Application Of Multimodality Ultrasound In Diagnosis Of Three Superficial Lymph Node Diseases

Objective: To study the characteristics of brightness-mode ultrasonography,color Doppler ultrasonography and ultrasound elastography in the diagnosis of superficial lymph node diseases such as cervical histiocytic necrotizing lymphadenitis and cervical tuberculous lymphadenitis and malignant lymphoma,and to evaluate their differential diagnostic value.Methods: A retrospective analysis of 100 cases of cervical histiocytic necrotizing lymphadenitis,100 cases of cervical tuberculous lymphadenitis,43 cases of malignant lymphoma,which was confirmed by pathology,about the general information and results of brightness-mode ultrasonography,color Doppler ultrasonography.Record the location and number of lymph nodes.In each case,selected a larger lymph node and measured value analysis:record the position of the lymph node,longitudinal diameter,transverse diameter,aspect ratio,shape,boundary(border),hilum,echogenicity,calcification,necrosis,liquefaction,inflammatory changes around the lymph nodes,and record the characteristics of color Doppler flow in the lymph node.From the three groups of cases were selected 40 pieces of cervical histiocytic necrotizing lymphadenitis,45 pieces of cervical tuberculous lymphadenitis(non-liquefied or less liquefied),8 pieces of malignant lymphoma,ultrasonic elastography was performed on those lymph nodes.Record the characteristics about lymph nodes of ultrasound elasticity imaging score,strain rate ratio(7 malignant lymphomas)and blue part of lymph node area ratio in elastic imaging(hard rate degree level 20%,HRD_LEV20 %).The results were analyzed statistically.Results: The cervical histiocytic necrotizing lymphadenitis group(KFD group)was compared with the cervical tuberculous lymphadenitis group(TL group)and the malignant lymphoma group(ML group): the KFD group had the youngest age,the smallest longitudinal and transverse diameter,the largest aspect ratio.The majority of the KFD lymph nodes shape regularity(98.0%),border smoothing(81.0%),hilum(central type 44.0%,offset type 26.0%),inflammatory changes around the lymph nodes(73.0%),the difference between other two groups was statistically significant(P< 0.05);the echogenicity of the three groups was uneven(75.0%),but the incidence of calcification(4.0%)and necrotic liquefaction(4.0%)was lower in the KFD group,which was different from the TL group(P < 0.05),the incidence of liquefaction was lower than that of the ML group(16.3%),the difference was statistically significant(P < 0.05).Color Doppler ultrasonography was used to detect the internal blood flow classification of the lymph nodes.Color Doppler ultrasonography was used to detect the internal blood flow classification,of KFD group,70.0% ? type(hilus type),significantly more than TL group and ML group,? type(borderline type,4.0%)and? type(without blood type,2.0%)was significantly lower than TL group,the difference was statistically significant(P< 0.05);Blood flow grading(Adler method)internal blood flow KFD group was major in grade III(40.0%)and grade IV(52.0%),the rest was less.The difference from TL group was statistically significant(P < 0.05),and ML group differences had no statistical significance(P ?0.05);Ultrasonic elastography KFD group was no statistically significant difference in the entire strain ratio(ESR)method with the other two groups(P ? 0.05).The elastography score method and the blue part of lymph node area ratio in elastic imaging(hard rate degree level 20%,HRD_LEV20 %)method,the KFD group ' s results were softer than TL group's(P < 0.05).There was no significant difference between the KFD group and the ML group(P>0.05).Conclusions: The cervical histiocytic necrotizing lymphadenitis has certain ultrasound imaging characteristics: two-dimensional brightness-mode ultrasonography and color Doppler ultrasound have important value in differential diagnosis of KFD,TL and ML.The hardness of the KFD group was lower than that of the TL group(non-liquefaction or less liquefaction type)(P < 0.05)by the elastography score method and the blue part of lymph node area ratio in elastic imaging(hard rate degree level 20%,HRD_LEV20 %)method;by the entire strain ratio(ESR)method showed no significant difference.There was no statistically significant difference between KFD group and ML group,TL group and ML group on ultrasound elastography.