三维超声联合超声造影观察颈部不典型淋巴结血流特征

目的 探讨三维超声联合超声造影观察颈部不典型淋巴结的血流特征。方法 对97例常规超声检查不能提示淋巴结良恶性的颈部淋巴结肿大患者（161个淋巴结）行三维超声和超声造影检查。根据最终诊断结果，将淋巴结分为4组：反应性增生组25例（45个淋巴结）、结核组19例（27个淋巴结）、转移瘤组32例（54个淋巴结）、淋巴瘤组21例（35个淋巴结）。比较4组淋巴结长径与短径比值（L/S）、门髓质形态、血流类型和超声造影特征。结果 4组间L/S及门髓质形态差异均有统计学意义（P均<0.05）。反应性增生组与转移瘤组L/S差异有统计学意义（P<0.008），反应性增生组与转移瘤组、转移瘤组与淋巴瘤组的门髓质形态差异有统计学意义（P均<0.008）；其余各组两两比较差异均无统计学意义（P均>0.008）。4组间血流类型、动脉相造影剂进入方式和实质相造影剂分布状态差异均有统计学意义（P均<0.05）。反应性增生组与结核组、反应性增生组与转移瘤组血流类型差异均有统计学意义（P均<0.008），反应性增生组与结核组、反应性增生组与转移瘤组、淋巴瘤组与结核组、淋巴瘤组与转移瘤组动脉相造影剂进入方式和实质相造影剂分布状态差异均有统计学意义（P均<0.008）；其余各组两两比较差异均无统计学意义（P均>0.008）。结论 三维超声联合超声造影可全面了解淋巴结的血流灌注，可诊断二维声像图特征不典型的淋巴结提供较有价值的信息。

Three-dimensional ultrasound combined with contrast-enhanced ultrasound in observation of blood flow characteristics of atypical lymph nodes in neck

Objective To explore three-dimensional (3D) ultrasound combined with contrast-enhanced ultrasound (CEUS) in observation of blood flow characteristics of atypical lymph nodes in neck. Methods Totally 97 cases with 161 lymph nodes in neck which couldnot be determinated as benign or malignant by common ultrasound were involved. 3D ultrasound and CEUS were performed in each lymph nodes. These nodes were divided into 4 groups according to the final diagnosis: Reactive hyperplasia group (25 cases, 45 lypmph nodes), tuberculosis group (19 cases, 27 lypmph nodes), metastatic tumor group (32 cases, 54 lypmph nodes), lymphoma group (21cases, 35 lypmph nodes). Long diameter and short diameter ratio (L/S), morphology of hilus and medulla, blood flow type and CEUS characteristics in 4 groups were compared. Results The L/S and morphology of hilus and medulla both had statistical differences (both P<0.05).The difference of L/S between reactive hyperplasia group and metastatic tumor group had statistical significance (P<0.008). The morphology of hilus and medulla between reactive hyperplasia group and metastatic tumor group, metastatic tumor group and lymphoma group both had statistical differences (both P<0.008). The pairwise compare of other groups had no statistical differences (all P>0.008). The differences of blood flow type, entering mode of contrast medium in artery phase and distribution mode of contrast medium in venous phase both had statistical significance (both P<0.05). Blood flow type between reactive hyperplasia group and tuberculosis group, reactive hyperplasia group and metastatic tumor group both had statistical differences (both P<0.008). Entering mode of contrast medium in artery phase and distribution mode of contrast medium in venous phase between reactive hyperplasia group and tuberculosis group, reactive hyperplasia group and metastatic tumor group, lymphoma group and tuberculosis group, lymphoma group and metastatic tumor group all had statistical differences (all P<0.008). The pairwise compare of other groups had no statistical differences (all P>0.008). Conclusion The characteristics of blood flow in lymph nodes can be totally observed by 3D ultrasound combined with CEUS, which can offer valuable diagnostic information to discriminate cervical lymph nodes with atypical two-dimensional ultrasonographic characteristics.