Li Lin, He Lan, Xiong Minchao, Wang Xiaoyan
Department of Radiology, Wuhan Asia General Hospital, Wuhan City, Hubei Province, PR China.
Department of Medical Imaging, Ezhou Central Hospital, Ezhou City, Hubei Province, PR China.
Clinics (Sao Paulo). 2024 Dec 20;80:100541. doi: 10.1016/j.clinsp.2024.100541. eCollection 2025.
To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN).
This prospective cohort study included 207 consecutive patients diagnosed with CTL. All patients underwent routine ultrasound and CEUS prior to pathology or laboratory confirmation. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests.
The diagnosis of MLN was confirmed pathologically or laboratory in 102 of 207 patients (49.27 %), and 50.8 % were confirmed to be TLN. According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal.
CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.
探讨超声造影（CEUS）联合降钙素原（PCT）在鉴别结核性淋巴结（TLN）与转移性淋巴结（MLN）中的价值。
这项前瞻性队列研究纳入了207例连续诊断为CTL的患者。所有患者在病理或实验室确诊前均接受了常规超声和CEUS检查。血清指标采用酶联免疫吸附测定（ELISA）法测定。通过多因素逻辑回归进行预测建模。通过绘制受试者操作特征（ROC）曲线和校准曲线，并使用曲线下面积（AUC）和Hosmer-Lemeshow（H-L）检验来评估预测模型的诊断和校准性能。
207例患者中有102例（49.27%）经病理或实验室确诊为MLN，50.8%确诊为TLN。根据CEUS的影像学表现，TLN在动脉期更常表现为同心性增强（67.65%对40.95%）和淋巴结内不均匀增强模式（70.59%对52.38%）。MLN患者病变的峰值强度（PI）更高。年龄增加、动脉期同心性增强、PI增加以及血清PCT大于5.39 ng/mL是MLN的独立危险因素。血清PCT联合CEUS的预测模型对MLN具有更高的诊断价值。H-L检验表明模型拟合良好（所有p>0.05），校准曲线与理想对角线密切近似。
CEUS联合血清PCT在TLN和MLN的鉴别诊断中具有较好的临床应用价值。
