实时剪切波弹性成像联合常规超声检查在诊断小儿颈部淋巴结炎中的应用价值

The Value of Real-time Shear Wave Elastography Combined with Conventional Ultrasonography in the Diagnosis of Cervical Lymphadenitis in Children

目的探讨实时剪切波弹性成像联合常规超声对小儿颈部淋巴结炎的临床诊断价值。方法选取在广州市妇女儿童医疗中心就诊的因感染性疾病引起的颈部淋巴结肿大患儿107例,无颈部淋巴结肿大的就诊儿童130例,均行常规超声检查及实时剪切波弹性成像,测量淋巴结的长径、短径、长短径比、弹性模量值,对两组淋巴结各项超声指标进行统计学分析,并应用ROC曲线评价弹性模量值在鉴别小儿炎性颈部淋巴结与正常颈部淋巴结中的诊断效能。结果107例小儿颈部炎性淋巴结及130例小儿颈部正常淋巴结的长径、短径、长短径比分别为(21.9±6.8)mm/(6.6±1.6)mm、(8.4±3.1)mm/(2.5±0.8)mm、(2.74±0.71)/(2.76±0.78),两组弹性模量最小值、平均值、最大值分别为(7.6±2.3)kPa/(12.9±6.7)kPa、(10.8±2.0)kPa/(18.2±8.7)kPa、(15.2±4.2)kPa/(24.7±11.2)kPa,两组均值不来自同一总体,组间具有可比性。小儿颈部炎性淋巴结与正常淋巴结长径、短径、弹性模量值之间的差异有统计学意义(均P<0.01),其中,两组弹性模量最小值、平均值、最大值的诊断界值分别为8.9 kPa、12.2 kPa、17.5 kPa,鉴别诊断的灵敏度分别为73.8%、75.7%、84.1%,特异度为63.3%、76.9%、74.6%。结论在淋巴结炎性期,实时剪切波弹性成像联合应用常规超声可以对小儿颈部炎性淋巴结进行更全面的评估,为诊断提供依据。

Objective To evaluate the clinical value of real-time shear wave elastography in the diagnosis of pediatric cervical lymphadenitis.Methods A total of 107 children with cervical lymph node enlargement caused by infectious diseases in our center and 60 children without cervical lymph node enlargement were selected.Routine ultrasonography and real-time shear wave elastography were performed in each child.The long diameter,short diameter,long diameter to short diameter ratio and elastic modulus of the lymph nodes were measured.The ultrasonic indexes of the lymph nodes in the 2 groups were statistically analyzed.ROC curve was used to evaluate the diagnostic efficacy of elastic modulus in differentiating inflammatory cervical lymph nodes from normal cervical lymph nodes in children.Results The long diameter,short diameter,long diameter to short diameter ratio of inflammatory cervicle lymph nodes of 107 children and normal cervicle lymph nodes of 60 children were(21.9±6.8)mm/(6.6±1.6)mm,(8.4±3.1)mm/(2.5±0.8)mm,(2.74±0.71)/(2.76±0.78),respectively.The minimum,average and maximum values of the elastic modulus of the 2 groups were(7.6±2.3)kPa/(12.9±6.7)kPa,(10.8±2.0)kPa/(18.2±8.7)kPa and(15.2±4.2)kPa/(24.7±11.2)kPa,respectively.The mean values of the 2 groups were not measured in the same population,so there was comparability between groups.There were statistically significant differences in long diameter,short diameter,long diameter to short diameter ratio and elasticity between inflammatory cervicle lymph nodes in children and normal cervicle lymph nodes(all P<0.05).Among them,the diagnostic thresholds of the minimum,mean and maximum elastic modulus of the 2 groups were 8.9 kPa,12.2 kPa and 17.5 kPa,respectively.The sensitivities of differential diagnosis were 73.8%,75.7%and 84.1%,and the specificities were 63.3%,76.9%and 74.6%,respectively.Conclusion Real-time shear wave elastography combined with conventional ultrasound can provide a comprehensive evaluation of the inflammatory cervicle lymph nodes of children during the inflammatory phase,providing a theoretical basis for diagnosis.