Objective To assess the elasticity of cervical lymph nodes by real-time shear wave elastography（SWE）

and to explore its clinical value for diagnosis of children with SWE in lymph-node-first presentation of Kawasaki disease（NFKD）.Methods A total of 88 children with fever and cervical lymph nodes enlargement as the first symptoms were selected to collect baseline data

laboratory data

cervical conventional ultrasound characteristics and SWE measurements.According to the clinical diagnosis results

they were divided into 47 cases of Kawasaki disease（NFKD group）

41 cases of bacterial lymphadenitis（BCL group）

and 41 healthy children in the same period were selected as the control group（HC group）.The laboratory data

conventional ultrasound characteristics

tmax and Emean were compared among the three groups

the correlation between laboratory data and Emean were analyzed.Results Except for neutrophil counts

the differences in laboratory test parameters of each group were statistically significant（all P<0.05）.The size and Emean of the largest cervical lymph nodes in BCL group were higher than those in NFKD group and HC group.The size and Emean of the largest cervical lymph node in NFKD group were higher than those in HC group.The differences among the three groups were statistically significant（all P<0.05）.The cervical lymph nodes in the NFKD group had even echoes

which were mostly located in the Ⅱ A area of left neck

and the distribution was mostly bead-like changes.The neck lymph nodes in the BCL group showed solitary enlargement and uneven internal echo.Erythrocyte sedimentation rate

Procalcitonin

White blood cell

alanine aminotransferase were positively correlated with Emean of BCL group（r=0.465

0.658

0.450

0.322

all P<0.05）

Interleukin-6

alanine aminotransferase

aspartate transaminase were positively correlated with Emean of NFKD group（r=0.388

0.439

0.686

0.521

all P<0.05）.Conclusion Cervical lymph node elasticity measured by SWE can provide imaging reference for early identification of NKFD and BCL in clinic.