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  • 毕珂,陈宏伟,朱惠铭,曾小凡,袁静,王茵.超声弹性成像在颈部淋巴结结核诊断中的价值[J].第二军医大学学报,2018,39(10):1082-1086    [点击复制]
  • BI Ke,CHEN Hong-wei,ZHU Hui-ming,ZENG Xiao-fan,YUAN Jing,WANG Yin.Value of ultrasound elastography in diagnosis of cervical tuberculous lymphadenopathy[J].Acad J Sec Mil Med Univ,2018,39(10):1082-1086   [点击复制]
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超声弹性成像在颈部淋巴结结核诊断中的价值
毕珂1△,陈宏伟2△,朱惠铭2,曾小凡3,袁静2,王茵2*
0
(1. 同济大学医学院, 上海 200092;
2. 同济大学附属上海市肺科医院超声科, 上海 200433;
3. 海军军医大学(第二军医大学)长海医院超声科, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 分析对比各型颈部淋巴结结核的超声弹性成像表现,探讨超声弹性成像在颈部淋巴结结核分型诊断中的应用价值和局限性。方法 纳入2017年7月至2018年3月同济大学附属上海市肺科医院收治的经病理或诊断性治疗证实为颈部淋巴结结核的患者70例,选择每例患者的最大淋巴结,回顾性分析其常规超声及弹性成像表现。依据淋巴结结核的常规超声分型标准,将病灶分为急性炎症型(Ⅰ型)、干酪坏死型(Ⅱ型)、寒性脓肿型(Ⅲ型)和愈合钙化型(Ⅳ型)。总结并比较4型颈部淋巴结结核病灶的弹性评分和应变率比值。结果 Ⅰ型24枚(34.29%)、Ⅱ型28枚(40.00%)、Ⅲ型12枚(17.14%)、Ⅳ型6枚(8.57%)。Ⅰ、Ⅱ型病灶硬度较高,弹性评分以3~4分为主(47/52,90.38%),应变率比值为3~5;Ⅲ型病灶硬度最低,弹性评分以1~2分为主(10/12,83.33%),应变率比值多<2;Ⅳ型硬度最高,弹性评分为4~5(6/6,100.00%),应变率比值多>5。4型病灶之间弹性评分与应变率比值差异均有统计学意义(H=30.756,F=23.177,P均<0.001);两两比较除Ⅰ、Ⅱ型病灶之间弹性评分与应变率比值差异无统计学意义外,其他各型比较差异均有统计学意义(P均<0.05)。结论 超声弹性成像对颈部淋巴结结核的分型诊断价值有限;在Ⅰ型中确定是否有明显肉芽肿形成,以及在Ⅲ型中判断病灶张力可能具有一定作用。
关键词:  超声弹性成像  淋巴结结核    弹性评分  应变率比值
DOI:10.16781/j.0258-879x.2018.10.1082
投稿时间:2018-07-06修订日期:2018-09-18
基金项目:上海市科学技术委员会2018年度医学引导类(中、西医)科技支撑项目(18411966700).
Value of ultrasound elastography in diagnosis of cervical tuberculous lymphadenopathy
BI Ke1△,CHEN Hong-wei2△,ZHU Hui-ming2,ZENG Xiao-fan3,YUAN Jing2,WANG Yin2*
(1. Tongji University School of Medicine, Shanghai 200092, China;
2. Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
3. Department of Ultrasound, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To analyze and compare the ultrasound elastography (UE) features of various types of cervical tuberculous lymphadenopathy (CTL), and to investigate the value and limitation of UE in diagnosis of CTL. Methods A total of 70 CTL patients confirmed by pathology or diagnostic treatment who were admitted to Shanghai Pulmonary Hospital affiliated to Tongji University from Jul. 2017 to Mar. 2018 were enrolled, and the images of conventional ultrasound and UE of the largest lymph nodes in each patient were retrospectively analyzed. According to the conventional ultrasound classification criteria of tuberculous lymphadenopathy, the lesions were divided into acute inflammatory type (typeⅠ), caseous necrotic type (typeⅡ), cold abscess type (type Ⅲ) and healing calcification type (type Ⅳ). The elasticity score and strain ratio of various types of CTL lesions were summarized and compared. Results There were 24 (34.29%) typeⅠCTL lesions, 28 (40.00%) typeⅡ, 12 (17.14%) type Ⅲ, and 6 (8.57%) type Ⅳ. The hardness of CTL lesions of typeⅠand typeⅡ was high, with the elastic score being 3-4 (47/52, 90.38%) and the strain ratio being 3-5; the hardness of type Ⅲ was the lowest, with the elastic score being 1-2 (10/12, 83.33%) and the strain ratio<2; the hardness of type Ⅳwas the highest, with the elastic score being 4-5 (6/6, 100.00%) and the strain ratio>5. There were significant differences in elastic score and strain ratio among the four type CTL lesions (H=30.756, F=23.177; both P<0.001). Pairwise comparison showed that except for the differences between typeⅠand typeⅡ lesions, there were significant differences in elastic scores and strain ratios between the four type CTL lesions (P<0.05). Conclusion The value of UE in the diagnosis of CTL is limited. It may play some roles in determining whether there is an obvious granuloma formation in typeⅠlesions and the tension of type Ⅲ lesions.
Key words:  ultrasonic elasticity imaging  lymph node tuberculosis  neck  elasticity score  strain ratio