Background/Objectives:This systematic review describes a largely descriptive synthesis of studies investigating the diagnostic performance of quantitative contrast-enhanced ultrasound (CEUS) in differentiating benign from malignant peripheral pulmonary lesions.Methods: Formal quantitative pooling of effect sizes was not feasible due to variability in outcome measurements and reporting.Results:Combining CEUS parameters with real-time on-site evaluation (ROSE) substantially improved percutaneous biopsy success rates. In one comparative study, biopsy yield reached 97.62% with CEUS, versus 84% using conventional ultrasound, while complications remained minimal. Other investigations focused on the discriminatory value of specific time-based indices (e.g., AT ≥ 10 s, lesion-lung AT difference ≥ 2.5 s) or complex multi-parameter models. A notable large study demonstrated that a six-parameter logistic regression model achieved near-excellent discrimination, with C-statistics exceeding 0.97 for both development and validation cohorts, outperforming single-threshold approaches. Nevertheless, certain findings emphasize that no single indicator—particularly arrival time alone—reliably distinguishes benign from malignant lesions, given the diverse vascular patterns and histological subtypes involved. TDOA-based analyses proved more promising, as malignant lesions generally exhibit a delayed but robust bronchial arterial supply and rapid washout. Heterogeneity in ultrasound systems, operator experience, and patient populations further underscores the need for standardized protocols.Conclusions: Overall, these data suggest that CEUS, particularly when combined with additional sonographic or cytological tools, significantly enhances diagnostic precision for peripheral pulmonary lesions.
背景/目的：本系统综述主要对定量对比增强超声（CEUS）鉴别周围性肺部良恶性病变诊断性能的研究进行描述性综合。 方法：由于结局指标测量和报告方式存在差异，无法对效应量进行正式的定量合并分析。 结果：将CEUS参数与实时现场评估（ROSE）相结合，显著提高了经皮穿刺活检的成功率。一项对比研究显示，使用CEUS引导的活检阳性率达97.62%，而传统超声引导仅为84%，且并发症发生率极低。其他研究重点关注特定时间参数（如达峰时间≥10秒、病灶-肺组织达峰时间差≥2.5秒）或复杂多参数模型的鉴别价值。一项大型研究证实，六参数逻辑回归模型具有接近完美的区分能力，开发队列和验证队列的C统计量均超过0.97，优于单一阈值方法。然而，鉴于病变血管模式和组织学亚型的多样性，部分研究强调单一指标（特别是单独使用达峰时间）无法可靠区分良恶性病变。基于时间-强度曲线差值（TDOA）的分析更具前景，因为恶性病变通常表现为延迟但显著的支气管动脉供血及快速廓清。超声设备、操作者经验和患者群体的异质性进一步凸显了标准化操作流程的必要性。 结论：总体而言，现有数据表明CEUS（尤其是联合其他超声或细胞学技术）能显著提升周围性肺部病变的诊断精确度。
Role of Quantitative CEUS in the Diagnosis of Peripheral Pulmonary Lesions: A Systematic Review
肿瘤(癌症)患者之家