高帧频超声造影在鉴别浅表淋巴结性质中的应用

目的应用高帧频超声造影（H-CEUS）技术观察浅表淋巴结微循环灌注模式，评价H-CEUS对浅表淋巴结良恶性的鉴别诊断效能。 方法选取2019年7月至2020年1月因怀疑浅表淋巴结异常而就诊于解放军总医院第一医学中心并行穿刺活检术或手术切除取得病理结果的患者39例，对39例浅表淋巴结先后进行H-CEUS、常规帧频超声造影（CEUS）检查，对比观察2种造影模式下淋巴结动脉期微血管灌注模式（向心性、离心性、混合性）显示的敏感度，并与病理结果对照，采用χ²检验分析两种超声检查模式的特异度、敏感度、准确性，并采用受试者操作特征（ROC）曲线分析2种超声造影模式的诊断效能。 结果H-CEUS对于浅表淋巴结动脉期微血管灌注模式的显示敏感度优于CEUS。CEUS的诊断特异度、敏感度、准确性分别为87.5%、73.3%、82.1%。H-CEUS的诊断特异度、敏感度、准确性分别为92.0%、85.7%和89.7%。H-CEUS与CEUS的ROC曲线下面积分别为0.889、0.813。H-CEUS与CEUS对淋巴结性质的鉴别与病理结果对比，差异均无统计学意义（P均>0.05）；Kappa一致性分别为0.777和0.616。 结论H-CEUS可以通过提高造影图像的帧频而获得更高的时间分辨力，对于浅表淋巴结动脉期的微血管构架及动脉期灌注细节显示更清晰直观，可为诊断浅表淋巴结的性质提供更多有价值的信息。

Clinical application of high-frame-rate contrast-enhanced ultrasound in differentiation of benign and malignant superficial lymph nodes

ObjectiveTo observe the microcirculation perfusion pattern of superficial lymph nodes and differentiate benign and malignant superficial lymph nodes by high-frame-rate contrast-enhanced ultrasound (H-CEUS). MethodsThirty-nine patients with abnormal superficial lymph nodes who underwent puncture biopsy or surgical resection at the First Medical Center of Chinese PLA General Hospital were included. All patients underwent conventional CEUS and H-CEUS to compare lymph node microvascular perfusion pattern (central, annular, and mixed) in the arterial phase. Using pathological diagnosis results as the golden standard, the specificity, sensitivity, and accuracy of the two modalities were compared by the chi-squared test. ResultsH-CEUS was better than conventional CEUS in showing microvascular perfusion details in superficial lymph nodes. The diagnostic specificity, sensitivity, and accuracy of conventional CEUS were 87.5%, 73.3%, and 82.1%, respectively; the corresponding percentages of H-CEUS were 92.0%, 85.7%, and 89.7%. ROC analysis showed that the areas under the curve of high-frame-rate and conventional CEUS were 0.889 (P=0.000) and 0.813 (P=0.001), respectively. Both high-frame-rate and conventional CEUS showed no significant difference from pathology in the identification of lymph node nature. ConclusionH-CEUSshows better microvascular perfusion details in superficial lymph nodes in the arterial phase, providing more valuable information for determining the nature of superficial lymph nodes.