Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
J Ultrasound Med. 2021 Oct;40(10):2069-2078. doi: 10.1002/jum.15584. Epub 2020 Dec 2.
To investigate ultrasound (US) features of enlarged cervical lymph nodes (LNs) to differentiate between Kikuchi disease (KD) and other common types of infectious lymphadenitis in an East Asian pediatric patient population.
A total of 142 pediatric patients with KD and 45 patients with infectious lymphadenitis (suppurative lymphadenitis [n = 29], nontuberculous mycobacterial lymphadenitis [n = 9], and tuberculous lymphadenitis [n = 7]) were included. The clinical characteristics, laboratory results, and US features of LNs were reviewed. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used as a diagnostic accuracy measure.
A multiple clustered adjacent pattern, bilaterality, an even size, posterior neck involvement, no enlargement, an elongated-to-ovoid shape, homogeneous hypoechogenicity, a well-defined margin, presence of an echogenic fatty hilum, no intranodal gross necrosis, increased perinodal fat echogenicity, and no increased echogenicity of the adjacent sternocleidomastoid muscle were significant US features of the affected LNs to discriminate KD from infectious lymphadenitis (P < .05). Homogeneous hypoechogenicity in KD showed the highest AUC (0.930) as a single variable (95% confidence interval, 0.88-0.96). The AUCs were increased in 3 combination models with 2 US features: homogeneous echogenicity and 1 of 3 other US features (increased perinodal fat echogenicity, 0.935; number of affected LNs, 0.947; and LN shape, 0.949).
Homogeneous hypoechogenicity of LNs was a significant US feature with the highest diagnostic accuracy in differentiating KD from common infectious lymphadenitis on a univariate analysis. In the combination model, US features of an elongated-to-ovoid shape and homogeneous hypoechogenicity showed the highest diagnostic accuracy.
探究东亚儿科患者中肿大的颈部淋巴结（LNs）的超声（US）特征，以区分菊池病（KD）与其他常见类型的感染性淋巴结炎。
共纳入 142 例 KD 患儿和 45 例感染性淋巴结炎患儿（化脓性淋巴结炎[n=29]、非结核分枝杆菌性淋巴结炎[n=9]和结核性淋巴结炎[n=7]）。回顾了 LNs 的临床特征、实验室结果和 US 特征。使用受试者工作特征曲线分析的曲线下面积（AUC）作为诊断准确性的度量。
多个簇状相邻模式、双侧性、均匀大小、后颈部受累、无肿大、长椭圆形、均匀低回声、边界清晰、存在回声脂肪门、无门内大体坏死、周围脂肪回声增强、无邻近胸锁乳突肌回声增强是区分 KD 与感染性淋巴结炎的肿大 LNs 的显著 US 特征（P<0.05）。KD 中的均匀低回声在单一变量时显示出最高的 AUC（0.930，95%置信区间，0.88-0.96）。在 3 个具有 2 个 US 特征的组合模型中，AUC 增加：均匀回声和其他 3 个 US 特征中的 1 个（周围脂肪回声增强，0.935；受累 LNs 数量，0.947；和 LN 形状，0.949）。
在单变量分析中，均匀低回声是区分 KD 与常见感染性淋巴结炎的重要 US 特征，具有最高的诊断准确性。在组合模型中，长椭圆形和均匀低回声的 US 特征显示出最高的诊断准确性。
