Lian Yi, Yang Ye, Lin Zhongying, Wang Peng, Jiang Luo, Zhu Tiantong, Huang Ying
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5247-5257. doi: 10.21037/qims-24-1672. Epub 2025 May 27.
Kikuchi disease (KD) typically presents as lymphadenopathy and is easily confounded with lymphoma. This study analyzes the contrast-enhanced ultrasound (CEUS) characteristics of KD for the differentiation from lymphoma. This study aims to delineate the imaging features of KD and differentiate it from lymphoma, avoiding unnecessary core needle biopsy (CNB).
A retrospective analysis of the clinical and ultrasound (US) examination data of 60 patients with surgically and pathologically confirmed KD or lymphoma was conducted. The basic characteristics, US, CEUS characteristics were compared between two groups. The univariate and multivariate analyses were used to identify features associated with KD.
A total of 22 KD and 38 lymphoma patients were evaluated in this study, including 26 males and 34 females (mean age 42.92±21.24 years). The age, long diameter (LD), short diameter (SD), perinodal fat hyper-echogenicity, normal echogenic hilus, color Doppler flow images (CDFI) distribution, enhancement margin, enhancement pattern, perfusion defect, numbers of perfusion defect, margin of perfusion defect, percentage of perfusion defect and reticulated enhancement showed statistically significant differences between two groups (P<0.05). Univariate analysis showed that age, LD, SD, normal echogenic hilus, perinodal fat hyper-echogenicity, lymph nodule hilar vascularity, ill-defined enhancement margin, perfusion defect and reticulated enhancement absent were the independent predictors of KD (P<0.05). Multivariate analysis showed that age and SD were independent predictors of KD (P<0.05). The area under the curve (AUC) of age, SD and predicted probability were 0.939 [95% confidence interval (CI): 0.876-1.000], 0.809 (95% CI: 0.702-0.916) and 0.974 (95% CI: 0.938-1.000) respectively.
Combining with age, size of lymph nodules, US and CEUS features could effectively diagnose KD. KD is characterized by ill-defined enhancement margins and typically presents with a single, small, well-defined perfusion defect on CEUS. A reticulated enhancement is the distinctive CEUS presentation of lymphoma. CEUS could yield more information for further diagnosis.
菊池病（KD）通常表现为淋巴结病，易与淋巴瘤混淆。本研究分析KD的超声造影（CEUS）特征以与淋巴瘤相鉴别。本研究旨在明确KD的影像学特征并将其与淋巴瘤区分开来，避免不必要的粗针活检（CNB）。
对60例经手术及病理证实为KD或淋巴瘤患者的临床及超声（US）检查数据进行回顾性分析。比较两组患者的基本特征、US及CEUS特征。采用单因素和多因素分析确定与KD相关的特征。
本研究共评估了22例KD患者和38例淋巴瘤患者，其中男性26例，女性34例（平均年龄42.92±21.24岁）。两组患者的年龄、长径（LD）、短径（SD）、淋巴结周围脂肪高回声、正常回声的淋巴结门、彩色多普勒血流成像（CDFI）分布、增强边缘、增强模式、灌注缺损、灌注缺损数量、灌注缺损边缘、灌注缺损百分比及网状增强存在统计学差异（P<0.05）。单因素分析显示，年龄、LD、SD、正常回声的淋巴结门、淋巴结周围脂肪高回声、淋巴结门血管、边界不清的增强边缘、灌注缺损及无网状增强是KD的独立预测因素（P<0.05）。多因素分析显示，年龄和SD是KD的独立预测因素（P<0.05）。年龄、SD及预测概率的曲线下面积（AUC）分别为0.939 [95%置信区间（CI）：0.876 - 1.000]、0.809（95%CI：0.702 - 0.916）和0.974（95%CI：0.938 - 1.000）。
结合年龄、淋巴结大小、US及CEUS特征可有效诊断KD。KD的特征为边界不清的增强边缘，CEUS上通常表现为单个、小的、边界清晰的灌注缺损。网状增强是淋巴瘤独特的CEUS表现。CEUS可为进一步诊断提供更多信息。
