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。

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。

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）。

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。

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.

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.

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).

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.