多普勒超声在鉴别良恶性腋下淋巴结中的意义探讨
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| 时间：2009-01-16 20:51:16 来源： 作者： |
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Value of color Doppler ultrasonography in differentiating of benign and malignant axillary lymph nodes
SHI You－hong, WANG Yong.
Shanghai Ruilin clinic, Shanghai 200336, China and Department of Ultrasound， Huashan Hospital
【Ａｂｓｔｒａｃｔ】 Objective Purpose: To evaluate the value of color Doppler ultrasonography and Doppler velosity tracing in differentiating of benign and malignant axillary lymph nodes. Methods Totally, 27 benign and 16 metastatic axillary lymph nodes confirmed by pathology from breast cancer patients were analyzed. The 19 axillary lymph nodes from normal women and 22 lymph nodes from breast benign diseases patients were analyzed as control. The CDFI density、CDFI distribution、peak systolic velosity and resistive index were measured as parameters to identify normal and malignant axillary nodes. Results CDFI density was more in malignant nodes (2,range0-3）than in benign nodes（1,range0-4）；The quantificational value of malignant nodes （9.82±4.94）was larger than benign nodes（5.55±5.53）. The CDFI distribution grade was significantly higher in malignant（2,range0-3） than benign（1,range0-3）lymph nodes. The peak systolic velosity and resistive index were demonstrated equally in benign and malignant axillary nodes. Conclusion CDFI is valuable in identifying normal and malignant axillary lymph nodes. Doppler velocity tracing analysis is failure in this theme.
【Ｋｅｙ ｗｏｒｄｓ】 Axillary lymph nodes; Color Doppler ultrasonograph; Dianosis; Doppler velocity tracing
灰阶超声在鉴别良恶性腋下淋巴结中具有一定的应用价值。但良恶性腋下淋巴结在灰阶超声声像图特征中，仍存在部分重叠，导致没有一个指标的敏感性、特异性均大于80％[1]。CDFI能检测淋巴结内血流信号的强度和分布，多普勒能分析淋巴结内血流动力学的变化。本文的目的：评价多普勒超声在鉴别良恶性腋下淋巴结中的意义。
资料和方法
一、临床资料
研究对象为华山医院外科自2000年6月至2001年9月收治的43例乳腺癌患者的27枚阴性和16枚阳性腋下淋巴结。另有乳腺良性病变患者的19枚腋下淋巴结和正常组的22枚腋下淋巴结作为对照。其中乳癌患者的腋下淋巴结均经超声体表定位后病理证实。
二、仪器与方法
使用仪器为HDI-3000型（Advanced Technology Laboratories，ATL）全数字化彩色超声诊断仪，配备5～12MHz的高频探头。仪器设置：见表1。
测量方法 参数测量 CDFI：淋巴结内CDFI密度等级（分4级），CDFI分布（分4级），详见表2。
多普勒流速曲线分析：淋巴结内血流峰值流速（Vmax），阻力指数（RI）。
多普勒流速曲线测量时，选取淋巴结内最粗大的一根血流进行测量。取样门宽为1mm，置于血管的中央。取样角度≤60°。
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