常规超声和超声弹性成像在颈部淋巴结良恶性鉴别诊断中
的价值
刘奇志 吴卫华 王雷 陈洁 宫霞 谢晓奕
【摘 要】摘要 目的： 对比实时静态超声弹性成像技术与二维灰阶、彩色多普勒等传统超声方法在判断颈部淋巴结良恶性中的诊断价值。方法： 选取2012年1月—2013年12月诊治的311例颈部淋巴结肿大患者(共322个颈部淋巴结)，所有淋巴结均经病理学证实良恶性。采用灰阶超声进行病灶检查，记录淋巴结的长径、短径，并计算长短径的比值。采用彩色多普勒超声对淋巴结进行血管模式分型，分为淋巴门型、中央型、周围型及混合型，并记录血流阻力指数(RI)值。对病灶行超声弹性成像，根据弹性图显示图像将感兴趣区(ROI)内病灶区与周围组织硬度相比较，并对弹性图进行分型。绘制受试者工作特征(receiver operating characteristic,ROC)曲线，评价各项指标对颈部浅表淋巴结良恶性的诊断价值。结果： 322个颈部淋巴结中经病理证实良性淋巴结73个，恶性淋巴结249个。长短径比值截断值1.5789，曲线下面积0.766，准确性65.22%，敏感性61.40%，特异性78.10%。RI截断值0.655，曲线下面积0.787，准确性72.98%，敏感性73.10%，特异性72.60%。血管模式中，淋巴门型恶性病变率11.8%，中央型恶性病变率52.9%，周围型恶性病变率83.3%，混合型恶性病变率88.8%，其差异有统计学意义(P<0.01)。以弹性分级≥Ⅲ级作为判断淋巴结良恶性的标准，249个恶性淋巴结中弹性分级≥Ⅲ级222个，73个良性淋巴结中弹性分级≤Ⅱ级31个，超声弹性分级诊断颈部淋巴结良恶性准确性为78.57%。长短径比值、RI、超声弹性分级用于诊断颈部淋巴结良恶性的准确性差异有统计学意义(P<0.05)。结论： 淋巴结长短径比值、
RI、血管模式分型、超声弹性图分级对于判断颈部淋巴结的良恶性有诊断价值，超声弹性分级用于判断颈部淋巴结良恶性的准确性优于RI及长短径比值，RI优于长短径比值。血管模式分型为周围型及混合型的淋巴结恶性病变率高于中央型及淋巴门型。
【期刊名称】中国临床医学 【年(卷),期】2016(023)001 【总页数】3
【关键词】关键词 超声弹性; 淋巴结; 鉴别诊断 ·论著·
Abstract Objective： To compare the diagnostic value for judging benign and malignant cervical lymph nodes of real-time static ultrasound elastography with that of traditional methods such as 2D grayscale ultrasonography, color Doppler, etc.Methods： A total of 322 cervical lymph nodes from 311 patients, who were treated during Jan 2012 and Dec 2013, were selected. And the benignancy and malignancy of all lymph nodes were confirmed by pathology. The lesions were examined by grayscale ultrasonography and the major and minor diameters were recorded, the ratio between which was calculated. The vascular type, including lymphatic type, central type, peripheral type and mixed type, were classified by color Doppler ultrasonography, and the resistance index(RI) was also recorded. Ultrasound elastography were undertaken for the lesions, so as to compare the hardness of
lesions in region of interest(ROI) with that of peripheral tissues by elasticity figure and classify the elasticity figure. Receiver operating characteristic(ROC) curves were drawn so as to evaluate the diagnostic value of each index for determining the benignancy and malignancy of cervical lymph nodes.Results： Among the 322 lymph nodes, which were confirmed by pathology, 73 were benign and the other 249 were malignant. The cutoff value of major-minor diameter ratio was 1.5789, and the AUC was 0.766, of which accuracy, sensitivity, specificity were 65.22%, 61.40%, 78.10%, respectively. The cutoff value of RI was 0.655, and the AUC was 0.787, of which accuracy, sensitivity, specificity were 72.98%, 73.10%, 72.60%, respectively. According to vascular type, rates of malignant lesions for lymphatic type, central type, peripheral type, mixed type were 11.8%, 52.9%, 83.3%, 88.8%, respectively, and the difference among them was statistically significant(P<0.01) . Elasticity classification≥Ⅲ was set as criteria for judging benignancy and malignancy of lymph nodes. Among the 249 malignant lymph nodes, 222 were classified as≥Ⅲ. Among the 73 benign lymph nodes, 31 were classified as ≤Ⅱ. The accuracy of ultrasonography elasticity classification for judging benignancy and malignancy of lymph nodes was 78.57%.The difference among major-minor diameter ratio, RI, elasticity classification regarding accuracy for judging benignancy and malignancy
of
lymph
nodes
was
statistically
常规超声和超声弹性成像在颈部淋巴结良恶性鉴别诊断中的价值
