Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review

Jacobsen, Niels; Pietersen, Pia Iben; Nolsøe, Christian Pállson; Konge, Lars; Graumann, Ole; Laursen, Christian B.

doi:10.1055/a-1143-3141

Cited by 19 publications

(16 citation statements)

References 64 publications

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“…In the point-of-care setting, lung US may be abbreviated and tailored to only transverse and sagittal views of the area of interest. Contrast-enhanced US of the lungs has been investigated and may provide additional benefit to assess peripheral pulmonary lesions and guide biopsies (40)(41)(42)(43)(44). Color Doppler US has an established role in the evaluation of abscess and empyema as well as a lesser known role in the evaluation of pneumothorax (37,(45)(46)(47)(48)(49).…”

Section: Image Acquisition At Lung Usmentioning

confidence: 99%

Lung Ultrasound: The Essentials

Marini

Rubens

Zhao

et al. 2021

Radiology: Cardiothoracic Imaging

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L ung US has dramatically increased in popularity over the last decade and is routinely performed at the patient's bedside, especially in the emergency department and the intensive care unit (ICU) (1-3). Formal training in the performance and interpretation of lung US, however, is not a traditional component of radiology residency education in the United States. As this modality becomes an imaging staple, the diagnostic radiologist should be fluent in lung US performance and interpretation to maintain relevance and assist the ordering clinician. In this imaging essay, the essentials of lung US are described and radiographic correlation for lung US imaging findings on chest radiographs and chest CT images is provided. A discussion of the role of lung US in health care delivery and the future directions of lung US is also included. Utility of Lung USLung US is radiation-free, low-cost, rapid, and portable, allowing real-time examination of pulmonary structures. Meta-analyses suggest that compared with chest radiography, lung US may have higher sensitivity and similar specificity for detection of pleural effusion, pneumonia, pneumothorax, and pulmonary edema (Table ) (4-7). It is increasingly used in the ICU to detect these diseases. Critical care providers have adopted the bedside lung US in emergency (BLUE) protocol as a standardized approach to lung US in the ICU. This protocol can be performed in less than 3 minutes at the bedside and has a diagnostic accuracy greater than 90% for asthma and/ or chronic obstructive pulmonary disease, pneumonia, pneumothorax, pulmonary edema, and pulmonary embolism (1,8). The accuracy for pulmonary embolism derives from the protocol directing the provider to examine the deep venous structures if there is no sign of pulmonary disease. Many practitioners have advocated for the regular use of lung US in the ICU to decrease the use of chest radiography, which is associated with This copy is for personal use only. To order printed copies, contact reprints@rsna.org Although US of the lungs is increasingly used clinically, diagnostic radiologists are not routinely trained in its use and interpretation. Lung US is a highly sensitive and specific modality that aids in the evaluation of the lungs for many different abnormalities, including pneumonia, pleural effusion, pulmonary edema, and pneumothorax. This review provides an overview of lung US to equip the diagnostic radiologist with knowledge needed to interpret this increasingly used modality.

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Section: Image Acquisition At Lung Usmentioning

confidence: 99%

Lung Ultrasound: The Essentials

Marini

Rubens

Zhao

et al. 2021

Radiology: Cardiothoracic Imaging

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“…Quantitative CEUS parameters were measured and calculated according to the time-intensity curve (TIC). We used the TIC analysis software in LOGIQ E9 to select the earliest enhancing areas of air-filled lung tissues, the thoracic wall and the lesion as the regions of interest (ROIs) to plot TICs and obtained the following parameters: (a) AT of lung, (b) AT of thoracic wall, (c) AT of lesion, (d) lesion-lung AT difference, (e) ratio of AT difference, (f) basic intensity (BI), (g) peak intensity (PI), (h) time to peak (TTP), (i) WIR, (j) WOR (9).…”

Section: Image Acquisition and Analysismentioning

confidence: 99%

“…To date, both B-mode US (B-US) and contrast-enhanced US (CEUS) have been proven to be valuable in the differential diagnosis of subpleural pulmonary lesions (SPLs) (7)(8)(9). Reportedly, qualitative parameters such as degree and homogeneity of enhancement, perfusion pattern, and vascular sign; and quantitative parameters such as arrival time (AT), lesion-lung AT difference, wash-in rate (WIR) and wash-out rate (WOR) were the potentially useful parameters (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Among them, AT is the most frequently assessed parameter and is recommended by the guidelines proposed by European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) (8).…”

Section: Introductionmentioning

confidence: 99%

“…As for CEUS, AT >7.5s and lesion-lung AT difference >2.5s are recommended as the criteria for predicting malignancy. Nevertheless, they are still limited to the exploration of small samples or single indicators, and the level of evidence is low (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Therefore, the value of lung US requires a larger and more robust study design (9).…”

Section: Introductionmentioning

confidence: 99%

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Development and Prospective Validation of an Ultrasound Prediction Model for the Differential Diagnosis of Benign and Malignant Subpleural Pulmonary Lesions: A Large Ambispective Cohort Study

Xia

Fan

et al. 2021

Front. Oncol.

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ObjectiveTo develop and prospective validate an ultrasound (US) prediction model to differentiate between benign and malignant subpleural pulmonary lesions (SPLs).MethodsThis study was conducted retrospectively from July 2017 to December 2018 (development cohort [DC], n = 592) and prospectively from January to April 2019 (validation cohort [VC], n = 220). A total of 18 parameters of B-mode US and contrast-enhanced US (CEUS) were acquired. Based on the DC, a model was developed using binary logistic regression. Then its discrimination and calibration were verified internally in the DC and externally in the VC, and its diagnostic performance was compared with those of the existing US diagnostic criteria in the two cohorts. The reference criteria were from the comprehensive diagnosis of clinical-radiological-pathological made by two senior respiratory physicians.ResultsThe model was eventually constructed with 6 parameters: the angle between lesion border and thoracic wall, basic intensity, lung-lesion arrival time difference, ratio of arrival time difference, vascular sign, and non-enhancing region type. In both internal and external validation, the model provided excellent discrimination of benign and malignant SPLs (C-statistic: 0.974 and 0.980 respectively), which is higher than that of “lesion-lung AT difference ≥ 2.5 s” (C-statistic: 0.842 and 0.777 respectively, P <0.001) and “AT ≥ 10 s” (C-statistic: 0.688 and 0.641 respectively, P <0.001) and the calibration curves of the model showed good agreement between actual and predictive malignancy probabilities. As for the diagnosis performance, the sensitivity and specificity of the model [sensitivity: 94.82% (DC) and 92.86% (VC); specificity: 92.42% (DC) and 92.59% (VC)] were higher than those of “lesion-lung AT difference ≥ 2.5 s” [sensitivity: 88.11% (DC) and 80.36% (VC); specificity: 80.30% (DC) and 75.00% (VC)] and “AT ≥ 10 s” [sensitivity: 64.94% (DC) and 61.61% (VC); specificity: 72.73% (DC) and 66.67% (VC)].ConclusionThe prediction model integrating multiple parameters of B-mode US and CEUS can accurately predict the malignancy probability, so as to effectively differentiate between benign and malignant SPLs, and has better diagnostic performance than the existing US diagnostic criteria.Clinical Trial Registrationwww.chictr.org.cn, identifier ChiCTR1800019828.

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“…Dear Editor, Jacobsen N et al [1] have published in this journal an interesting systematic literature review of the clinical application of contrast-enhanced thoracic ultrasound (CETUS). CETUS is a real-time ultrasound technique evaluating tissue perfusion using an injected suspension of gas microbubbles that enhances the echogenicity of the intravascular 'blood pool'.…”

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confidence: 99%