Introduction:Ultrasound elastography is increasingly used across medical imaging, yet its role in thoracic disease remains poorly defined. While both transthoracic ultrasonography (TUS) and endobronchial ultrasound (EBUS) offer real-time assessment of pleural and pulmonary structures, the diagnostic and clinical value of elastography in this context remains uncertain.Materials and Method:A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted according to PRISMA guidelines (April 2023; updated January 2025). Original studies evaluating transthoracic or endobronchial elastography for pleural or pulmonary conditions were included. Data extraction and quality assessment were performed independently by three reviewers, with QUADAS-2 used to evaluate risk of bias.Results:Thirty studies met inclusion criteria. Twenty-eight evaluated TUS elastography and two examined EBUS. Shear wave elastography was most frequently applied, particularly for differentiating malignant from benign pleural effusion or subpleural lesions. Surface wave elastography demonstrated consistently higher stiffness values in patients with interstitial lung disease compared with healthy controls, correlating with radiological and functional disease severity. Elastography-guided pleural biopsy improved diagnostic yield compared with conventional ultrasound-guided biopsy. Overall, substantial methodological variation existed among scanning techniques, elastography modalities, reporting methods, and diagnostic thresholds, limiting cross-study comparison.Conclusions:Ultrasound elastography shows promise for evaluating pleural effusion and pulmonary lesions, procedural guidance, and interstitial lung disease possibly improving diagnostic possibilities with bedside evaluation and reducing patient exposure to radiation. However, methodological variation and limited high-quality evidence preclude clinical implementation. Standardized acquisition protocols and multicentre validation studies are necessary to define its diagnostic utility in thoracic imaging.
引言：超声弹性成像在医学影像中的应用日益广泛，但其在胸部疾病中的作用仍不明确。尽管经胸超声（TUS）和支气管内超声（EBUS）均可对胸膜及肺部结构进行实时评估，但弹性成像在此领域的诊断与临床价值尚未明确。 材料与方法：根据PRISMA指南（2023年4月检索，2025年1月更新）对MEDLINE、EMBASE和Cochrane图书馆进行系统性检索。纳入评估经胸或支气管内弹性成像用于胸膜或肺部疾病诊断的原始研究。由三位评审员独立完成数据提取和质量评估，并采用QUADAS-2工具评估偏倚风险。 结果：共纳入30项研究。其中28项评估经胸超声弹性成像，2项研究支气管内超声弹性成像。剪切波弹性成像应用最为广泛，尤其在鉴别恶性与良性胸腔积液或胸膜下病变方面。表面波弹性成像显示，间质性肺疾病患者的组织硬度值持续高于健康对照组，且与影像学及功能学疾病严重程度相关。与传统超声引导活检相比，弹性成像引导的胸膜活检显著提高了诊断阳性率。总体而言，各研究在扫描技术、弹性成像模式、报告方法和诊断阈值方面存在显著的方法学差异，限制了跨研究比较。 结论：超声弹性成像在评估胸腔积液与肺部病变、引导介入操作及诊断间质性肺疾病方面展现出潜力，有望通过床旁评估提升诊断效能并减少患者辐射暴露。然而，方法学的异质性和高质量证据的缺乏阻碍了其临床推广应用。未来需要建立标准化的采集方案并开展多中心验证研究，以明确其在胸部影像中的诊断价值。
Application of Transthoracic and Endobronchial Elastography—A Systematic Review
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