超声造影定量分析在鉴别颈部淋巴结良恶性的应用研究

Quantitative analysis of contrast-enhanced ultrasound in differential diagnosis of benign and malignant cervical lymph nodes

目的:探究超声造影(CEUS)定量分析鉴别颈部淋巴结良恶性的应用价值。方法:回顾2019年4月—2020年9月于我院行常规超声发现颈部异常淋巴结并进一步行CEUS的42例患者(43枚淋巴结)资料。CEUS定量分析选取淋巴结髓质-门区(中央)和皮质区(外周)为感兴趣区生成两条曲线,分别记录显影时间(AT)、峰值强度(PI)、达峰时间(TTP)、上升速度(C)及下降速度(k),并计算前者与后者差值△AT、△PI、△TTP、△C及△k。采用ROC评价各参数的诊断价值。结果:病理诊断为22枚良性淋巴结和21枚恶性淋巴结。恶性淋巴结髓质-门区AT、△AT和△k显著高于良性淋巴结,皮质区k、△PI低于良性淋巴结(P<0.05)。皮质区k≤0.33 dB/s、△AT≥-0.04 s、△PI≤1.18 dB及△k≥-0.01 dB/s均对颈部恶性淋巴结有良好诊断效果(P<0.05),而髓质-门区AT的诊断效能较低(P>0.05)。CEUS定量分析总体敏感度、特异度、准确度和AUC分别为85.71%、72.73%、79.07%和0.823。结论:CEUS定量分析能为颈部淋巴结良恶性鉴别提供有价值信息。

Objective: To explore the application value of quantitative analysis of contrast-enhanced ultrasound(CEUS) in differential diagnosis of benign and malignant cervical lymph nodes. Methods: The data of 42 patients(43 lymph nodes) who were diagnosed with abnormal cervical lymph nodes by conventional ultrasound and underwent CEUS in our hospital from April 2019 to September 2020 was observed retrospectively. The medullary portal area(central) and cortical area(peripheral) of lymph nodes were selected as regions of interest, and generated two curves. The arrival time(AT), peak intensity(PI), time to peak(TTP), wash-in speed(C) and wash-out speed(k) were recorded respectively, and the differences between the former and the latter △AT, △PI, △TTP, △C and △K were calculated. ROC was used to evaluate the diagnostic value of each parameter. Results: There were 22 benign and 21 malignant lymph nodes. AT in medullary-portal area, △AT and △k of malignant lymph nodes were significantly higher than that of benign lymph node while k in cortex area and △PI were significantly lower than that of benign lymph nodes(P<0.05). The results showed that k≤0.33 db/s, △AT≥-0.04 s, △PI≤1.18 db and △k≥-0.01 db/s had good diagnostic efficiency on cervical malignant lymph nodes(P<0.05), but AT in medullary-portal area had lower diagnostic efficiency(P>0.05). The overall sensitivity, specificity, accuracy and AUC of quantitative analysis of CEUS were85.71%, 72.73%, 79.07% and 0.823, respectively. Conclusion: The quantitative analysis of CEUS can provide valuable basis for differentiating benign and malignant cervical lymph nodes.