Download PDF
Ultraschall Med 2019; 40(05): 603-608
DOI: 10.1055/a-0725-7865
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

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

Vaskularisation primärer peripherer Lungenkarzinome in der kontrastmittelunterstützten Sonografie (CEUS) – retrospektive Studie bei n = 89 Patienten
Hajo Findeisen
1   Interdisciplinary Centre for Ultrasound Diagnostics, Philipps-University of Marburg, Germany
,
Corinna Trenker
2   Hematology, Oncology and Immunology, Philipps-University of Marburg, Germany
,
Jens Figiel
3   Diagnostic and Interventional Radiology, Philipps-University of Marburg, Germany
,
Brandon H. Greene
4   Epidemiology and Biostatistics, Philipps-University of Marburg, Germany
,
Konrad Görg
2   Hematology, Oncology and Immunology, Philipps-University of Marburg, Germany
,
Christian Görg
1   Interdisciplinary Centre for Ultrasound Diagnostics, Philipps-University of Marburg, Germany
› Author Affiliations
Further Information

Publication History

18 January 2018

18 August 2018

Publication Date:
17 October 2018 (online)

Also available at
    Permissions and Reprints

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.

Zusammenfassung

Ziel Beschreibung von B-Bild-Ultraschall (US) und CEUS-Mustern peripherer Lungenkarzinome mittels CEUS in Bezug zu Histologie und klinischen Parametern.

Material und Methoden Im Zeitraum von April 2004 bis September 2015 wurden n = 89 Patienten mit histologisch gesichertem peripherem Lungenkarzinom im B-Bild-US und CEUS untersucht. In der CEUS wurden Ausmaß (EE: hypoechogen, hyperechogen), Homogenität (HE: homogen, inhomogen) und die Zeit zum Enhancement (TE) bestimmt. Ein vorzeitiges pulmonal-arterielles Enhancement (PA) wurde im Vergleich zur Thoraxwand von einem zeitgleichen bronchial-arteriellen Enhancement (BA) unterschieden. CEUS-Daten wurden mit B-Bild-US und Histologie verglichen.

Ergebnisse n = 25 Patienten (28 %) hatten ein vorzeitiges PA-Enhancement (TE: 8 ± 3,7 s), n = 64 (72 %) ein zeitgleiches BA-Enhancement (TE: 17,6 ± 6,2 s) (p < 0,001). Das PA-Enhancement (EE/HE) war hyperechogen (n = 11/25), homogen (n = 11/25) und zeigte im B-Bild-US häufiger ein Aerobronchogramm (n = 11/17, p < 0,001). Das BA-Enhancement (EE/HE) war bevorzugt hypoechogen (n = 34/64) und inhomogen (n = 54/64). Bei einem BA-Enhancement fanden sich häufiger Nekrosen (n = 36/42, p = 0,009). PA- und BA-Enhancement verteilten sich in den unterschiedlichen Histologien: n = 42 Adenokarzinome (18 PA, 24 BA), n = 30 Plattenepithelkarzinome (4 PA, 26 BA), n = 13 sonstige NSCLC (3 PA, 10 BA) und n = 4 SCLC (0 PA, 4 BA) (p = 0,016).

Schlussfolgerung Die Vaskularisation von peripheren Lungenkarzinomen ist heterogen und wird durch die Histologie beeinflusst. Es zeigt sich neben einer vorherrschend bronchial-arteriellen Versorgung von malignen Lungentumoren auch ein Anteil von Adenokarzinomen und Nicht-Adenokarzinomen, die ein PA-Enhancement aufweisen.

Key words

peripheral lung carcinoma - tumor vascularization - lung ultrasound - contrast-enhanced sonography
 

  • References

  • 1 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 2006; 27: 437-444 . doi:10.1055/s-2006-927021
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 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 der Medizin 2012; 33: 33-59 . doi:10.1055/s-0031-1281676
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Görg C. Transcutaneous contrast-enhanced sonography of pleural-based pulmonary lesions. European Journal of Radiology 2007; 64: 213-221 . doi:10.1016/j.ejrad.2007.06.037
    CrossrefPubMedGoogle Scholar
  • 4 Wright RD. The blood supply of abnormal tissues in the lungs. J Pathol 1938; 47: 489-499 . doi:10.1002/path.1700470311
    CrossrefPubMedGoogle Scholar
  • 5 Wood D, Miller M. The role of the dual pulmonary circulation in various pathologic conditions. J Thorac Surg 1938; 7: 649-670
    PubMedGoogle Scholar
  • 6 Boijsen E, Zsigmond M. Selective angiography of bronchial and intercostal arteries. Actaradiologica: diagnosis 1965; 3: 513-528
    PubMedGoogle Scholar
  • 7 Neyazaki T, Ikeda M, Mitsui K. et al. Angioarchitecture of pulmonary malignancies in humans. Cancer 1970; 26: 1246-1255 . doi:10.1002/1097-0142(197012)26:6<1246: AID-CNCR2820260611>3.0.CO;2-I
    CrossrefPubMedGoogle Scholar
  • 8 Hsu WH, Yu YH, Tu CY. et al. Color Doppler US pulmonary artery vessel signal: a sign for predicting the benign lesions. Ultrasound in Medicine &Biology 2007; 33: 379-388 . doi:10.1016/j.ultrasmedbio.2006.08.011
    PubMedGoogle Scholar
  • 9 Hsu WH, Ikezoe J, Chen CY. et al. Color Doppler ultrasound signals of thoracic lesions. Correlation with resected histologic specimens. American journal of respiratory and critical care medicine 1996; 153: 1938-1951 . doi:10.1164/ajrccm.153.6.8665059
    CrossrefPubMedGoogle Scholar
  • 10 Yuan A, Chang DB, Yu CJ. et al. Color Doppler sonography of benign and malignant pulmonary masses.
    PubMedGoogle Scholar
  • 11 Görg C, Seifart U, Görg K. et al. Color Doppler sonographic mapping of pulmonary lesions: evidence of dual arterial supply by spectral analysis. Journal of Ultrasound in Medicine 2003; 22: 1033-1039
    CrossrefPubMedGoogle Scholar
  • 12 Sartori S, Postorivo S, Di Vece F. et al. Contrast-enhanced ultrasonography in peripheral lung consolidations: What’s its actual role?. World Journal of Radiology 2013; 5: 372-380 . doi:10.4329/wjr.v5.i10.372
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Sperandeo M, Sperandeo G, Varriale A. et al. Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study. Ultrasound in Medicine &Biology 2006; 32: 1467-1472 . doi:10.1016/j.ultrasmedbio.2006.06.018
    PubMedGoogle Scholar
  • 15 Milne M, Eric N. et al. Circulation of primary and metastatic pulmonary neoplams. American Journal of Roentgenology 1967; 100: 603-619 . doi:10.2214/ajr.100.3.603
    CrossrefPubMedGoogle Scholar
  • 16 Kiessling F, Boese J, Corvinus C. et al. Perfusion CT in patients with advanced bronchial carcinomas: a novel chance for characterization and treatment monitoring?. European Radiology 2004; 14: 1226-1233 . doi:10.1007/s00330-004-2288-2
    PubMedGoogle Scholar
  • 17 Yuan X, Zhang J, Quan C. et al. Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT. EurRadiol 2013; 23: 2469-2474 . doi:10.1007/s00330-013-2842-x
    PubMedGoogle Scholar
  • 18 Nguyen-Kim TDL, Frauenfelder T, Strobel K. et al. Assessment of bronchial and pulmonary blood supply in non-small cell lung cancer subtypes using computed tomography perfusion. Investigative Radiology 2015; 50: 179-186 . doi:10.1097/RLI.0000000000000124
    CrossrefPubMedGoogle Scholar
  • 19 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: 531507 . doi:10.1155/2015/531507
    PubMedGoogle Scholar
  • 20 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 research international 2015; 2015: 231782 . doi:10.1155/2015/231782
    PubMedGoogle Scholar
  • 21 Görg C, Seifart U, Holzinger I. et al. Bronchioloalveolar carcinoma: sonographic pattern of ‘pneumonia’. European journal of ultrasound official journal of the European Federation of Societies for Ultrasound in Medicine and Biology 2002; 15: 109-117
    PubMedGoogle Scholar
  • 22 Görg C, Kring R, Bert T. Transcutaneous contrast-enhanced sonography of peripheral lung lesions. American Journal of Roentgenology 2006; 187: 9 . doi:10.2214/Am J Roentgenol.05.0890
    PubMedGoogle Scholar
  • 23 Suzuki N, Saitoh T, Kitamura S. Tumor invasion of the chest wall in lung cancer: Diagnosis with US. Radiology 1993; 187: 39-42 . doi:10.1148/radiology.187.1.8451433
    CrossrefPubMedGoogle Scholar
  • 24 Kolin A, Koutoulakis T. Invasion of pulmonary arteries by bronchial carcinomas. Human Pathology 1987; 18: 1165-1171
    CrossrefPubMedGoogle Scholar
  • 25 Fisseler-Eckhoff A, Müller KM. Pathologie der Pulmonalarterien bei Lungentumoren. Deutsche medizinische Wochenschrift (1946) 1994; 119: 1415-1420 . doi:10.1055/s-2008-1058854
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Gehmacher O, Mathis G, Kopf A. et al. Ultrasound imaging of pneumonia. Ultrasound in Medicine&Biology 1995; 21: 1119-1122 . doi:10.1016/0301-5629(95)02003-9
    PubMedGoogle Scholar
  • 27 Mathis G, Metzler J, Fußenegger D. et al. Ultraschallbefunde bei Pneumonie. UltraschallKlinPrax 1992; 7: 45-49
    PubMedGoogle Scholar
  • 28 Pezzella F, Pastorino U, Tagliabue E. et al. Non-small-cell lung carcinoma tumor growth without morphological evidence of neo-angiogenesis. The American Journal of Pathology 1997; 151: 1417-1423
    PubMedGoogle Scholar
  • 29 Sardari Nia P, Colpaert C, Vermeulen P. et al. Different growth patterns of non-small cell lung cancer represent distinct biologic subtypes. The Annals of thoracic surgery 2008; 85: 395-405 . doi:10.1016/j.athoracsur.2007.08.054
    PubMedGoogle Scholar