超声造影联合实时弹性成像在浅表肿大淋巴结良恶性鉴别诊断中的应用价值

Value of Contrast-Enhanced Ultrasound Combined with Real-Time Elastography in Differential Diagnosis of Benign and Malignant Superficial Enlarged Lymph Nodes

目的:探讨超声造影联合实时弹性成像鉴别浅表肿大淋巴结良恶性的应用价值。方法:选择2017年6月~2019年6月在我院超声科检查的300例患者共362枚浅表肿大淋巴结作为研究对象,所有患者均给予灰阶超声、超声造影、实时弹性成像技术进行检测,以病理检测结果为金标准,并绘制受试者工作特征曲线比较3种方法及联合应用鉴别浅表肿大淋巴结的诊断效能。结果:362枚肿大淋巴结中,良性淋巴结121枚(33. 43%),恶性淋巴结241枚(66. 57%);灰阶超声诊断的灵敏度78. 42%、特异度72. 73%、准确度76. 52%;实时弹性成像诊断的灵敏度90. 04%、特异度78. 51%、准确度86. 19%;超声造影诊断的灵敏度87. 97%、特异度83. 47%、准确度86. 46%;超声造影联合实时弹性成像诊断的灵敏度95. 02%、特异度77. 69%、准确度89. 23%;超声造影联合实时弹性成像诊断淋巴结性质的诊断效能(P <0. 05)均明显高于其他3种方法。结论:超声造影与实时弹性成像技术在鉴别浅表肿大淋巴结良恶性方面均较灰阶超声具有优势,联合使用可有效提高诊断效能。

Objective: To evaluate the value of contrast-enhanced ultrasound combined with real-time elastography in differentiating benign and malignant superficial enlarged lymph nodes. Methods: A total of 362 superficial enlarged lymph nodes were examined in 300 patients in our hospital from June 2017 to June 2019. All patients were examined by gray-scale ultrasound,contrast-enhanced ultrasound and real-time elastography. Results of pathological examination were regarded as the gold standard. Receiver operating characteristic curves of subjects were drawn. Diagnostic effects of the three methods and their combination in the differential diagnosis of superficial enlarged lymph nodes were compared. Results: Among the362 enlarged lymph nodes,121( 33. 43%) were benign and 241( 66. 57%) were malignant;the sensitivity,specificity and accuracy of gray-scale ultrasound were 78. 42%,72. 73% and 76. 52%,respectively;those of real-time elastography were90. 04%,78. 51% and 86. 19%,respectively;those of contrast-enhanced ultrasound were 87. 97%,83. 47% and 86.46%,respectively;those of contrast-enhanced ultrasound combined with real-time elastography were 95. 02%,77. 69% and89. 23%,respectively. The diagnostic efficacy of contrast-enhanced ultrasound combined with real-time elastography in the diagnosis of lymph nodes was significantly higher than those of other three methods( P < 0. 05). Conclusion: Contrastenhanced ultrasonography and real-time elastography are supe-rior to gray-scale ultrasound in differentiating benign and malignant superficial enlarged lymph nodes. The combined use of contrast-enhanced ultrasonography and real-time elastography can effectively improve the diagnostic efficiency.