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