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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (04) : 562 -567. doi: 10.3877/cma.j.issn.2095-3232.2024.04.021

临床研究

超声及超声造影在肝移植术后上腹部淋巴结良恶性鉴别诊断中的应用
张红君1, 郑博文1, 廖梅1, 任杰1,†()   
  1. 1. 510630　广州，中山大学附属第三医院超声科
  • 收稿日期:2024-03-15 出版日期:2024-08-10
  • 通信作者: 任杰
  • 基金资助:
    国家自然科学基金面上项目(81971632); 中山大学附属第三医院"五个五"工程(2023WW102)

Application of ultrasound and contrast-enhanced ultrasound in differential diagnosis of benign and malignant upper abdominal lymph nodes after liver transplantation

Hongjun Zhang1, Bowen Zheng1, Mei Liao1, Jie Ren1,†()   

  1. 1. Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2024-03-15 Published:2024-08-10
  • Corresponding author: Jie Ren
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张红君, 郑博文, 廖梅, 任杰. 超声及超声造影在肝移植术后上腹部淋巴结良恶性鉴别诊断中的应用[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 562-567.

Hongjun Zhang, Bowen Zheng, Mei Liao, Jie Ren. Application of ultrasound and contrast-enhanced ultrasound in differential diagnosis of benign and malignant upper abdominal lymph nodes after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(04): 562-567.

目的

探讨常规超声及超声造影（CEUS）对肝移植术后上腹部良恶性淋巴结的鉴别诊断价值。

方法

回顾性分析2008年1月至2021年11月在中山大学附属第三医院同时接受常规超声及CEUS检查的70例肝移植术后上腹部淋巴结肿大患者临床资料。其中男62例，女8例；平均年龄（48±11）岁。符合医学伦理学规定，知情同意书已豁免。根据CT、MRI、PET-CT、病理诊断确诊淋巴结良恶性，其中41例为良性淋巴结患者（良性组），29例为恶性淋巴结患者（恶性组）。分析肝移植术后上腹部良恶性淋巴结的常规超声及CEUS特征。两组淋巴结直径等比较采用t检验，率的比较采用χ2检验或Fisher确切概率法。

结果

常规超声检查显示，恶性淋巴结均为多发，良性淋巴结多发占56%（23/41），差异有统计学意义（P<0.05）。恶性组淋巴结的长径、短径分别为（33±13）、（21±9）mm，良性组分别为（16±4）、（11±4）mm，差异有统计学意义（t=7.754，6.648；P<0.05）。恶性组表现为淋巴结边界不清、形态不规则、合并肝内占位分别24%（7/29）、14%（4/29）、52%（15/29），良性组均为0，差异有统计学意义（P<0.05）；恶性组内部见彩色血流信号为28%（8/29），良性组为7%（3/41），差异有统计学意义（χ2=3.850，P<0.05）。CEUS检查中，恶性组灌注模式表现为均匀增强、不均匀增强、厚环状增强分别为4、10、15例，良性组相应为30、11、0例，差异有统计学意义（P<0.05）。

结论

肝移植术后上腹部恶性淋巴结通常较大、边界不清及内部可见血流信号，常伴肝内占位，CEUS表现为不均匀增强及厚环状增强。超声可作为肝移植术后辅助诊断和监测上腹部淋巴结的有效影像手段。

关键词: 肝移植, 超声检查, 超声造影, 淋巴结, 诊断
Objective

To evaluate the value of routine ultrasound and contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant lymph nodes in the upper abdomen after liver transplantation.

Methods

Clinical data of 70 patients with lymph node enlargement in the upper abdomen after liver transplantation who received routine ultrasound and CEUS simultaneously in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to November 2021 were retrospectively analyzed. Among them, 62 patients were male and 8 female, aged (48±11) years on average. The informed consents of all patients were exempted and the local ethical committee approval was received. According to CT, MRI, PET-CT and pathological diagnosis, 41 patients were diagnosed with benign lymph nodes (benign group) and 29 patients with malignant lymph nodes (malignant group). Routine ultrasound and CEUS features of benign and malignant lymph nodes in the upper abdomen after liver transplantation were analyzed. The diameter of lymph nodes between two groups was compared by t test. The rate comparison was performed by Chi-square test or Fisher's exact test.

Results

Routine ultrasound showed that the percentage of patients with multiple malignant lymph nodes was 100% (29/29), and 56% (23/41) for benign lymph nodes, and the difference was statistically significant (P<0.05). The maximum and minimum diameters of lymph nodes in the malignant group were (33±13) and (21±9) mm, and (16±4) and (11±4) mm in the benign group, and the differences were statistically significant (t=7.754, 6.648; P<0.05). In the malignant group, the lymph nodes had unclear margins and irregular morphology and complicated with intrahepatic space-occupying lesions, which accounted for 24%(7/29), 14%(4/29) and 52%(15/29), and 0 in the benign group, the differences were statistically significant (P<0.05). In the malignant group, color blood flow signal was observed in 28%(8/29), and 7%(3/41) in the benign group, and the difference was statistically significant (χ2=3.850, P<0.05). CEUS showed that the perfusion patterns of uniform enhancement, uneven enhancement and thick-ring enhancement were seen in 4, 10 and 15 cases in the malignant group, and 30, 11 and 0 cases in the benign group, and the differences were statistically significant (P<0.05).

Conclusions

After liver transplantation, malignant lymph nodes in the upper abdomen are mainly large, featuring unclear margins and visible blood flow signals, primarily complicated with intrahepatic space-occupying lesions. CEUS shows uneven enhancement and thick-ring enhancement. Ultrasound can be employed as an effective imaging approach for auxiliary diagnosis and monitoring of upper abdominal lymph nodes after liver transplantation.

Key words: Liver transplantation, Ultrasound examination, Contrast-enhanced ultrasonography, Lymphaden, Diagnosis
表1 肝移植术后上腹部良恶性淋巴结患者一般资料比较
参数 恶性组 良性组 统计值 P值
性别（例）     χ2=3.115 0.078
男 28 34    
女 1 7    
年龄（岁，±s） 52±8 45±12 t=2.829 0.117
术后检出时间[月，M（Q1，Q3）] 5.0 （2.5，9.5） 0.9 （0.5，1.8） Z=-3.984 <0.001
原发病（例）     - <0.001
肝癌 29 15    
肝衰竭 0 26    
再次移植（例） 0 1 - 0.397
术前AFP升高（例） 20 19 χ2=3.524 0.060
术后AFP升高（例） 19 5 χ2=21.435 <0.001
肝肿瘤数目≥3个（例） 21 3 χ2=10.954 0.001
肝肿瘤直径（mm，±s） 82±50 29±14 t=3.996 <0.001
侵犯血管(例) 26 5 χ2=15.066 <0.001
超出米兰标准（例） 26 8 χ2=5.503 0.019
移植前治疗（例） 13 7 χ2=0.013 0.908
肝肿瘤分化程度（例）     χ2=1.453 0.228
低级 19 7    
中高级 10 8    
术前MELD分级（例）     - <0.001
低危 29 23    
中危 0 5    
高危 0 13    
术后EAD（例） 11 8 χ2=2.914 0.088
图1 一例肝移植术后患者肝门部良性淋巴结超声和CT检查注：a为二维超声显示淋巴结位于肝门部，形态规则，边界清晰，内部回声均匀；b为淋巴结内未见明显彩色血流信号；c为CEUS动脉期示淋巴结均匀等增强；d为CEUS静脉期示淋巴结呈均匀等增强；e为淋巴结CT平扫示稍低密度病灶；f为1个月后常规超声复查，肝门部淋巴结明显缩小；红色圈内示淋巴结，CEUS为超声造影
图2 一例肝移植术后患者肝门部恶性淋巴结超声和CT检查注：a为二维超声示肝门部多发淋巴结肿大，类圆形，边界清楚，内部回声均匀；b为病灶内可见稀疏点状血流信号；c为CEUS动脉期示淋巴结呈厚环状稍高增强；d为CEUS静脉期示淋巴结呈不均匀等增强；e为增强CT动脉期淋巴结表现为厚环状高增强；f为3个月后常规超声复查示淋巴结明显增大并相互融合；红色圈内示淋巴结，CEUS为超声造影
表2 肝移植术后上腹部良恶性淋巴结的常规超声及CEUS表现
指标 恶性组 良性组 统计值 P值
多发（例） 29 23 - <0.001
淋巴结长径（mm，±s） 33±13 16±4 t=7.754 <0.001
淋巴结短径（mm，±s） 21±9 11±4 t=6.648 <0.001
长径/短径（±s） 1.57±0.26 1.50±0.35 t=0.910 0.183
形态规则（例） 25 41 - 0.026
边界清楚（例） 22 41 - 0.002
淋巴结门（例） 0 0 - 1.000
彩色血流信号（例） 8 3 χ2=3.850 0.042
合并肝内占位（例） 15 0 - <0.001
CEUS增强形态（例）     - <0.001
均匀增强 4 30    
不均匀增强 10 11    
周边厚环状增强 15 0    
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