恶性浅表淋巴结病变的常规超声及超声造影特征

目的探讨与恶性浅表淋巴结病变相关的常规超声及经静脉超声造影(CEUS)特征。资料与方法对68例患者共68枚淋巴结进行常规超声检查,并对其中62枚行CEUS检查,所有淋巴结均获取病理结果。比较良、恶性浅表淋巴结的常规超声及CEUS特征差异,对各因素分别做受试者工作特征(ROC)曲线,计算其对良、恶性淋巴结病变的鉴别诊断效能。结果良性和恶性浅表淋巴结病变短径、长短径之比、有无淋巴门、周围型/混合型血流、增强是否均匀、增强时有无淋巴门、外周向中心增强、增强时有无灌注缺损等超声特征比较,差异均有统计学意义(P均<0.05),其对良、恶性淋巴结病变的ROC曲线下面积分别为0.687、0.665、0.786、0.676、0.628、0.662、0.725和0.648。结论浅表淋巴结病变短径、长短径之比、有无淋巴门、周围型/混合型血流、增强是否均匀、增强时有无淋巴门、外周向中心增强、增强时有无灌注缺损等超声特征是鉴别诊断良恶性的指标。     

高频超声在胸肌淋巴结检测中的应用价值

目的：评价高频超声在探测胸肌淋巴结中的应用价值。材料和方法：行腋窝淋巴结清扫的乳腺癌患者56例，另有乳腺良性病变患者22例，正常者24例作为对照组。使用仪器为ATL－3000型彩色多普勒超声诊断仪。运用高频超声探测胸肌淋巴结体表定位，并与术后病理标本中找到的胸肌淋巴结对照。结果：超声对胸肌淋巴结的检出率，乳腺癌患者92．9％（52／56），乳腺良性病变患者86．4％（19／22），正常组91．7％（22／24），三组间无显著性差异。结论：运用高频超声探测胸肌淋巴结，是一个简便、可行的方法。     

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...     

32P胶体局部给药防治H22移植瘤淋巴道转移的实验研究

目的探讨不同剂量的^32P胶体局部注射对小鼠H22移植瘤和区域淋巴结转移灶的治疗作用。方法应用小鼠H22腹水型肝癌淋巴道转移模型，通过肿瘤组织局部给药，观察^32P胶体在模型小鼠移植瘤、区域淋巴结及全身各器官、组织内的分布。结果^32P胶体局部给药后主要聚集在瘤体注射局部和区域淋巴结内，而在肝、脾、肺等脏器分布的活度较低。区域淋巴结聚集的活度随给药剂量增高而递增。治疗早期瘤体和胭窝淋巴结转移灶呈现局灶性坏死。后期移植瘤和区域淋巴结转移灶的瘤组织呈现出血、坏死。结论^32P胶体瘤体给药可在局部富集，并可经淋巴道转运、聚集于区域淋巴结，对肿瘤组织和邻近的淋巴结转移灶具有明显的杀伤作用。     

Role of contrast enhanced ultrasound in characterization of focal liver lesions

Aim

The purpose of the study was to describe the enhancement patterns of focal liver lesions (FLLs) on contrast enhanced sonography (CEUS), assessing the potential of this technique for characterizing the lesions and to compare its diagnostic accuracy with conventional baseline sonography including color Doppler.

Materials and methods

Between August 2009 and July 2010, 50 patients with FLLs underwent gray scale sonography, color Doppler and CEUS. The enhancement patterns of these FLL’s were analyzed throughout the arterial phase, the portal venous phase and the extended portal venous phase (the late parenchymal phase). The final diagnosis was established on the basis of histopathologic examination or CT/MRI imaging.

Results

Out of these 50 FLLs, 33 were malignant (4 hepatocellular carcinoma and 29 metastasis) and 17 were benign (5 hemangioma, 5 abscess, 2 cyst and 1 each of FNH, focal fat sparing area, focal fatty infiltration, adenoma and benign/granulomatous lesion). The enhancement patterns after injecting microbubble contrast agent allowed characterization of FLLs. The malignant lesions showed intratumoral and/or peritumoral vascularity during the arterial phase and perfusion defect during the late parenchymal phase. Contrast enhanced sonography improved sensitivity in detecting malignancy (CEUS vs. baseline sonography, 100% vs. 81.8%).

Conclusion

CEUS improves detection and characterization of FLLs. It should be used as problem solving tool in cases where conventional gray scale and color Doppler sonography are non-diagnostic.     

Primary mediastinal lymph node tuberculosis diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration: Literature review and case report

Tuberculosis bacilli can enter the human body through the respiratory system, digestive system, or skin and mucous membranes, with the respiratory tract representing the primary point of entry. Once inside the body, tuberculosis bacilli can enter the bloodstream and attack other organs, including the lymphatic system. One manifestation associated with lymphatic tuberculosis infiltration is the presence of large hilar and mediastinal lymph nodes, which are common in children and classified as primary tuberculosis. A diagnosis of primary tuberculosis in adults is often overlooked by doctors due to its low frequency. When a single enlarged mediastinal lymph node is observed, most doctors suspect other causes, especially malignancy. Determining the correct diagnosis for enlarged hilar and mediastinal lymph nodes can be difficult because diagnostic interventions in this area are challenging to perform. We report a clinical case of primary lymph node tuberculosis in an adult, confirmed by endobronchial ultrasound-guided transbronchial needle aspiration. We aim to provide doctors with a more comprehensive approach for diagnosing this disease.     

Cervical lymphodenopathy--a single presentation of sarcoidosis?

BACKGROUND: Sarcoidosis is a chronic inflammatory disease, commonly found in lungs and hilar lymph nodes, but multiple organs could be involved. The diagnosis is based on specific pathohistology which should be always combined with clinical, radiological and laboratory findings. CASE REPORT: A patient initially presented with pneumonia, and treated with antibiotics, but with the general symptoms that persisted despite radiological resolution of lung infiltration was reported. The further diagnostic procedures revealed the presence of sarcoid granulomas in cervical lymph nodes. The peripheral lymph nodes are often affected in the early course of the disease, but it is difficult to distinguish if the illness is a sarcoid reaction to lung infection or a acute onset of sarcoidosis. CONCLUSION: The detection of sarcoid granulomas in cervical lymph nodes should be precisely analyzed for the presence of sarcoidal changes in other tissues, primarily in the lungs tissue. Early diagnosis of lung sarcoidosis is significant, especially in the light of the fact that the latest studies point out that the prednisone therapy, started immediately after the diagnosis has been made, renders positive effects also in asympthomatic patients in II and III phase of the disease.     

Contrast enhanced ultrasound (<Emphasis Type="Italic">CEUS</Emphasis>) in blunt abdominal trauma

In the assessment of polytrauma patient, an accurate diagnostic study protocol with high sensitivity and specificity is necessary. Computed Tomography (CT) is the standard reference in the emergency for evaluating the patients with abdominal trauma. Ultrasonography (US) has a high sensitivity in detecting free fluid in the peritoneum, but it does not show as much sensitivity for traumatic parenchymal lesions. The use of Contrast-Enhanced Ultrasound (CEUS) improves the accuracy of the method in the diagnosis and assessment of the extent of parenchymal lesions. Although the CEUS is not feasible as a method of first level in the diagnosis and management of the polytrauma patient, it can be used in the follow-up of traumatic injuries of abdominal parenchymal organs (liver, spleen and kidneys), especially in young people or children.     

Gray-scale contrast-enhanced utrasonography in detecting sentinel lymph nodes: An animal study

Objective

To investigate the usefulness of gray-scale contrast-enhanced ultrasonography for detecting sentinel lymph nodes.

Methods

Contrast-enhanced ultrasonography was performed in five normal dogs (four female and one male) after subcutaneous administration of a sonographic contrast agent (Sonovue, Bracco, Milan, Italy). Four distinct regions in each animal were examined. After contrast-enhanced ultrasonography, 0.8 ml of blue dye was injected into the same location as Sonovue and the sentinel lymph nodes were detected by surgical dissection. The findings of contrast-enhanced ultrasonography were compared with those of the blue dye.

Results

Twenty-one sentinel lymph nodes were detected by contrast-enhanced ultrasonography while 23 were identified by blue dye with surgical dissection. Compared with the blue dye, the detection rate of enhanced ultrasonography for the sentinel lymph nodes is 91.3% (21/23). Two patterns of enhancement in the sentinel lymph nodes were observed: complete enhancement (5 sentinel lymph nodes) and partial enhancement (16 sentinel lymph nodes). The lymphatic channels were demonstrated as hyperechoic linear structures leading from the injection site and could be readily followed to their sentinel lymph nodes. Histopathologic examination showed proliferation of lymphatic follicles or lymphatic sinus in partial enhanced sentinel lymph nodes while normal lymphatic tissue was demonstrated in completely enhanced sentinel lymph nodes.

Conclusions

Sonovue combined with gray-scale contrast-enhanced ultrasonography may provide a feasible method for detecting sentinel lymph nodes.     

胃癌组与正常组螺旋CT淋巴结检出率比较研究

目的　分析螺旋CT对正常人与胃癌患者淋巴结检出情况。方法　对 88例正常人和 10 6例胃癌患者进行上腹部螺旋CT扫描 ,比较淋巴结检出情况。结果　正常组与胃癌组间淋巴结检出情况有显著差异。螺旋CT对淋巴结总检出率为 3 9.7% ,转移阳性淋巴结检出率达 69.2 %。结论　淋巴结密度增高对CT淋巴结检出率有重要影响 ,淋巴结CT检出率与胃癌具有明显相关性 ,对胃癌淋巴引流区域检出的淋巴结必须给予高度重视     

Clinical staging of malignant tumors of the head and neck region by the TNM system: contribution of modern imaging procedures

Currently, the method of choice for evaluation of head and neck cancers is CT, because in many respects it is superior to the other imaging modalities except for MR. For parotid tumors, however, histological grading is of major importance. The staging of tumors of the hypopharynx and larynx can be done just as reliably by CT and microlaryngoscopy; the latter has the advantage of including biopsy. Ultrasound is of primary value in providing information on metastases to the cervical lymph nodes. If CT is used for staging of the primary tumor or planning radiation therapy, then it also can be utilized for the detection of lymphatic spread.     

严重急性呼吸综合征肺脏及免疫器官淋巴细胞亚群分析

目的 探讨严重急性呼吸综合征(SARS)肺脏的免疫反应类型和状况，及免疫器官淋巴细胞亚群的数量变化。方法 采用免疫组织化学方法，以CD3、CD4、CD8、CD20、CD57、CD68、S-100、HLA-DR单克隆抗体，对1例重型SARS的肺组织及免疫器官中多种淋巴细胞亚群进行标记，并以健康人体脾脏及淋巴结作对照，观察分析各淋巴亚群的分布及数量变化。结果 该例重型SARS病例肺间质中主要以CD8^ 淋巴细胞浸润为主，杂以少数CD4^ 淋巴细胞。淋巴细胞亚群半定量分析显示，31枚胸腔淋巴结中，CD3^ 、CD4^ 、CD8^ 和CD20^ 细胞数减少的淋巴结百分率分别为74．2％、67．7％、74．2％、83．9％，其中各淋巴细胞亚群明显减少者比例较高，腹腔淋巴结中各淋巴细胞亚群减少较轻；脾脏中CD3^ 、CD4^ 、CD8^ 、CD20^ 细胞均呈不同程度的减少，其中以CD20^ 细胞数目减少最为显著；而淋巴结及脾脏中CD57^ 、CD68^ 、S-100^ 、HLA-DR^ 细胞数目呈相对增加改变。结论 结果提示SARS肺组织原位以细胞免疫反应为主，推测肺脏内细胞免疫反应可能具有清除受感染细胞内冠状病毒病原体和诱发肺组织免疫损伤的双重作用；疾病后期重型SARS病例免疫器官可能存在淋巴细胞亚群的不同程度减少及比例失衡，并呈围病变肺组织愈近，淋巴结内主要淋巴细胞亚群减少愈甚之趋势。     

前哨淋巴结显像研究

前哨淋巴结系指原发肿瘤淋巴引流的第一级淋巴结,淋巴显像可准确定位前哨淋巴结及其数目,检出率达80%~100%。常用的前哨淋巴结显像剂有99Tcm-硫胶体、99Tcm-人血清白蛋白、99Tcm-右旋糖酐等。该法简便安全、实用性强,已先后应用于黑色素瘤、乳腺癌、妇科肿瘤等疾病的术前常规定位诊断,取得了很好的结果。     

Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors

OBJECTIVE: We determined whether contrast-enhanced color Doppler sonography can differentiate benign from malignant enlarged cervical lymph nodes in head and neck tumors. SUBJECTS AND METHODS: Ninety-four enlarged lymph nodes in 39 adult patients (32 men and seven women; age range, 30-81 years) were examined with B-mode sonography and with unenhanced and contrast-enhanced color Doppler sonography. All patients had carcinoma of the oral cavity. Histologically, lymphadenitis was found in 57 nodes and metastases in 37 nodes. Geometric dimension, texture, and margin of the node and detection and location of vessels were noted. Histology and imaging findings were correlated. RESULTS: The transverse-to-longitudinal diameter ratio in combination with texture and margin analysis resulted in a correct diagnosis in only approximately 79% of the nodes. With contrast-enhanced color Doppler sonography, 86% of nodes showed vessels, and 28% of nodes showed vessels with this technique exclusively. Characteristic configurations were identified: hilar vessels with branching indicated lymphadenitis (sensitivity, 98%; specificity, 100%), and predominantly peripheral vessels indicated metastases (100%, 98%). These findings changed the diagnosis in 13 nodes, changed the therapy in four patients, and led to an incorrect diagnosis in one patient. CONCLUSION: Enlarged lymph nodes can be characterized as metastatic or inflammatory with high diagnostic accuracy on the basis of their vascular architecture as seen on contrast-enhanced color Doppler sonography.     

间质磁共振淋巴管造影在检测乳腺癌患者前哨淋巴结转移情况中的应用价值

目的探讨间质磁共振(MR)淋巴管造影与弥散加权成像(DWI)序列相结合检测乳腺癌患者前哨淋巴结转移情况的应用价值。方法选取河南大学第一附属医院2018年6月至2019年6月30例前哨淋巴结阳性乳腺癌患者,并招募30名健康志愿者作为阴性组,给予MR间质淋巴造影检查,观察乳腺癌患者淋巴管及前哨淋巴结情况,对比分析2组淋巴管走行、管径情况和前哨淋巴结数目、大小、边缘、形态及弥散系数(ADC)值的指标。结果阳性组淋巴管走行、管径与阴性组对比差异有统计学意义(P<0.05);阳性组及阴性组前哨淋巴结平均数目差异无统计学意义(P>0.05);阳性组前哨淋巴结大小、边缘、形态及ADC值的指标均有明显差异(P<0.05)。结论 MR间质淋巴管造影与DWI序列相结合可以高分辨率的显示淋巴管和淋巴结的形态和功能,提高了乳腺癌患者前哨淋巴结转移的检出率。     

Clinical experience with intra lymphatic administration of111In-labelled monoclonal antibody PAY 276 for the detection of pelvic nodal metastases in prostatic carcinoma

The ability of¹¹¹In-PAY 276 (anti prostatic acid phosphatase antibody) in detecting pelvic lymph node metastasis following bipedal intra lymphatic administration was studied in five patients with carcinoma of the prostate. The labeled antibody was injected directly into the lymphatics of each foot. Planar and tomographic images radioactivity content of lymph nodes resected during staging pelvic lymphadenectomy were compared to the histologic and immunoperoxidase findings. Radioactivity in pelvic lymph nodes was prominently seen within 20 min of injection and was present 16 days later. Persistent accumulation of tracer in the lymphatics of the lower extremities was also observed in all patients 16 days post injection. Radioactivity counts in tumor-free lymph nodes were higher than in tumored lymph nodes resected. Our results demonstrate that intra lymphatic administration of¹¹¹In-labeled PAY 276 monoclonal antibody has major technical limitations, and that further research directed at the causes of tracer accumulation in the lymphatics and tumor-free lymph nodes is required.     

Clinical experience with intra lymphatic administration of 111In-labelled monoclonal antibody PAY 276 for the detection of pelvic nodal metastases in prostatic carcinoma

The ability of 111In-PAY 276 (anti prostatic acid phosphatase antibody) in detecting pelvic lymph node metastasis following bipedal intra lymphatic administration was studied in five patients with carcinoma of the prostate. The labeled antibody was injected directly into the lymphatics of each foot. Planar and tomographic images radioactivity content of lymph nodes resected during staging pelvic lymphadenectomy were compared to the histologic and immunoperoxidase findings. Radioactivity in pelvic lymph nodes was prominently seen within 20 min of injection and was present 16 days later. Persistent accumulation of tracer in the lymphatics of the lower extremities was also observed in all patients 16 days post injection. Radioactivity counts in tumor-free lymph nodes were higher than in tumored lymph nodes resected. Our results demonstrate that intra lymphatic administration of 111In-labeled PAY 276 monoclonal antibody has major technical limitations, and that further research directed at the causes of tracer accumulation in the lymphatics and tumor-free lymph nodes is required.     

术中超声判断肺癌淋巴结转移的研究

目的 评价术中超声(IUS)在肺癌手术中检出纵隔和肺门淋巴结的能力及其判断淋巴结转移的准确性。方法 对33例肺癌患者进行了术中超声俭查，逐区探查并记录纵隔和肺门淋巴结的数目、大小、部位，根据淋巴结的几何尺寸和声像特征预测其是否为转移，以手术淋巴结清扫和病理检查的结果为对照。结果 (1)IUS检出淋巴结的敏感度为83．6％(163／195)．阳性预告值为97．0％(165／168)。不同分区和淋巴结的大小对于检出率有影响。(2)IUS预测淋巴结转移的结果：以淋巴结几何尺寸为标准，其敏感度为70．3％，特异度为71．7％，准确率为71．2％，以声像特征为标准则分别为85．7％、75．0％、83．3％。结论 IUS是肺癌手术中探查和发现纵隔淋巴结的一种有效的方法。     

Imaging of gastrointestinal and abdominal tuberculosis

This article discusses the range of manifestations of tuberculosis (TB) of the abdomen, including involvement of the gastrointestinal tract, the peritoneum, mesentery, omentum, abdominal lymph nodes, solid abdominal organs, the genital system and the abdominal aorta. Abdominal TB is a diagnostic challenge, particularly when pulmonary TB is absent. It may mimic many other abdominal diseases, both clinically and radiologically. An early correct diagnosis, however, is important in order to ensure proper treatment and a favorable outcome. Modern imaging is a cornerstone in the early diagnosis of abdominal TB and may prevent unnecessary morbidity and mortality. Generally, CT appears to be the imaging modality of choice in the detection and assessment of abdominal tuberculosis, other than gastrointestinal TB. Barium studies remain superior for demonstrating mucosal intestinal lesions. Ultrasound may be used for follow-up to monitor therapy response. The diagnosis of abdominal TB should be considered if suggestive imaging findings are found in patients with a high index of suspicion.     

腹腔及腹膜后间隙淋巴结结核的多层螺旋CT强化特征

目的研究腹腔及腹膜后间隙淋巴结结核的多层螺旋CT强化特征,以提高该疾病的影像诊断水平。方法收集本院经临床病理证实的腹部淋巴结结核19例,在多层螺旋CT强化图像上,观察受累淋巴结的大小、形态、密度、强化类型、优势解剖分布以及淋巴结外器官病变的强化特征。结果94.7%淋巴结结核呈典型的环状强化,仅5.3%增大的淋巴结呈均匀强化。腹部淋巴结结核常优势地累及肠系膜(73.7%)、门腔间隙(63.2%)、肝十二指肠韧带(57.9%)、肝胃韧带(47.4%)和腹主动脉周围上部淋巴结(47.4%)。9例(47.4%)脾增大,其中5例(26.3%)脾内有多发低密度灶,病灶周边强化;6例(31.5%)腹腔积液;3例(15.8%)大网膜、肠系膜和壁层腹膜广泛结节样增厚。结论结核累及腹腔及腹膜后间隙淋巴结的多层螺旋CT强化具有一定特征。