Prospective Analysis of the Predictive Value of Sonographic Pleural Fluid Echogenicity for the Diagnosis of Exudative Effusion
Prospective Analysis of the Predictive Value of Sonographic Pleural Fluid Echogenicity for the Diagnosis of Exudative Effusion
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DOI：
10.1159/000496153
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发表时间：
2019-01-01
期刊：
影响因子：
3.7
通讯作者：
Rahman, Najib M.
中科院分区：
文献类型：
--
作者：
Asciak, Rachelle;Hassan, Maged;Rahman, Najib M.
背景：胸腔积液超声回声先前被认为可以识别渗出物。一个病例系列表明，回声均匀的积液总是渗出液。随着现代成像技术和更先进的超声技术的发展，这可能不再是真的。目的：本研究旨在前瞻性评估回声在识别渗出物中的预测价值。方法：前瞻性分析了140例在胸腔积液采样前接受胸部超声检查的患者。如果液体总蛋白（TP）> 29 g/L且液体乳酸脱氢酶（LDH）>正常血清LDH上限的2/3（女性为255 IU/L，男性为235 IU/L），则将胸腔液归类为渗出液。如果仅符合其中一项标准，则认为积液具有不一致的生化特征。结果：55例（39%）患者无回声，85例（61%）患者有回声积液。6例（7.1%）回声性积液患者有漏出液;该组的中位液体TP为18.5 g/L（IQR 9.75），中位LDH为63.0 IU/L（IQR 40.3）。排除生化指标不一致的患者，超声诊断渗出液的特异性为57.1%，阳性预测值（PPV）为90.3%，敏感性为65.1%，阴性预测值（NPV）为21.0%。回声识别渗出液（包括不一致的生化）的特异性为57.1%，PPV为92.9%，敏感性为62.7%，NPV为14.5%。结论：胸腔积液的回声对于识别潜在渗出物的特异性较低，并且液体的回声质量不应影响临床决策。(c)2019 S. Karger AG，巴塞尔
Background: Pleural effusion echogenicity on ultrasound has previously been suggested to allow identification of exudates. A case series suggested that homogenously echogenic effusions are always exudates. With modern imaging techniques and more advanced ultrasound technology, this may no longer be true. Objectives: This study aims to prospectively assess the predictive value of echogenicity in the identification of exudates. Method: Patients undergoing thoracic ultrasound before pleural fluid sampling were analysed prospectively (n = 140). Pleural fluid was classified as an exudate if both fluid total protein (TP) > 29 g/L and fluid lactate dehydrogenase (LDH) > 2/3 upper limit of normal serum LDH (which is 255 IU/L in females and 235 IU/L in males) were present. If only one of these criteria was met, the effusion was considered to have discordant biochemistry. Results: Fifty-five (39%) patients had non-echogenic and 85 (61%) had echogenic effusions. Six (7.1%) patients with echogenic effusions had transudates; the median fluid TP for this group was 18.5 g/L (IQR 9.75) and median LDH 63.0 IU/L (IQR 40.3). The specificity of echogenicity identifying exu(dates from transudates, excluding patients with discordant biochemistry, was 57.1%, positive predictive value (PPV) 90.3%, sensitivity 65.1%, and negative predictive value (NPV) 21.0%. The specificity of echogenicity identifying exudates (including discordant biochemistry) from transudates was 57.1%, PPV 92.9%, sensitivity 62.7%, and NPV 14.5%. Conclusions: Echogenicity of a pleural effusion has a low specificity for identifying an underlying exudate, and the echogenic qualities of the fluid should not influence clinical decision-making. (c) 2019 S. Karger AG, Basel