The Value Of Contrast-enhanced Ultrasound In The Diagnosis Of The Peripheral Pulmonary Tuberculosis

Objective:To investigate the value of contrast-enhanced ultrasound(CEUS)in diagnosis of pulmonary tuberculosis(PTB).Methods:68 patients with peripheral PTB confirmed by CT or clinic were examined by conventional ultrasound and contrast-enhanced ultrasound,and the location,shape,size,echo and enhanced intensity and mode were observed.After CEUS,biopsy was performed on the enhanced area and the non-enhanced area respectively,and the pathological examination and x-pert examination were carried out to compare the influence of the samples taken from different target areas on the diagnosis.Results:The ultrasonography image of peripheral PTB divided into three forms:pulmonary atelectasis(49/68,72.1%),tuberculoma(12/68,17.6%)and abscess(7/68,10.3%).There were four types shown on contrast-enhanced ultrasound:homogeneous enhancement(5/68,7.4%),rim enhancement(26/68,38.2%),heterogeneous enhancement type(33/68,48.5%),and no enhancement(4/68,5.9%).Necrosis was demonstrated in 100%of the lesions in histopathology and in 86.8%of CEUS.The incidence of necrosis in peripheral PTB was not related to lesion size,and there was no significant difference in the necrosis rate between different diameters(r=-0.153,P=0.458).There was statistical significance in the CEUS of different types of peripheral PTB(p=0.014).The majority of pulmonary atelectasis group were heterogeneous enhancement(29/49,59.2%),most of the tuberculoma group showed rim enhancement(8/12,66.7%),and the difference between the two groups was statistically significant(p=0.032).There was a statistically significant difference in the enhancement pattern between the pulmonary atelectasis and lung abscess groups(p=0.020),with almost all the abscess showed rim enhancement(6/7,85.7%).The pathological diagnosis rate was 77.9%(53/68)in sixty-eight lesions,11 of 15 cases without definite diagnosis cases were confirmed by X-pert,and the other four cases were confirmed by bacterial culture.The combined diagnosis rate of pathology and x-pert was 92.6%(64/68),which was statistically significant compared with pathological diagnosis(x2=4.335,P=0.018).Conclusions:The CEUS of most peripheral PTB were heterogeneous enhancement and rim enhancement,The display rate of the latter is low,but it shows a certain benign characteristic,which may have certain help to the diagnosis of peripheral PTB.The necrosis rate of peripheral PTB was high,and there was no significant correlation with lesion size.CEUS can reflect the lesion size and internal necrosis objectively,and guided biopsy furtherly.Obtain the precision specimen of different enhancing regional is of great significance,helps to provide a wealth of information for the diagnosis of peripheral PTB.CEUS was a new diagnosis approach for part of intolerance to radiological examination,iodine allergy and for teenagers patients of peripheral PTB.The difference CEUS performance of different types of peripheral PTB was statistically significant,enhancement pattern can reflect the different pathological process,ultrasound imaging has the potential to the evaluation of tuberculosis activity and for outcome judgment to offer information.