实时灰阶超声造影鉴别诊断浅表良恶性淋巴结

目的 探讨实时灰阶CEUS早期鉴别诊断浅表良恶性淋巴结的价值。方法 对48例患者的56个肿大浅表淋巴结进行常规超声和实时灰阶CEUS,观察淋巴结造影灌注模式,分析时间-强度曲线(TIC)形态,并测量开始增强时间(AT)、达峰时间(TTP)、峰值强度(PI)、平均渡越时间(MTT)和曲线下面积(AUC)。 结果 病理结果示良性淋巴结23个,恶性淋巴结33个,包括转移性淋巴结20个、恶性淋巴瘤13个。良性淋巴结大多表现为自淋巴结门开始的均匀增强(16/23,69.57%),转移性淋巴结半数表现为自周边开始的不均匀增强(10/20,50.00%),恶性淋巴瘤多表现为均匀增强(7/13,53.85%)。良性淋巴结中19个(19/23,82.61%)TIC呈快退型,转移性淋巴结中17个(17/20,85.00%)、恶性淋巴瘤中12个(12/13,92.31%)TIC呈慢退型。良恶性淋巴结AT、TTP差异无统计学意义(P均>0.05);良性淋巴结PI值与转移性淋巴结差异无统计学意义(P>0.05),且均显著低于恶性淋巴瘤(P均<0.05);转移性淋巴结和恶性淋巴瘤MTT和AUC均显著高于良性淋巴结(P均<0.05)。 结论 CEUS中良恶性淋巴结造影模式、TIC及定量参数存在差异,有助于鉴别诊断。

Quantitative CEUS in differential diagnosis of benign and malignant superficial lymphadenopathy

Objective To observe the diagnostic value CEUS in differential diagnosis of benign and malignant superficial lymph nodes. Methods Forty-eight patients with 56 enlarged superficial lymph nodes underwent conventional ultrasound and real-time CEUS. The enhanced mode, pattern of time-intensity curve (TIC) and parameters of TIC including arrival time (AT), time to peak (TTP), peak intensity (PI), mean transit time (MTT) and area under the curve (AUC) were observed and analyzed. Results There were 23 benign and 33 malignant lymph nodes (20 metastasis lymph nodes and 13 lymphomas) according to pathological results. Most of benign lymph node (16/23, 69.57%) showed central homogeneous perfusion pattern from hilum, half of metastasis lymph node (10/20, 50.00%) manifested as heterogeneous peripheral enhancement pattern, while more than half of lymphoma (7/13, 53.85%) showed homogeneous enhancement. For TIC, 19 (19/23, 82.61%) of benign lymph node showed fast-down pattern, whereas 17 (17/20, 85.00%) of metastasis and 12 (12/13, 92.31%) of lymphoma showed slow-down pattern. There was no significant difference of AT and TTP between benign and malignant lymph nodes (all P>0.05), nor of PI between benign and metastasis lymph nodes (P>0.05), which were both lower than lymphomas (both P<0.05). Compared with benign lymph nodes, MTT and AUC of metastasis lymph nodes and lymphomas were higher (all P<0.05). Conclusion Benign and malignant lymph nodes display diverse enhanced mode with different parameters of TIC in CEUS, which is helpful to differential diagnosis.