Application of quantitative contrast-enhanced ultrasound for evaluation and guiding biopsy of peripheral pulmonary lesions: a preliminary study

Abstract

To evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in differentiating malignant from benign peripheral pulmonary lesions, and to evaluate the feasibility, accuracy, and utility of CEUS-guided biopsy for peripheral pulmonary lesions. MATERIALS AND METHODS: Thirty-three patients with histopathologically confirmed peripheral pulmonary lesions (22 malignant, 11 benign) were enrolled in this retrospective study. Conventional ultrasound (US) was first performed and then CEUS with a contrast-specific mode and sulfur hexafluoride-filled microbubble contrast agent. CEUS indicesdtime of enhancement (TE), time to peak (TP), extent of peak (EP), mean transit time (MTT), area under curve (AUC), and slopedwere recorded and compared between the groups. The ability of CEUS and US to detect necrotic areas within lesions was also compared and the accuracy of CEUS-guided biopsy was calculated. RESULTS: On CEUS, TE was significantly shorter in acute pneumonia lesions than in other types of lesions (p¼0.03). Other indices were not significantly different between benign and malignant lesions. Detection of necrosis within lesions was significantly higher with CEUS than with US (51.5% versus 27.3%; p¼0.04). The accuracy of CEUS-guided biopsy was 96.9% (32/33). CONCLUSION: The study findings suggest that CEUS can identify necrotic areas within lesions, and thereby, play a useful role in imaging-guided biopsy. The present pilot study indicates that CEUS may help to identify acute pneumonia lesions from other types of pulmonary lesions. CEUS might be a useful additional technique for the diagnosis of lung lesions.

Contrast-enhanced ultrasound of pediatric lungs

“…SonoVue (Bracco Imaging, Milan, Italy), which is marketed as Lumason (Bracco Diagnostics, Monroe Township, NJ) in the United States, is the only ultrasound contrast agent (UCA) that has been used for lung CEUS applications in adults and children [12][13][14][15][16][17][18][19][20][24][25][26][27][28][29][30]. In adults, SonoVue doses range from 2.4 mL to 4.8 mL for various lung-related IV CEUS applications [14-17, 26, 30].…”

“…US is already well-established for the characterization of opacities that have been detected by chest radiograph. US can accurately differentiate whether the opacity is from atelectasis or subpleural consolidation, pleural disease, or a variable combination of these entities [21,22,24,[32][33][34].…”

Propensity-score-matching analysis to compare efficacy and safety between 16-gauge and 18-gauge needle in ultrasound-guided biopsy for peripheral pulmonary lesions

“…In addition, the rate of post-procedure complications with percutaneous biopsy was reported to be high [ 14 ]. On the contrary, the real-time ultrasound (US)-guided percutaneous needle biopsy for PPLs is more beneficial in terms of being radiation-free, convenient, economical and dynamic than the CT-guided procedure [ 15 – 17 ]. Therefore, the US-guided biopsy for PPLs is considered a potentially feasible and reliable technique [ 18 ].…”

Contrast-enhanced ultrasound (CEUS) guided drainage in the treatment of a patient with lung abscess secondary to hypervirulent Klebsiella pneumoniae (hvKP) infection: A case report

“…Drainage is important for the treatment of lung abscess. Contrast-enhanced ultrasound (CEUS) can identify necrotic areas within peripheral pulmonary lesions, which plays a useful role in imaging-guided biopsy [ 4 ]. We report a case in which thoracic CEUS depicted lung abscess from consolidation secondary to hvKP, providing an appropriate time and path for drainage, after computed tomography (CT) yielded inconclusive findings, and CEUS-guided drainage played a key role in the treatment of lung abscess.…”