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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (09) : 841 -847. doi: 10.3877/cma.j.issn.1672-6448.2020.09.005

所属专题: 文献

浅表器官超声影像学

高帧频超声造影在鉴别浅表淋巴结性质中的应用
梁舒媛1, 罗渝昆1,(), 费翔1, 韩鹏1, 张艳1, 李楠1   
  1. 1. 100853 北京,解放军总医院第一医学中心超声诊断科
  • 收稿日期:2020-07-29 出版日期:2020-09-01
  • 通信作者: 罗渝昆

Clinical application of high-frame-rate contrast-enhanced ultrasound in differentiation of benign and malignant superficial lymph nodes

Shuyuan Liang1, Yukun Luo1,(), Xiang Fei1, Peng Han1, Yan Zhang1, Nan Li1   

  1. 1. Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2020-07-29 Published:2020-09-01
  • Corresponding author: Yukun Luo
  • About author:
    Corresponding author: Yukun Luo, Email:
引用本文:

梁舒媛, 罗渝昆, 费翔, 韩鹏, 张艳, 李楠. 高帧频超声造影在鉴别浅表淋巴结性质中的应用[J/OL]. 中华医学超声杂志(电子版), 2020, 17(09): 841-847.

Shuyuan Liang, Yukun Luo, Xiang Fei, Peng Han, Yan Zhang, Nan Li. Clinical application of high-frame-rate contrast-enhanced ultrasound in differentiation of benign and malignant superficial lymph nodes[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 841-847.

目的

应用高帧频超声造影(H-CEUS)技术观察浅表淋巴结微循环灌注模式,评价H-CEUS对浅表淋巴结良恶性的鉴别诊断效能。

方法

选取2019年7月至2020年1月因怀疑浅表淋巴结异常而就诊于解放军总医院第一医学中心并行穿刺活检术或手术切除取得病理结果的患者39例,对39例浅表淋巴结先后进行H-CEUS、常规帧频超声造影(CEUS)检查,对比观察2种造影模式下淋巴结动脉期微血管灌注模式(向心性、离心性、混合性)显示的敏感度,并与病理结果对照,采用χ2检验分析两种超声检查模式的特异度、敏感度、准确性,并采用受试者操作特征(ROC)曲线分析2种超声造影模式的诊断效能。

结果

H-CEUS对于浅表淋巴结动脉期微血管灌注模式的显示敏感度优于CEUS。CEUS的诊断特异度、敏感度、准确性分别为87.5%、73.3%、82.1%。H-CEUS的诊断特异度、敏感度、准确性分别为92.0%、85.7%和89.7%。H-CEUS与CEUS的ROC曲线下面积分别为0.889、0.813。H-CEUS与CEUS对淋巴结性质的鉴别与病理结果对比,差异均无统计学意义(P均>0.05);Kappa一致性分别为0.777和0.616。

结论

H-CEUS可以通过提高造影图像的帧频而获得更高的时间分辨力,对于浅表淋巴结动脉期的微血管构架及动脉期灌注细节显示更清晰直观,可为诊断浅表淋巴结的性质提供更多有价值的信息。

Objective

To observe the microcirculation perfusion pattern of superficial lymph nodes and differentiate benign and malignant superficial lymph nodes by high-frame-rate contrast-enhanced ultrasound (H-CEUS).

Methods

Thirty-nine patients with abnormal superficial lymph nodes who underwent puncture biopsy or surgical resection at the First Medical Center of Chinese PLA General Hospital were included. All patients underwent conventional CEUS and H-CEUS to compare lymph node microvascular perfusion pattern (central, annular, and mixed) in the arterial phase. Using pathological diagnosis results as the golden standard, the specificity, sensitivity, and accuracy of the two modalities were compared by the chi-squared test.

Results

H-CEUS was better than conventional CEUS in showing microvascular perfusion details in superficial lymph nodes. The diagnostic specificity, sensitivity, and accuracy of conventional CEUS were 87.5%, 73.3%, and 82.1%, respectively; the corresponding percentages of H-CEUS were 92.0%, 85.7%, and 89.7%. ROC analysis showed that the areas under the curve of high-frame-rate and conventional CEUS were 0.889 (P=0.000) and 0.813 (P=0.001), respectively. Both high-frame-rate and conventional CEUS showed no significant difference from pathology in the identification of lymph node nature.

Conclusion

H-CEUSshows better microvascular perfusion details in superficial lymph nodes in the arterial phase, providing more valuable information for determining the nature of superficial lymph nodes.

表1 11例转移性淋巴结不同帧频超声造影在中增强方式显示率[例(%)]
图1 转移性淋巴结常规超声与超声造影图像。高帧频(横箭头上)、常规帧频(横箭头下)。图a和k为淋巴结灰阶超声图像,静脉注射造影剂后,选取微泡显示最清晰的图像,高帧频模式63帧/s,常规帧频模式10帧/s,图b~j可较清晰地显示淋巴结内自周边向中心的灌注过程,图l~o淋巴结内部灌注模式显示不清,似呈混合性增强
表2 3例淋巴瘤在不同帧频超声造影中增强方式显示率[例(%)]
图2 淋巴瘤常规超声与超声造影图像。高帧频(横箭头上)、常规帧频(横箭头下)。图a和k为淋巴结灰阶超声图像,静脉注射造影剂后,选取微泡显示最清晰的图像,高帧频模式55帧/s,常规帧频模式10帧/s,图b~j可显示淋巴结内紊乱走行的微血管结构,图l~o淋巴结内部灌微血管结构显示不清
表3 25例良性淋巴结在不同帧频超声造影中增强方式显示率[例(%)]
图3 增生性淋巴结常规超声与超声造影图像。高帧频(横箭头上)、常规帧频(横箭头下)。图a和k为淋巴结灰阶超声图像,静脉注射造影剂后,选取微泡显示最清晰的图像,高帧频模式74帧/s,常规帧频模式10帧/s,图b~j可清晰显示淋巴结内自中心向周边的灌注过程及淋巴门的微血管结构,图l~o淋巴结内部灌注模式及微血管结构显示不清
表4 不同帧频超声造影诊断结果与病理结果的一致性
图4 高帧频与常规帧频超声造影对淋巴结良恶性诊断受试者工作特征曲线
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