儿童肠系膜淋巴结炎的超声诊断及临床价值探讨

目的：探讨超声在肠系膜淋巴结炎诊断中的临床价值.方法：回顾分析我院148例确诊为儿童肠系膜淋巴结炎的声像图特征,观察到肠系膜肿大淋巴结的部位、大小、形态、内部回声、纵横比值（S/L）及彩色多普勒血流信号.结果：148例患儿腹腔内均可见两枚以上不同程度的肿大淋巴结,多分布于脐周及右侧腹;其最大切面长轴径（L）：10～25 mm,短轴径（S）：5～12mm,纵横比值（S/L）＜2,彩色多普勒显示其内可探及血流信号.结论：超声是临床诊断儿童肠系膜淋巴结炎首选检查方法,为肠系膜肿大淋巴结的病因分析及临床诊断提供客观依据.     

关于腹腔及后腹膜淋巴结的超声图像分析、临床意义的讨论

目的：讨论分析腹腔及腹膜后肿大淋巴结的超声图像图。 方法：总结分析腹腔及腹膜后肿大淋巴结与相关疾病的联系。 结果：肠系淋巴结炎、肝炎、胆囊炎、阑尾炎的淋巴结肿大有别于肝癌、胃癌、胰腺癌等转移性淋巴结肿大及恶性淋巴瘤。 结论：前者特点：淋巴结数量少，体积小，边界清，内部回声均匀，周围间质无增多，无明显血供。后者特点：淋巴结数量多，体积较大，形态饱满，包膜回声增厚增强，内回声不均匀，周围间质回声紊乱，多个淋巴结可相互融合，彩色血流丰富。     

彩色多普勒超声对腋窝淋巴结病变的诊断价值

目的探讨彩色多普勒超声诊断腋窝淋巴结病变的价值。方法应用彩色多普勒超声观察与测量42例良性、36例恶性肿大淋巴结长径与前后径(L/S)比值,内部回声,CDFI,血流分布及PWD频谱特征。结果良性淋巴结L/S比值大于1.8,平均为(2.02±0.24),RI为(0.62±0.08);恶性肿大淋巴结L/S比值小于1.8,平均为(1.50±0.29),RI为(0.82±0.07),二项指标比较均具有显著性差异(P<0.05),良性淋巴结血流分支细少,走行规律,低阻力,而恶性肿大淋巴结呈不规则扭曲、紊乱血流,高阻力。结论彩色多普勒超声对腋窝肿大淋巴结良、恶性的鉴别诊断具有较大意义,可作为首选方法。     

甲状腺良恶性结节的超声鉴别诊断

目的探讨甲状腺良恶性结节声像图表现及鉴别诊断。方法对经手术病理证实的60例甲状腺良性结节和21例恶性结节的超声二维及彩色多普勒血流声像图（CDFI）表现进行对比分析。结果良恶性结甲在形态,边界,内部回声,彩色血流分布,阻力指数,颈部淋巴结肿大等指标有统计学显著性差异。结论形态不规整,边界不清,内部不均匀低回声,微钙化,内部血流丰富而周边少或无血流,RI〉0．7等可以作为恶性结节的主要指标;不清晰、不完整、宽窄不一的晕环及颈部淋巴结肿大高度提示恶性;囊性结节可作为排除恶性指标。微小乳头状癌结节及良恶性并发的多源性结节常常会被误诊。     

尾部悬吊大鼠不同部位动脉血管内皮细胞几何形状与排列的变化

目的探讨模拟失重对动脉血管内皮细胞几何形状与排列的影响。方法采用ｅｎｆａｃｅ小皮贴片技术观察了尾部悬吊４周（ＳＵＳ－４）、悬吊４周后恢复１周（ＲＥＣ－１）及对照（ＣＯＮ）大鼠后肢和头颈部动脉血管内皮的形态学改变。结果股动脉：与ＣＯＮ比较，ＳＵＳ－４组内皮细胞的平均长度（Ｌ）降低１０％（Ｐ＜０．０１），平均宽度（Ｗ）增大４５％（Ｐ＜０．０１），平均宽／长之比（Ｗ／Ｌ）增大６５％（Ｐ＜０．０１），细胞更趋于圆形，内皮细胞的数目（Ｎ）无明显改变（Ｐ＞０．０５）；ＲＥＣ－１组Ｌ、Ｗ、Ｗ／Ｌ已基本恢复。颈总动脉：其变化趋势与股动脉相反。与ＣＯＮ比较，ＳＵＳ－４组内皮细胞的Ｌ增加１０％（Ｐ＜０．０５），Ｗ降低２４％（Ｐ＜０．０１），平均宽／长之比减小３１％（Ｐ＜０．０１），细胞更趋于梭形，Ｎ变化不明显（Ｐ＞０．０５）；ＲＥＣ－１组Ｌ、Ｗ、Ｗ／Ｌ已基本恢复。结论上述内皮细胞这些变化进一步表明，模拟失重大鼠头颈部的血流量增大，而后肢的血流量降低。     

甲状腺微小癌的超声诊断研究

目的：探讨甲状腺微小癌（TMC）的超声声像图特点。材料和方法：2003年1月至2005年1月71例甲状腺微小癌住院患者，其中男性17例，女性54例，男女比例为1：3．18，年龄26～77岁，平均49．6岁。所有患者的超声检查在手术前1周内进行，均经手术和病理证实。分析病灶多少、大小、内部回声类型、钙化、内部血流信号、颈淋巴结肿大等超声征象。结果：检出多发性病灶32例，检出单发性病灶35例，漏诊4个（10．3％），病灶检出率89．7％（35／39）。结论：对单发灶及长期随访结节性甲状腺肿患者的甲状腺内发现直径在1cm以内的低回声伴钙化，CDFI显示血流信号较丰富，必须警惕甲状腺微小癌的可能，并仔细扫查颈部淋巴结。     

肺癌P53基因突变与临床关系的研究

采用ＰＣＲ－限制性片段长度多态性分析法（ＰＣＲ－ＲＦＬＰ）检测４７例人肺癌Ｐ５３基因２４９位密码子点突变。结果显示，ＮＳＣＬＣＰ５３基因２４９密码子突变率２４．２４％（８／３３），ＳＣＬＣ突变率为０（０／１４），Ｐ５３基因２４９位密码子点突变与肺癌分期、组织分化、吸烟无关（Ｐ＞０．０５），与ＮＳＣＬＣ淋巴结转移相关（Ｐ＜０．０５）提示：Ｐ５３基因２４９位密码子突变是ＮＳＣＬＣ突变热点，是评估ＮＳＣＬＣ预后因素之一。     

颈部淋巴结超声特征的计算机提取及相关性评价

目的：评价计算机所提取的颈部淋巴结超声特征与医生的经验判断的相关性，以预测能否实现颈部淋巴结超声图像计算机辅助诊断。材料和方法：利用彩色多普勒超声观察43例患者的106个淋巴结的超声特征，包括大小、形态、边界、纵横比、淋巴门、皮髓质分布及比例、淋巴结内部回声、血流分布等。将超声医生判断分级的结果与计算机提取的淋巴结超声特征的参数定量结果作相关分析。结果：相关性较好的参数为NRL过零率（r=0．304，P=0．002）、凸包深度（r=0．32，P=0．001）、长／短径比率（r=-0．318，P=0．001）、血流像素点数（r=0．702，P〈0．001）、投影轮廓点分布的熵（r=0．719，P〈0．001）。结论：通过对颈部淋巴结超声图像提取量化特征参数，初步实现了颈部淋巴结良、恶性疾病的计算机辅助诊断。     

80例颈部淋巴结彩色多普勒超声显像及病理基础

从 1998～ 2 0 0 0年 ,我们观察了 35例 82个颈部正常淋巴结与 80例 12 0个颈部肿大淋巴结的超声表现及病理检查结果 ,报告如下。1　资料和方法　正常对照组为无相关疾病的健康查体人员 ,年龄 13～ 5 9岁 ,平均 35岁。 80例颈部淋巴结肿大患者均为我院住院或门诊病人。全部病例经彩色多普勒检查 ,在超声引导下穿刺活检或术后病理检查证实。采用美国百胜Ａｕ - 3彩色多普勒诊断仪 ,线阵探头 ,频率 7 5～ 10ＭＨｚ ,具有彩色血流显像 (ＣＤＦＩ) ,多普勒显像功能。对颈部肿大淋巴结测量最大长径Ｌ及短径Ｓ ,观察淋巴内部回声及血流情况 ,测量…     

超声对乳腺癌腋下淋巴结良恶性的诊断价值

目的：探讨高频彩色多普勒超声对乳腺癌腋下淋巴结转侈诊断的价值。方法：回顾性分析了72例经超声检查并手术病理证实的乳腺癌患者的腋下淋巴结，观察乳腺癌患者双侧腋下淋巴结的大小，形态、数目、内部回声（皮质、淋巴门）、内部血流信号。结果：72例乳腺癌中，手术病理证实有淋巴结转移者31例，无淋巴结转移者41例。良性淋巴结的超声表现长径、短径大于1．5，最大皮质厚度小于3mm，血流分布为无血流型或门型。转移性淋巴结表现为圆形，形态不规则，长境径小于2，最大皮质厚度大于3mm，血流分布为周围型或混合型。结论：高频彩色多普勒超声是诊断乳腺癌淋巴结转移的一种简便、有效的检查方法。     

浅表淋巴结病变二维超声显像及多普勒血流检测的临床研究

目的探讨良、恶性浅表肿大淋巴结声像图及多普勒血流参数变化特征,评价超声诊断技术的临床应用价值。方法98例213枚肿大淋巴结分为良、恶性两组,采用高频探头观察肿大淋巴结的形态、大小、内部回声及血流动力学指标。并结合病理,分析不同病因浅表肿大淋巴结的超声特征。结果恶性淋巴结横径、形态更接近圆形,多融合,其周边型血流明显高于良性淋巴结(P<0.05),良性肿大淋巴结血流分支细少,走行规律,呈低阻力;恶性呈高阻力,为不规则扭曲、紊乱血流。结论超声在浅表肿大淋巴结定性诊断中可为临床提供更多诊断信息,为影像学首选诊断方法。     

Current status of power Doppler and color Doppler sonography in the differential diagnosis of lymph node lesions

The use of Power Doppler sonography in nodal diseases provides an improvement of early and noninvasive diagnosis of regional metastatic involvement. By using Power Doppler sonography it is possible to characterize lymph nodes as reactively enlarged, metastases, malignant lymphoma, tuberculosis and to study cervical cysts. The high diagnostic accuracy is based on perfusion-characteristics of these lymph nodes. Reactive lymph nodes show increased central perfusion of the hilum, whereas metastases tend to show increased peripheral perfusion. Affected lymph nodes in patients with by malignant lymphoma are highly perfused in the center but also peripheral. Power Doppler sonography is still not able to discriminate small (<8 mm) nonnecrotic metastasis or micrometastases from reactive lymph nodes. The purpose of this paper is to provide a summary of the current status of power Doppler and Doppler sonography in the differential diagnosis of lymph nodes.     

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

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...     

Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy

OBJECTIVES: The purpose of the study was to evaluate the efficacy of colour Doppler ultrasound (CDUS) to differentiate between benign and malignant cervical lymph nodes. METHODS: During a period of 12 months, 100 untreated patients with clinical evidence of cervical lymphadenopathy (50 patients with clinically suspected malignant/metastatic cervical lymphadenopathy and 50 patients with clinically suspected reactive/benign cervical lymphadenopathy) were prospectively evaluated with CDUS. CDUS was performed for 168 cervical lymph nodes in these 100 patients. Histopathological confirmations were obtained by fine needle aspiration biopsy and/or excisional biopsy. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological/histological features of enlarged cervical lymph nodes was then done. RESULTS: Initially, clinical examination evaluated 143 cervical lymph nodes. CDUS evaluation discovered additional 25 lymph nodes (143+25 = 168). Correlation of patterns of colour Doppler flow signals with pathological diagnosis showed that central flow for benign nodes and peripheral flow for malignant nodes were highly significant parameters (P < 0.01). CDUS has a higher specificity than clinical evaluation, being 94.28% and 58.76%, respectively. Accuracy of the CDUS examination was also definitely higher than clinical evaluation at 92.85% and 63.67%, respectively. CONCLUSIONS: Nodal vascularity can be used to differentiate benign from malignant lymphadenopathy. Proper judicious CDUS examination provides an opportunity to eliminate the need for biopsy/FNAC in reactive nodes.     

Quantitative evaluation of vascularity within cervical lymph nodes using Doppler ultrasound in patients with oral cancer: relation to lymph node size

Objectives

The aim of this study was to quantitatively evaluate the relationship between vascularity within lymph nodes and lymph node size on Doppler ultrasound images of patients with oral cancer.

Methods

A total of 310 lymph nodes (86 metastatic, 224 benign) from 63 patients with oral cancer were classified into 4 groups according to their short axis diameters: Group 1, short axis diameters of 4–5 mm; Group 2, 6–7 mm; Group 3, 8–9 mm; and Group 4, ≥10 mm. Vascular and scattering indices of lymph nodes on Doppler ultrasound images were analysed quantitatively. The vascular index was defined as the ratio of blood flow area to the whole lymph node area and the scattering index was defined as the number of isolated blood flow signal units.

Results

For metastatic lymph nodes, the vascular index was highest in Group 1 and decreased as lymph node size increased. The vascular index of benign lymph nodes did not differ significantly among the four groups. The vascular index of metastatic lymph nodes was significantly higher than that of benign lymph nodes in Group 1. For metastatic lymph nodes, the scattering index increased as lymph node size increased and was significantly higher than that of benign lymph nodes in Groups 2–4.

Conclusions

An increase in vascularity is a characteristic of Doppler ultrasound findings in small metastatic lymph nodes. As the metastatic lymph node size increases, blood flow signals become scattered, and the scattering index increases.     

彩色多普勒超声评价肿瘤血管在甲状腺结节诊断中的应用

目的:研究甲状腺结节内肿瘤血管及颈部转移淋巴结的彩色多普勒超声表现。方法:分析42例甲状腺癌和46例甲状腺良性结节的血管形态及血流动力学特征。结果:甲状腺癌及甲状腺癌复发病例中,69.0%(29/42)血流为Alder2级或3级,38.1%(16/42)可见穿入性或分支异常的血管,71.4%(30/42)血流为高阻力型(RI>0.7)。甲状腺良性结节中,上述表现发生率分别为39.1%(18/46)、6.5%(3/46)、10.9%(5/46)。23例甲状腺癌可见颈部转移性淋巴结,其中82.6%(19/23)的血流形态表现为紊乱分布的包膜下血流。结论:甲状腺癌肿瘤血管的发现及颈部淋巴结的血流表现有助于甲状腺癌的正确诊断。     

鼻咽癌颈转移淋巴结的多普勒血流信号特征

目的研究鼻咽癌颈转移淋巴结的彩色多普勒血流信号特征.材料与方法鼻咽癌伴颈淋巴结转移患者52例共134枚颈转移淋巴结,在接受治疗前行彩色多普勒血流检查,分析其血流信号特征和血供强度与淋巴结大小、部位的关系.结果鼻咽癌颈转移淋巴结的动脉血管多分布在淋巴结的周边,血流阻抗(RI)高;淋巴结血流强度的分布因淋巴结部位、大小的变化而不同,大淋巴结较小淋巴结血供丰富;中、下颈淋巴结较上颈淋巴结血供丰富.结论鼻咽癌颈转移淋巴结以周边型高阻血流信号为主.血供强度与淋巴结大小、部位有关.     

Can ultrasound elastography distinguish metastatic from reactive lymph nodes in patients with primary head and neck cancers?

Objectives

The purpose of this study was to evaluate the diagnostic utility of real-time elastography (RTE) in differentiating between reactive and metastatic cervical lymph nodes (LN) in patients with primary head and neck cancer in comparison with the conventional B mode and power Doppler parameters.

Methods

A total of 127 lymph nodes in 78 patients with primary head and neck cancer were examined by B-mode sonography, power Doppler ultrasound and elastography. Elastographic patterns were determined on the distribution and percentage of the lymph node area with low elasticity (hard), with pattern 1 being an absent or very small hard area to pattern 5, a hard area occupying the entire lymph node. Patterns 3–5 were considered metastatic. Ultrasound guided aspiration cytology was done for 57 lymph nodes. Excision biopsy was done for 52 lymph nodes. Eighteen lymph nodes responded to conservative treatment, and were considered reactive.

Results

The majority (85.3%) of the metastatic lymph nodes had elastography pattern 3–5. This finding was observed in only 5% of the benign lymph nodes (P < 0.001). The elastography pattern had sensitivity of 85.3%, specificity of 95.5%, PPV of 97.2%, NPV of 78.1% and overall accuracy of 88.9% in differentiation between benign and malignant lymph nodes. On the other hand, for the B mode criteria, the best accuracy was given to abnormal hilum (83%). The accuracy of power Doppler ultrasound pattern was 70.8%.

Conclusions

The accuracy of sonoelastography is higher than usual B mode and power Doppler ultrasound parameters in differentiation between benign and malignant nodes. The integration of lymph node sonoelastography in the follow up of patients with known head and neck cancer may reduce the number of biopsies.     

PET/CT在头颈部肿大淋巴结定性中的临床价值

目的：探讨PET/CT检查定性诊断头颈部肿大淋巴结的应用价值。材料和方法：于2006-06～2008-10对38例头颈部淋巴结肿大的患者行全身18氟-脱氧葡萄糖（FDG）PET/CT检查,测取相应淋巴结的平均标准摄取值（SUVmean）和颈部正常组织的SUV（SUVneck）。所有恶性淋巴结全部得到病理确诊。结果：30例恶性肿瘤患者中,35个肿大淋巴结的SUVmean高于相应的颈部正常组织SUVneck;5例7个良性肿大淋巴结未见显影,3例4个良性肿大淋巴结显影。PET对头颈部淋巴结肿大定性诊断准确率高于颈部超声与CT、MRI检查（P〈0.001）。结论：对于头颈部淋巴结肿大的患者,PET/CT检查是一种有效的定性诊断途径。     

超声内镜下肺癌纵隔淋巴结的影像学特征

为探讨超声内镜 (EUS)下肺癌纵隔淋巴结的影像学特征 ,以便为EUS在肺癌术前分期中的应用奠定基础 ,对 2 1例肺癌患者手术切除的 10 3枚纵隔淋巴结的EUS声像图进行研究。结果显示 ,良、恶性淋巴结均为低回声 ;恶性淋巴结的影像学特征为短径≥ 1.0cm ,边界清楚或圆形 ;而良性淋巴结大多短径 1.0cm ,边界不清 ;其差异具有统计学意义 (P <0 .0 1)。淋巴结的长径及长、短径的比值良、恶性淋巴结无显著差异 (P >0 .0 5 )。提示超声内镜对肺癌纵隔淋巴结的良恶性鉴别有一定价值