Application Of Ultrasonic Contrast In The Diagnosis And Biopsy Of Peripheral Pulmonary Focal Lesions

[Objective]To explor the value of the ultrasonic contrast in the differential diagnosis of benign and malignant of peripheral pulmonary focal lesions and guiding lung needle biopsy.[method]52patients who satisfied the diagnosis standard of peripheral pulmonary focal lesions by CT in the second affiliated hospital of Kunming medical university. All objects were randomly divided into two groups.The conventional ultrasound group include 17 males,5 females during 2012 September to 2015 February with the average age of (58.27±19.53) years.The ultrasound contrast group contain 23 males,7 femals during 2013 September to 2015 March with the average age of (59.54 ±13.82) years.Adopt Philips IU22 color ultrasonic diagnostic apparatus as ultrasonic instrument using 3～5MHz probe,with real-time ultrasound contrast imaging and quantitative analysis software. Use ultrasound SonoVue produced by Italy Bracco company(SonoVue) as contrast agent.Bard automated biopsy gun and 18G-16GTru-cut biopsy needle were used in lung biopsy.(1)The conventional ultrasound examination:Based on the subjects of different focus location to take the seat,supine,prone position or lateral position and according to the CT show of pulmonary focal lesions location, passing throngh intercostal space to find lesions with a comprehensive under standing of the lesion size,shape,internalstructure,the sound color flow signal and the spectral characteristic,the relationship between the lesion and the surrounding lung tissue and blood vessels,at the same time record related measurements.(2)CEUS when CEUS,select the showed lesions of the largest and most clear view,maintain stable to probe,adjust the instrutment to contrast-enhanced ultrasound,set mechanical index(MI) to 0.06.Inject with SonoVue suspension 1.2ml/through antecubital vein,than 5ml saline was injected to wash the pipe.After injection of contrast agent,start to observe immedietaly real-time enhanced lesions and store images,until the lesion contrast agent washout for 3 minutes ～5 minutes continuously.(3)Ultrasound contrast quantitative image analysis:Make a analysis for the ultrasound image obtained with software of QLAB provided by the company of Philips,enter the QLAB interface and choose ROI to measure images for three times.The relevant parameters are obtained from the average value of three.QLAB software to index equation Y=A(1-e-βt)automatically generate backscatter curve changes with time,namely TIC curve,then the TIC curve to gamma fitted formula genarate related quantitative parameters,including AUC,PI,alpha,TTP, AT,PHT.(4)Biopsy:In routine conditions,show the lesions of most clear section once again,start the puncture guide line button and adjust guide line angle through the sampling target area(ultrasound group selected enhanced area as target area,conventional ultrasound group selected the lesion edges and the area of the interior of lesions with rich blood supply as target area),and try to ensure that the punctureline near inferior costal margin.On the basis of selected target area,to determine the location and depth of the needle and confirmthe the needle direction.The probe was fixed with puncture guiding device and wearde a sterile probe set.After general skin disinfection,towel,local anesthesia,the puncture needle was piercing perpendicularly to the chest wall surface layer under the guidance of ultrasound.when the needle close to the pleura,stay for a while,ask the patient to hold his breath for fastly drawing materials.Each patient was taken 2 times and out of 2 tissues.The tissues will be put into 10% neutral formalin fixed liquid and given pathology examination.Keep postoperative close observation to vital signs of patients and whether if a hemoptysis and follow-up complications.[results] (1)The difference of puncture success rate between ultrasound group and ultrasound contrast group was statistically significant (P<0.05).(2)There was no statistically significant difference in the size of lung lesions between benign and malignant groups(P>0.05).(3)The difference of lung lesions echo types was statistically significant between benign and malignant groups(P<0.05).(4)The difference of pulmonary blood flow grading between benign and malignant groups was not statistically significant(P>0.05).(5)The difference of Doppler spectrum resistance index was statistically significant compared benign group with malignant group (P<0.05).(6)The difference of pulmonary lesion enhancement beginning phase was statistically significant compared benign group with malignant group in ultrasound contrast group(P<0.05).(7)The difference of the initially enhanced morphology of pulmonary lesions was not statistically significant between benign and malignant groups in ultrasound contrast group(P>0.05).There was no significant difference in time to peakenhancement of pulmonary lesions morphology between benign and malignant groups(P<0.05).(8)The difference of enhancement pattern of lung lesions group compared benign group with malignant group,was statistically significant in ultrasound contrast group(P<0.05).(9)There were statistically significant differences in parameters of quantitative analysis including AT,PHT,AUC and alpha in ultrasound contrast group (P<0.05),on the contrary,other parameters like TTP,TTP-AT,PI and A were not statistically significant compared benign group with malignant group(P>0.05).[Conclusion](1)The echo characteristics of conventional ultrasound lesions and the resistance index of Doppler spectrum have a certain reference value for the peripheral pulmonary focal lesions in the differential diagnosis of benign and malignant lessions.(2)The morphology of enhanced lesions and the enhanced pattern have a certain guiding significance for the peripheral pulmonary focal lesions in the differential diagnosis of benign and malignant lesions in real-time contrast-enhanced ultrasonography;The differences of peripheral lung lesions on TIC curve PHT、AT AUC and alpha is of certain significance in differential diagnosis of benign and malignant lessions.(3)Contrast-enhanced ultrasound is helpful to improve the success rate of percutaneous puncture biopsy in peripheral pulmonary lesions.