气道内超声弹性成像技术在纵隔淋巴结性质判定中的价值*

Endobronchial ultrasound elastography in diagnosis of mediastinal lymph nodes*

摘要:

通过测定纵隔淋巴结的超声弹性成像（UE）各参数，探讨气道内UE技术对纵隔淋巴结良恶性性质判定的价值。方法 收集2016年6月-2017年3月南京市第一医院呼吸科气管镜室拟行超声内镜引导下的经支气管针吸活检（EBUS-TBNA）的46例患者共63例淋巴结，对目标淋巴结进行常规超声和弹性成像检查，分析并记录淋巴结常规超声特征和弹性成像各个参数，并以病理结果及3个月的随访确认为依据，分析比较UE的诊断价值。结果 ①UE图像类型、超声弹性评分、UE应变率比值、UE蓝色面积比例诊断纵隔淋巴结良恶性的准确率、敏感度、特异度均明显高于常规超声，差异有统计学意义（P <0.05）；②常规超声特征中边界、回声强弱、内部回声均匀程度对诊断淋巴结良恶性差异有统计学意义（P <0.05），边界（清楚）对恶性淋巴结诊断的价值最高。弹性成像各参数中，弹性评分的准确率最高。将两者分别与边界（清楚）作为联合指标判断纵隔淋巴结性质，其准确率、灵敏度、特异度及曲线下面积均明显高于常规超声及UE单独使用的诊断准确率，差异有统计学意义（P <0.05）。结论  UE参数对纵隔淋巴结性质判定的价值优于常规超声特征，且两者综合应用能够提高对于良恶性淋巴结鉴别的准确率。

Abstract:

To evaluate the value of endobronchial ultrasound elastography in diagnosis of mediastinal lymph nodes by measuring the parameters of endobronchial ultrasound elastography. Methods Between 2016 and 2017, 46 patients with 63 lesions underwent EBUS-TBNA examination were included. Conventional ultrasound and ultrasound elastography were performed respectively to examine 63 lymph nodes before aspiration. Then various features of conventional ultrasound and parameters of ultrasound elastography were analyzed and recorded. Then evaluate the value of ultrasound elastography by pathological results and three-month follow-up data. Result The diagnostic value of ultrasound elastography image type, elasticity score, strain ratio and blue area ratio for malignant lymph nodes were higher than that of conventional ultrasound features in accuracy, sensitivity and specificity (P < 0.05); The accuracy of the boundary was the highest in the diagnosis of malignant lymph nodes. In the ultrasound elastography parameters, the accuracy of the elasticity score was the highest, and the blue area ratio had the largest area under the curve. When the boundary was used as the joint index to judge malignant lymph nodes with elasticity score and area ratio respectively, significantly higher than the diagnostic accuracy of conventional ultrasound and ultrasound elastography alone (P < 0.05). Conclusion The value of ultrasound elastography parameter in mediastinal lymph nodes diagnosis is higher than the conventional ultrasound features and a combination of both applications can improve discrimination accuracy of benign and malignant lymph nodes.