【摘要】 目的 探讨多模态超声在原发性结内弥漫性大B细胞淋巴瘤（N-DLBCL）诊断及分型、分期中的作用。资料与方法 回顾性纳入2020年10月—2022年6月南京医科大学第一附属医院96例经病理诊断为N-DLBCL(51例)或良性淋巴结（45例）患者，共96个淋巴结。所有患者均行高频超声、剪切波弹性成像和超声造影检查。分析3种方法在N-DLBCL与良性淋巴结、DLBCL不同分型和分期方面的差异。绘制受试者工作特征曲线，获得剪切波弹性成像和超声造影定量指标的诊断阈值，并评价不同检查方法的疗效。结果 单因素分析显示，N-DLBCL与良性淋巴结间有14项参数差异有统计学意义（χ~2=12.289～32.934,P均<0.05）。多因素分析显示，两组间长径/短径（OR=11.205,P=0.012）、皮质回声（OR=10.367,P=0.002）、最大弹性（OR=0.180,P=0.014）、达峰时间（OR=0.111,P=0.025）、峰值强度-本底强度（OR=0.061,P=0.002）及增强方式（OR=0.065,P=0.001）差异有统计学意义，生发中心组与非生发中心组的最大弹性（χ~2=5.299,P=0.021）差异有统计学意义，局限期N-DLBCL与进展期N-DLBCL的血流分布方式（χ~2=9.663,P=0.017）、到达时间（χ~2=2.851,P=0.034）和达峰时间（χ~2=6.702,P=0.018）差异有统计学意义。高频超声、剪切波弹性成像、超声造影及多模态超声诊断N-DLBCL和良性淋巴结的曲线下面积分别为0.754、0.839、0.875、0.963。结论 多模态超声不仅能够区分良性淋巴结与N-DLBCL，在明确N-DLBCL分型、分期中也有一定的应用价值，能够指导临床医师对患者进行合理的诊断和治疗。更多还原

【Abstract】 Purpose To investigate the application value in diagnosis, typing and staging of multimodal ultrasound in primary nodal diffuse large B-cell lymphoma(N-DLBCL). Materials and Methods A total of 96 patients(96 nodes) with a pathological diagnosis of N-DLBCL(51 nodes) or benign lymph nodes(45 nodes) in the First Affiliated Hospital of Nanjing Medical University from October 2020 to June 2022were enrolled, retrospectively. All these patients were examined by high-frequency ultrasound, shear wave elastography(SWE) and contrastenhanced ultrasonography(CEUS). The differences among the three ultrasound imaging methods in differentiating N-DLBCL from benign lymph nodes, typing and staging of N-DLBCL were analyzed. Receiver operating characteristic curve were drawn to obtain the diagnostic thresholds of SWE and CEUS quantitative indexes, and the efficacy of the different examination methods were assessed. Results Univariate analysis demonstrated 14 parameters were significantly different between the N-DLBCL and benign lymph nodes(χ~2=12.289-32.934, all P<0.05). Multivariate analysis showed the difference in long diameter/short diameter(OR=11.205, P=0.012), cortical echo(OR=10.367,P=0.002), maximum elasticity(OR=0.180, P=0.014), peak time(OR=0.111, P=0.025), peak intensity-basic intensity(OR=0.061, P=0.002)and enhancement distribution(OR=0.065, P=0.001) were statistically significant between the two groups. There were statistically significant differences of maximum elasticity(χ~2=5.299, P=0.021) between germinal center and non-germinal center N-DLBCL groups. There were statistically significant differences in blood flow pattern(χ~2=9.663, P=0.017), arrival time(χ~2=2.851, P=0.034) and peak time(χ~2=6.702,P=0.018) between the limited and advanced N-DLBCL. The area under the curve for the diagnosis of N-DLBCL and benign lymph nodes by high-frequency ultrasound, SWE, CEUS and multimodal ultrasound were 0.754, 0.839, 0.875 and 0.963, respectively. Conclusion Multimodal ultrasound has high application value in differential diagnosis, classification and staging of N-DLBCL, and can provide basis for diagnosis and treatment of N-DLBCL.更多还原