超声造影对颈部淋巴结结核与鼻咽癌转移性淋巴结的鉴别诊断

The value of contrast-enhanced ultrasound in differential diagnosis of cervical tuberculous lymphadenitis and lymph nodes metastasis in nasopharyngeal carcinoma

目的分析颈部淋巴结结核(CTBL)与鼻咽癌转移性淋巴结的超声造影(CEUS)增强模式表现,评价CEUS在两者鉴别诊断中的应用价值。方法回顾性分析2013年7月至2017年8月在杭州市红十字会医院行颈部淋巴结常规超声及CEUS检查,并经病理证实的61例CTBL患者和48例鼻咽癌转移性淋巴结患者的超声资料,观察淋巴结的分区,长径(L)/短径(S)值、淋巴门、钙化、内部坏死、血流、阻力指数(RI)及CEUS的增强模式,采用χ~2检验比较各组间的统计学差异。结果 CTBL常规超声表现的钙化多呈粗钙化(≥0.5 mm),鼻咽癌转移性淋巴结的钙化多呈微钙化(<0.5 mm),两者比较差异有统计学意义(P<0.05);两组淋巴结的L/S、淋巴门、内部坏死、血流比较,差异均无统计学意义(P均>0.05);61例CTBL分区以Ⅲ、Ⅳ、Ⅱ区常见(39.3%、31.1%、14.8%),48例鼻咽癌转移性淋巴结分区以Ⅱ、Ⅴ、Ⅲ区常见(45.8%、29.2%、12.5%),两组间不同分区的构成差异有统计学意义(χ~2=32.125,P<0.05);根据CEUS环形增强的厚度分为厚环、薄环及无环形增强。其中CTBL以厚环多见(39/54,72.2%),鼻咽癌转移性淋巴结以薄环多见(26/38,68.4%),两组之间差异有统计学意义(χ~2=25.171,P<0.05)。结论结合常规超声,CEUS能够在淋巴结增强特征上进一步提供信息,有助于鉴别CTBL及鼻咽癌转移性淋巴结。

Objective To analyze the characteristics of contrast-enhanced ultrasound in cervical tuberculous lymphadenitis(CTBL)and lymph nodes metastasis of nasopharyngeal carcinoma(NPC),and to investigate the value of CEUS in differential diagnosis.Methods The images of 61 cases of CTBL and 48 cases with metastatic lymph nodes in patients with NPC,which confirmed by histopathology in Hangzhou Red Cross Hospital during Jul 2013 to Aug 2017,were retrospectively analyzed.The location,shape,hilum,calcification,necrosis,blood flow and the pattern of contrast enhancement were recorded.The different characteristics were compared byχ2 test.Results U1trasonographic features specific to CTBL were calcifications,and microcalcifications were the ultrasound features of lymph nodes metastasis in NPC.There were statistically significant difference of calcification between two groups(P<0.05).The shape,hilum,necrosis,blood flow of two groups had no significant difference(all P>0.05).Most of the 61 cervical tuberculous lymphadenitis were found at levelⅢ,ⅣandⅡ(39.3%,31.1%and 14.8%).Most of the 48 lymph nodes metastasis of nasopharyngeal carcinoma were found at levelⅡ,ⅤandⅢ(45.8%,29.2%and 12.5%).There were statistically significant difference of the location between two groups(χ2=32.125,P<0.05).According to the thickness of rim,there were three forms of enhancements:thick rim enhancements,thin rim enhancements and no rim enhancement.The thick rim enhancements was more common in the CTBL(39/54,72.2%),while more metastatic lymph nodes of NPC showed the thin rim enhancements(26/38,68.4%).There were statistically significant difference between two groups(χ2=25.171,P<0.05).Conclusions Combined with conventional ultrasound,contrast-enhanced ultrasound can provide valuable information of lymph node blood flow in the enhanced mode further,which can help to identify the tuberculous lymphadenitis and lymph nodes metastasis of nasopharyngeal carcinoma.