Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review

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.

Key words

systematic review - chest - contrast-enhanced ultrasound

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