彩色多普勒超声对浅表肿大淋巴结病变的鉴别诊断价值

目的探讨彩色多普勒超声对常见良、恶性浅表淋巴结病变的鉴别诊断价值。方法回顾性分析116例患者的139个浅表肿大淋巴结的彩色多普勒声像图，依病理及随访结果分为三组：反应性增生淋巴结组、淋巴瘤组及转移性淋巴结组。比较其长径与短径比（L/S）、淋巴门位置形态及血流分布状况，并据此三项指标建立判别函数，讨论其鉴别诊断价值。结果运用上述三项指标及判别函数能较好的区分反应性增生淋巴结与恶性淋巴结（淋巴瘤及转移性淋巴结），其正确率为88．5％，三项指标的判别能力大小依次为：淋巴门位置形态、血流分布、L/S。但仅此三项指标仍不易区分淋巴瘤与转移性淋巴结。结论超声在常见浅表肿大淋巴结良、恶性病变鉴别诊断方面有较高的应用价值。     

颈部淋巴结肿大的彩色多普勒超声诊断与鉴别分析

目的 探讨颈部淋巴结肿大的二维超声及彩色多普勒血流特征与定性诊断.方法 应用彩色多普勒超声观察86例患者,计132个颈部肿大淋巴结,其中反应性淋巴结52个,结核性淋巴结16个,淋巴瘤38个,转移性淋巴结癌26个.对淋巴结大小形态、内部回声、门结构、纵横比(L/T)与周围解剖关系进行分析,脉冲多普勒(PWD)检测收缩期最大血流速度(Vmax)与最小血流速度(Vmin)及阻力指数(RI).结果 反应性淋巴结与淋巴瘤的形态结构、纵横比等声像图特征相近;结核性淋巴结与转移性淋巴结癌的形态结构等声像图特征相近.多普勒血流检测Vmax、Vmin、RI差异较大,组间比较均有显著性差异(P＜0.05).结论 反应性淋巴结与淋巴瘤之间、结核性淋巴结与转移性淋巴结癌之间单凭声像图特征难以鉴别,需结合多普勒血流特征及临床体征综合鉴别.     

彩色多普勒超声鉴别颈部淋巴结疾病良恶性的临床价值

目的探讨彩色多普勒超声对颈部淋巴结疾病良恶性的鉴别诊断价值。方法回顾性分析经病理确诊的61例患者共103个颈部肿大淋巴结的彩色多普勒超声检查资料,按病理结果分为良性组44个和恶性组59个,比较两组淋巴结的纵横比、收缩期最大血流速度(Vmax)、阻力指数及血流分型。结果良性组淋巴结的纵横比均≥2,恶性组纵横比均<2,两组比较差异有统计学意义(P<0.05);两组Vmax值比较差异无统计学意义;良性组淋巴结阻力指数值为0.60±0.08,较恶性组(0.70±0.07)低,差异有统计学意义(P<0.05);良性组以淋巴门型血流为主,恶性组以边缘型血流为主。结论纵横比和阻力指数对鉴别淋巴结疾病良恶性有一定的意义;淋巴门出现血流分布是良性淋巴结的重要特征,淋巴结边缘和(或)中央出现血流分布是淋巴结恶性病变的重要特征。     

超声诊断颈部淋巴结肿大的价值研究

目的探讨超声在鉴别诊断颈部淋巴结肿大中的价值。方法对172例患者200个颈部肿大淋巴结行超声检查，并记录其部位及超声特征。结果病理证实200个淋巴结中，转移性淋巴结112个，6个非何杰金氏淋巴瘤，78个反应性增生淋巴结和4个结核性淋巴结。转移性淋巴结多分布在Ⅲ、Ⅳ、Ⅵ区，反应性增生淋巴结多分布在Ⅱ区。长短轴之比（L／S）、髓质、液化、钙化和血流模式在良恶性淋巴结之间比较差异有统计学意义（P〈0．05）。L／S预测恶性淋巴结的敏感性为72．88％，特异性为84．15％；髓质扭曲变形或消失的敏感性为92．37％，特异性为75．61％；液化的敏感性为22．03％，特异性为93．90％；钙化的敏感性为39．83％，特异性为93．90％；周边型或混合型血流的敏感性为79．46％，特异性为80．49％。结论在颈部淋巴结的超声诊断中，尚无一项指标特指良性或恶性，但是当L／S〈2、髓质扭曲、变形，内部出现无回声或钙化，血流达皮质边缘或丰富杂乱则强烈提示恶性的可能。     

彩色多普勒超声对腋窝淋巴结的诊断

目的：探讨彩色多普勒超声诊声在诊断腋窝淋巴结中的临床应用价值。方法：共检查肿大淋巴结80个，测量长径L和短径S，结合彩色多普勒超声了解其血流情况，结果：12例炎性肿大的淋巴结，18例反应性增生的淋巴结，16例淋巴瘤的淋巴结，34例转移性肿大淋巴结。结论：本组30例炎症及反应性增生的淋巴结血流形态和RI与文献报道一致，50例恶性淋巴结彩色多普勒血流形态及频谱分析，有助于淋巴结良性及恶性病变的鉴别。     

高频彩超对颈部淋巴结疾病定性诊断的研究

目的 探讨高频彩超在颈部淋巴结疾病定性诊断中的应用价值.方法 应用彩色多普勒超声观察56例患者98个淋巴结内部回声特点、纵/横径(L/S)、收缩期血流速度(Vmax)、阻力指数(RI)及血流分型.按血流分布方式分为淋巴门型、中央型、边缘型和混合型.结果 良性淋巴结与恶性淋巴结L/S值比较差异有显著性意义(P＜0.05).Vmax在各型淋巴结疾病中比较无显著性差异(P均＞0.05).炎性淋巴结与恶性淋巴结的RI值比较有显著性差异(P＜0.05).所有炎性淋巴结均出现淋巴门血流,结核性淋巴结的血流分布与转移性淋巴结相似,淋巴瘤的中央血流出现率高于其他各型淋巴结疾病(P均＜0.05).结论 L/S比值、RI值、血流分型等有助于提高颈部淋巴结疾病定性诊断的准确率.     

彩色多普勒超声评估颈部淋巴结疾病血管模式的探讨

目的应用彩色多普勒超声评估颈部病变淋巴结的血管模式。方法用彩色多普勒超声观察113例患者的120个颈部淋巴结,将这些淋巴结的血管模式分为淋巴门型、中央型、边缘型和混合型等4种类型。结果120个淋巴结中,30个(25.0%)表现为淋巴门型血管,16个(13.3%)为中央型血管,19个(15.8%)为边缘型血管,52个(43.3%)为混合型血管。结论根据血管空间分布和血流起源,尝试建立了病变淋巴结血管模式的标准化分型。     

彩超鉴别诊断颈部肿大淋巴结

目的：探讨彩色多普勒超声在颈部淋巴结良、恶性病变鉴别诊断中的价值。方法：检查108例，158例肿大颈部淋巴结（良性46例，恶性62例）。全部病例经手术活检病理证实。观察淋巴结形态，彩色血流信号，测长短轴比（L／S），动脉流速（Vmax)及阻力指数（RI）。结果：良、恶性淋巴结二维超声表现，L／S具有各自特点，彩色多普勒超声均可不同程度显示彩色血液信号，恶性淋巴瘤与结核性淋巴结肿均可表现为环绕型血流信号，但PW参数中Vmax,RI有差异。结论：颈部淋巴结形态，病史，血流参数有助于淋巴结良，恶性病变的鉴别诊断。     

超声造影在浅表淋巴结疾病鉴别诊断中的应用研究

目的 探讨超声造影在浅表淋巴结疾病鉴别诊断中的应用价值。方法 对43例患者的75个浅表肿大淋巴结（良性28个，转移性39个，淋巴瘤8个）进行常规二维、彩色多普勒超声检查和灰阶超声造影，观察淋巴结造影剂灌注特征，并与病理对照，比较造影前后超声诊断的准确性。结果 良性淋巴结中57％（16／28）造影表现为均匀增强型，36％（10／28）表现为淋巴门不均匀增强型；转移性淋巴结中77％（30／39）表现为实质不均匀增强型，21％（8／39）表现为微弱增强型。常规超声诊断良恶性淋巴结的敏感性70％，特异性86％，准确性75％；超声造影诊断的敏感性87％，特异性93％，准确性89％，超声造影诊断的准确率显著提高（P〈0．05）。结论 灰阶超声造影发现淋巴结疾病的不同灌注特征，为良恶性淋巴结疾病的鉴别诊断提供了有价值的依据。     

彩色多普勒能量图在浅表淋巴结病变诊断中的应用

目的：比较彩色多普勒能量图与彩色多普勒血流显像在观察浅表淋巴结内血流状态的作用，探讨彩色多普勒以胆图在淋巴结病变良性鉴别中的价值。方法：应用彩色多普勒血流显像和彩色多普勒能量图观察13个（良性28个，恶性85个）浅表淋巴细内的彩色血流形态和分布。所有病例均经组织学证实，检查前均未进行过临床治疗。结果：113个淋巴结内的彩色多普勒超声表现可分为5种类型，即淋巴结门型，树枝状血流型，周边血流为主型，网状血流型和无血流型。与CDFI相比，CDPI显示的血流数目更多，血管连续性更好。淋巴结门型和无血流型多见于良性淋巴结病变，恶性淋巴结病变主要表现为树枝状血流型，周边血流为主型和网状血流型。结论：对于观察浅表淋巴结内血流状态，CDPI优于彩色普勒血流显像。但是，CDPI对于提高超声对淋巴结病变诊断的准确性作用有限。     

三维彩色能量图在颈部淋巴结良恶性鉴别诊断中的价值

目的探讨颈部淋巴结的三维彩色能量图（3D—CDE）超声表现特点对良恶性病变的鉴别意义。方法应用高频超声检查53例患者的156个颈部淋巴结，对其淋巴结3D—CDE所见与病理结果进行对照分析。结果超声检查发现并获得病理结果的淋巴结156个，其中，良性30个，恶性120个，交界性6个。3D—CDE表现：良性组以中央型为主，占83．3％（25／30），其中反应性增生23个，淋巴结结核2个。恶性组以周边型和混合型为主，占81．7％（98／120），内部可见走行迂曲不规则的血管，缺乏淋巴门样的规则血流。2例血管免疫母细胞淋巴结病发现6个淋巴结，3D—CDE血流呈树枝状，分支丰富，走行规则。结论依据CDE和3D—CDE超声表现特点有助于颈部淋巴结的良恶性鉴别。     

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

Purpose

To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy.

Methods and materials

The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22–84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal).

Results

A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III).

Conclusion

The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy.     

Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy

This study was undertaken to evaluate the accuracy of the power Doppler sonographic features in differentiating cervical lymphadenopathy in different diseases. We reviewed power Doppler sonograms of 270 patients with palpable neck nodes (metastases n = 101, lymphoma n = 21, tuberculosis n = 76, reactive n = 72). Confirmed diagnosis was either made by fine-needle aspiration cytology on the largest node or by excision biopsy. In each patient, the largest node was included in the study. The node was evaluated using the vascular pattern, displacement of vascularity and vascular resistance (resistance index, RI, and pulsatility index, PI). Individual groups were compared and the optimum vascular feature in the differential diagnosis was determined. Vascular pattern was more useful in differentiating reactive nodes from malignant nodes, with a sensitivity of 88% for metastases and 67% for lymphoma, and a specificity of 100%. RI with a cut-off value of 0.8 was more accurate in distinguishing metastases (RI > 0.8) from lymphoma (RI < 0.8), with an accuracy of 65% and 75%, respectively. Displacement of vascularity was helpful to differentiate tuberculous nodes (accuracy: 67%) from reactive and lymphomatous nodes (accuracy: 100% and 95%, respectively), whereas PI with a cut-off of 1.5 helped the differentiation between tuberculosis (PI < 1.5) and metastases (PI > 1.5), with an accuracy of 77% in both diseases. When appropriate criteria are used, power Doppler sonography is a valuable adjunct in the sonographic evaluation of cervical lymphadenopathy.     

Evaluation of cervical lymph node vascularity: a comparison of colour Doppler, power Doppler and 3-D power Doppler sonography

This study was undertaken to compare the performance of colour Doppler (CDS), power Doppler (PDS) and 3-D power Doppler sonography (3-D PDS) in the assessment of vascular pattern and vessel displacement of cervical lymph nodes. Colour Doppler (2-D CDS), power Doppler (2-D PDS) and 3-D power Doppler sonograms (3D PDS) of 145 cervical nodes were reviewed (metastases n=60, lymphoma n=30, tuberculosis n=23, reactive n=25, Kimura disease n=7). Sonograms of the three imaging modes were reviewed separately with an interval of 2 weeks. Lymph nodes were assessed for the vascular pattern (hilar, peripheral or mixed) and the presence or absence of displacement of hilar vascularity. For the assessment of displacement of hilar vascularity, only lymph nodes that showed hilar or mixed vascularity in the three imaging modes were included in the analysis. Results showed that there was a high level of agreement between CDS and PDS in assessment of vascular patterns (kappa=0.914), whereas the level of agreement between CDS and 3-D PDS (kappa=0.484) and between PDS and 3-D PDS (kappa=0.452) was low. There was a high level of agreement in the assessment of displacement of hilar vascularity among the three imaging modes (CDS and PDS, kappa=0.942; CDS and 3-D PDS, kappa=0.808; PDS and 3-D PDS, kappa=0.865). In the assessment of vascular patterns of cervical lymphadenopathy, CDS and PDS have a similar performance. However, accurate assessment of the vascular pattern of cervical nodes may be difficult using 3-D PDS. In the assessment of displacement of hilar vascularity, the performances of CDS, PDS and 3-D PDS are similar.     

Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes.

OBJECTIVE: We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes. METHODS: We selected 130 individuals who underwent sonography, color Doppler imaging, fine-needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, "hilar normal"; type II, "hilar activated"; and type III, "peripheral." RESULTS: Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non-Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non-neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma. CONCLUSIONS: The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.     

Pathological angioarchitecture in lymph nodes: underlying histopathologic findings

Pathologic changes of the intranodal angioarchitecture, as displayed by colour Doppler sonography, were used in recent studies to predict malignant infiltration of superficial lymph nodes. We searched for the underlying histopathologic findings in a prospective study including 100 lymph nodes in 86 patients. In the histopathologic specimens, we evaluated tumour infiltration, distribution of intranodal vessels, hilar structures, thickness of the capsule and tissue alterations (necrosis, sclerosis, lipo-/fibromatosis). Using the only prospectively tested classification, a pathologic angioarchitecture was described as displacement, aberrant course, avascular foci or subcapsular vessels. Testing these four criteria by multivariate regression analysis, the most important correlations were found between the following pairs of sonographic and histopathologic findings: displacement with perinodal tumour spread, aberrant vessels with intranodal sclerosis, avascular foci with intranodal necroses and subcapsular vessels with intranodal necroses. In conclusion, the criteria describing a pathologic angioarchitecture correlate with histopathologic findings that are frequently seen in malignant lymph nodes.     

颈部淋巴结的超声诊断

本研究使用彩色多普勒观察７０例患者的８０个颈部良性及恶性淋巴结的血管类型。发现良性淋巴结（３０个）多在门部有一支和／或有小的分支；而恶性淋巴结（５０个）血流主要是外周型和／或中央血流型。这一特征，加上淋巴结形态及病史，有助于淋巴结良性及恶性病变的鉴别诊断     

Two-dimensional and three-dimensional power Doppler sonographic classification of vascular patterns in cervical lymphadenopathies.

Vascular patterns may reflect some pathologic behaviors of tumors and lymph nodes. Power Doppler ultrasonography, with improved sensitivity and better noise contrast, were used to depict vasculature in 289 cases of cervical lymphadenopathy. Four patterns of vasculature, in addition to avascular nodes, were classified. Benign lymphadenopathies represented 89% and 83% of avascular and hilar type nodes, respectively. However, malignant lymphadenopathies dominated in nodes that were of spotted (72%), peripheral (60%), and mixed type (80%). Correlation between nodal sizes and chronologic changes of vascular patterns in malignant lymphadenopathies implied a reasonable classification. Three-dimensional power angiography, with the advantage of less plane-sampling bias, was further used to validate our classification.     

Color/power Doppler sonographic differential diagnosis of superficial lymphadenopathy: metastasis, malignant lymphoma, and benign process.

OBJECTIVE: Differentiation of lymph nodes as metastasis, malignant lymphoma, and benign lesions by gray scale and color/power Doppler ultrasonography has been reported. In this study we sought to determine patterns of abnormal vascularity, the relationship between diagnostic criteria and node size, and which vessel in the node was best suited for Doppler spectral analysis. Extrahilar vessels, defined as vessels entering through the lymphatic surface and not through the hilus, were also investigated. METHODS: One hundred twenty-nine nodes were examined by color/power Doppler ultrasonography. RESULTS: Extrahilar vessels were seen in 85.4% of metastatic, 40.5% of lymphomatous, and 7.7% of benign nodes regardless of node size. The mean pulsatility index and resistive index values of metastatic nodes were higher than those of benign nodes regardless of their size. Those of lymphoma were intermediate compared with the others. CONCLUSIONS: A pulsatility index greater then 1.3 and a resistive index greater than 0.72 suggested malignancy as measured from any vessel.