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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (8): 808-815.doi: 10.3969/j.issn.1000-6621.2019.08.002

• 论著 • 上一篇    下一篇



  1. 同济大学附属同济医院病理科(毕珂)
  • 收稿日期:2019-05-21 出版日期:2019-08-10 发布日期:2019-08-13
  • 通信作者: 王茵
  • 基金资助:

Performance characteristics of conventional ultrasound scanning and contrast-enhanced ultrasonography of pleural tuberculoma

Yang CONG,Yi ZHANG,Ke BI,Meng-jun SHEN,Hui-ming ZHU,Hong-wei CHEN,Yin WANG()   

  1. Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
  • Received:2019-05-21 Online:2019-08-10 Published:2019-08-13
  • Contact: Yin WANG


目的 探讨胸膜结核瘤的常规超声及超声造影表现特征,为临床鉴别诊断及介入超声诊治提供依据。方法 回顾性分析2018年1—12月同济大学附属上海市肺科医院经病理或实验室检查证实的49例胸膜结核瘤患者,均行常规超声及超声造影检查,观察并总结胸膜结核瘤病灶在常规超声模式下的形态、纵横径值、边缘情况、血流分布、有无肺滑动征及钙化等特点;超声造影从定性和定量两个方面进行归纳和分析,定性指标包括增强模式、增强强度、增强形态、均匀程度和有无坏死区及面积大小;定量指标包括病灶开始增强时间、达峰时间、曲线下面积。结果 49例患者共计49个病灶被纳入本研究,其中双肺多发病灶选取其中最大者观察;常规超声检查显示病灶呈自胸膜向肺部凸起的“D”字形(71.43%,35/49),以及类圆形(18.37%,9/49)、不规则形(10.20%,5/49)等形态,与胸膜多呈宽基底相交且胸膜增厚(89.80%,44/49),边缘多较光整(59.18%,29/49),多数有肺滑动征(61.22%,30/49);超声造影定性指标显示病灶多表现为高增强(93.88%,46/49),由外向中心灌注(91.84%,45/49);灌注形态以枯枝状增强(32.65%,16/49)和环状增强(30.61%,15/49)为主;多见坏死区(75.51%,37/49),且坏死区面积多<50%(65.31%,32/49)。超声造影定量指标中病变区域开始增强时间、达峰时间、曲线下面积与胸壁组织测值接近,其中病灶和正常肺组织的开始增强时间[11.35(9.58,14.49)s和5.35(4.24,7.38)s]、达峰时间[26.79(22.57,30.17)s和17.20(14.81,24.38)s]、曲线下面积[1018.61(784.90,1505.91)dB·s和2853.05(1428.96,3261.56)dB·s]差异均有统计学意义(H=8.317、5.356、5.215,P值均<0.001);病灶和胸壁组织开始增强时间[11.35(9.58,14.49)s和10.70(9.35,13.37)s]、达峰时间[26.79(22.57,30.17)s和24.93(21.05,27.02)s]和曲线下面积[1018.61(784.90,1505.91)dB·s和711.89(527.90,1254.84)dB·s]差异均无统计学意义(H=1.019,P=0.924;H=1.427,P=0.461;H=1.212,P=0.676)。结论 胸膜结核瘤的常规超声及超声造影声像图具有一定的特征性表现,能为临床鉴别诊断及介入超声诊治提供参考依据。

关键词: 结核, 胸膜, 结核瘤, 超声检查, 诊断显像, 研究


Objective To provide a certain imaging basis for clinical diagnosis and interventional ultrasound, analyzing the image data of pleural tuberculoma with conventional ultrasound and contrast-enhanced ultrasound.Methods Retrospective analysis of 49 patients with pleural tuberculoma confirmed by pathology or laboratory examination from January to December 2018 in Tongji University Affiliated to Shanghai Pulmonary Hospital. All patients underwent routine ultrasound and contrast-enhanced ultrasonography. Morphology, longitudinal and transverse diameter values, marginal conditions, blood flow, presence or absence of pleural slip sign and calcification in conventional ultrasound scan mode; contrast-enhanced ultrasound was summarized and analyzed from both qualitative and quantitative aspects. Qualitative indicators of contrast-enhanced ultrasound include enhanced mode, enhanced intensity, enhanced morphology, enhanced uniformity, and presence or absence of necrotic areas and their types. Quantitative indicators include initial enhancement time, peak time, area under the curve, and gradient curve.Results A total of 49 lesions were included in the study in 49 patients. The largest lesions were selected from the two lungs for observation. Conventional ultrasonography showed that the lesions were mostly “D” shaped from the pleura to the lungs (71.43%, 35/49), round-like (18.37%, 9/49) and irregular shape (10.20%,5/49), intersecting the pleura thickening (89.80%, 44/49), with many edges compared with smoothing (59.18%, 29/49), most of them had lung slip sign (61.22%, 30/49); qualitative indicators of contrast-enhanced ultrasound showed that the lesions showed high enhancement (93.88%, 46/49), from external to internal perfusion. (91.84%, 45/49); perfusion morphology was dominated by annual enhancement (32.65%, 16/49) and bad branch enhancement (30.61%, 15/49); more common no enhancement zone (75.51%, 37/49), and the area of no enhancement area was more than <50% (65.31%, 32/49). In the quantitative contrast index of contrast-enhanced ultrasound, the enhancement time, peak time, and area under the curve of the lesion area were close to those of the chest wall tissue, and the initial enhancement time of the lesion and normal lung tissue (11.35 (9.58, 14.49) s and 5.35 (4.24, 7.38) s), peak time (26.79 (22.57, 30.17) s and 17.20 (14.81, 24.38) s), area under the curve (1018.61 (784.90, 1505.91) dB·s and 2853.05 (1428.96, 3261.56) dB·s), the differences were statistically significant (H=8.317, 5.356, 5.215; Ps<0.001); lesion and chest wall tissue began to enhance time (11.35 (9.58, 14.49) s and 10.70 (9.35, 13.37) s), peak time (26.79 (22.57, 30.17) s and 24.93 (21.05, 27.02) s) and area under the curve (1018.61 (784.90, 1505.91) dB·s and 711.89 (527.90, 1254.84) dB·s),the differences were not statistically significant (H=1.019, P=0.924; H=1.427, P=0.461; H=1.212, P=0.676).Conclusion Conventional ultrasound and contrast-enhanced angiography of pleural tuberculoma have certain characteristic performance and can provide diagnostic basis in clinical Identification and ultrasound interventional treatment.

Key words: Tuberculosis, pleural, Tuberculoma, Ultrasonography, Diagnostic imaging, Research