Assessment of pleural effusion using intracavitary contrast-enhanced ultrasound: a pilot study
- 1Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Abstract
Objectives: To address the limitations of current imaging modalities, the present study aimed to develop and validate a novel intracavitary contrast-enhanced ultrasound (CEUS) approach for the quantitative assessment of pleural effusion (PE) volume and differentiation of exudative PE from transudative PE.
Methods: This cross-sectional diagnostic accuracy study prospectively enrolled 100 patients with PE undergoing US-guided thoracentesis. Intracavitary CEUS was performed using SonoVue microbubbles, and time-intensity curve parameters (A, B, and A+B) were analyzed. PE volume was measured based on the drainage volume, and effusions were classified as exudates or transudates according to Light’s criteria. Diagnostic performance was assessed by receiver operating characteristic (ROC) analysis, and a linear regression model was developed to predict PE volume.
Results: Exudative PE showed significantly higher baseline intensity parameter B (−35.18 ± 5.17 vs. −41.41 ± 8.64, p < 0.01) and lower peak intensity increment parameter A (1.20 ± 3.27 vs. 6.61 ± 6.10, p < 0.01) compared to transudative PE. The combined parameter A+B (steady-state microbubble concentration index) showed a strong correlation with PE volume ( r = 0.912, R ² = 0.831), yielding the predictive model: V(mL) = −33.345 × (A+B) − 453.071 (intraclass correlation coefficient = 0.950). The ROC analysis revealed moderate diagnostic accuracy for the A value (area under the curve (AUC) = 0.779) and B value (AUC = 0.719) in differentiating exudative PE from transudative PE.
Conclusion: Intracavitary CEUS could serve as a reliable, minimally invasive, feasible radiation-free adjunctive technique for quantifying PE volume and differentiating exudative versus transudative PE in patients undergoing thoracentesis. The A+B-based regression model provides high predictive accuracy, while A and B values facilitate effusion classification. This quantitative CEUS workflow may facilitate clinical decision-making, and its utility for serial monitoring requires further verification in large-scale real-world cohorts.
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BibTeX
@article{tang2026assessment,
title = {{Assessment of pleural effusion using intracavitary contrast-enhanced ultrasound: a pilot study}},
author = {Dachuan Tang and Dan Wang and Zhongyu Li and Bohan Lu and Huiming Yi and Wei Zhang},
journal = {PeerJ},
year = {2026},
month = oct,
doi = {10.7717/peerj.21765},
url = {https://peerj.com/articles/21765},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Assessment of pleural effusion using intracavitary contrast-enhanced ultrasound: a pilot study
AU - Dachuan Tang
AU - Dan Wang
AU - Zhongyu Li
AU - Bohan Lu
AU - Huiming Yi
AU - Wei Zhang
PY - 2026
DA - 2026/10/02
JO - PeerJ
DO - 10.7717/peerj.21765
UR - https://peerj.com/articles/21765
AB - Objectives: To address the limitations of current imaging modalities, the present study aimed to develop and validate a novel intracavitary contrast-enhanced ultrasound (CEUS) approach for the quantitative assessment of pleural effusion (PE) volume and differentiation of exudative PE from transudative PE. Methods: This cross-sectional diagnostic accuracy study prospectively enrolled 100 patients with PE undergoing US-guided thoracentesis. Intracavitary CEUS was performed using SonoVue microbubbles, and time-intensity curve parameters (A, B, and A+B) were analyzed. PE volume was measured based on the drainage volume, and effusions were classified as exudates or transudates according to Light’s criteria. Diagnostic performance was assessed by receiver operating characteristic (ROC) analysis, and a linear regression model was developed to predict PE volume. Results: Exudative PE showed significantly higher baseline intensity parameter B (−35.18 ± 5.17 vs. −41.41 ± 8.64, p < 0.01) and lower peak intensity increment parameter A (1.20 ± 3.27 vs. 6.61 ± 6.10, p < 0.01) compared to transudative PE. The combined parameter A+B (steady-state microbubble concentration index) showed a strong correlation with PE volume ( r = 0.912, R ² = 0.831), yielding the predictive model: V(mL) = −33.345 × (A+B) − 453.071 (intraclass correlation coefficient = 0.950). The ROC analysis revealed moderate diagnostic accuracy for the A value (area under the curve (AUC) = 0.779) and B value (AUC = 0.719) in differentiating exudative PE from transudative PE. Conclusion: Intracavitary CEUS could serve as a reliable, minimally invasive, feasible radiation-free adjunctive technique for quantifying PE volume and differentiating exudative versus transudative PE in patients undergoing thoracentesis. The A+B-based regression model provides high predictive accuracy, while A and B values facilitate effusion classification. This quantitative CEUS workflow may facilitate clinical decision-making, and its utility for serial monitoring requires further verification in large-scale real-world cohorts.
SN - 2167-8359
ER -