探讨多模态超声检查在颈部淋巴瘤诊断中的价值。

回顾性分析杭州市红十字会医院2016年6月至2018年4月疑似颈部淋巴瘤的98例患者的超声声像图资料，包括二维超声、实时超声弹性成像及超声造影图像。所有患者均取得穿刺活检或手术病理结果。分析颈部淋巴瘤的超声图像特征，并以病理结果为"金标准"，评价单一检查方式及多模态超声对颈部淋巴瘤的诊断价值。

98例颈部淋巴结的病理结果为：淋巴瘤58例，转移性淋巴结14例，淋巴结结核13例，反应性增生淋巴结13例。二维超声诊断淋巴瘤的敏感度、特异度与准确性分别为63.8%、60.0%、62.2%。超声造影诊断淋巴瘤的敏感度、特异度与准确性分别为72.4%、72.5%、76.5%。应用二维超声、实时超声弹性成像及超声造影的多模态超声联合诊断淋巴瘤的敏感度、特异度与准确性分别为79.3%、82.5%、80.6%，高于单一检查方法。颈部淋巴瘤二维超声图像中低或极低回声背景下见条状、网格样回声（38/58，65.5%）及超声造影弥漫性增强（47/58，81.0%）、峰值时呈均匀增强（53/58，91.4%），与非淋巴瘤组比较差异有统计学意义（P均<0.05）。而淋巴瘤组实时弹性成像评分≤2分的占46.6%（27/58），弹性成像评分≥3分的占53.4%（31/58），与非淋巴瘤组比较差异无统计学意义（P>0.05），弹性评分不能有效区分淋巴瘤。

多模态超声检查的应用可为颈部淋巴瘤的诊断提供更多信息，避免了单一超声模式的局限性，尤其超声造影暴风雪样增强与二维超声淋巴结呈低回声背景下条状或网格状回声的特征，更有助于对颈部淋巴瘤的超声诊断。

To explore the value of multi-modal ultrasound in the diagnosis of cervical lymphoma.

A retrospective analysis was performed on the ultrasonographic data of 98 patients with suspected cervical lymphoma at Hangzhou Red Cross Hospital from June 2016 to April 2018, including conventional ultrasound (US), real-time elastography (RTE), and contrast-enhanced ultrasound (CEUS) data. Puncture biopsy or surgical pathological results were obtained in all patients. Pathologic results were used as the gold standard to evaluate the performance of multi-modal ultrasound in the diagnosis of cervical lymphoma.

The pathologic results of 98 cases of cervical lymph nodes were: lymphoma in 58 cases, metastatic lymph nodes in 14, lymph node tuberculosis in 13, and hyperplasia of reactivity lymph nodes in 13. The sensitivity, specificity, and accuracy of US, RTE, and CEUS for diagnosis of lymphoma were 63.80%, 60.00%, and 62.20%, 53.40%, 45.00%, and 50.00%, and 72.40%, 72.50%, and 76.50%, respectively. The sensitivity, specificity, and accuracy of multi-modal ultrasound in the diagnosis of lymphoma were 79.30%, 82.50%, and 80.60%, which were higher than those of either method alone. On conventional US, cervical lymphoma showed stripe- or grid-like echo (38/58, 65.5%); on contrast-enhanced ultrasound (47/58,81.0%), diffuse enhancement was observed, and homogeneous enhancement was noted at peak value (53/58, 91.4%), which was significantly different form that of the non-lymphoma group (P<0.05); on RTE, the elastic score ≤2 accounted for 46.6% (27/58), and the elastic score ≥3 accounted for 53.4% (31/58), and there was no significant difference compared with the non-lymphoma group (P>0.05). The elastic score could not effectively distinguish lymphoma.

The application of multi-mode ultrasound can provide more information for the diagnosis of cervical lymphoma and avoid the limitation of single-mode ultrasound. Especially, the features of stripe- or grid-like echo under the background of low echo on conventional US and snowstorm enhancement on CEUS are more helpful for the ultrasonic diagnosis of cervical lymphoma.