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目的探讨三维超声联合超声造影观察颈部不典型淋巴结的血流特征。方法对97例常规超声检查不能提示淋巴结良恶性的颈部淋巴结肿大患者(161个淋巴结)行三维超声和超声造影检查。根据最终诊断结果,将淋巴结分为4组:反应性增生组25例(45个淋巴结)、结核组19例(27个淋巴结)、转移瘤组32例(54个淋巴结)、淋巴瘤组21例(35个淋巴结)。比较4组淋巴结长径与短径比值(L/S)、门髓质形态、血流类型和超声造影特征。结果 4组间L/S及门髓质形态差异均有统计学意义(P均<0.05)。反应性增生组与转移瘤组L/S差异有统计学意义(P<0.008),反应性增生组与转移瘤组、转移瘤组与淋巴瘤组的门髓质形态差异有统计学意义(P均<0.008);其余各组两两比较差异均无统计学意义(P均>0.008)。4组间血流类型、动脉相造影剂进入方式和实质相造影剂分布状态差异均有统计学意义(P均<0.05)。反应性增生组与结核组、反应性增生组与转移瘤组血流类型差异均有统计学意义(P均<0.008),反应性增生组与结核组、反应性增生组与转移瘤组、淋巴瘤组与结核组、淋巴瘤组与转移瘤组动脉相造影剂进入方式和实质相造影剂分布状态差异均有统计学意义(P均<0.008);其余各组两两比较差异均无统计学意义(P均>0.008)。结论三维超声联合超声造影可全面了解淋巴结的血流灌注,可诊断二维声像图特征不典型的淋巴结提供较有价值的信息。
Objective To investigate the blood flow characteristics of cervical atypical lymph nodes by three-dimensional ultrasonography combined with contrast-enhanced ultrasound. Methods Three hundred and seventy cases of cervical lymphadenopathy (161 lymph nodes) who did not show benign and malignant lymph nodes by conventional ultrasonography were examined by three-dimensional ultrasonography and contrast-enhanced ultrasonography. According to the final diagnosis, the lymph nodes were divided into 4 groups: 25 (45 lymph nodes) in the reactive hyperplasia group, 19 (27 lymph nodes) in the tuberculosis group, 32 (54 lymph nodes) in the metastatic tumor group, 21 (35 lymph nodes). The ratio of long diameter to short diameter (L / S), medullary morphology, blood flow type and contrast-enhanced ultrasound were compared between the four groups. Results The morphological differences of L / S and medulla between the four groups were statistically significant (all P <0.05). There was significant difference in L / S between reactive hyperplasia group and metastatic tumor group (P <0.008), and there was significant difference in the morphology of medullary medulla between reactive hyperplasia group and metastatic tumor group, metastatic tumor group and lymphoma group (P All <0.008). There was no significant difference between the other groups (P> 0.008). There were significant differences in the type of blood flow between the four groups, the way of arterial phase contrast agent injection, and the distribution of contrast agent in the substantial phase (all P <0.05). Reactive proliferative group and tuberculosis group, reactive hyperplasia group and metastatic tumor group blood flow type differences were statistically significant (P all <0.008), reactive hyperplasia group and tuberculosis group, reactive hyperplasia group and metastatic tumor group, lymph There were significant differences in the way of enteric contrast medium and the distribution of contrast agent in the lymphoma group and the tuberculosis group, lymphatic tumor group and metastatic tumor group (all P <0.008). There was no significant difference in the other groups between the two groups Significance (P> 0.008). Conclusion Three-dimensional ultrasonography combined with contrast-enhanced ultrasound can fully understand the perfusion of lymph nodes and provide valuable information for diagnosing atypical lymph nodes with two-dimensional sonography.