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Transthoracic ultrasound shear wave elastography for the study of subpleural lung lesions

Ultrasonography 2022년 41권 1호 p.93 ~ 105
Quarato Carla Maria Irene, Venuti Mariapia, Dimitri Lucia, Lacedonia Donato, Simeone Anna, Mirijello Antonio, De Cosmo Salvatore, Maiello Evaristo, Taurchini Marco, Scioscia Giulia, Copetti Massimiliano, Sperandeo Marco,
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 ( Quarato Carla Maria Irene ) - University of Foggia Policlinico Riuniti di Foggia Institute of Respiratory Diseases Department of Medical and Surgical Sciences
 ( Venuti Mariapia ) - University of Foggia Policlinico Riuniti di Foggia Institute of Respiratory Diseases Department of Medical and Surgical Sciences
 ( Dimitri Lucia ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine
 ( Lacedonia Donato ) - University of Foggia Policlinico Riuniti di Foggia Institute of Respiratory Diseases Department of Medical and Surgical Sciences
 ( Simeone Anna ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Radiology
 ( Mirijello Antonio ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine
 ( De Cosmo Salvatore ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine
 ( Maiello Evaristo ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine
 ( Taurchini Marco ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine
 ( Scioscia Giulia ) - University of Foggia Policlinico Riuniti di Foggia Institute of Respiratory Diseases Department of Medical and Surgical Sciences
 ( Copetti Massimiliano ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine
 ( Sperandeo Marco ) - IRCCS Fondazione Casa Sollievo della Sofferenza Department of Internal Medicine

Abstract


Purpose: The aim of this study was to assess whether new-generation shear wave elastography (SWE) is suitable for the characterization of lung subpleural lesions.

Methods: In total, 190 consecutive patients with subpleural lung lesions received ultrasonography and SWE. Patients with suspected malignancy underwent ultrasound-guided transthoracic needle biopsy. Final diagnoses were made on the basis of patients’ clinical course, microbiological studies, and histological results. SWE was also performed in 25 healthy volunteers.

Results: We found no statistically significant differences in stiffness between lung carcinomas, lung metastases, and pneumonia (P=0.296) or between different histological types of lung cancer (P=0.393). Necrosis was associated with reduced stiffness in pneumonia. Excluding necrotic lesions, pneumonia showed higher stiffness than lung carcinomas (2.95±0.68 m/s vs. 2.60±0.54 m/s, P=0.006). Chronic pneumonia showed increased stiffness (3.03±0.63 m/s), probably due to the presence of fibrotic tissue on histology. Pleural effusion was associated with a statistically significant reduction in stiffness, both in lung carcinomas (P=0.004) and lung metastases (P=0.002). The presence of air in healthy lung tissue may lead to incorrect speed estimates due to shear wave reflection (very high values, 14.64±2.19 m/s).

Conclusion: Transthoracic SWE could not distinguish lung malignancy from pneumonia, or between different histological types of lung carcinomas. In particular, SWE seems unable to resolve the clinical dilemma of chronic subpleural consolidations.

키워드

Transthoracic ultrasound; Ultrasound elastography; Shear wave elastography; Ultrasound-guided transthoracic needle biopsy; Subpleural lesions; Artifacts

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