Application Of Real-time Contrast-enhanced Ultrasound Guided Percutaneous Lung Biopsy

Objectives:The purpose of this study was to research the pleural pulmonaryperipheral masses by using the second generation ultrasound contrast agent SonoVuewith real-time ultrasound contrast imaging technology,to understand thecharacteristics of pulmonary perfusion imaging peripheral lesions,to explore theapplication value of real-time contrast ultrasound guidance in percutaneous lungpuncture biopsy in pulmonary peripheral masses.Methods:The100patients underwent CT examination to determine theexistence of adjacent pleural pulmonary peripheral masses were randomly dividedinto two groups. Among them50cases(experimental group) of contrast enhancedultrasound and biopsy are operated at the same time,the other50cases(control group)were done by two-dimensional ultrasound guided.All the patients were assessed bytwo-dimensional ultrasound and color Doppler ultrasound examination to determinethe location, size, morphology, echo, blood flow and the relationship with adjacentorgans and make the preliminary judgment of lesions. After the location of lesions inthe experimental group was determined by the two-dimensional ultrasound.The probewas disinfected and installed a puncture guidance supporter.They were done by thecontrast-enhanced ultrasonography and biopsy.The contrast agent was six sulfurhexafluoride(trade name:SonoVue) which was produced by the Italy Braccocompany.We monitored the lesion contrast perfusion and enhancement in lowmechanical index, had edged moved the puncture probe to make the puncture paththrough the lesion homogeneous enhancement region, determine the puncture depth,enjoin patient breath hold, immediately using a biopsy gun in the diseased tissue. Thecontrol group was guided puncture in the two-dimensional ultrasound.They tried towear the lesions of the edge or CDFI.The incidence rate of success rate andcomplications were compared between the two groups.Results:(1)Malignant lesions in the experimental group were36cases, including16cases of adenocarcinoma,13cases of squamous cell carcinoma,2cases of metastatic carcinoma,1cases of small cell lung cancer,1cases of B cell lymphoma,1cases ofnon-Hodgkin’s lymphoma,1cases of bronchial alveolar carcinoma,1cases ofsarcomatoid carcinoma.Benign lesions in the experimental group were14cases,including7cases of pulmonary tuberculosis,4cases of inflammatory mass,2cases of pulmonary recessive infection,1cases of lung abscess. The contrast showedthat50%(25/50) lesions have different degree of necrosis and focal necrosis wereincreased in proportion with the occupying volume increased.In this study,the contrastshowed that there was no obvious necrosis in the5cases of the maximum diameter ofthe lesions line <3.5cm;In the28cases the maximal diameter3.5-5.5cm, theoccupying necrosis was the proportion of42.86%(12/28);In the17cases with themaximum diameter of the lesions line>5.5cm,the occupying necrosis was theproportion of76.47%(13/17).(2)Malignant lesions in the experimental group were36cases, including23cases of low echo,13cases of nonhomogeneous hypoechoic,0cases of noecho;Benign lesions were14cases,9cases of low echo,4cases of nonhomogeneoushypoechoic,1cases of no echo.There were no significance between benign andmalignant lesions in the echo(P>0.05).(3)Color Doppler Flow Image(CDFI) of lesions was divided into fourgrades.Malignant lesions in the experimental group were36cases, including4casesof grade0,11cases of grade I,17cases of grade II,4cases of grade III;Benignlesions were14cases, including5cases of grade0,6cases of grade I,2cases ofgrade II,1cases of grade III.There were significant differences between benign andmalignant lesions in the CDFI(P<0.05).(4)Malignant lesions in the experimental group were36cases, including17cases of homogeneous enhancement,19cases of inhomogeneous enhancement,0casesof no enhancement.Benign lesions were14cases, including10cases of homogeneousenhancement,3cases of inhomogeneous enhancement,1cases of no enhancement.There were significant differences between benign and malignant lesions in theenhancement(P<0.05).(5)The average number of puncture of the experimental group is (1.38±0.57)needles.The average number of puncture of the control group is (1.63±0.63) needles.There were significant differences between them(P<0.05).(6)The success rate of puncture of the experimental group was higher than thatof the control group.The complication rate of the experimental group was lower thanthe control group.Conclusion:Real contrast ultrasound guided percutaneous lung puncture canobviously improve the pulmonary peripheral lesions of the success rate of puncture,provides a very important value for clinical diagnosis.