| Objective: This study aimed at the color Doppler ultrasound assessment in mesenteric lymphadenitis in pediatrics.Methods:1 One hundred and thirteen cases from pediatric department in the second hospital of Hebei medical university from 10/2006 to 03/2008 (male 66,femal 47,age 2～14 year-old,mean age 7.1±2.7 year-old) were included in this study. These children hospitalized abdominal pain or recrrent abdominal pain,and were diagnostic mesenteric lymphadenitis in clinic.2 One hundred cases healthy children who had no symptom of fever,vomiting,and diarrhea (male 58,femal 42,age 2～13 year-old. mean age 6.5±2.4 year-old) were included as control group.3 ATL HDI-5000 and PHILIPS IU22 color Doppler ultraso- unic machines was used to evaluate all the cases, the frequency of the probe was 5-12MHz.4 Liver,gallbladder,spleen,pancreas,and bilateral kidney were checked on suspine position at the same time and some other imaging examinations were done to exclude the mass inside,seroperitoneum,intestinal obstruction,intussusception,dilated intestinal and swelled appendix. Mesenteric lymph nodes were identified with high frequency probe,scanned around the navel by longitudinal, transverse and oblique transabdominal scanning. Sometimes need to press the probe. The number, shape, location, echo-inside, and color Doppler flow imaging of these lymph nodes were recorded. To our knowledge,the length and width ratio is the better parameter to differentiate the benign lymph node and the malignant lymph node. When the ratio is 2.0,the sensitivity is 81%~95%. Peak systolic velocity (PSV) and end diastolic velocity (EDV) need to be measured using pulsed Doppler,and resistant index parameter is also to be calculated.Results:1 Mesenteric lymph nodes could be found in ninety-one of one hundred cases in control group,and the lymph nodes were low echoic and located almost around navel and right lower abdomen,the number less than five,and the shape was oval, renal-like or horsebean,they had clear margin and smoothly surface. The length was 0.45～0.85cm, mean length was (0.66±0.10)cm, the width was 0.18～0.38cm, mean width was (0.28±0.04)cm, and the length width ratio was 2.13～2.59, mean ratio was (2.35±0.11). No color Doppler flow signal was detected in most lymph nodes, and spot color flow signal could be found in few lymph nodes. No artery waveform was detected in these mesenteric lymph nodes.2 The swelled mesenteric lymph nodes were detected in all the pediatric group. 2.1 Located distribution The swelled mesenteric lymph nodes almost located around the navel and the right lower abdomen, the next location was right mid-abdomen, a little lymph nodes was at the left mid-abdomen. All the nodes distributed liking areatus, pearl, but no fusing modality along the mesentery.2.2 Number The numbers of swelled lymph node were multiple and more than six.2.3 Size The length was 1.03~2.06cm, mean length was (1.47±0.24) cm, the width was 0.50～0.96cm, mean width was (0.68±0.11)cm,and the length width ratio was 2.0～2.32, mean ratio was (2.16±0.07). The lymph node which located at the left mid-abdomen was larger and isolation.2.4 Modality Oval, renal-like lymph nodes were often detected with smoothly surface and clear margin.2.5 Echo Two kinds of types were divided in our study. Most of the cases were the first type which showed homogenous low-echoic, the cortex and the medulla was unclearly to be identified, included 102 cases (90.3%). The second type was iso-echoic which Included 11 cases (9.7%), the cortex in this type was a little bit higher echoic and homogenous with not so clearly cortex and medulla. No calcification was found in the two kinds of types.2.6 Color Doppler flow imaging Color flow showed that color flow signal in these swelled lymph nodes, which was divided into three types. The first one was little color flow signal, only spot color flow was found. The second one was richer color flow, banded-like color flow signal was detected in this type. The third type was very rich flow signal, which showed branch-like color flow signal from the hilum to the centre of lymph nodes.2.7 Pulsed Doppler flowwave The peak systolic velocity (22.04±7.43)cm/s and the end diastolic velocity(8.66±3.14) cm/s was detected in the third type and most of the second type by color Doppler sonography, these included 97 cases. The resistance index was 0.50～0.71,mean (0.61±0.04). The color flow signal was difficult to be found in the first type and some of the second type.Conclusion: The general anatomy can be clearly detected in pediatric abdomen by color Doppler sonography. The higher accurate diagnostic of the mesenteric lymphadenitis was obtained with color Doppler sonography. Because of the direct-viewing, safety, convenience and repetition, it was the first choice to diagnosis and evaluate the mesenteric lymphadenitis sufficiently in pediatric. |
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