Clinical Value Of Differentiating Benign From Malignant Of Lung Lesions And Percutaneous Lung Puncture Biopsy With Contrast Enhanced Ultrasound

ObjectivesThe purpose of this study was to evaluate the enhancement pattern of peripheral pulmonary lesion by using real-time gray-scale CEUS and time-intensity curves of ACQ software and to investigate the clinical value of differentiating benign from malignant of peripheral pulmonary lesion and percutaneous lung puncture biopsy with contrast enhanced ultrasound.Methods139patients with peripheral pulmonary lesion underwent percutaneous lung puncture biopsy guided by ultrasonography. Of the139patients,69patients underwent CEUS before biopsy and enhancement information was referred for selecting of tissue sampling site. The rest of70patients did not undergo CEUS before biopsy. All patients were evaluated by traditional gray-scale sonography and color Doppler sonography, which provided a preliminary imaging judgement through scaning for observation of the size, internal echo and vascular distribution of lung lesions. The contrast agent SonoVue was used. The gray-scale contrast enhanced ultrasound was performed to observe the time to enhancement, the extent of enhancement and the dynamic enhancement pattern of each lesion. Each lesion was recorded and analyzed by quantitative software-ACQ to further characterize the lesions. Each of arrival time(AT), time to peak intensity(TTP), half time of descending(HT), peak intensity(PI), base-to-peak ascending slope(BPAS), base-to-peak descending slope(BPDS) were recorded. The video were recorded in ninety seconds, and the images were saved in the equipment. The difference in the positive rate between the two groups was evaluated the value of CEUS before biopsy.Results1.Of the69patients who underwent CEUS,30were diagnosed for lung cancer,21for pulmonary tuberculosis,10for pneumonia,2for lung abscess,1for neurofibroma,1for malignant mesothelioma,1for malignant neurogenic spindle cell tumors,1for castleman disease,1for malt lymphoma,1for solitary fibrous tumor.2.There were no significance in the imaging of two dimensional ultrasonography between benign and malignant groups(P>0.05).3. There were significant differences in the grade of CDFI between benign and malignant groups(P<0.05).4. The AT and TTP in the malignant group were earlier than those in the benign group(P<0.05).5. The positive rate of puncture biopsy of peripheral pulmonary lesion resulted from CEUS guided group (95.7%,66/69) was higher than that in un-CEUS group (85.7%,60/70)(P<0.05).Conclusions1. The modes of enhancement and time-intensity curve were different in benign and malignant lesion of peripheral lungs. AT and TTP is an important parameter to differentiate benign from malignant peripheral pulmonary lesion.2. CEUS before transthoracic peripheral lung lesion biopsy improved the diagnostic accuracy of the procedure by providing information for differentiating viable from necrotic tissue and consequently provide more accurate infoumation about the site of biopsy.