Ultrasonographic findings of cervical lymph node tuberculosis in acquir immunodeficiency syndrome patients at different CD4+ T cell levels

Abstract

Objective \nTo evaluate ultrasonographic findings of cervical lymph node tuberculosis in acquir immunodeficienoy syndrome (AIDS) patients at different CD4+ cell levels. \n \n \nMethods \nForty-two cases of cervical lymph node tuberculosis confirmed by ultrasound-guided core needle biopsy from AIDS patients were selected as the samples. The CD4+ T cell values of all cases were measured and divided into 4 groups based on the figures (200 cell/ ul, 100~<200 cell/ul, 50~<100 cell/ul and<50 cell/ul) within 24 hours before the puncture. The patients underwent the ultrasound and contrast-enhanced ultrasonography within 24 hours before the neck lesions puncture, and the ultrasonographic features of the lesions were recorded in detail and the ultrasonographic features of lymph nodes in different CD4+ T cell groups were analyzed statistically. \n \n \nResults \nIn 42 cases, 9 cases were classified into CD4+ T cells≥ 200 cell/µl group, 9 cases in 100~<200 cell/µl group, 9 cases in 50~<100 cell/µl group, and 15 cases in<50 cell/µl group. In the CD4+ T cells ≥ 200 cell/µl group, the largest diameters of lymph nodes mainly were 2~<3 cm, and the proportion of calcification in the lymph nodes was higher than that in other three groups. There was no lymph node fusion and sinus formation. Contrast-enhanced ultrasound enhanced mode with uniform enhancement and inhomogeneous enhancement was detected. The diameters of lymph nodes were mostly 2~<3 cm and≥3 cm in the 100~<200 cell/µl group. Only one lymph node showed calcification, while contrast-enhanced ultrasound showed heterogeneous enhancement. In the 50~<100 cell/µl group, 7 cases had lymph node diameter≥3 cm, no lymph node showed calcification, 5 cases had lymph node fusion, 7 cases had sinus formation, and contrast-enhanced ultrasound showed inhomogeneous enhancement and circular enhancement. The maximum diameter of lymph nodes in group <50 cell/µl was≥3 cm, and there was no calcification of lymph nodes. The proportion of liquefaction, lymph node fusion and sinus formation in the lesion was higher than that in other three groups. Contrast-enhanced ultrasound showed mainly circular enhancement With the decrease of CD4+ T cells and the enlargement of lymph node diameter, the probability of lymph node fusion and sinus formation increased and the formation of calcification decreased, and there were statistical differences among different groups (χ2=30.89, P<0.01). Additionally, statistical differences appeared among different groups (χ2=62.63, P<0.01). With the decrease of CD4+ T cells, contrast-enhanced mode gradually changed from uniform enhancement to circular enhancement, and there were statistical differences among different groups (χ2=23.48, P<0.01). \n \n \nConclusion \nUltrasound manifestations of AIDS complicated with cervical lymph node tuberculosis are different at different CD4+ T cell levels, which provides an imaging basis for clinical evaluation of the progression of AIDS complicated with cervical lymph node tuberculosis. \n \n \nKey words: \nCD4+ T cells;\xa0Ultrasonography;\xa0Acquir immunodeficiency syndrome;\xa0Lymph node of neck;\xa0Lymph node tuberculosis