摘要
目的通过超声造影时间一强度曲线相关参数评价颈部淋巴结的性质。方法对129例颈部淋巴结肿大的患者进行超声造影检查，确定淋巴结的增强模式，应用SonoLiver软件进行后处理，ROC曲线分析找到相应截断值。所有淋巴结均行穿刺活检或手术取得病理结果。结果①反应性淋巴结多呈淋巴门均匀增强模式，转移性淋巴结多呈周边型不均匀增强或微弱增强，淋巴结淋巴瘤通常无固定增强模式。②三组淋巴结的上升时间（RT）、达峰时间（TTP）、平均渡越时间（mTT）、峰值强度（IMAX％）、上升支斜率（Kup）、半降斜率绝对值（Kdown）、曲线下面积（AUC）、灌注指数（PI）差异均有统计学意义（P〈O．05）。反应性淋巴结的RT、TTP、mTT最短，与转移性淋巴结及淋巴瘤相比，差异具有统计学意义（P〈0．05）。反应性淋巴结的Kup、Kdown、IMAX％、AUC、PI相比转移性淋巴结均较低，差异有统计学意义（P〈0．05），但与淋巴瘤组相比差异无统计学意义（P〉0．05）。③反应性与转移性淋巴结造影参数ROC分析：当TTP≥7．74s，mTT≥26．5s时，倾向转移性淋巴结。④反应性与淋巴瘤造影参数ROC分析：当RT≥4．62s，TTP≥7．74S，mTT≥28．32S时，不考虑反应性淋巴结。结论通过超声造影动态图像、增强模式可以基本判断颈部淋巴结性质，时间一强度曲线参数最佳诊断截点可以进一步帮助鉴别淋巴结性质，为临床选择治疗方案提供有力支持。
Objective To evaluate the ability of contrast-enhanced ultrasonography （CEUS） in differentiate reactive lymph node, metastatic lymph node and lymphoma. Methods In a prospective study CEUS was performed in 129 patients with cervical lymph node enlargement. The entire process were recorded and preserved in DICOM format. The results were registered with Sonoliver. The receiver operating characteristic curve （ROC curve） analysis was performed to find the corresponding cutoff values. The selected node was removed surgically and submitted for histology. Results Of all the nodes,26 were reactive nodes,85 were metastases and 18 were lymphoma. Enhancement pattern was the most accurate way to characterize lymph nodes. The enhancement pattern of reactive lymph nodes was homogeneous and most of them were enhanced by lymphatic type while the metastatic lymph nodes were inhomogeneously enhanced or weakly enhanced by peripheral type. Lymph node lymphoma usually had no fixed enhancement pattern. Arrive time （AT） ,rise time （RT）, time to peak （TTP）, mean transit time （mTT）, maximum intensity （IMAX）, under the curve （AUC）, rising slope （Kup）, semi descending slope （Kdown） and perfusion index （PI） were significantly different in the three groups（ P 〈0.05）. RT,TTP and mTT of reactive lymph nodes were the shortest, which had significant difference compared with those of metastatic lymph nodes and lymphoma （ P 〈 0.05）. Kup, Kdown, IMAX%, AUC, PI in the reactive lymph nodes were significantly decreased compared with the metastatic group （ P 〈0.05）, but there was no significant difference compared with those in lymphoma （ P〉0.05）. When TTP≥7.74 s, mTT≥26.54 s, metastatic lymph nodes were considered. When RT≥4.62 s, TTP≥7.74 s, mTT≥28.32 s, reactive lymph nodes were not considered. Conclusions Dynamic contrast-enhanced ultrasound image and enhancement pattern can distinguish necklymph nodes while the optimal cut-off point time of the time-intensity curve parameters can further contribute to the identification of lymph nodes.
出处
《中华超声影像学杂志》
CSCD
北大核心
2015年第12期1051-1055,共5页
Chinese Journal of Ultrasonography
关键词
超声造影
淋巴结
诊断
鉴别
Contrast-enhanced ultrasound
Lymph nodes
Diagnosis,differential
