高频超声诊断儿童肠系膜淋巴结炎的价值

High-frequency Ultrasound in the Diagnosis of Pediatric Mesenteric Lymphadenitis

目的 分析不同年龄段肠系膜淋巴结炎患儿淋巴结的高频超声声像图特征。资料与方法 139例肠系膜淋巴结炎患儿（研究组）与60例正常儿童（对照组）按年龄分为1-5岁、6-10岁、11-15岁年龄段,分析其高频超声声像图特点,ROC曲线评估肠系膜淋巴结纵径（L）、横径（S）、纵横径比（L/S）及彩色血流信号分级预测肠系膜淋巴结肿大的准确性。结果 对照组肠系膜淋巴结呈纺锤形,血流信号稀疏,L及L/S均随着年龄增大而增加（F=4.047、9.586,P〈0.01）。研究组肠系膜淋巴结呈椭圆形或水滴形,血流信号较丰富,L、S及L/S随着年龄增大均无明显变化（F=0.184、1.084、2.083,P〉0.05）。研究组各年龄段血流信号较对照组丰富,L及S均明显高于对照组（L：t=-13.798、-12.813、-8.089;S：t=-8.212、-13.172、-9.606,P〈0.01）,两组L/S仅在1-5岁年龄段差异有统计学意义（t=-3.208,P〈0.05）。1-5岁,当L=9.85mm时判断淋巴结肿大的敏感度为95.56%,特异度为100.00%;6-10岁,当L=10.25mm时判断淋巴结肿大的敏感度为95.59%,特异度为100.00%;11-15岁,当S=4.40mm时判断淋巴结肿大的敏感度为92.31%,特异度为100.00%。结论 高频超声可以观察儿童肠系膜淋巴结的分布位置及形态特点,准确地测量淋巴结各径线及血流信号的分布情况,为儿童肠系膜淋巴结炎的诊断提供有价值的依据。

Purpose To analyze the high-frequency sonographic images of lymph nodes in mesenteric lymphadenitis of different ages. Materials and Methods 139 children with mesenteric lymphadenitis （study group） and 60 normal children （control group） were divided into 1 to 5 years, 6 to 10 years and 11 to 15 years group, the characteristics of high-frequency ultrasound sonographic images were analyzed, accuracy of longitudinal diameter （L）, transverse diameter （S）, aspect ratio （L/S） and color Doppler blood flow signal classification for the prediction of mesenteric lymph nodes swelling were evaluated using receiver operating characteristic （ROC） curve. Results Mesenteric lymph nodes in the control group appeared as spindle shape with sparse blood flow signals, L, and L/ S increased with age increasing （F-4.047, 9.586; P〈0.05）. Mesenteric lymph nodes in the study group displayed as oval or teardrop-shaped with rich blood flow signals, L, S and L/S did not change significantly with age increasing （F-0.184, 1.084, 2.083： P〉0.05）. Compared with the control group, blood flow signals were more abundant in all age groups of the study group, L and S were also significantly higher （L： t=- 13.798, -12.813, -8.089; S： t=-8.212, -13.172, -9.606, P〈0.01）, only in the 1 to 5 years group statistically significant difference （t= - 3.208, P〈0.05） was showed between the two groups. From 1 to 5 years, the sensitivity and specificity for the judgment of lymph node swelling were 95.56% and 100.00%, respectively when using L-9.85 mm as a standard; from 6 to 10 years, the sensitivity and specificity for the judgment of lymph node swelling were 95.59% and 100.00%, respectively when using L=10.25 mm as a standard; from 11 to 15 years, the sensitivity and specificity for the judgment of lymph node swelling were 92.31% and 100.00%, respectively when using S=4.40 mm as a standard. Conclusion High-frequency ultrasound is able to display the location distribution and morphological characteristics of the mesenteric lymph nodes in children, and also to accurately measure the diameters and flow signal distribution of the lymph nodes, thus will provide valuable evidence for the diagnosis of pediatric mesenteric lymphadenitis.