is better at displaying blood vessels in the lesion than Doppler ultrasound.Contrast-enhanced ultrasound has a better display rate and necrosis range in the lesion than the scanning CT value.When guiding puncture biopsy,it can be more conducive to avoiding serious bleeding caused by damaging blood vessels.In real-time state,puncture biopsy is expected to better avoid the necrotic areas and improve the probability of successful material extraction.