超声造影在肠系膜淋巴结结核诊断中的应用价值

The value of contrast-enhanced ultrasound in the diagnosis of tuberculous mesenteric lymphadenitis

目的分析肠系膜淋巴结结核的超声造影(CEUS)增强模式,评价CEUS在肠系膜淋巴结结核诊断中的应用价值。方法回顾性分析经粗针穿刺或手术切除病理证实为肠系膜淋巴结结核的62例患者,共62个淋巴结的常规超声及CEUS资料,观察淋巴结位置,淋巴结大小、长径(L)/短径(S)值、内部回声及后方回声改变。根据淋巴结最大径分为≤20 mm组和>20 mm组,并分析其CEUS的增强模式。结果 62个肠系膜淋巴结结核常规超声表现为淋巴结回声不均匀减低,其中19个(30.6%)可见点状或团状钙化。肠系膜淋巴结结核CEUS增强模式有3种:环形增强29个(46.8%),不均匀增强21个(33.9%),无增强12个(19.3%)。≤20 mm组以环形增强型为主,>20 mm组以不均匀增强为主,2组间增强模式差异有统计学意义(χ2=6.782,P=0.034)。结论肠系膜淋巴结结核CEUS表现以环形及不均匀增强为主,不同大小的肠系膜淋巴结结核CEUS表现模式不同,CEUS可为肠系膜淋巴结结核的诊断提供有价值的信息。

Objective To investigate the value of contrast-enhanced ultrasonography （CEUS） in the diagnosis of tuberculous mesenteric lymphadenitis by analyzing its enhancement pattern. Methods The conventional ultrasound and contrast-enhanced ultrasound images of 62 patients with tuberculous mesenteric lymphadenitis confirmed by needle core biopsy or surgery were retrospectively analyzed. The location, size, shape, internal echo and posterior enhancement of mesenteric lymph nodes were recorded. All cases were divided into two groups：the maximum diameter of the lymph node≤20 mm and the maximum diameter of the lymph node ＆gt;20 mm, and the patterns of enhancement in two groups were analyzed. Results The conventional ultrasound of 62 cases with tuberculous mesenteric lymph nodes showed enlargement. And the echogenicity was hypoechoic or heterogeneity, containing punctate or clusters of calcification in 19 cases （30.6%）. After CEUS, there were three forms of enhancements：rim enhancement in 29 cases （46.8%）;inhomogeneous enhancement in 21cases （33.9%）;non-enhancement in 12 cases （19.3%）. Rim enhancement was more common in the≤20 mm group, while inhomogeneous enhancement was more common in the lymph nodes〉20 mm. There was statistically significant difference of the enhancement type between the≤20 mm group and the〉20 mm group （χ2=6.782, P=0.034）. Conclusions Most of tuberculous mesenteric lymph nodes showed rim and inhomogeneous enhancement in CEUS, and the sizes of mesenteric lymph node tuberculosis influenced the CEUS enhancement patterns. CEUS may provide useful information for the diagnosis of the tuberculous mesenteric lymph node.