Abstract:

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