摘要
目的:观察鼻咽癌颈部肿大淋巴结超声学特点,评价超声学检查对鼻咽癌颈部肿大淋巴结的诊疗价值。方法:对33例病理确诊为鼻咽癌颈部肿大淋巴结患者,在放疗前后进行超声学对比检查,对放疗后残留者随访观察,记录淋巴结大小、回声、结构、血流分级,对血流分级Ⅰ级以上者测定血流最大速度及阻力指数。结果:(1)B超较体检或MRI分别高出68.6%、43.3%的检出率。(2)放疗前1例患者淋巴结血流分级评为0级,5例显示在0级到Ⅰ级之间,Ⅰ级7例,Ⅱ级14例,Ⅲ级6例。Ⅰ级以上者肿大淋巴结血流最大速度Vmax位于0.13～0.42m/s,多数为0.14～0.25m/s;阻力指数RI位于0.46～0.89,多数为0.57～0.65;6例血流丰富评为Ⅲ级者,出现高阻力、高流速,RI0.67～0.88,Vmax0.23～0.42m/s。(3)放疗前后转移淋巴结超声学特点变化明显,淋巴结消失或直径变小,或者表现为回声增强,边界模糊,血流分级下降,呈0～Ⅰ级,血流速度下降,部分仅测得0.04～0.06m/s的静脉血供。结论:(1)超声学方法可作为鼻咽癌颈部转移淋巴结无创、定性的诊断方法;(2)淋巴结直径<2cm,无血流或血流<Ⅰ级,且淋巴结皮髓质境界分明者,即使CT或MRI检查提示淋巴结存在,仍可按非转移淋巴结观察随访;(3)直径1～2cm者,血流分级Ⅱ～Ⅲ级者,考虑转移淋巴结;(4)直径≥2cm,孤立肿大淋巴结,有无血流均考虑转移淋巴结。
Objective：To investigate ultrasonic features and the value of swelling cervical lymph nodes in patients with nasopharyngeal carcinoma（NPC）. Methods：Thirty-three NPC patients with cervical lymph nodes swollen were examined by ultrasonography before and after radiotherapy. Received radiotherapy, patients with lymph nodes remained were followed up. These lymph nodes were described according to size, echoes, morphologic and vascular structure. The maximal velocity（Vmax） and resistance index（RI） were measured. Results：The detection rate of lymph nodes was respective 68.6%, 43.3% higher than that of palpation and MRI. According to blood flow intensity score of these lymph nodes, 1 case was 0 grade, 5 cases were 0-Ⅰ grade,7 cases were Ⅰ grade, 14 cases were Ⅱ grade,and 6 cases were Ⅲ grade before radiotherapy. The Vmax of enlarging nodes ranged from 0.13m/s to 0.42m/s. Most were between 0.14m/s and 0.25m/s. RI of those nodes was between 0.46 and 0.89. And most were 0.57 to 0.65. The blood flow pattern of the nodes with Ⅲ grade blood intensity presented high resistance and peak velocity.Their RI was 0.67 to 0.88, and Vmax was 0.23m/s to 0.42m/s. The ultrasonic features of metastatic lymph nodes changed obviously after radiotherapy. Shrinking in size, increasing internal echoes, indistinct margins, blood flow intensity and velocity regression were observed. Conclusion：Ultrasonagraphy is a non-invasion method to diagnose metastatic lymph nodes. Nodes, whose diameter was smaller than 2cm, blood flow score was bellow Ⅰ grade, cortical echoes and hilus structure were clear, should be regarded as unmetastasis and follew up even though CT or MRI suggest lymph nodes exist. The diameter was 1cm to 2cm and blood flow was Ⅱ-Ⅲ grade suggest metastasis exist. The single node which was larger than 2cm should be considered as metastatic even its internal blood flow wasn＇t observed.
出处
《临床肿瘤学杂志》
CAS
2007年第12期926-928,932,共4页
Chinese Clinical Oncology
关键词
鼻咽肿瘤
颈淋巴结
超声检查
Nasopharyngeal neoplasms
Neck lymph node
Ultrasonography
