高频超声与CT在良恶性浅表淋巴结鉴别诊断中的应用价值

目的:探讨超声及电子计算机断层扫描（CT）在浅表淋巴结病变筛查诊断中的价值。方法:回顾性分析均行超声及CT检查的96例浅表淋巴结病变患者，根据病理组织活检结果将患者分为良性淋巴结组（n=41例）和恶性淋巴结组（n=55例）。根据超声、CT检查结合病理学诊断，描述不同类型浅表淋巴结的声像学特点。采用Kappa一致性得到CT、超声及两种检查方法联合检测的灵敏度、特异度、阳性预测值、阴性预测值；根据高频超声图像测量淋巴结最长径值、最短径值，采用血流频谱多普勒彩超和流量计算公式测定血流阻力指数（RI）、动脉收缩期及舒张末期血流速度。结果:CT诊断准确率显著低于超声和联合检测（P<0.05）；CT误诊率显著高于超声和联合检测（P<0.05）；CT、超声、联合检测的AUC值分别为0.617、0.723、0.787，其中联合检测AUC值最高（P<0.05）。良性结节组患者行超声检测的最长径值、最短径值及RI值显著低于恶性结节组患者（P<0.05）；良性结节组患者的动脉收缩期血流速度显著高于恶性结节组患者（P<0.05）。两组患者行超声检测浅表淋巴结的最长径值、最短径值、RI值、动脉收缩期血流速度、定量值联合预测的AUC分别为0.753、0.686、0.787、0.698、0.897，其中定量值联合预测的预测价值最大（P<0.05）。结论:CT与超声联合和超声检测在浅表淋巴结良恶性诊断准确率较CT高，且联合检测和彩色多普勒超声检测具有相同诊断价值；彩色多普勒超声检测中浅表淋巴结的最长径值、最短径值及血管RI值、动脉收缩期血流速度的联合检测有较好预测价值。

Value of high-frequency ultrasound and CT in the differential diagnosis of benign and malignant superficial lymph node lesions

Abstract: Objective To explore the value of ultrasound and computed tomography (CT) in the screening and diagnosis of superficial lymph node lesions. Methods A retrospective analysis was performed on the 96 patients with superficial lymph node lesions undergoing ultrasound and CT examinations. According to the results of pathological biopsy, the patients were divided into benign lymph node group (n=41) and malignant lymph node group (n=55). Based on the results of ultrasound and CT examination combined with pathological diagnosis, the sonographic characteristics of different types of superficial lymph nodes were described. Kappa consistency was applied to obtain the sensitivity, specificity, positive predictive value and negative predictive value of CT, ultrasound and combined detection. The longest and shortest diameters of lymph nodes were measured in high-frequency ultrasound image. Moreover, the blood flow resistance index (RI), arterial peak systolic velocity and end diastolic velocity were obtained by blood flow spectrum of color Doppler ultrasound and flow calculation formula. Results Compared with ultrasound and combined detection, CT had a lower diagnostic accuracy rate (P<0.05) and a higher misdiagnosis rate (P<0.05). The combined detection achieved the greatest AUC, which was 0.787, higher than 0.617 and 0.723 of CT and ultrasound (P<0.05). The long diameter, short diameter and RI measured by ultrasound in benign nodule group were significantly lower than those in malignant group (P<0.05), but arterial peak systolic velocity in benign nodule group was significantly higher (P<0.05). The AUC of long diameter, short diameter, RI, arterial peak systolic velocity, and combined detection for predicting superficial lymph node lesions were 0.753, 0.686, 0.787, 0.698 and 0.897, respectively, which indicated that the predicted value of combined detection was the highest (P<0.05). Conclusion The accuracy rates of CT combined with ultrasound and ultrasound alone are higher than that of CT in the diagnosis of benign and malignant superficial lymph node lesions, and the combination of CT and ultrasound has the same diagnostic value with color Doppler ultrasound. For the color Doppler ultrasound detection, the combined detection of long diameter, short diameter, vascular RI and arterial peak systolic velocity is of great predictive value for superficial lymph nodes.