高频超声在浅表淋巴结性质鉴别诊断中的应用价值

Application Value of High Frequency Ultrasound in the Differential Diagnosis of Superficial Lymph Node

目的:探讨高频超声对浅表淋巴结良、恶性质鉴别诊断的应用价值。方法:回顾分析84例术前高频超声检查浅表淋巴结肿大的患者,根据肿大淋巴结形态、内部回声等二维声像图特征及内部血流分布状态、血流动力学对浅表淋巴结良、恶性质初步诊断,与术后病理结果进行对照分析。结果:超声检查与病理诊断符合率为87.4%(180/206)。良性淋巴结多呈椭圆形或肾形,多数纵径/横径比(L/T)≥2,淋巴门结构清晰,内部无钙化灶及囊性变,血流信号多呈无血流型及门血管型,收缩期峰值流速(PSV)和阻力指数(RI)正常;恶性淋巴结多呈圆球形及类圆球形,多数L/T<2,淋巴门结构消失,内部常出现微小钙化灶及囊性变,血流信号异常丰富且紊乱,多呈边缘血管型及混合型,PSV和RI明显增高。良、恶性淋巴结血流分布例数、PSV、RI比较差异均有统计学意义(P<0.05)。结论:高频超声对浅表淋巴结良、恶性质鉴别诊断准确性较高,对临床诊疗策略有着重要的指导意义。

Objective：To discuss the application value of high frequency ultrasound in the differential diagnosis of superficial lymph node（benign or malignant）.Method：84 patients with superficial lymph node swelling examined by preoperative high frequency ultrasound examination were retrospectively analyzed. Based on the morphology of the swelling lymph node,2D acoustic imaging characteristics（such as internal echo）,internal blood flow distribution and haemodynamics,the properties of superficial lymph nodes（benign or malignant）were compared and analyzed with the postoperative pathological results. Result：The coincidence rate of ultrasound examination with pathological diagnosis was 87.4%（180/206）.The benign lymph node showed oval or kidney-shaped,with the ratio of longitudinal diameter/transverse diameter ≥2. The structure of hilus lymph was clear. No calcification or cystic change was seen. Blood flow signals were shown no blood flow or hilus blood vessel. Peak systolic velocity（PSV）and resistance index（RI）were normal. Malignant lymph nodes were represented as spherosome or quasi-circle sphere,with L/T〈2.The hilus structure was disappeared.Tiny calcifications and cystic changed were often seen in the lymph node.Blood flow signal was usually rich and disorderly,with edge vascular and hybrid type as the main type. PSV and RI were increased significantly. The cases of blood flow distribution,PSV,RI of benign and malignant lymph nodes were compared,the differences were statistically significant（P〈0.05）.Conclusion：High-frequency ultrasound examination has relatively higher diagnosis accuracy in differentiation of superficial lymph nodes（benign or malignant）,which has an important guiding significance for clinical diagnosis and treatment strategy.