Yue Zong-Hua, Du Jia-Rui, Li Wen-Hui, Zhang Han-Yu, Yin Shao-Hua, Huang Mei-Yu, Liu Xing-Rui, Sui Guo-Qing
Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
Quant Imaging Med Surg. 2024 Sep 1;14(9):6362-6373. doi: 10.21037/qims-24-658. Epub 2024 Aug 16.
In many clinical situations, it is critical to exclude or identify abnormally lymph nodes (LNs). The nature of superficial abnormally LNs is closely related to the stage, treatment, and prognosis of the disease. Ultrasound (US) is an important method for examining superficial LNs due to its cheap and safe characteristics. However, it is still difficult to determine the nature of some LNs with overlapping benign and malignant features in images. Contrast-enhanced ultrasound (CEUS) can be used to evaluate the microperfusion status of tissues in real time, and it can improve diagnostic accuracy to a certain extent. Therefore, in this study, we will analyze the correlation between CEUS quantitative parameters and benign and malignant superficial abnormally LNs, to evaluate the efficacy and value of CEUS in distinguishing benign and malignant superficial LNs.
This study retrospectively analyzed 120 patients of abnormal LNs who underwent US and CEUS at the China-Japan Union Hospital of Jilin University from December 2020 to August 2023. All 120 cases of abnormal LNs underwent US-guided coarse needle biopsy, and accurate pathological results were obtained, along with complete US and CEUS images. According to the pathological results, LNs were divided into benign and malignant groups, and the qualitative and quantitative parameters of US and CEUS between the two groups were analyzed. The cutoff value is determined by the receiver operating characteristic (ROC) curve of the subjects, and sensitivity, specificity, and accuracy are applied to evaluate the ability of the cutoff value to distinguish between the two groups.
There were a total of 120 LNs, including 36 in the benign group and 84 in the malignant group. The results showed that malignant LNs were usually characterized by the disappearance of lymphatic hilum, round ness index (L/T) <2, irregular morphology, and the manifestation of uneven perfusion (P<0.05). The differences in the quantitative parameters peak enhancement (PE), rise time (RT), time to peak (TTP), wash-in rate (WIR), and wash-out rate (WOR) were statistically significant (P<0.05). The result showed that RT and TTP in the malignant LNs were higher than those in the benign LNs, while the PE, WIR, and WOR were lower. A comparison of the ∆ values showed that the differences in ∆PE, ∆WIR, and ∆fall time (FT) were statistically significant (P<0.05), Among them, the ∆PE and ∆WIR of malignant LNs were higher than those of benign LNs, while the ∆FT was lower than that of benign LNs.
Quantitative analysis of CEUS features is valuable in the diagnosis of benign and malignant LNs, and US combined with CEUS helps to improve the accuracy of identifying the nature of LNs.
在许多临床情况下，排除或识别异常淋巴结（LNs）至关重要。浅表异常淋巴结的性质与疾病的分期、治疗及预后密切相关。超声（US）因其价格低廉且安全的特点，是检查浅表淋巴结的重要方法。然而，在图像中仍难以确定一些具有良性和恶性特征重叠的淋巴结的性质。超声造影（CEUS）可实时评估组织的微灌注状态，在一定程度上可提高诊断准确性。因此，在本研究中，我们将分析CEUS定量参数与良性和恶性浅表异常淋巴结之间的相关性，以评估CEUS在鉴别良性和恶性浅表淋巴结方面的有效性和价值。
本研究回顾性分析了2020年12月至2023年8月在吉林大学中日联谊医院接受超声和CEUS检查的120例异常淋巴结患者。所有120例异常淋巴结均接受超声引导下粗针活检，获得准确的病理结果以及完整的超声和CEUS图像。根据病理结果，将淋巴结分为良性组和恶性组，并分析两组之间超声和CEUS的定性和定量参数。通过受试者工作特征（ROC）曲线确定截断值，并应用敏感性、特异性和准确性来评估截断值区分两组的能力。
共有120个淋巴结，其中良性组36个，恶性组84个。结果显示，恶性淋巴结通常表现为淋巴门消失、纵横比（L/T）<2、形态不规则以及灌注不均匀（P<0.05）。峰值增强（PE）、上升时间（RT）、达峰时间（TTP）、流入率（WIR）和流出率（WOR）等定量参数差异具有统计学意义（P<0.05）。结果表明，恶性淋巴结的RT和TTP高于良性淋巴结，而PE、WIR和WOR则较低。∆值比较显示，∆PE、∆WIR和∆下降时间（FT）差异具有统计学意义（P<0.05），其中恶性淋巴结的∆PE和∆WIR高于良性淋巴结，而∆FT低于良性淋巴结。
CEUS特征的定量分析在良性和恶性淋巴结的诊断中具有重要价值，超声联合CEUS有助于提高识别淋巴结性质的准确性。
