超声造影和超声弹性成像在宫颈结核性淋巴结炎病理分类和治疗反应预测中的临床价值
Clinical Value of Contrast-Enhanced Ultrasound and Ultrasound Elastography in the Pathological Classification and Treatment Response Prediction of Cervical Tuberculous Lymphadenitis.
摘要(中文译文)
目前关于颈部结核性淋巴结炎（CTL）的影像学分类及治疗反应预测的证据有限。本研究旨在探讨超声造影（CEUS）和超声弹性成像（UE）在区分CTL病理亚型及预测抗结核治疗反应中的临床价值。本回顾性队列研究纳入2021年1月至2025年10月期间经病理检查确诊的120例CTL患者。所有患者在治疗前均接受CEUS和UE检查。记录参数包括无灌注区面积比、增强模式、应变比和弹性评分。以病理诊断为参照标准，评估CEUS和UE对不同病理亚型的诊断效能。根据治疗后6个月淋巴结体积缩小率（VRR），将患者分为治疗敏感组（VRR ≥ 50%）和治疗不敏感组（VRR < 50%）。分析影像学参数与治疗反应之间的关联。II型患者在CEUS上的环形增强比例、无灌注区面积比、UE高弹性评分比例及应变比均显著高于I型和III型患者（均P < 0.05）。CEUS和UE的灵敏度分别为87.5%和85.0%，特异度分别为87.5%和76.3%。应变比、无灌注区面积比和病程是治疗不敏感的独立危险因素。联合CEUS和UE参数的预测模型表现优于任一单一模态。CEUS和UE可无创且有效地区分CTL的病理亚型，对II型（干酪样坏死）的诊断准确率尤其高。我们建议将CEUS和UE纳入CTL治疗前评估，以指导亚型识别和抗结核治疗的风险分层。
Abstract
Limited evidence exists on imaging-based classification and treatment response prediction in cervical tuberculous lymphadenitis (CTL). This study aimed to investigate the clinical value of contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE) in differentiating pathological subtypes of CTL and predicting response to anti-tuberculosis therapy. This retrospective cohort study included 120 patients with CTL confirmed by pathological examination between January 2021 and October 2025. All patients underwent CEUS and UE prior to treatment. Parameters including the non-perfusion area ratio, enhancement pattern, strain ratio, and elasticity score were recorded. Using pathological diagnosis as the reference standard, the diagnostic performance of CEUS and UE for different pathological subtypes was evaluated. Based on the lymph node volume reduction rate (VRR) at 6 months after treatment, patients were classified into a treatment-sensitive group (VRR ≥ 50%) and a treatment-insensitive group (VRR < 50%). The associations between imaging parameters and treatment response were analyzed. The proportion of annular enhancement on CEUS, non-perfusion area ratio, proportion of high elasticity scores on UE, and strain ratio were significantly higher in Type II patients than in Type I and Type III patients (all P < 0.05). CEUS and UE yielded sensitivities of 87.5% and 85.0% and specificities of 87.5% and 76.3%, respectively. Strain ratio, non-perfusion area ratio, and disease duration were independent risk factors for treatment insensitivity. The predictive model combining CEUS and UE parameters showed superior performance compared with either modality alone. CEUS and UE can noninvasively and effectively differentiate pathological subtypes of CTL, with particularly high diagnostic accuracy for Type II (caseous necrosis). We recommend incorporating CEUS and UE into the pre-treatment evaluation of CTL to guide subtype identification and risk stratification for anti-tuberculosis therapy.
如何引用
AMA
Xiangjun Fu, Xianzhong Zhu, Xiaoyan Liu. Clinical Value of Contrast-Enhanced Ultrasound and Ultrasound Elastography in the Pathological Classification and Treatment Response Prediction of Cervical Tuberculous Lymphadenitis.. Infection and drug resistance. 2026; doi:10.2147/IDR.S610269.
APA
Xiangjun Fu, Xianzhong Zhu, Xiaoyan Liu (2026). Clinical Value of Contrast-Enhanced Ultrasound and Ultrasound Elastography in the Pathological Classification and Treatment Response Prediction of Cervical Tuberculous Lymphadenitis.. Infection and drug resistance. https://doi.org/10.2147/IDR.S610269
GB/T 7714
Xiangjun Fu, Xianzhong Zhu, Xiaoyan Liu. Clinical Value of Contrast-Enhanced Ultrasound and Ultrasound Elastography in the Pathological Classification and Treatment Response Prediction of Cervical Tuberculous Lymphadenitis.[J]. Infection and drug resistance, 2026 doi:10.2147/IDR.S610269.
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