【摘要】 目的 比较结内型淋巴瘤与转移性淋巴结的常规超声及超声造影特征，探讨其诊断转移性淋巴结的价值。方法 2023年6-12月西安交通大学第二附属医院经活检组织病理证实的结内型淋巴瘤患者27例为结内型淋巴瘤组，转移性淋巴结患者67例为转移性淋巴结组。比较2组活检前常规超声及超声造影特征；绘制ROC曲线，评价2组单因素分析有差异的常规超声及超声造影特征诊断转移性淋巴结的效能。结果 (1)转移性淋巴结组淋巴结边界模糊(53.73%)、淋巴门消失(89.55%)、无网格样回声(100%)、有钙化(29.85%)、有融合(26.87%)、血流形态呈边缘型(50.75%)、血流密度Ⅰ级(23.88%)占比均高于结内型淋巴瘤组(14.81%、48.15%、70.37%、7.41%、3.70%、11.11%、0)(χ~2=4.228～19.409,P均<0.05),血流密度Ⅳ级占比(11.94%)低于结内型淋巴瘤组(40.74%)(χ~2=16.991,P=0.002)。(2)转移性淋巴结组向心性灌注(71.64%)、等/低增强(44.77%)占比均高于结内型淋巴瘤组(14.82%、11.11%)(χ~2=27.069,P<0.001;χ~2=10.073,P=0.006)。(3)淋巴结边界模糊、淋巴门消失、无网格样回声、有钙化、有融合、边缘型血流形态、血流密度0～Ⅰ级、向心性灌注、等/低增强灌注诊断转移性淋巴结的AUC分别为0.695(95%CI:0.583～0.807,P=0.003)、0.707(95%CI:0.580～0.834,P=0.002)、0.648(95%CI:0.513～0.783,P=0.025)、0.612(95%CI:0.494～0.730,P=0.090)、0.616(95%CI:0.499～0.733,P=0.080)、0.698(95%CI:0.588～0.808,P=0.003)、0.657(95%CI:0.547～0.767,P=0.018)、0.784(95%CI:0.683～0.886,P<0.001)、0.668(95%CI:0.555～0.781,P=0.011),灵敏度分别为53.7%、89.6%、100%、29.9%、26.9%、50.7%、31.3%、71.6%、44.8%,特异度分别为85.2%、51.9%、29.6%、92.6%、96.3%、88.9%、100%、85.2%、88.9%;边界模糊、淋巴门消失、无网格样回声、边缘型血流形态、血流密度0～Ⅰ级、向心性灌注、等/低强度灌注联合诊断转移性淋巴结的AUC为0.912(95%CI:0.856～0.967,P<0.001),灵敏度为83.6%,特异度为81.5%。联合诊断的AUC大于单独检测(Z=3.654～7.441,P均<0.001)。结论 结内型淋巴瘤与转移淋巴结的常规超声及超声造影特征存在差异，转移性淋巴结主要表现为边界模糊、淋巴门消失、无网格样回声、边缘性血流形态、血流密度0～Ⅰ级、向心性灌注模式、灌注强度等/低增强；上述特征对转移性淋巴结的诊断有一定价值。更多还原

【Abstract】 Objective To compare the conventional ultrasound and contrast-enhanced ultrasound(CEUS) features of intranodal lymphoma and metastatic lymph nodes,and to explore their diagnostic values for metastatic lymph nodes.Methods From June to December 2023,27 patients with intranodal lymphoma and 67 patients with metastatic lymph nodes were diagnosed by biopsy and pathology in the Second Affiliated Hospital of Xi’ an Jiao tong University.The conventional ultrasound and CEUS features before biopsy were compared between two groups.ROC curves were plotted to evaluate the performance of the conventional ultrasound and CEUS features with differences in univariate analysis for diagnosing metastatic lymph nodes.Results(1) The proportions of blurred lymph node boundaries,disappearance of lymphoid hilum,no grid-like echoes,presence of calcification,fusion,edge-type blood flow pattern and grade I blood flow density were significantly higher in the metastatic lymph node group(53.73 %,89.55%,100%,29.85 %,26.87% 50.75%,23.88%) than those in the intranodal lymphoma group(14.81%,48.15%,70.37%,7.41%,3.70%,11.11%,0)(χ~2=4,228-19.409,all P values <0.05),and the proportion of blood flow density grade Ⅳ(11.94%) was significantly lower than that in the intranodal lymphoma group(40.74%)(χ~2=16.991,P=0.002).(2) The proportions of centripetal perfusion pattern and iso/hypo-enhancement perfusion were significantly higher in the metastatic lymph node group(71.64%,44.77%) than those in the intraductal lymphoma group(14.82%,11.11%)(χ~2=27.069,P<0.001;χ~2=10.073,P=0.006).(3) The AUCs of blurred lymph node boundaries,disappearance of lymphoid hilum,no grid-like echoes,presence of calcification,fusion,edge-type blood flow pattern,blood flow density grade 0-I,centripetal perfusion pattern,and iso/hypo-enhancement perfusion were 0.695(95% CI:0.583-0.807,P=0.003),0.707(95 % CI:0.580-0.834,P=0.002),0.648(95% CI:0.513-0.783,P=0.025),0.612(95% CI:0.494-0.730,P=0.090),0.616(95%CI:0.499-0.733,P=0.080),0.698(95% CI:0.588-0.808,P=0.003),0.657(95%CI:0.547-0.767,P=0.018),0.784(95%CI:0.683-0.886,P<0.001),and 0.668(95% CI:0.555-0.781,P=0.011),with sensitivities of 53.7%,89.6% 100 %,29.9%,26.9%,50.7%,31.3%,71.6% and 44.8%,and specificities of 85.2%,51.9 %,29.6%,92.6%,96.3%,88.9%,100%,85.2% and 88.9%,respectively.The AUC of combined application of blurred boundaries,disappearance of lymphoid hilum,no grid-like echoes,edge-type blood flow pattern,blood flow density grade 0-I, centripetal perfusion pattern,and iso/hypo-enhancement perfusion for diagnosing metastatic lymph nodes was 0.912(95 % CI:0.856-0.967,P<0.001),with a sensitivity of 83.6 % and a specificity of 81.5%.The AUC of the combined diagnosis was greater than that of the individual test(Z=3.654-7.441,all P values <0.001).Conclusions The conventional ultrasound and CEUS features are different between intranodal lymphoma and metastatic lymph nodes.Metastatic lymph nodes mainly present as blurred boundaries,disappearance of lymphoid hilum,absence of grid-like echoes,marginal blood flow morphology,blood flow density grade 0-I,centripetal perfusion pattern,and iso-hypo-enhancement perfusion,which contributes to its diagnosis.更多还原