RSS-Feed abonnieren
DOI: 10.1055/a-1143-3141
Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review
Klinische Anwendungen von kontrastverstärktem Thorax-Ultraschall (CETUS) im Vergleich zu Standard-Referenztests: Eine systematische Übersichtsarbeit![](https://www.thieme-connect.de/media/ultraschall/202201/lookinside/thumbnails/uim-3124_10-1055-a-1143-3141-1.jpg)
Abstract
Introduction Contrast-enhanced ultrasound is utilized in an increasing array of medical fields, including thoracic medicine. However, the technique is still relatively new and only sporadically mentioned in current guidelines and recommendations. The aim of this systematic review is to provide a literature overview and to critically appraise the current clinical applications of contrast-enhanced thoracic ultrasound (CETUS).
Materials and Methods A systematic literature search using major electronic databases and in accordance with PRISMA guidelines was performed. Studies with a primary focus on CETUS of thoracic disorders compared to a standard reference test were included. The QUADAS-2 tool was used for quality assessment of the studies.
Results The search identified 43 articles: 1 randomized controlled study, 6 non-randomized controlled studies, 16 non-randomized non-controlled studies, 5 case series, 10 single case reports, and 5 animal studies. The overall risk of bias was judged to be high. Diagnostic accuracy measurements of noninvasive applications of CETUS were only reported in a few studies and they were too dissimilar for meta-analysis. Six studies compared CETUS-guided versus ultrasound-guided transthoracic needle biopsy of thoracic masses. They individually reported a significant increase in diagnostic accuracy in favor of CETUS guidance but were too heterogeneous for meta-analysis.
Conclusion The current literature on CETUS is overall heterogeneous with a few high evidence level studies, small study populations and a high risk of bias. CETUS-guided biopsy is the most frequent clinical application and increases diagnostic accuracy compared to ultrasound guidance by an average of 14.6 percentage points.
Zusamenfassung
Einleitung Der kontrastverstärkte Ultraschall wird in immer mehr medizinischen Bereichen eingesetzt, darunter auch in der Thoraxmedizin. Diese Technik ist jedoch noch relativ neu und wird in aktuellen Richtlinien und Empfehlungen nur sporadisch erwähnt. Ziel dieser systematischen Übersichtsarbeit ist es, einen Literaturüberblick zu geben und die aktuellen klinischen Anwendungen des kontrastverstärkten Thorax-Ultraschalls (CETUS) kritisch zu bewerten.
Material und Methoden Es wurde eine systematische Literaturrecherche unter Verwendung der wichtigsten elektronischen Datenbanken in Übereinstimmung mit den PRISMA-Richtlinien durchgeführt. Eingeschlossen wurden Studien mit dem primären Schwerpunkt auf CETUS bei Erkrankungen des Thorax im Vergleich zum Standard-Referenztest. Das QUADAS-2-Tool wurde angewandt, um die Qualität der Studien zu beurteilen.
Ergebnisse Die Suche ergab 43 Artikel, davon 1 randomisierte kontrollierte Studie, 6 nichtrandomisierte kontrollierte Studien, 16 nichtrandomisierte nichtkontrollierte Studien, 5 Fallserien, 10 Einzelfallberichte und 5 Tierstudien. Das Bias-Risiko (Risiko für systematische Fehler) wurde insgesamt als hoch bewertet. Über Messungen der diagnostischen Genauigkeit von nichtinvasiven CETUS-Anwendungen wurde nur in wenigen Studien berichtet und diese waren für eine Metaanalyse zu unterschiedlich. In 6 Studien wurde die CETUS-geführte mit der ultraschallgeführten transthorakalen Nadelbiopsie bei Raumforderungen des Thorax verglichen. Jede von ihnen berichtete von einem signifikanten Anstieg der diagnostischen Genauigkeit zugunsten der CETUS-geführten Nadelbiopsie; die Studien waren jedoch für eine Metaanalyse zu heterogen.
Schlussfolgerung Die aktuelle Literatur zu CETUS ist insgesamt heterogen bei wenigen Studien mit hoher Evidenz, kleinen Studienpopulationen und einem hohen Bias-Risiko. Die CETUS-gesteuerte Biopsie ist die häufigste klinische Anwendung und erhöht die diagnostische Genauigkeit im Vergleich zur Ultraschallführung im Durchschnitt um 14,6 Prozentpunkte.
Publikationsverlauf
Eingereicht: 25. Oktober 2019
Angenommen: 25. Februar 2020
Artikel online veröffentlicht:
07. April 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Wisnivesky J, De-Torres JP. The Global Burden of Pulmonary Diseases: Most Prevalent Problems and Opportunities for Improvement. Ann Glob Health 2019; 85 DOI: 10.5334/aogh.2411.
- 2 Shah DJ, Sachs RK, Wilson DJ. Radiation-induced cancer: a modern view. Br J Radiol 2012; 85: e1166-e1173 DOI: 10.1259/bjr/25026140.
- 3 Neumann RD, Bluemke DA. Tracking radiation exposure from diagnostic imaging devices at the NIH. J Am Coll Radiol 2010; 7: 87-89 DOI: 10.1016/j.jacr.2009.07.012.
- 4 Morzycki A, Bhatia A, Murphy KJ. Adverse Reactions to Contrast Material: A Canadian Update. Can Assoc Radiol J 2017; 68: 187-193 DOI: 10.1016/j.carj.2016.05.006.
- 5 Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015; 147: 1659-1670 DOI: 10.1378/chest.14-1313.
- 6 Li YL, Hyun D, Abou-Elkacem L. et al Visualization of Small-Diameter Vessels by Reduction of Incoherent Reverberation With Coherent Flow Power Doppler. IEEE Trans Ultrason Ferroelectr Freq Control 2016; 63: 1878-1889 DOI: 10.1109/tuffc.2016.2616112.
- 7 Sidhu PS, Cantisani V, Dietrich CF. et al The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in Med 2018; 39: e2-e44 DOI: 10.1055/a-0586-1107.
- 8 Nolsoe CP, Nolsoe AB, Klubien J. et al Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay. J Ultrasound Med 2018; 37: 1305-1324 DOI: 10.1002/jum.14498.
- 9 Claudon M, Dietrich CF, Choi BI. et al Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver – update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210 DOI: 10.1016/j.ultrasmedbio.2012.09.002.
- 10 Piscaglia F, Nolsoe C, Dietrich CF. et al The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med 2012; 33: 33-59 DOI: 10.1055/s-0031-1281676.
- 11 Moher D, Liberati A, Tetzlaff J. et al Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097 DOI: 10.1371/journal.pmed.1000097.
- 12 Whiting PF, Rutjes AW, Westwood ME. et al QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536 DOI: 10.7326/0003-4819-155-8-201110180-00009.
- 13 Yi D, Feng M, Wen Ping W. et al Contrast-enhanced US-guided percutaneous biopsy of anterior mediastinal lesions. Diagn Interv Radiol 2017; 23: 43-48 DOI: 10.5152/dir.2016.15590.
- 14 Zhou JH, Shan HB, Ou W. et al Contrast-Enhanced Ultrasound Improves the Pathological Outcomes of US-Guided Core Needle Biopsy That Targets the Viable Area of Anterior Mediastinal Masses. Biomed Res Int 2018; 2018: 9825709 DOI: 10.1155/2018/9825709.
- 15 Sperandeo M, Rea G, Grimaldi MA. et al Contrast-enhanced ultrasound does not discriminate between community acquired pneumonia and lung cancer. Thorax 2017; 72: 178-180 DOI: 10.1136/thoraxjnl-2016-208913.
- 16 Mao F, Dong Y, Ji Z. et al. Mao 2017 Comparison of contrast-enhanced ultrasound and conventional ultrasound for guiding peripheral pulmonary biopsies. Int J Clin Exp Med 2017; 10: 3677-3684
- 17 Fu J, Yang W, Wang S. et al Clinical value of contrast-enhanced ultrasound in improving diagnostic accuracy rate of transthoracic biopsy of anterior-medial mediastinal lesions. Chinese Journal of Cancer Research 2016; 28: 617-625 DOI: 10.21147/j.issn.1000-9604.2016.06.08.
- 18 Wang S, Yang W, Zhang H. et al The Role of Contrast-Enhanced Ultrasound in Selection Indication and Improveing Diagnosis for Transthoracic Biopsy in Peripheral Pulmonary and Mediastinal Lesions. Biomed Res Int 2015; 2015: 231782 DOI: 10.1155/2015/231782.
- 19 Cao BS, Wu JH, Li XL. et al Sonographically Guided Transthoracic Biopsy of Peripheral Lung and Mediastinal Lesions Role of Contrast-Enhanced Sonography. J Ultras Med 2011; 30: 1479-1490 DOI: 10.7863/jum.2011.30.11.1479.
- 20 Trenker C, Wilhelm C, Neesse A. et al Contrast-Enhanced Ultrasound in Pulmonary Lymphoma: A Small Pilot Study. J Ultrasound Med 2018; 37: 2943-2947 DOI: 10.1002/jum.14651.
- 21 Lei Z, Lou J, Bao L. et al Contrast-enhanced ultrasound for needle biopsy of central lung cancer with atelectasis. Journal of Medical Ultrasonics 2017; 45: 461-467 DOI: 10.1007/s10396-017-0851-0.
- 22 Trenker C, Apitzsch JC, Pastor S. et al Detection of peripheral embolic consolidations using contrast-enhanced ultrasonography in patients with no evidence of pulmonary embolism on computed tomography: A pilot study. J Clin Ultrasound 2017; 45: 575-579 DOI: 10.1002/jcu.22511.
- 23 Bai J, Yang W, Wang S. et al Role of Arrival Time Difference Between Lesions and Lung Tissue on Contrast-Enhanced Sonography in the Differential Diagnosis of Subpleural Pulmonary Lesions. J Ultras Med 2016; 35: 1523-1532 DOI: 10.7863/ultra.15.08022.
- 24 Wang S, Yang W, Fu JJ. et al Microflow imaging of contrast-enhanced ultrasound for evaluation of neovascularization in peripheral lung cancer. Medicine (Baltimore) 2016; 95: e4361 DOI: 10.1097/MD.0000000000004361.
- 25 Hong-xia Z, Wen H, Ling-gang C. et al A New Method for Discriminating between Bronchial and Pulmonary Arterial Phases using Contrast-Enhanced Ultrasound. Ultrasound in Medicine & Biology 2016; 42: 1441-1449 DOI: 10.1016/j.ultrasmedbio.2016.01.029.
- 26 Bartelt S, Trenker C, Görg C. et al Contrast-enhanced ultrasound of embolic consolidations in patients with pulmonary embolism: A pilot study. Journal of Clinical Ultrasound 2016; 44: 129-135 DOI: 10.1002/jcu.22313.
- 27 Dong Y, Mao F, Wang WP. et al Value of Contrast-Enhanced Ultrasound in Guidance of Percutaneous Biopsy in Peripheral Pulmonary Lesions. BioMed Research International 2015; 2015: 1-7 DOI: 10.1155/2015/531507.
- 28 Wang J, Zhou D, Xie X. et al. Utility of contrast-enhanced ultrasound with SonoVue in biopsy of small subpleural nodules. Int J Clin Exp Med 2015; 8: 15991-15998
- 29 Sartori S, Postorivo S, Vece FD. et al Contrast-enhanced ultrasonography in peripheral lung consolidations: What's its actual role?. World J Radiol 2013; 5: 372-380 DOI: 10.4329/wjr.v5.i10.372.
- 30 Cao BS, Liang YM, Li XL. et al Contrast-Enhanced Sonography of Juxtapleural Pulmonary Tuberculoma. J Ultras Med 2013; 32: 749-756 DOI: 10.7863/ultra.32.5.749.
- 31 Linde HN, Holland A, Greene B. et al Kontrastunterstützte Sonografie (CEUS) bei Pneumonie: Darstellungsmuster und prognostische Bedeutung – eine retrospektive Studie bei n=50 Patienten. Ultraschall in der Medizin – European Journal of Ultrasound 2011; 33: 146-151 DOI: 10.1055/s-0031-1273280.
- 32 Qureshi NR, Hintze C, Risse F. et al The feasibility of low mechanical index contrast enhanced ultrasound (CEUS) in distinguishing malignant from benign thoracic lesions. Ultrasound Med Biol 2011; 37: 1747-1754 DOI: 10.1016/j.ultrasmedbio.2011.08.003.
- 33 Caremani M, Benci A, Lapini L. et al Contrast enhanced ultrasonography (CEUS) in peripheral lung lesions: A study of 60 cases. Journal of Ultrasound 2008; 11: 89-96 DOI: 10.1016/j.jus.2008.05.008.
- 34 Görg C, Bert T, Kring R. et al Transcutaneous contrast enhanced sonography of the chest for evaluation of pleural based pulmonary lesions: experience in 137 patients. Ultraschall in der Medizin – European Journal of Ultrasound 2006; 27: 437-444 DOI: 10.1055/s-2006-927021.
- 35 Sperandeo M, Sperandeo G, Varriale A. et al Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study. Ultrasound Med Biol 2006; 32: 1467-1472 DOI: 10.1016/j.ultrasmedbio.2006.06.018.
- 36 Deganello A, Rafailidis V, Sellars ME. et al Intravenous and Intracavitary Use of Contrast-Enhanced Ultrasound in the Evaluation and Management of Complicated Pediatric Pneumonia. J Ultras Med 2017; 36: 1943-1954 DOI: 10.1002/jum.14269.
- 37 Sparchez Z, Radu P, Kacso G. et al. Contrast-enhanced ultrasound guided biopsy of superficial toraco-abdominal and neck lesions. Initial experience in 20 patients. Med Ultrason 2012; 14: 288-293
- 38 Caremani M, Benci A, Tacconi D. et al Sonographic management of mediastinal syndrome. Journal of Ultrasound 2009; 12: 61-68 DOI: 10.1016/j.jus.2009.03.001.
- 39 Gorg C, Bert T, Kring R. Contrast-enhanced sonography of the lung for differential diagnosis of atelectasis. J Ultras Med 2006; 25: 35-39
- 40 Gorg C, Bert T, Gorg K. Contrast-enhanced sonography for differential diagnosis of pleurisy and focal pleural lesions of unknown cause. Chest 2005; 128: 3894-3899 DOI: 10.1378/chest.128.6.3894.
- 41 García-Alfonso L, Vollmer I, Benegas M. et al Contrast-Enhanced Ultrasound in the Diagnosis of Rounded Atelectasis: A Case Report. Archivos de Bronconeumología (English Edition) 2018; 54: 113-114 DOI: 10.1016/j.arbr.2017.12.001.
- 42 Laursen CB, Graumann O, Møller TV. et al Contrast-enhanced Ultrasound–guided Transthoracic Lung Biopsy. American Journal of Respiratory and Critical Care Medicine 2016; 194: e5-e6 DOI: 10.1164/rccm.201603-0500IM.
- 43 Tombesi P, Di Vece F, Ermili F. et al Active bleeding revealed by contrast-enhanced ultrasonography: beyond the abdominal cavity. J Med Ultrason (2001) 2014; 41: 247-249 DOI: 10.1007/s10396-013-0493-9.
- 44 Di Vece F, Tombesi P, Ermili F. et al Contrast-enhanced ultrasound (CEUS) and CEUS-guided biopsy in the diagnosis of lung abscess in a patient with achalasia: Case report. Interv Med Appl Sci 2013; 5: 31-33 DOI: 10.1556/imas.5.2013.1.6.
- 45 Nilsson A, Krause J. Targeted tumour biopsy under contrast-enhanced ultrasound guidance. Eur Radiol 2003; 13 (Suppl. 04) L239-L240 DOI: 10.1007/s00330-003-1823-x.
- 46 Tombesi P, Di Vece F, Salviato E. et al Spontaneous active bleeding in thoracoacromial artery diagnoses by contrast-enhanced ultrasound – a case report. Ultraschall in Med 2012; 33: E355-E356 DOI: 10.1055/s-0032-1325325.
- 47 Badea R, Barsan M, Mercea V. et al A case report of solitary fibrous tumor of the pleura: ultrasound diagnostic features. Journal of Medical Ultrasonics 2012; 39: 97-100 DOI: 10.1007/s10396-011-0338-3.
- 48 Sugihara T, Koda M, Tokunaga S. et al Contrast-enhanced ultrasonography revealed active thoracic bleeding. J Med Ultrason (2001) 2010; 37: 143-145 DOI: 10.1007/s10396-010-0257-8.
- 49 Tombesi P, Sartori S, Postorivo S. et al Contrast-enhanced ultrasonographically guided percutaneous biopsy in the diagnosis of paravertebral schwannoma. J Ultrasound Med 2009; 28: 1747-1750 DOI: 10.7863/jum.2009.28.12.1747.
- 50 Sartori S, Nielsen I, Trevisani L. et al Contrast-enhanced sonography as guidance for transthoracic biopsy of a peripheral lung lesion with large necrotic areas. J Ultras Med 2004; 23: 133-136 DOI: 10.7863/jum.2004.23.1.133.
- 51 Xing J, He W, Ding YW. et al Correlation between Contrast-Enhanced Ultrasound and Microvessel Density via CD31 and CD34 in a rabbit VX2 lung peripheral tumor model. Med Ultrason 2018; 1: 37-42 DOI: 10.11152/mu-1234.
- 52 Linta N, Baron Toaldo M, Bettini G. et al The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats. BMC Veterinary Research 2017; 13 DOI: 10.1186/s12917-017-1061-0.
- 53 Rick T, Kleiter M, Schwendenwein I. et al. Contrast-enhanced ultrasonography of peripheral pulmonary and mediastinal mass lesions in dogs and cats. Vet Radiol Ultrasound 2016; 57: 84-98
- 54 Caivano D, Birettoni F, Bufalari A. et al Contrast-enhanced ultrasonographic findings in three dogs with lung lobe torsion. Journal of Veterinary Medical Science 2016; 78: 427-430 DOI: 10.1292/jvms.15-0417.
- 55 Zhuo J, Fu W, Liu S. Correlation of contrast-enhanced ultrasound with two distinct types of blood vessels for the assessment of angiogenesis in lewis lung carcinoma. Ultraschall in Med 2014; 35: 468-472 DOI: 10.1055/s-0033-1356194.
- 56 Dietrich CF, Averkiou M, Nielsen MB. et al How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 2018; 4: E2-E15 DOI: 10.1055/s-0043-123931.
- 57 Nguyen-Kim TD, Frauenfelder T, Strobel K. et al Assessment of bronchial and pulmonary blood supply in non-small cell lung cancer subtypes using computed tomography perfusion. Invest Radiol 2015; 50: 179-186 DOI: 10.1097/rli.0000000000000124.
- 58 Yuan X, Zhang J, Ao G. et al Lung cancer perfusion: can we measure pulmonary and bronchial circulation simultaneously?. Eur Radiol 2012; 22: 1665-1671 DOI: 10.1007/s00330-012-2414-5.
- 59 di Bardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. J Thorac Dis 2015; 7: S304-S316 DOI: 10.3978/j.issn.2072-1439.2015.12.16.
- 60 Montaudon M, Latrabe V, Pariente A. et al Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions. Eur Radiol 2004; 14: 1234-1240 DOI: 10.1007/s00330-004-2250-3.
- 61 Francica G, Meloni MF, de Sio I. et al Biopsy of Liver Target Lesions under Contrast-Enhanced Ultrasound Guidance – A Multi-Center Study. Ultraschall in Med 2018; 39: 448-453 DOI: 10.1055/s-0043-122496.
- 62 Wu W, Chen MH, Yin SS. et al The role of contrast-enhanced sonography of focal liver lesions before percutaneous biopsy. Am J Roentgenol 2006; 187: 752-761 DOI: 10.2214/ajr.05.0535.
- 63 Bray F, Ferlay J, Soerjomataram I. et al Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424 DOI: 10.3322/caac.21492.