多模态超声成像对鼻咽癌颈部淋巴结转移的诊断价值

Value of multi-modal ultrasound in diagnosis of cervical lymph node metastasis of nasopharyngeal carcinoma

目的:探讨多模态超声成像对鼻咽癌(nasopharyngeal carcinoma,NPC)颈部淋巴结转移的诊断价值。方法:选取82例NPC患者共计108枚颈部肿大淋巴结,术前对淋巴结行常规超声、应变弹性成像(strain elastography,SE)及超声造影(contrast-enhanced ultrasound,CEUS)检查,依据病理学检查结果将其分为转移组(59枚)、未转移组(49枚)。对比分析两组淋巴结的分区特点、超声特征、SE评分及CEUS特征,评价常规超声、SE、CEUS及多模态超声联合诊断对NPC颈部淋巴结转移的诊断效能。结果:①NPC转移组与未转移组淋巴结在分区、有无淋巴门、内部回声、是否有钙化、是否有坏死囊变、血流类型、SE评分、CEUS灌注模式、增强均匀性、增强强度、有无灌注缺损方面的差异均有统计学意义(P均<0.05)。②常规超声、SE、CEUS及联合诊断对诊断NPC颈部淋巴结转移的灵敏度分别为79.7%、83.1%、93.2%、94.9%,特异度分别为67.3%、57.1%、77.6%、87.8%,准确度分别为74.1%、71.3%、86.1%、91.7%;多模态超声联合诊断的灵敏度、特异度、准确度均高于单一检查方法。结论:多模态超声成像对鉴别NPC颈部肿大淋巴结良恶性有良好的诊断效能,可为诊断NPC颈部淋巴结转移提供更可靠的影像学依据。

Objective:To explore the value of multi-modal ultrasound in diagnosis of cervical lymph node metastasis of nasopharyngeal carcinoma(NPC).Method:A total of 108 cervical swollen lymph nodes from 82 NPC patients were selected.They were examined by conventional ultrasound,strain elastography(SE)and contrast-enhanced ultrasound(CEUS),and were divided into metastatic group and non-metastatic group according to the pathological results.The zoning characteristics,conventional ultrasound characteristics,SE scores and CEUS characteristics of each group were analyzed.And the diagnostic efficacy of conventional ultrasound,SE,CEUS and multi-modal ultrasound combined diagnosis in diagnosis of cervical lymph node metastasis of NPC were evaluated.Results:①There were significant differences between the metastatic group and the non-metastatic group in lymph nodes anatomical regions,internal echo,blood flow types,SE scores,CEUS perfusion pattern,enhancement uniformity,enhancement intensity,and whether there were lymphatic hilum,calcification,necrosis,and perfusion defects(all P<0.05).②The sensitivity of conventional ultrasound,SE,CEUS and multi-modal ultrasound combined diagnosis was 79.7%、83.1%、93.2%and 94.9%,respectively;the specificity was 67.3%,57.1%,77.6%and 87.8%,respectively;and the accuracy was 74.1%,71.3%,86.1%and 91.7%,respectively.The sensitivity,specificity and accuracy of the multi-modal ultrasound combined diagnosis were all higher than that of the single examination method.Conclusion:Multi-modal ultrasound has a good diagnostic efficacy in differentiating benign and malignant lymph nodes of NPC.It can provide a more reliable imaging basis for the diagnosis of NPC cervical lymph node metastasis.