超声在鉴别诊断浅表肿大淋巴结良恶性中的应用

Effect of ultrasoud on differential diagnosis of benign and malignant in superficial lymph nodes

目的观察浅表淋巴结良恶性病变的声像图特征，探讨其超声诊断价值。方法回顾性分析50例浅表淋巴结肿大的患者的声像图，应用彩色多普勒超声观察133个浅表淋巴结的纵径／横径（L／H）值、内部回声（淋巴门髓质部形态）、彩色多普勒血流显像及脉冲多普勒频谱特征。结果良恶性肿大淋巴结的L／H值分别为2．09±0．22、1．38±0．27，恶性淋巴瘤淋巴结多数呈类圆形，淋巴门髓质消失、且常多处肿大。淋巴门处髓质主干动脉收缩期峰值血流速度（Vmax）分别为（19±13）cm／s、（36±15）cm／s；舒张期末血流速度（Vmin）分别为（8±4）cm／s、（6±4）cm／s。阻力指数（RI）分别为0．59±0．13、0．78±0．11。四项指标中L／H值及RI比较差异有统计学意义（P〈0．01）。结论通过对淋巴结超声测量的L／H值分析，结合淋巴结内部回声、彩色多普勒血流显像和频谱分析，对淋巴结的良恶性鉴别具有实用价值，可作为淋巴结诊断的首选方法，并为进一步穿刺活检提供依据。

Objective To observe the sonographic characteristics of benign and malignant superficial lymph nodes and investigate its diagnostic value. Methods The ultrasound images of 50 patients with superficial lymph nodes swelling was retrospectively analyzed. By color doppler ultrasonic sound, 133 cases of superficial lymph nodes longitudinal/horizontal diameters （L/H） value, internal echo （ form of lymphatic door medulla）, CDFI and PWD frequency spectrum characteristics were observed. Results Benign and malignant lymph nodes in the L/H values were 2.09 ±0. 22, 1. 38 ±0.27, the majority ofmalignant lymph nodes were circle-like, and lymph door medulla disappeared, often with nodes swelling. The peak systolic velocity（ V max）at lymphatic door medulla arterial trunk were （19 ±13）cm/s and （36 ±15）cm/s; and the flow velocity at the end of diastolic（V min）were（8 ±4）cm/s and （6 ±4）cm/s. Resistance index （RI） were 0. 59 ±0. 13 and 0. 78 ±0. 11. In the above four indicators, the L/H values and the RI differences were significant（ P 〈 0. 01 ）. Conclusions It has practical value to identify benign and malignant lymph nodes, by analyzing the L/H values of lymph nodes by ultrasound measurement, combined with lymph node internal echo, CDFI and frequency spectrum analysis. It can also be used as the preferred method for diagnosis of lymph nodes, and provide a basis for further biopsy.