Accuracy of Contrast-enhanced Ultrasonography with Perfluorobutane for Diagnosing Subpleural Lung Lesions

Rationale and Objectives

To investigate the diagnostic value of perfluorobutane-enhanced ultrasound (US) examinations for differentiating benign from malignant subpleural lung lesions.

Methods

This single-center, retrospective study enrolled consecutive patients with subpleural lung lesions between January 2022 and March 2023. The cause of the lung lesions was confirmed by biopsy and follow-up examinations. The lesions were continuously evaluated using perfluorobutane-enhanced US for 0–180 s, and washout (WT) was observed after 3, 5, and 10 min. Univariate and multivariate analyses were used to identify significant US features, which were evaluated for their diagnostic performance. The diagnostic performance of combining several features for predicting malignant lung lesions was also assessed by multivariate logistic regression analysis.

Results

Seventy cases were included (17 benign lesions [13 men, 4 women; mean age: 57.5 ± 12.2 years] and 53 malignant lesions [41 men, 12 women; mean age: 63.3 ± 11.6 years]). Peak intensity (PI), arrival time (AT), and WT after 10 min significantly differed between malignant and benign lesions. The sensitivity and accuracy were significantly higher for 10-minute WT than for AT (both p < 0.05). The area under the curve of the combined diagnostic evaluation with AT, PI, and 10-minute WT was 0.897 (95% [CI]: 0.806–0.988), which was significantly higher than that of AT or PI alone.

Conclusion

Perfluorobutane-enhanced US can differentiate benign from malignant lung lesions, and combining AT, PI, and 10-minute WT for diagnostic purposes performed better than a single feature.