Clinical utility of bedside Contrast-Enhanced Ultrasound (CEUS) in the diagnosis of pneumonia in elderly patients: Comparison with clinical, -radiological and ultrasound diagnosis.

IF 2 Q3 RESPIRATORY SYSTEM Multidisciplinary Respiratory Medicine Pub Date : 2024-10-01 DOI:10.5826/mrm.2024.967

Francesco Giangregorio, Emilio Mosconi, Maria Grazia Debellis, Stella Provini, Ciro Esposito, Manuela Mendozza, Rita Raccanelli, Luigi Maresca, Sara Cinquini, Francesco Tursi

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Abstract

Aims: to measure the clinical impact of contrast-enhanced ultrasound (CEUS) in the diagnosis of -community-acquired pneumonia (CAP), compared to clinical, radiological and ultrasound diagnosis.

Methods: 84 patients (47/37 males/females, mean age:78,57±11,7 Y) with clinical suspicion of pneumonia and with ultrasound findings of peripheral lung lesions, were investigated with CEUS for a better characterization. Final diagnosis of 65 cap was obtained with complete disappearance of symptoms and pulmonary nodule(s); 19 neoplasms: 16 patients performed histologically with bronchoscopy; 3 refused (non-invasive diagnosis with basal CT-scan and positron emission tomography (PET) with fluorodeoxyglucose (FDG)). Sensitivity, specificity, overall diagnostic accuracy (ODA) (and corresponding AUROC) of clinical-data (CD), chest X-ray(CXR), Lung-ultrasound(LUS), CEUS were calculated with SPSS 26.0 software.

Results: Final diagnosis: 65 CAP, and 19 chest cancers. 9/65 (13%) patients died, of these 7/9 with older age and heart disease as comorbidity. CD: True-Positive (TP):23, True-negative (TN): 17; False-Positive (FP):2; False-negative (FN):42 (sens:35,4% spec:89,5% ODA10%: PPV:92%, NPV:28,8%) (AUROC±SEauc:0,46±0,076); CXR: TP: 36, TN:14; FP:5, FN:29; (sens: 55,4%; spec: 73,7%; ODA: 32%; PPV:87,5%, NPV:32,66%) (AUROC±SEauc:0,645±0,068). US: TP:59; TN: 14; FP:5, FN:6 (sens: 90,8%, spec: 73,7%, ODA: 84,9%, PPV:92,2%, NPV:70%) (AUROC±SEauc:0,9417±0,024); CEUS: TP: 63; TN: 19; FP:0; FN:2 (sens: 96,9%; spec: 100% ODA: 97,5%; PPV: 100%, NPV:90,5%) (AUROC±SEauc:0,98±0,01).

Conclusions: Clinical-data and chest X-RAYS are insufficient to obtain a correct diagnosis of CAP in elderly population; US demonstrated a good accuracy to establish CAP, but with a relatively low specificity; in these cases, CEUS is able to give a correct characterization, allowing you to save the need for a chest contrast-enhanced-CT (CECT).

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床旁对比增强超声（CEUS）在老年患者肺炎诊断中的临床实用性：与临床、放射学和超声诊断的比较。

目的：与临床、放射学和超声诊断相比，衡量对比增强超声（CEUS）在诊断社区获得性肺炎（CAP）中的临床影响。方法：对 84 例临床怀疑为肺炎并经超声检查发现周围肺部病变的患者（47/37 男/女，平均年龄：78,57±11,7 Y）进行 CEUS 检查，以更好地确定病变特征。最终确诊 65 例患者的症状和肺结节完全消失，其中 19 例为肿瘤：16 名患者通过支气管镜进行了组织学检查；3 名患者拒绝接受检查（通过基础 CT 扫描和含氟脱氧葡萄糖（FDG）的正电子发射断层扫描（PET）进行无创诊断）。用 SPSS 26.0 软件计算了临床数据（CD）、胸部 X 光（CXR）、肺部超声（LUS）和 CEUS 的敏感性、特异性、总体诊断准确性（ODA）（以及相应的 AUROC）：最终诊断：65 例 CAP，19 例胸部肿瘤。9/65（13%）名患者死亡，其中 7/9 合并有老年和心脏病。CD：真阳性（TP）:23，真阴性（TN）:17；假阳性（FP）:2；假阴性（FN）:42（感度:35,4%，标度:89,5%，ODA10%：PPV:92%，NPV：28,8%) (AUROC±SEauc:0,46±0,076); CXR: TP: 36, TN:14; FP:5, FN:29; (sens: 55,4%; spec: 73,7%; ODA: 32%; PPV:87,5%, NPV:32,66%) (AUROC±SEauc:0,645±0,068).美国TP:59；TN:14；FP:5，FN:6（感觉：90,8%，规格：73,7%，ODA：84,9%，PPV：92,2%，NPV：70%）（AUROC±SEauc：0,9417±0,024）；CEUS：TP：63；TN：19；FP：0；FN：2（感觉：96.9%；规格：100% ODA：97.5%；PPV：100%，NPV：90.5%）（AUROC±SEauc：0.98±0.01）。结论临床数据和胸部 X 射线不足以正确诊断老年人群中的 CAP；US 显示了确定 CAP 的良好准确性，但特异性相对较低；在这些病例中，CEUS 能够给出正确的特征，使您无需进行胸部对比增强 CT (CECT)。

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来源期刊

Multidisciplinary Respiratory Medicine 医学-呼吸系统

CiteScore

4.40

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.