Perfusion Patterns of Peripheral Pulmonary Granulomatous Lesions Using Contrast‐Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns

Abstract

Purpose To describe the perfusion patterns of peripheral pulmonary granulomatous lesions (PPGLs) by contrast‐enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical (CD34) endothelial staining. Patients and methods From January 2007 until September 2020, 10 consecutive patients with histologically confirmed PPGLs were investigated by CEUS. The time to enhancement, classified as early pulmonary‐arterial (PA) pattern of enhancement versus delayed bronchial‐arterial (BA) pattern of enhancement, the extent of enhancement, classified as marked or reduced, the homogeneity of enhancement, classified as homogeneous or inhomogeneous, and the decrease of enhancement, classified as rapid washout (<120 seconds) or a late washout (≥120 seconds), were analyzed retrospectively. Furthermore, the tissue samples from the study patients and as a control group, 10 samples of normal lung tissue obtained by autopsy, and 10 samples of lung tissue with acute pneumonia obtained by autopsy were immunohistochemically stained with CD34 antibody. The presence of avascular areas (AAs) and the VPs were evaluated in all tissue samples. Results On CEUS, all PPGLs showed a reduced inhomogeneous BA pattern of enhancement and a rapid washout (<120 seconds). On CD34 staining, all PPGLs showed central AAs in granulomas and a chaotic VP similar to angiogenesis in lung tumors. The lung tissue in control groups revealed on CD34 staining a regular alveolar VP. Conclusion The PPGLs on CEUS show an identical perfusion pattern similar to those of malignant lesions. Furthermore, for the first time, neoangiogenesis was demonstrated as a histopathological correlate to BA pattern of enhancement on CEUS.

Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions

“…This finding can be used in combination with clinical suspicion to improve the identification of malignant PEs in patients with initially negative cytological results. A further value of CEUS is the identification of disturbed perfusion of associated lung consolidation [20,28,29]. Inhomogeneous perfusion seen in the CEUS can be found in various pathological conditions, including peripheral pulmonary infarction, peripheral pulmonary granulomatous lesions [28], chronic pneumonia-associated lung abscess, and tumour-associated necrosis or vascularisation disturbance in the consolidated lung [15,29].…”

“…A further value of CEUS is the identification of disturbed perfusion of associated lung consolidation [20,28,29]. Inhomogeneous perfusion seen in the CEUS can be found in various pathological conditions, including peripheral pulmonary infarction, peripheral pulmonary granulomatous lesions [28], chronic pneumonia-associated lung abscess, and tumour-associated necrosis or vascularisation disturbance in the consolidated lung [15,29]. PE-associated lung consolidations with peripheral wedge-shaped non-perfused areas are highly suggestive of infarction in patients with pulmonary embolic disease [20,30].…”

Perfusion Patterns of Peripheral Organizing Pneumonia (POP) Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns

“…For the first 30 s, the perfusion patterns of the lesions were continuously examined and recorded by a clip. Subsequently, several short examinations were performed at one-minute intervals up to 3 min, and the changes in the perfusion pattern were saved as images [17].…”

“…All ultrasound examinations were performed in the upright sitting position and horizontal to the ribs [17].…”

“…B-mode lung ultrasound (LUS) is considered to be a noninvasive complementary diagnostic method in addition to CT and PET-CT for the assessment of peripheral-based pulmonary lesions [7]. Furthermore, the visualization of the perfusion patterns of peripheral pulmonary lesions using contrast enhanced ultrasound (CEUS) improves the specificity of the B-mode LUS for the evaluation of these lesions and has been described for pleurisy, community-acquired pneumonia, pulmonary infarcts, peripheral granulomatous lesions, and peripheral lung cancer [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. In contrast to the previous entities, to the best of our knowledge, neither B-mode LUS nor CEUS data for histologically confirmed OP have been reported in a large patient cohort.…”