面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声鉴别诊断

目的 分析面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声特点,总结其鉴别诊断要点,探讨彩色多普勒超声在2种深部病变鉴别诊断中的意义。方法 回顾分析2012年12月—2013年12月临沂市肿瘤医院收治的经手术病理或DSA下经皮穿刺瘤体造影确诊的32例静脉畸形和29例面颈部淋巴管畸形的临床和彩色多普勒超声资料,分析静脉畸形和淋巴管畸形的彩色多普勒超声特点,以病理诊断或DSA诊断为金标准,应用SPSS 18.0软件包对数据进行统计学分析,计量特异度和敏感度。结果 32例静脉畸形病例,二维超声均显示无回声,无间隔,14例病变内见低回声血栓,11例内见高回声静脉石。多普勒超声均见周边动脉血流, PSV为(13.98±7.93) cm/s,RI为(0.71±0.83) cm/s, 30例探头加压可见静脉频谱的血流信号;29例淋巴管畸形病例,单囊者8例,多囊者10例,网格状11例,二维超声也均呈无回声,但21例病变内可见多发强回声间隔;多普勒超声2例探头加压见血流信号,PI下为静脉频谱,间隔内均可见动脉血流信号,PSV为(14.32±6.57) cm/s,RI为(0.68±0.79) cm/s。经t检验,2组PSV和RI比较无显著差异（P均>0.05）。经χ²检验2组低回声血栓、高回声静脉石、探头加压见血流信号和多发强回声间隔出现率,有显著差异（P<0.05）。探头加压见血流信号诊断静脉畸形的敏感度为93.75%,低回声血栓、高回声静脉石和探头加压见血流信号诊断静脉畸形的特异度较高,分别为96.55%、93.33%和100%。多发强回声间隔诊断淋巴管畸形的敏感度和特异度较高,分别为72.41%和100%。结论 彩色多普勒超声鉴别面颈深部静脉畸形和淋巴管畸形具有无创、价廉、准确的特点。病变内出现低回声血栓或高回声静脉石,探头加压出现血流信号支持静脉畸形诊断;病变内有多发强回声间隔,同时间隔内见动脉血流信号时支持淋巴管畸形诊断。

Diagnosis of deep facial and cervical lymphatic malformation and venous malformation with color Doppler ultrasonography

PURPOSE: To study the diagnostic significance of color Doppler ultrasound in deep facial and cervical lymphatic malformation and venous malformation by analyzing their color Doppler ultrasonographic characteristics. METHODS: The color Doppler ultrasonographic data of 29 cases of deep-seated facial and cervical lymphatic malformation and 32 cases of venous malformation which had been confirmed by surgical pathology or percutaneous puncture biopsy guided by DSA in Linyi Tumour Hospital from December 2012 to December 2013 were retrospectively analyzed. With final pathology or DSA as gold standard, specificity and sensitivity were calculated and compared with SPSS 18.0 software package. RESULTS: Of the 32 cases of venous malformation, there was no echo and interval by 2-dimensional ultrasound, hypoechoic thrombosis was found in 14 cases and high echo vein stone was found in 11 cases. There were artery flow around and PSV result was (13.98±7.93) cm/s, RI was (0.71±0.83) cm/s. In 30 cases vein blood flow signals were seen under probe pressure. Of the 29 cases, eight were single cystic lymphatic malformation, ten multiple and 11 mesh grid. There was no echo by 2-dimensional ultrasound but multiple hyperechoic interval was found in 21 cases. In 2 cases flow signals were seen under probe pressure which appeared as vein in PI. There were arterial blood flow signals in these intervals, PSV was 14.32±6.57 cm/s,RI was 0.68±0.79 cm/s. There was no significant difference between PSV results and RI results by Student′s t test （t=1.346, 1.474, P>0.05）, while there was significant difference (P<0.05) between the 2 groups in hypoechoic thrombosis (χ²=13.352), high echo vein stone (χ²=12.162), flow signals under probe pressure (χ²=46.015), occurrence of multiple hyperechoic interval (χ²=35.338) by Chi-square test (P<0.05). The sensitivity was 93.75% with probe pressure of blood flow signal to diagnose venous malformation, and the sensitivities of hypoechoic thrombosis (96.55%), hyperechoic vein stone (93.33%) and probe pressure (100%) were all high in diagnosis of venous malformation. The sensitivity and specificity of multiple hyperechoic interval to diagnose venous malformation was 72.41% and 100%, respectively. CONCLUSIONS: Color Doppler ultrasound is noninvasive, inexpensive and accurate in diagnosis of deep-seated facial and cervical lymphatic malformation and venous malformation. Multiple hyperechoic interval with arterial blood flow signals could support the diagnosis of lymphatic malformation, whereas hypoechoic thrombosis or high echo vein stone in the lesion and flow signals under probe pressure would help to confirm venous malformation.