实时超声弹性成像检查颈部恶性肿大淋巴结应变率比值及诊断价值分析

Analysis of SR and diagnostic value of real-time ultrasound elastography examination in malignantly swollen lymph gland of neck

目的:分析实时超声弹性成像检查颈部恶性肿大淋巴结应变率比值(SR)及诊断价值分析。方法:选取医院收治的53例颈部淋巴结肿大患者,淋巴结共计74个,其中良性淋巴结33个,恶性淋巴结41个。采用彩色多普勒超声诊断仪,获取弹性成像图后,采用SR软件、面积测量软件,描记目标淋巴结病灶与周围肌肉SR、弹性面积及二维面积比值。以病理检测结果为金标准,分别以SR值<2.12、评分值<2.30诊断为良性淋巴结,SR值>2.12、评分值>2.30诊断为恶性淋巴结,鉴别灵敏度、特异度和准确率。结果:实时超声弹性成像显示,颈部转移性淋巴结评分较高,≥3分的淋巴结为18个(占90.00%),良性淋巴结、原发恶性淋巴结评分较低,≤2分分别为24个(占72.73%)、14个(占66.67%)。恶性淋巴结SR平均值、评分法平均值明显高于良性淋巴结,差异具有统计学意义(t=10.118,t=7.614;P<0.05)。SR、弹性评分鉴别颈部良恶性肿大淋巴结的受试者工作特征(ROC)曲线下面积(AUC)分别为0.861、0.858,两种方法鉴别的灵敏度分别为96.97%、84.85%、特异度分别为60.98%、7.73%,准确率均为75.68%。转移性淋巴结弹性面积与二维面积比值明显高于非特异性反应淋巴结和结核性淋巴结,差异具有统计学意义(t=3.038,t=2.240;P<0.05)。结论:实时超声弹性成像评分法和SR比值在诊断颈部恶性肿大淋巴结方面具有较高的诊断正确率,是临床诊断颈部淋巴结良恶性的有效方法,可为进一步加强患者的治疗奠定良好的基础。

Objective:To analyze the strain ratio(SR)and diagnostic value of real-time ultrasound elastography examination in malignantly swollen lymph gland of neck.Methods:53 patients with swollen lymph gland of neck who admitted to hospital were selected and there were 74 lymph nodes in total,including 33 benign lymph nodes and 41 malignant lymph nodes.SR ratio software and area measurement software were used to trace the SR ratio,elastic area and two-dimensional area ratio of the target lymph node focus to the surrounding muscle after the elastic imaging picture was obtained from color Doppler ultrasound diagnostic instrument.The results of pathological examination were used as gold standard,and the benign lymph nodes were diagnosed when SR value and score value of them were less than 2.12 and 2.30,respectively.And the malignant lymph nodes were diagnosed when SR value and score value of them were larger than 2.12 and 2.30,respectively.And then,the sensitivity,specificity and accuracy were identified.Results:The results of real-time ultrasound elastography showed that the score of metastatic lymph nodes of neck was higher,the lymph nodes of 18 cases(90.00%)were larger than and equal to 3 scores,while the scores of benign lymph nodes and primarily malignant lymph nodes were lower,and the scores of 24 cases(72.73%)and 14 cases(66.67%)were less than and equal to 2 scores,respectively.The mean values of SR and scoring method of malignant lymph nodes were significantly higher than those of benign lymph nodes(t=10.118,t=7.614,P<0.05).And the area under curve(AUC)of SR value and elastic score in differentiating benignly and malignantly swollen lymph nodes of neck with lymph node were 0.861 and 0.858,respectively.The sensitivities of the two methods were 96.97%and 84.85%,respectively.And the specificities of them were 60.98%and 7.73%,respectively.The accuracy was 75.68%.The ratio of elastic area and two-dimensional area of metastatic lymph nodes was significantly higher than that of non-specific reactive lymph nodes and tuberculous lymph nodes(t=3.038,t=2.240,P<0.05),respectively.Conclusion:The real-time ultrasound elastography score and SR ratio have higher diagnostic accuracy in the diagnosis of malignantly swollen lymph nodes of neck,which is an effective method in the clinical diagnosis of benign and malignant lymph nodes of neck.And it can lay a favorable foundation for further strengthening the treatment of patients.