浅表型结节性筋膜炎患者肌骨超声图像特征及诊断价值分析

Characteristics of musculoskeletal ultrasound images of the patients with superficial nodular fasciitis and their diagnostic value

目的探讨浅表型结节性筋膜炎患者肌骨超声图像特征及诊断价值。方法选择2014年10月至2017年12月收治的131例怀疑为的浅表型结节性筋膜炎患者。全部患者均接受择期手术治疗,均于手术切除前15 d内行超声检查,观察并评价入组病例肿块大小、轮廓、内部回声、血供等情况据此作出超声诊断,以后续手术切除组织病理学检验结果为金标准,分析超声诊断与金标准诊断结果间的一致性,计算超声诊断效能指标,以受试者工作(ROC)曲线参数曲线下面积(AUC)评估超声诊断价值。结果131例患者经术中病理检验证实128例为浅表型结节性筋膜炎,超声诊断120例与金标准相符,3例被误诊为血管瘤,3例被误诊为皮脂瘤,2例被误诊为神经鞘瘤,超声诊断结果与金标准结果间具有一致性(Kappa>0.4,P<0.05);超声诊断灵敏度为93.75%,特异度为100%,诊断符合率为93.89%;ROC曲线分析具有较高诊断价值(AUC>0.9,P<0.05);浅表型结节性筋膜炎病灶多表现为单发椭圆形或分叶状椭圆形,多上肢发病,超声表现多为低回声或高低混杂回声;伴有少量血流信号。结论肌骨超声在浅表型结节性筋膜炎的定位、诊断具有较高的准确性,浅表型结节性筋膜炎有不同于其他浅表肿块的超声表现,多表现为低回声信号、高低混杂信号及伴有较少的血流信号。

Objective To investigate the characteristics of musculoskeletal ultrasound images of the patients with superficial nodular fasciitis(NF)and their diagnostic value.Methods A total of 131 patients with suspected superficial nodular fasciitis,who were treated in our hospital from October 2014 to December 2017,were enrolled in the study.All the patients underwent elective surgery and ultrasonography at 15d before operation.The tumor size,contour,internal echo and blood supply were observed and evaluated for ultrasonic diagnosis.Moreover,the consistency between ultrasonic diagnosis and gold standard in diagnosis was analyzed with the results of pathology test on subsequent surgical removal of the tissues as the gold standard.In addition,efficiency index of ultrasonic diagnosis was measured,and AUC of ROC was used to evaluate the value of ultrasonic diagnosis.Results Among the 131 patients,128 patients were confirmed as superficial nodular fasciitis by intraoperative pathological test,of whom,120 cases were consistent with the gold standard,3 cases were misdiagnosed as hemangioma,3 cases were misdiagnosed as sebaceoma,and 2 cases were misdiagnosed as schwannoma.The results of ultrasonic diagnosis were consistent with those of the gold standard(Kappa>0.4,P<0.05).The sensitivity,specificity and coincidental rate of ultrasonic diagnosis were 93.75%,100%and 93.89%,respectively.Moreover,ROC curve analysis was of high diagnostic value(AUC>0.9,P<0.05).In addition,lesions of superficial nodular fasciitis were mainly manifested as single oval or lobulated elliptical and most of them were located in upper limbs.Ultrasound was mainly manifested as hypoechoic or high-low mixed echo,with little signals of blood flow.Conclusion The musculoskeletal ultrasound is of high accuracy in the localization and diagnosis of superficial NF,which is characterized by hypoechoic signals,high-low mixed signals and little signals of blood flow.