Comparative study on the clinical value of contrast-enhanced ultrasound- and CT-guided percutaneous puncture biopsy in peripheral lung masses / 国际肿瘤学杂志

Objective:To compare the clinical value of contrast-enhanced ultrasound (CEUS) - and CT-guided percutaneous puncture biopsy in the diagnosis of peripheral lung masses.Methods:The clinical data of 90 patients with peripheral lung masses who underwent puncture biopsy in Tumor Hospital Affiliated to Nantong University from October 2019 to December 2021 were retrospectively analyzed. According to different puncture guidance methods, patients were divided into CEUS-guided percutaneous puncture biopsy group (CEUS group, n=40) and the CT-guided percutaneous puncture biopsy group (CT group, n=50) , and the differences in puncture success rates, complication rates and other factors between the two groups were evaluated. Meanwhile, the correlations between microvascular density (MVD) and CEUS parameters were detected. Results:The puncture success rate in the CEUS group was higher than that in the CT group, but there was no statistically significant difference [97.5% (39/40) vs. 92.0% (46/50) , P=0.337], and the complication rate in the CEUS group was significantly lower than that in the CT group [0 (0/40) vs. 12.0% (6/50) , P=0.032]. Compared with the CT group, the CEUS group has fewer punctures [ (2.0±1.6) times vs. (2.8±1.2) times, t=-2.43, P=0.018], shorter duration [ (7.6±2.5) min vs. (15.3±2.6) min, t=-8.86, P<0.001] and lower cost of surgery [ (1 308.4±545.6) yuan vs. (2 046.4±645.3) yuan, t=-2.01, P=0.046]. The MVD, CEUS peak intensity and enhancement index of lung adenocarcinoma were higher than those of squamous cell carcinoma [ (25.4±4.9) /HP) vs. (16.6±7.3) /HP, t=3.43, P=0.002; (46.9±6.5) db vs. (36.8±5.4) db, t=4.12, P<0.001; 5.2±1.4 vs. 4.1±1.2, t=3.27, P=0.006]. The peak intensity and intensity index of CEUS in lung adenocarcinoma or squamous cell carcinoma were positively correlated with itself MVD (squamous cell carcinoma: r=0.66, P<0.001; r=0.56, P<0.001; adenocarcinoma: r=0.62, P<0.001; r=0.70, P<0.001) . Conclusion:Although CEUS-guided percutaneous puncture biopsy does not achieve a higher puncture success rate in the diagnosis of peripheral lung masses compared to CT, it really decreases the complication rate, and has the advantages of less time, low cost, no radiation and real-time dynamic monitoring, which is worth promoting in clinic. Moreover, there are correlations between CEUS quantitative parameters of adenocarcinoma and squamous cell carcinoma of the lung and MVD, which may be useful for diagnosis.

An Experimental Study of Exo genous Lipoid Pneumonia: Sequential Changes in High-Resolution CT and MR Findings

PURPOSE: To evaluate sequential changes in high-resolution CT(HRCT) and MR findings of exogenous lipoidpneumonia in rabbits and to compare the radiologic and histopathologic findings. MATERIALS AND METHODS: A singleendobronchial administration of shark liver oil(0.5 or 1 ml/kg of body weight) was given to 25 rabbits. HRCT scanswere obtained immediately(n=17), at 1 day(n=14), 3 days(n=10), 1 week(n=15), 2 weeks(n=10), 4 weeks(n=9), 6weeks(n=5), 8 weeks(n=6), 10 weeks(n=4), 12 weeks(n=2), 14 weeks(n=3), and 16 weeks(n=2) after administration.Changes in distribution, extent, and attenuation were assessed on HRCT scans. MR scans were obtainedimmediately(n=12), at 1 day(n=9), 3 days(n=9), 1 week(n=15), 2 weeks(n=9), 4 weeks(n=11), 6 weeks(n=5), 8weeks(n=7), 10 weeks(n=3), 14 weeks(n=3), and at 16 weeks(n=2) after administration. Changes in distribution,extent, and signal intensity were assessed on MR scans. In 16 rabbits, CT and MR findings were compared withhistopatholo-gic findings obtained in the same plane. RESULTS: HRCT findings included consolidation withair-bronchogram, ground-glass attenuation and fat attenuation within the lesion at earlier stages(immediate-2weeks). The extent of lesions was greatest at 1 week, and was then seen to gradually decrease on follow-up CTscans. T1-weighted MR images(T1WI) showed high or intermediate signal intensity(SI) at earlier stages andintermediate SI at later stages, while T2-weighted MR images(T2WI) showed high SI at both earlier and laterstages. Histopathologic correlation showed that ground-glass attenuation and consolidation on HRCT reflectedintraalveolar lipid-laden macrophages, cuboidal metaplasia of alveolar epithelial cells, and alveolar septalwidening with inflammatory cell infiltration. Maximal infiltration of oil in the lung correlated closely with thepeak low-attenuation seen on CT scans and the high signal intensity seen on T1WI. CONCLUSION: Shark liveroil-induced exogenous lipoid pneumonia in rabbits is reliably diagnosed by HRCT and MR during earlier stages(1-2weeks). The absence of fat at later stages cannot exclude for certain a diagnosis of exogenous lipoid pneumonia.

Squalene Aspiration Pneumonia: Thin-Section CT and Histopathologic Findings

PURPOSE: The purpose of this study was to describe the thin-section computed tomography (CT) findings andhistopathologic findings of squalene aspiration pneumonia. MATERIALS AND METHODS: Thin-section CT scans wereobtained from nine patients with proven exogenous lipoid pneumonia resulting from aspiration of squalene (derivedfrom shark liver oil). The condition was diagnosed by biopsy (n=3), bronchoalveolar lavage (n=4), or sputumcytology and clinical history (n=2); a clinical history of squalene use was confirmed in all patients. Specimensof transbronchial lung biopsy were also reviewed and compared with thin-section CT findings. RESULTS: Thin-section CT findings included ground-glass attenuation (n=8), consolidations obliterating vascular marking(n=4), scattered centrilobular ground-glass attenuation (n=2), and interlobular interstitial thickening (n=6).Geographic lobular distribution with peripheral spared lobules was observed in all patients. These diseasesinvolved multiple lobes (n=5) and abnormalities were usually located in the dependent portion of the lung. Inthree cases, histopathological correlation showed that ground-glass attenuation reflected intra-alveolarinfiltration of lipid-laden macrophages with exudative fluid. Interlobular septal thickening representedhyperplasia of type II pneumonocytes with mild fibrosis. CONCLUSION: On the basis of these results, we concludedthat squalene aspiration pneumonia can be reliably diagnosed by thin-section CT findings particularly when theappropriate history is known.

Squalene-Induced Lipoid Pneumonia in Rabbits: High-Resolution CT and Pathologic findings

PURPOSE: To describe the HRCT and pathologic findings of squalene-induced lipoid pneumonia in rabbits. MATERIALS AND METHODS: Three ml of squalene was instilled into the trachea between the second and the third tracheal ring in 16 rabbits. Serial HRCT scans were obtained on day 4 (n=8), at 1 week (n=7), 2 weeks (n=1), 4 weeks(n=1), 6 weeks (n=2) and 20 weeks (n=1) after squalene instillation. With sacrifice of the rabbits pathology was reviewed at 1 week (n=3), 4 weeks (n=3), and 6 weeks (n=4) after CT scans. RESULTS: Lipoid pneumonia was induced in 8 rabbits; lesions were distributed mainly in the dependent posterior lung. On serial HRCT scans, airspace consolidation, as seen on an air-bronchogrm, and nodular opacities were early findings; these gradually diminshed and with time were replaced by nodular & linear opacities. Histologically, pulmonary fibrosis appeared one week after squalene instillation and progressed over time. Alveolar septal thickening and cuboidal change of the alveolar lining epithelium were more prominent at week 6. CONCLUSION: The early change of squalene-induced lipoidpneumonia in rabbits is the proliferation of intraalveolar macrophage, which is responsible for air-space consolidation with air-bronchograms on HRCT. Nodular and linear opacities on HRCT are due to the appearance of pulmonary fibrosis one week after squalene instillation, and its subsequent progression.