Ahuja A T, Ying M, Ho S S, Metreweli C
Department of Diagnostic Radiology and Organ Imaging, The Hong Kong Polytechnic University, Shatin, N.T., Hong Kong.
Clin Radiol. 2001 Mar;56(3):197-201. doi: 10.1053/crad.2000.0574.
Recent studies report high accuracy of power Doppler sonography in the differentiation of benign from malignant cervical lymphadenopathy. This study was undertaken to identify which of the parameters used in Doppler sonography of cervical lymph nodes is accurate and readily applicable in routine clinical practice.
We reviewed the power Doppler ultrasound examinations of 50 patients with cytologically proven metastatic nodes from nasopharyngeal carcinoma and 50 patients with proven reactive lymphadenopathy. All the examinations had been performed by an experienced sonologist, and intranodal vascular distribution and resistance were evaluated during real-time ultrasound. Twenty metastatic nodes and 40 reactive nodes were less than 10 mm in maximum transverse diameter. The vascular patterns of lymph nodes were classified into three categories: (1) hilar; (2) capsular; (3) hilar and capsular. The resistive index (RI) and pulsatility index (PI) were measured by spectral Doppler.
Although metastatic nodes (RI, 0.81 +/- 0.11; PI, 1.89 +/- 0.89) tended to have higher intranodal vascular resistance than reactive nodes (RI, 0.65 +/- 0.08; PI, 1.07 +/- 0.26), there was considerable overlap of the resistance parameters between benign and malignant nodes. Most of the metastatic nodes showed the presence of capsular vascularity (capsular, 16%; capsular and hilar, 78%), whereas the majority of the reactive nodes showed hilar vascularity (98%), and the difference was significant.
The distribution of intranodal vascularity appears to be more useful than RI or PI in differentiating benign from malignant cervical lymphadenopathy. It is also easier to evaluate the distribution and the results are therefore readily applicable in routine clinical practice.
近期研究报告称，能量多普勒超声检查在鉴别颈部淋巴结病变的良恶性方面具有较高的准确性。本研究旨在确定颈部淋巴结多普勒超声检查中使用的哪些参数准确且易于在常规临床实践中应用。
我们回顾了50例经细胞学证实为鼻咽癌转移淋巴结患者和50例经证实为反应性淋巴结病患者的能量多普勒超声检查结果。所有检查均由经验丰富的超声科医生进行，在实时超声检查过程中评估淋巴结内血管分布和阻力。20个转移淋巴结和40个反应性淋巴结的最大横径小于10mm。淋巴结的血管模式分为三类：（1）门部；（2）包膜；（3）门部和包膜。通过频谱多普勒测量阻力指数（RI）和搏动指数（PI）。
尽管转移淋巴结（RI，0.81±0.11；PI，1.89±0.89）的淋巴结内血管阻力往往高于反应性淋巴结（RI，0.65±0.08；PI，1.07±0.26），但良性和恶性淋巴结的阻力参数存在相当大的重叠。大多数转移淋巴结显示有包膜血管（包膜，16%；包膜和门部，78%），而大多数反应性淋巴结显示门部血管（98%），差异有统计学意义。
在鉴别颈部淋巴结病变的良恶性方面，淋巴结内血管分布似乎比RI或PI更有用。评估血管分布也更容易，因此其结果易于在常规临床实践中应用。
