彩色多普勒超声诊断小儿面颈部淋巴管瘤
摘要
目的：小儿面颈部淋巴管瘤由淋巴管腔异常扩大所形成，90%的病例于小儿出生时或两岁内即可被发现。目前有多种影像学检查方法用于该病的诊断，其中彩色多普勒超声成像(color Doppler flow image, CDFI)技术的诊断价值正日益受到临床关注。本研究旨在总结小儿面颈部淋巴管瘤的声像图特征和血流动力学变化特点，证实B型超声（B-mode ultrasound, B-US）结合CDFI有助于提高诊断的准确性。
方法：采用彩色多普勒超声仪观察32例患儿的病变区，记录病变部位、大小、形态及內部回声结构，了解包块与周围组织的关系，同时用CDFI 观察包块周边和内部有无血流彩束。利用手术（12例）或穿刺取活组织检查（20例）得到标本行病理检查，在光镜下观察病变的组织形态学改变，将超声发现与病检结果对照分析。5例患儿在给予注射治疗后随访超声图像变化。
结果：32例超声诊断与病理诊断符合者31例（96.9%）。1
例误诊主要是将海绵状淋巴管瘤判断为实质性肿块。典型声像图特征为面颈部皮下软组织内边界清晰或略欠清晰的囊性包块，囊液内有强回声条状分隔，伴有感染或出血时则囊液粘稠。CDFI显示分隔上有短条状血流信号。注射治疗后瘤体消退明显，病变区内液性成份减少，代之以不均质的增强回声结构。
结论：CDFI 诊断技术可多切面观察淋巴管瘤的病变范围和内部结构，同时显示瘤体内血供和周围血管的分布情况，能够早期诊断淋巴管瘤，为临床选择手术途径、注射药物治疗及评价疗效提供可靠的图像依据，具有较好的临床实用价值。
OBJECTIVE：Lymphangioma is characterized by dilated lymph channels.It presents commonly in the head and neck region with over 90% of lesions diagnosed before 2 years of age.Until recently, many kinds of image methods have been used for the diagnosis of lymphangiomas.Top of them is the ultrasonography (US) .This study was undertaken to analyse the sonographic characteristics and the hemodynamic changes of facial and cervical lymphangiomas.
METHODS：Color Doppler flow image (CDFI) was performed in 32 cases to assess the extension, location and internal echo. CDFI also provided the informations about blood flow vasoularity of the lesion and blood surrounding tissues. All patients with surgically(12 cases) and needle aspiration biopsy pathologically(20 cases) had been proved lymphangioma .
Follow-up clinical and ultrasonography examinations were performed to evaluate regression of the lesion .
RESULTS：The accuracy rate of US was 96.9% .The error of determing was that cavernous lymphangioma was misdiagnosed as solid lesion . The specific sonogram of lymphangioma was well-defined cystis with several thin septa . The dense liquid always showed infection or hemorrhage . CDFI showed mottling blood supply in the septa . Regression was excellent in 5 patients who were treated with percutaneous sclerotherapy . The internal echo became hyper echo and liquid was less .
CONCLUSIONS：CDFI can help establish the stage and structure of the lesion . The vascularity can be additionally assessed with the application of CDFI . Ultrasound-guided fine-needle aspiration is invaluable in indeterminate cases . So the unique characteristics of facial and cervical lymphangioma can be used in clinical practice for the diagnosis and differential diagnosis .
方法：采用彩色多普勒超声仪观察32例患儿的病变区，记录病变部位、大小、形态及內部回声结构，了解包块与周围组织的关系，同时用CDFI 观察包块周边和内部有无血流彩束。利用手术（12例）或穿刺取活组织检查（20例）得到标本行病理检查，在光镜下观察病变的组织形态学改变，将超声发现与病检结果对照分析。5例患儿在给予注射治疗后随访超声图像变化。
结果：32例超声诊断与病理诊断符合者31例（96.9%）。1
例误诊主要是将海绵状淋巴管瘤判断为实质性肿块。典型声像图特征为面颈部皮下软组织内边界清晰或略欠清晰的囊性包块，囊液内有强回声条状分隔，伴有感染或出血时则囊液粘稠。CDFI显示分隔上有短条状血流信号。注射治疗后瘤体消退明显，病变区内液性成份减少，代之以不均质的增强回声结构。
结论：CDFI 诊断技术可多切面观察淋巴管瘤的病变范围和内部结构，同时显示瘤体内血供和周围血管的分布情况，能够早期诊断淋巴管瘤，为临床选择手术途径、注射药物治疗及评价疗效提供可靠的图像依据，具有较好的临床实用价值。
OBJECTIVE：Lymphangioma is characterized by dilated lymph channels.It presents commonly in the head and neck region with over 90% of lesions diagnosed before 2 years of age.Until recently, many kinds of image methods have been used for the diagnosis of lymphangiomas.Top of them is the ultrasonography (US) .This study was undertaken to analyse the sonographic characteristics and the hemodynamic changes of facial and cervical lymphangiomas.
METHODS：Color Doppler flow image (CDFI) was performed in 32 cases to assess the extension, location and internal echo. CDFI also provided the informations about blood flow vasoularity of the lesion and blood surrounding tissues. All patients with surgically(12 cases) and needle aspiration biopsy pathologically(20 cases) had been proved lymphangioma .
Follow-up clinical and ultrasonography examinations were performed to evaluate regression of the lesion .
RESULTS：The accuracy rate of US was 96.9% .The error of determing was that cavernous lymphangioma was misdiagnosed as solid lesion . The specific sonogram of lymphangioma was well-defined cystis with several thin septa . The dense liquid always showed infection or hemorrhage . CDFI showed mottling blood supply in the septa . Regression was excellent in 5 patients who were treated with percutaneous sclerotherapy . The internal echo became hyper echo and liquid was less .
CONCLUSIONS：CDFI can help establish the stage and structure of the lesion . The vascularity can be additionally assessed with the application of CDFI . Ultrasound-guided fine-needle aspiration is invaluable in indeterminate cases . So the unique characteristics of facial and cervical lymphangioma can be used in clinical practice for the diagnosis and differential diagnosis .
引文
1 Muick W, Wosh P, Lirnhard P , et al .CT and MRI imaging of cystic lymphangiomas in pediatric patients. AJR,2000,174:827～832
2 Kitt S, Melissa L ,Edward F ,et al.Thoracic lymphangioma in adults: CT and MR imaging features.AJR,1994,162:283～289
3 Siegel MS, Glazer HS,Amour TE,et al.Lymphangiomas in children: MR imaging.Radiology,1989,170:467～470
4 Cohen MD, Rougraff B,Faught P. Cystic angiomatosis of bone : MR findings . Pediatr Radiol,1994,24:256~257
5 Mastrod JM, Andres RL. Case 8 : Obstetrical lymphangioma of the neck. J Ultrasound Med,2000,19:360
6 Wadsworth DT , Newman B ,Abramson SJ , et al . Splenic lymphangiomatosis in children.Radiology,1997,202:173～176
7 Parentin F, Borzajhinl L, Perissutti P . The role of ultrasonography in the diagnosis of orbital lymphangiomatosis . Oph,2001,215(3):238～240
8 Priolean PG , Santa CDJ . Lymphangioma circumscriptum following radical mastectomy and radiation therapy.Cancer,1978,42:1989～1991
9 Castellote A , Wazqouez E,Vera J ,et al.Cervicothoracic lesions in infants and children. Radiographics,1999,19(3):583～600
10 Telander RL,Filston HC. Review of head and neck lesions in infancy and childhood.Surg Clin North Am,1992,72:1429～1447
11 Eugene H,Vibbuti S,Berek C,et al.Cavernous lymphangioma. J Pediatr, 2001,138:146
Budhir S,Rattan K,Cupta S,et al. Abdomino-scrotal lymphangioma.
12 Indian J Pediatr,1997,64(5):720～722
13 Merrot T,Chaumoitre K,Simeoni J, et al.Abdominal cystic lymphangiomas in children. Ann Chir,1999,53(6)494～499
14 陈文卫，赵玉荣，孙彬,等.两种颈面部海绵样肿块的高频彩超鉴别诊断.中华超声影像学杂志,2000,9(8):509
15 Rioux M,Gariepy JL. Cystic lymphangioma of the colon: ultrasonographic and computed tomographic features.Can Assoc Radiol J, 1995, 46(2) : 127～130
16 Komatsuda T, Ishida H,Konno K, et al. Splenic lymphangioma: US and CT diagnosis and clinical manifestations.Abdom Imaging , 1999,24(4):414～417
17 Vargas B, Alegre N,Cortina B, et al. Abdominal cystic lymphangiom as: US and CT findings. Eur J Radiol, 1995,19 (3) : 183～187
18 Lopez JD,Ramirez F,Lopez C,et al.Imaging diagnosis of measenteric cystic lymphangioma:case report in newborn.Eur Radiol,1999,9(4):754
19 陈衣敏, 张武. 周围海绵状血管瘤的超声表现.中国超声医学杂志, 1997,13(8):33-34
20 Dubois J,Garel L,Grignon A,et al.Imaging of hemangioma and vascular malformation in children.Acad Radiol,1998,5(5):390～400
21 Cohen SR,Thompson JW.Lymphangiomas of the larynx in infants and children:a survey of pediatric lymphangioma.Ann Otol Rhinol Laryngol , 1986,95:1～20
22 Ogita K,Suita S,Taguchi T,et al.Outcome of fetal cystic hygoma and experionce of intrauterine treatment.Petal Diagn Ther,2001,16(2) : 105～110
Claeson J, Gordon L, Kuylenstierna R . A revolutionary Japanese
23 method for treatment of lymphangioma.Lakar,1998,95(18):2074～2077
24 Mikhail M , Kennedy R , Cramer B , et al . Sclerosing of recurrent lymphangioma using OK-432.J Pediatr Sury,1995,30:1159～1160
25 Sada C , Bossi MC , Barletta A . Therapy of subcutaneous cystic lymphangioma with ultrasound guided puncture and alcoholization. Radiol Med,1992,83(3):270～272
2 Kitt S, Melissa L ,Edward F ,et al.Thoracic lymphangioma in adults: CT and MR imaging features.AJR,1994,162:283～289
3 Siegel MS, Glazer HS,Amour TE,et al.Lymphangiomas in children: MR imaging.Radiology,1989,170:467～470
4 Cohen MD, Rougraff B,Faught P. Cystic angiomatosis of bone : MR findings . Pediatr Radiol,1994,24:256~257
5 Mastrod JM, Andres RL. Case 8 : Obstetrical lymphangioma of the neck. J Ultrasound Med,2000,19:360
6 Wadsworth DT , Newman B ,Abramson SJ , et al . Splenic lymphangiomatosis in children.Radiology,1997,202:173～176
7 Parentin F, Borzajhinl L, Perissutti P . The role of ultrasonography in the diagnosis of orbital lymphangiomatosis . Oph,2001,215(3):238～240
8 Priolean PG , Santa CDJ . Lymphangioma circumscriptum following radical mastectomy and radiation therapy.Cancer,1978,42:1989～1991
9 Castellote A , Wazqouez E,Vera J ,et al.Cervicothoracic lesions in infants and children. Radiographics,1999,19(3):583～600
10 Telander RL,Filston HC. Review of head and neck lesions in infancy and childhood.Surg Clin North Am,1992,72:1429～1447
11 Eugene H,Vibbuti S,Berek C,et al.Cavernous lymphangioma. J Pediatr, 2001,138:146
Budhir S,Rattan K,Cupta S,et al. Abdomino-scrotal lymphangioma.
12 Indian J Pediatr,1997,64(5):720～722
13 Merrot T,Chaumoitre K,Simeoni J, et al.Abdominal cystic lymphangiomas in children. Ann Chir,1999,53(6)494～499
14 陈文卫，赵玉荣，孙彬,等.两种颈面部海绵样肿块的高频彩超鉴别诊断.中华超声影像学杂志,2000,9(8):509
15 Rioux M,Gariepy JL. Cystic lymphangioma of the colon: ultrasonographic and computed tomographic features.Can Assoc Radiol J, 1995, 46(2) : 127～130
16 Komatsuda T, Ishida H,Konno K, et al. Splenic lymphangioma: US and CT diagnosis and clinical manifestations.Abdom Imaging , 1999,24(4):414～417
17 Vargas B, Alegre N,Cortina B, et al. Abdominal cystic lymphangiom as: US and CT findings. Eur J Radiol, 1995,19 (3) : 183～187
18 Lopez JD,Ramirez F,Lopez C,et al.Imaging diagnosis of measenteric cystic lymphangioma:case report in newborn.Eur Radiol,1999,9(4):754
19 陈衣敏, 张武. 周围海绵状血管瘤的超声表现.中国超声医学杂志, 1997,13(8):33-34
20 Dubois J,Garel L,Grignon A,et al.Imaging of hemangioma and vascular malformation in children.Acad Radiol,1998,5(5):390～400
21 Cohen SR,Thompson JW.Lymphangiomas of the larynx in infants and children:a survey of pediatric lymphangioma.Ann Otol Rhinol Laryngol , 1986,95:1～20
22 Ogita K,Suita S,Taguchi T,et al.Outcome of fetal cystic hygoma and experionce of intrauterine treatment.Petal Diagn Ther,2001,16(2) : 105～110
Claeson J, Gordon L, Kuylenstierna R . A revolutionary Japanese
23 method for treatment of lymphangioma.Lakar,1998,95(18):2074～2077
24 Mikhail M , Kennedy R , Cramer B , et al . Sclerosing of recurrent lymphangioma using OK-432.J Pediatr Sury,1995,30:1159～1160
25 Sada C , Bossi MC , Barletta A . Therapy of subcutaneous cystic lymphangioma with ultrasound guided puncture and alcoholization. Radiol Med,1992,83(3):270～272