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常规超声联合超声造影对颈部实性淋巴结良恶性的鉴别诊断 被引量:13

Differential Diagnosis of Benign and Malignant Cervical Solid Lymph Nodes by Conventional Ultrasound Combined with Contrast-Enhanced Ultrasound
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摘要 目的探讨常规超声联合超声造影(CEUS)对颈部实性淋巴结良恶性的鉴别诊断价值。资料与方法回顾性分析154例颈部淋巴结异常患者共158枚淋巴结,其中45例46枚淋巴结行CEUS,根据病理结果评价良、恶性淋巴结常规超声和CEUS特征的差异,分析恶性淋巴结的独立危险因素,采用ROC曲线评价两种方法单独及联合应用对淋巴结良恶性的诊断效能。结果恶性组淋巴结常规超声多表现为长短径之比(L/S)≤2(49/76,64.5%)、形态不规整(52/76,68.4%)、皮质回声异常(60/76,78.9%)、淋巴门偏移或消失(66/76,86.8%)、周边型或混合型血流(70/76,92.2%),CEUS灌注模式多表现为向心或混杂型(18/22,81.8%)、灌注类型多为不规则灌注缺损型(14/22,63.6%),与良性组比较,差异均有统计学意义(P<0.05)。其中形态不规整(OR=3.024,95%CI 1.313~6.966)、皮质回声异常(OR=4.951,95%CI 2.107~11.634)、淋巴门偏移或消失(OR=5.192,95%CI 2.010~13.414)、周边型或混合型血流(OR=4.820,95%CI 1.636~14.206)、向心或混杂型灌注(OR=5.921,95%CI 1.293~27.107)、不规则灌注缺损型或微弱增强型(OR=5.659,95%CI 1.223~26.180)是恶性淋巴结的独立危险因素(P<0.05)。常规超声、CEUS及两者联合鉴别淋巴结良恶性的敏感度分别为81.8%、63.6%和95.5%,特异度分别为70.8%、91.7%和66.7%,ROC曲线下面积分别为0.763、0.777和0.811。结论常规超声联合CEUS可提高颈部实性淋巴结良恶性鉴别诊断的敏感度。 Purpose To investigate the value of conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)in the differential diagnosis of benign and malignant cervical solid lymph nodes.Materials and Methods 158 lymph nodes of 154 patients with abnormal cervical lymph nodes were retrospectively analyzed,among which 46 lymph nodes in 45 patients underwent CEUS.According to the pathological results,the differences of US and CEUS features in benign and malignant lymph nodes were compared.The independent risk factors of malignant lymph nodes were analyzed through ROC,and the efficacy of the two methods for differentiating benign and malignant lymph nodes was evaluated,either alone or in combination.Results In malignant group,US showed L/S≤2(49/76,64.5%),irregular shape(52/76,68.4%),abnormal cortical echo(60/76,78.9%),migrated or disappeared hilum echo(66/76,86.8%),peripheral or mixed blood flow(70/76,92.2%).CEUS perfusion patterns showed centripetal or mixed type(18/22,81.8%),and perfusion type was irregular perfusion defect type(14/22,63.6%),with statistical difference(P<0.05).Irregular shape(OR=3.024,95%CI 1.313-6.966),abnormal cortical echo(OR=4.951,95%CI 2.107-11.634),migrated or disappeared hilum echo(OR=5.192,95%CI 2.010-13.414),peripheral or mixed blood flow(OR=4.820,95%CI 1.636-14.206),centripetal or mixed type(OR=5.921,95%CI 1.293-27.107),and irregular perfusion defect type or weak enhancement type(OR=5.659,95%CI 1.223-26.180)were independent risk factors of malignant lymph nodes(P<0.05).The sensitivity of ultrasound,CEUS and their combination was 81.8%,63.6%and 95.5%,respectively;the specificity was 70.8%,91.7%and 66.7%,respectively;and area under the ROC curve was 0.763,0.777 and 0.811,respectively.Conclusion Conventional ultrasound combined with CEUS can improve the sensitivity of differentiating benign and malignant cervical solid lymph nodes.
作者 张琦 庄连婷 李家兴 黄瑛 ZHANG Qi;ZHUANG Lianting;LI Jiaxing;HUANG Ying(Department of Ultrasound,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China;不详)
出处 《中国医学影像学杂志》 CSCD 北大核心 2021年第1期14-18,共5页 Chinese Journal of Medical Imaging
基金 辽宁省重点研发指导计划(2019JH8/10300008) 中国医科大学健康医疗大数据研究课题(HMB201902103) 辽宁省教育厅科研项目(ZF2019023)。
关键词 头颈部肿瘤 淋巴结 超声检查 多普勒 彩色 造影剂 病理学 外科 诊断 鉴别 Head and neck neoplasms Lymph nodes Ultrasonography,Doppler,color Contrast media Pathology,surgical Diagnosis,differential
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