彩色多普勒超声与颈部多层螺旋增强CT诊断颈部淋巴结病变的价值分析

The value and advantage of color Doppler and cervical multi-slice spiral CT in the diagnosis of cervical lymphadenopathy

目的探讨彩色多普勒超声与颈部多层螺旋增强CT(MSCT)诊断颈部淋巴结病变的价值。方法选择郴州市第一人民医院2019年1月至2020年12月诊治的130例颈部淋巴结病变患者,均接受彩色多普勒超声检查及MSCT检查,以病理检查结果为金标准,比较两种检查方法对颈部淋巴结病变良恶性的鉴别诊断效能。结果恶性淋巴结超声检查存在不规则边界,内部存在不均匀低回声,淋巴结内血流信号丰富;良性淋巴结超声检查内部呈均匀一致的细点状回声,内皮髓质均匀增长,边界清晰光滑,无血流信号或散在小点状血流信号。恶性淋巴结MSCT图像具有形状不规则、边缘模糊、强化程度明显、不均匀强化及钙化发生率高的特点。良性淋巴结纵横比高于恶性淋巴结(2.14±0.48比1.92±0.43),收缩期最大血流速度(Vmax)、阻力指数(RI)、血流量(BF)低于恶性淋巴结[(21.38±3.61)cm/s比(23.17±2.55)cm/s、0.62±0.14比0.71±0.17、(48.82±13.51)ml/(min·100 g)比(65.61±14.64)ml/(min·100 g)],差异有统计学意义(P<0.05)。良性淋巴结血流分型以淋巴门型居多[51.79%(29/56)],而恶性淋巴结以边缘型[44.59%(33/74)]、中央型[25.68%(19/74)]居多。超声联合MSCT鉴别诊断淋巴结良恶性病变的灵敏度为92.86%,特异度为95.95%,准确度为94.62%,Kappa值为0.890。结论彩色多普勒超声以及MSCT均可以通过淋巴结的影像学特征以及血流分布模式等参数较好地鉴别诊断颈部淋巴结病变的良恶性,两者联合诊断的灵敏度、特异度、准确度更高。

Objective To study the value and advantage of color Doppler and cervical multi-slice spiral CT(MSCT)in the diagnosis of cervical lymphadenopathy.Methods A total of 130 patients with cervical lymphadenopathy diagnosed and treated in the Chenzhou First People′s Hospital from January 2019 to December 2020 were selected and received color Doppler ultrasound examination and MSCT examination.The results of pathological examination were used as the gold standard to compare the efficacy of the two methods in the differential diagnosis of benign and malignant cervical lymphadenopathy.Results Ultrasound examination of malignant lymph nodes showed irregular boundaries,uneven internal hypoecho,and abundant blood flow signals in lymph nodes;ultrasound examination of benign lymph nodes showed uniform fine dot echo,uniform growth of endothelial medulla,clear and smooth boundary,no blood flow signal or scattered dot blood flow signal.The MSCT images of malignant lymph node showed irregular shape,blurred edge,obvious and uneven enhancement and higher rate of calcification.The aspect ratio of lymph nodes in benign lymph node was significantly higher than that in malignant lymph node(2.14±0.48 vs.1.92±0.43),and the maximum blood flow velocity(Vmax),resistance index(RI)and blood flow(BF)in systolic period were significantly lower than those in lymph node[(21.38±3.61)cm/s vs.(23.17±2.55)cm/s,0.62±0.14 vs.0.71±0.17,(48.82±13.51)ml/(min·100 g)vs.(65.61±14.64)ml/(min·100 g)],there were statistical differences(P<0.05).The most common blood flow types was lymphatic hilum type in benign lymph node,the proportion was 51.79%(29/56),while the most common type in malignant lymph node was marginal type and central type,the proportion was 44.59%(33/74)and 25.68%(19/74).The sensitivity,specificity,accuracy and Kappa value of ultrasound combined with MSCT in diagnosis were 92.86%,95.95%,94.62%and 0.890.Conclusions Both color Doppler ultrasonography and MSCT can differentiate the benign and malignant of cervical lymph node lesions with better parameters such as lymph node imaging characteristics and blood flow distribution pattern,but the combined diagnosis has higher sensitivity,specificity and accuracy.