Vascularization of Primary, Peripheral Lung Carcinoma in CEUS – A Retrospective Study (n = 89 Patients)

Abstract

Purpose To describe the vascularization of peripheral lung carcinoma in CEUS and to compare with B-mode ultrasound (US) and clinical data. Materials and Methods From April 2004 until September 2015, n = 89 patients with peripheral lung carcinoma were investigated by B-mode US and CEUS. The extent (EE: hypoechoic, hyperechoic), homogeneity (HE: homogeneous, inhomogeneous) and time of enhancement (TE) have been defined. Early pulmonary-arterial enhancement (PA) before contrast floating to the thoracic wall was differentiated from simultaneous or delayed bronchial-arterial enhancement (BA). CEUS parameters were compared by B-mode US and histology. Results n = 25 patients had early PA enhancement (TE: 8 ± 3.7 s), and n = 64 (72 %) had simultaneous/delayed BA enhancement (TE: 17.6 ± 6.2 s) (p < 0.001). PA enhancement (EE/HE) was hyperechoic (n = 11/25), homogeneous (n = 11/25) and showed an air bronchogram more often (n = 11/17, p < 0.001). BA enhancement (EE/HE) was frequently hypoechoic (n = 34/64) and inhomogeneous (n = 54/64). BA enhancement was associated with necrosis (n = 36/42, p = 0.009). PA and BA enhancement distributed to different histologies: n = 42 adenocarcinomas (18 PA, 24 BA), n = 30 squamous cell carcinomas (4 PA, 26 BA), n = 13 other types of NSCLC (3 PA, 10 BA), and n = 4 SCLC (0 PA, 4 BA) (p = 0.016). Conclusion The vascularization of peripheral lung carcinomas is heterogeneous and is influenced by histology. In this study, lung carcinomas are predominantly supplied by bronchial arteries, whereas a part of adenocarcinomas and non-adenocarcinomas show PA enhancement.

Recommendations for Operation, Measurement, Reporting and Application of Pediatric Lung Ultrasound: Chinese Experts Consensus

“…In open surgery, lung ultrasound can also be utilized in patients with unstable cardiopulmonary conditions or suspected pneumothorax [9,10]. For neoplastic diseases, lung ultrasound can identify nodules and metastatic lesions in the pleural cavity and subpleural areas [11]. In interventional surgery, guiding the biopsy of sub-pleural lung parenchyma or lung nodules in real time is another application of lung ultrasound [12].…”

Letter to the Editor Regarding the Article: “Vascularization of Primary, Peripheral Lung Carcinoma in CEUS – A Retrospective Study (n = 89 Patients)” by Findeisen H et al.

“…The article entitled "Vascularization of Primary, Peripheral Lung Carcinoma in CEUS -A Retrospective Study (n = 89 Patients)" by Findeisen H et al [1] described the vascularization of peripheral lung carcinoma in contrast-enhanced ultrasound (CEUS) and concluded that "lung carcinomas are predominantly supplied by bronchial arteries (BA), whereas a part of adenocarcinomas and non-adenocarcinomas show pulmonary artery (PA) enhancement". The premise of the authors is that "due to dual pulmonary blood vascularization, more precisely the nutritive bronchial artery system and functional role of the pulmonary arteries, analogous to the hepatic vasculature, CEUS is of particular interest for the examination of peripheral lung consolidations regarding the type of arterial blood supply".…”

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

“…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.…”

“…The time to enhancement (TE) of the contrast agent after intravenous injection was determined and classified as an early pulmonary-arterial (PA) pattern of enhancement (contrast enhancement of the lesion before the arrival of contrast agent in the thoracic wall) vs. delayed bronchial-arterial (BA) pattern of enhancement (contrast enhancement of the lesion simultaneous with the arrival of contrast agent in the thoracic wall or parenchymal organs) [17,19,25].…”

“…The extent of enhancement (EE) in the arterial phase was categorized as reduced EE (echo-free/hypoechoic) vs. marked EE (isoechoic) [17,19,25].…”