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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (8): 816-821.doi: 10.3969/j.issn.1000-6621.2019.08.003

• 论著 • 上一篇    下一篇

超微血流成像技术在颈部淋巴结结核分型诊断中的应用价值

沈梦君,陈宏伟,毕珂,张怡,丛阳,王茵()   

  1. 同济大学附属同济医院病理科(毕珂)
  • 收稿日期:2019-05-09 出版日期:2019-08-10 发布日期:2019-08-13
  • 通信作者: 王茵 E-mail:lpbbl@aliyun.com
  • 基金资助:
    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)

Application value of superb micro-vascular imaging in classification of cervical tuberculous lymphadenitis

Meng-jun SHEN,Hong-wei CHEN,Ke BI,Yi ZHANG,Yang CONG,Yin WANG()   

  1. *Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
  • Received:2019-05-09 Online:2019-08-10 Published:2019-08-13
  • Contact: Yin WANG E-mail:lpbbl@aliyun.com

摘要:

目的 对比超微血流成像(superb micro-vascular imaging,SMI)技术应用前后结核性淋巴结血流显示与超声分型诊断的差异,探讨SMI在颈部淋巴结结核诊断中的临床应用价值。方法 回顾性分析2018年3—6月就诊于上海市肺科医院超声科行淋巴结穿刺活检且明确诊断为颈部淋巴结结核的30例患者,对30例患者的78枚肿大淋巴结,对比应用灰阶超声+彩色多普勒血流成像(color doppler flow imaging, CDFI)与灰阶超声+SMI的血流信号显示情况和超声分型诊断的差异,并与病理结果进行比较。结果 应用CDFI血流模式,78枚淋巴结15枚出现内部血流信号,14枚出现外周血流信号,未出现混合血流信号,血流显示率为37.2%(29/78);应用SMI血流模式,19枚出现内部血流信号,22枚出现外周血流信号,6枚出现混合血流信号,血流显示率为60.3%(47/78),差异有统计学意义(χ2=16.056,P=0.000)。灰阶超声+CDFI分型结果为:Ⅰ型16枚(20.5%),Ⅱ型22枚(28.2%),Ⅲ型19枚(24.4%),Ⅳ型21枚(26.9%);灰阶超声+SMI肿大淋巴结分型结果为:Ⅰ型22枚(28.2%),Ⅱ型14枚(17.9%),Ⅲ型21枚(26.9%),Ⅳ型21枚(26.9%),两者差异有统计学意义(χ2=8.000,P=0.018)。78枚肿大淋巴结病理检查结果为:以淋巴细胞、肉芽肿性病变为主25枚(对应超声Ⅰ型),以凝固性坏死组织为主13枚(对应超声Ⅱ型),以坏死组织及肉芽肿性病变为主20枚(对应超声Ⅲ型),以纤维组织增生为主20枚(对应超声Ⅳ型)。灰阶超声+SMI分型结果与病理结果间具有极好的一致性(Kappa=0.948),符合率达96.2%(75/78)。灰阶超声+CDFI分型结果与病理结果对比,也有很好的一致性(Kappa=0.830),符合率为87.2%(68/78)。结论 SMI应用后能显著提高颈部结核性淋巴结血流的显示率,更准确地进行淋巴结结核分型诊断,指导临床医生及时选择有效治疗方案,具有更高的临床应用价值。

关键词: 结核, 淋巴结, 超声检查, 诊断显像, 对比研究, 超微血流成像, 彩色多普勒血流显像

Abstract:

Objective The aim of this study was to compare the difference of tuberculous lymph node blood flow display and ultrasonographic diagnosis before and after using superb micro-vascular imaging (SMI), and then explore the clinical application value of SMI in the diagnosis of cervical tuberculous lymphadenitis.Methods A total of 30 patients diagnosed with cervical tuberculous lymphadenitis from March to June 2018 who were admitted to Shanghai Pulmonary Hospital for ultrasound biopsy were retrospectively analyzed. There were 78 enlarged lymph nodes in 30 patients. The difference of blood flow signal display and ultrasonic classification between gray-scale ultrasound + color doppler flow imaging (CDFI) and gray-scale ultrasound + SMI were compared, and then they were compared with the pathological results.Results Based on CDFI blood flow mode, among 78 enlarged lymph nodes, there were 15 signed of internal blood flow, 14 signed of peripheral blood flow and 0 signed of mixed blood flow, with the blood flow rate of 37.2% (29/78). Based on SMI blood flow mode, among 78 enlarged lymph nodes, there were 19 signed of internal blood flow, 22 signed of peripheral blood flow, and 6 signed of mixed blood flow, with the blood flow rate of 60.3% (47/78). The difference was statistically significant (χ2=16.056, P=0.000) between CDFI and SMI blood flow modes. The classification results based on gray-scale ultrasound + CDFI were 16 (20.5%) Type Ⅰ, 22 (28.2%) Type Ⅱ, 19 (24.4%) Type Ⅲ, and 21 (26.9%) Type Ⅳ. The classification results of gray-scale ultrasound + SMI were: 22 (28.2%) Type Ⅰ, 14 (17.9%) Type Ⅱ, 21 (26.9%) Type Ⅲ, and 21 (26.9%) Type Ⅳ. The difference was statistically significant (χ2=8.000,P=0.018) between CDFI and SMI. The pathological results revealed that among 78 enlarged lymph nodes, 25 mainly showed lymphocytes and granulomatous lesions (corresponding to ultrasound type Ⅰ), 13 mainly showed solidified necrotic tissue (corresponding to ultrasound type Ⅱ), 20 mainly showed necrotic tissue and granulomatous lesions (corresponding to ultrasound type Ⅲ), and 20 mainly showed fibrous tissue hyperplasia (corresponding to ultrasound Ⅳ type). The classification results of gray-scale ultrasound + SMI and pathological results had excellent consistency (Kappa=0.948), with the compliance rate of 96.2% (75/78). Compared with the pathological results, the classification results of gray-scale ultrasound + CDFI also had a good consistency (Kappa=0.830), with the compliance rate of 87.2% (68/78).Conclusion SMI can significantly increase the display rate of blood flow in cervical tuberculous lymphadenitis, accurately classify lymphatic tuberculosis, and guide clinicians to choose effective treatment plans, which has higher clinical application value.

Key words: Tuberculosis, lymph node, Ultrasonography, Diagnostic imaging, Comparative study, Superb micro-vascular imaging, Color doppler flow imaging