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Zhou L, Shan J, Zu DM, Deng SH, Zhang Y, Shi XR, Zhu YC, Jiang Q. Value of conventional ultrasound and shear‑wave elastography in the assessment of mesenteric lymphadenitis in a paediatric population. Exp Ther Med 2024; 27:259. [PMID: 38756898 PMCID: PMC11097270 DOI: 10.3892/etm.2024.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/26/2024] [Indexed: 05/18/2024] Open
Abstract
The present retrospective study was designed to explore the value of conventional ultrasound (US) and Virtual Touch Tissue Imaging and Quantification (VTIQ) in the assessment of mesenteric lymphadenitis (ML) in a paediatric population. A total of 103 patients with ML and 60 healthy paediatric patients were examined. VTIQ was performed to assess mesenteric lymph node (MLN) stiffness via shear-wave velocity (SWV). Univariate and multivariate logistic regression analyses were conducted to reveal independent variables for the identification of ML. The diagnostic performance of US, and US combined with VTIQ, were compared. All the quantitative VTIQ parameters (including the SWVMean, SWVMax and SWVMin) were significantly greater for MLNs in the control group than for MLNs in the ML group (all P<0.001). The SWV values in the control group were nearly 2-fold greater than that in the ML group. According to the multivariate logistic regression analysis, the longest diameter [odds ratio (OR)=6.042; P=0.046] was revealed to be the strongest independent predictor for ML, followed by the CRP level (OR=2.310; P<0.001) and the SWVMean (OR=0.106; P<0.001). According to the receiver operating characteristic analysis, the area under the curve (AUC) for US combined with VTIQ was 0.890 (95% CI: 0.831-0.949) with a greater sensitivity of 91.26% and a greater specificity of 86.67% than that for US alone (AUC: 0.798; 95% CI: 0.724-0.872; sensitivity: 79.61%; specificity: 80.00%). A significant negative correlation between increased VTIQ parameters and ML was observed. Utilizing VTIQ to assess MLN stiffness offers a non-invasive, convenient, reliable and reproducible approach for identifying mesenteric lymphadenopathy.
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Affiliation(s)
- Li Zhou
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Jun Shan
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Dao-Ming Zu
- Department of Paediatrics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Shu-Hao Deng
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Xiu-Rong Shi
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
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Varoquaux A, Fakhry N, Baujat B, Verillaud B, Jegoux F, Barry B, Chabrillac E, Vergez S, Terroir-Cassou-Mounat M. Diagnostic imaging of salivary gland cancers: REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:27-31. [PMID: 38036312 DOI: 10.1016/j.anorl.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To define the indications for each imaging modality in the screening, characterization, extension and follow-up of salivary gland tumors. MATERIAL AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS If a swelling of a salivary gland is palpable for 3 weeks, an ultrasound scan is recommended to confirm a tumoral lesion and rule out differential diagnoses. For a salivary gland tumor, MRI is recommended with diffusion-weighted and dynamic contrast-enhanced techniques. In the case of histologically proven malignancy or a highly suspicious lesion, a CT scan of the neck and chest is recommended to assess the tumor, lymph nodes and metastases. FDG-PET is not currently recommended in routine clinical practice for initial diagnosis, assessment of extension, evaluation of response to treatment, staging of recurrence, or follow-up of salivary gland tumors. CONCLUSION Assessing salivary tumors is based on MRI. Extension assessment is based on neck and chest CT.
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Affiliation(s)
- A Varoquaux
- Département d'Imagerie Médicale, Hôpital La Conception, AP-HM, Aix-Marseille Univ, Marseille, France
| | - N Fakhry
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital La Conception, AP-HM, Aix-Marseille Univ, Marseille, France.
| | - B Baujat
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - B Verillaud
- Département d'ORL et de Chirurgie Cervico-Faciale, Hôpital Lariboisière, AP-HP, Inserm U1141, Université Paris Cité, Paris, France
| | - F Jegoux
- Département d'ORL et Chirurgie Cervico-Faciale, CHU de Rennes, Rennes, France
| | - B Barry
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital Bichat, AP-HP, Paris, France
| | - E Chabrillac
- Département de Chirurgie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - S Vergez
- Département de Chirurgie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France; Département de Chirurgie ORL et Cervico-Faciale, CHU de Toulouse-Larrey, Université Toulouse III Paul Sabatier, Toulouse, France
| | - M Terroir-Cassou-Mounat
- Département de Médecine Nucléaire, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
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Javed N, Ghazanfar H, Jyala A, Patel H. Associations of Real-Time Ultrasound and Strain and Shear Wave Elastography with Gastrointestinal Organs: A Systematic Review. Diagnostics (Basel) 2023; 13:3302. [PMID: 37958199 PMCID: PMC10649379 DOI: 10.3390/diagnostics13213302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Ultrasound elastography is gaining attention for its diagnostic potential across various medical fields, and its physical properties make it valuable in modern clinical medicine. However, its specific attributes, especially in the context of recent medical advancements, remain relatively unexplored. This study aimed to identify instrument-specific characteristics and applications of real-time ultrasound elastography, shear wave elastography, and strain elastography, particularly within gastroenterology. Following PRISMA guidelines, the study examined elastography articles on databases like PubMed, resulting in 78 included articles. Data on patient demographics, organ involvement, specificity, sensitivity, accuracy, positive predictive value, and negative predictive value were extracted. Statistical analysis involved SPSS version 21, with significance set at p < 0.05. The majority of patients were male (50.50%), with a mean age of 42.73 ± 4.41 years. Shear wave elastography was the most prevalent technique (48.7%), and liver investigations were predominant in gastroenterology (34.6%). Gastrointestinal applications showed higher sensitivity, positive predictive value, and negative predictive values (p < 0.05) but lower specificity (p < 0.05). Real-time ultrasound elastography exhibited increased specificity, accuracy, and predictive values (p < 0.05). Ultrasound elastography appears more accurate and effective in gastroenterological settings. Nonetheless, its performance depends on instrument-specific and operator-dependent factors. While promising, further studies are necessary to ascertain optimal utilization in both gastrointestinal and non-gastrointestinal conditions.
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Affiliation(s)
- Nismat Javed
- Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, USA;
| | - Haider Ghazanfar
- Department of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA; (H.G.); (A.J.)
| | - Abhilasha Jyala
- Department of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA; (H.G.); (A.J.)
| | - Harish Patel
- Department of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA; (H.G.); (A.J.)
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Gao Y, Fu X, Chen Y, Guo C, Wu J. Post-pandemic healthcare for COVID-19 vaccine: Tissue-aware diagnosis of cervical lymphadenopathy via multi-modal ultrasound semantic segmentation. Appl Soft Comput 2023; 133:109947. [PMID: 36570119 PMCID: PMC9762098 DOI: 10.1016/j.asoc.2022.109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
With the widespread deployment of COVID-19 vaccines all around the world, billions of people have benefited from the vaccination and thereby avoiding infection. However, huge amount of clinical cases revealed diverse side effects of COVID-19 vaccines, among which cervical lymphadenopathy is one of the most frequent local reactions. Therefore, rapid detection of cervical lymph node (LN) is essential in terms of vaccine recipients' healthcare and avoidance of misdiagnosis in the post-pandemic era. This paper focuses on a novel deep learning-based framework for the rapid diagnosis of cervical lymphadenopathy towards COVID-19 vaccine recipients. Existing deep learning-based computer-aided diagnosis (CAD) methods for cervical LN enlargement mostly only depend on single modal images, e.g., grayscale ultrasound (US), color Doppler ultrasound, and CT, while failing to effectively integrate information from the multi-source medical images. Meanwhile, both the surrounding tissue objects of the cervical LNs and different regions inside the cervical LNs may imply valuable diagnostic knowledge which is pending for mining. In this paper, we propose an Tissue-Aware Cervical Lymph Node Diagnosis method (TACLND) via multi-modal ultrasound semantic segmentation. The method effectively integrates grayscale and color Doppler US images and realizes a pixel-level localization of different tissue objects, i.e., lymph, muscle, and blood vessels. With inter-tissue and intra-tissue attention mechanisms applied, our proposed method can enhance the implicit tissue-level diagnostic knowledge in both spatial and channel dimension, and realize diagnosis of cervical LN with normal, benign or malignant state. Extensive experiments conducted on our collected cervical LN US dataset demonstrate the effectiveness of our methods on both tissue detection and cervical lymphadenopathy diagnosis. Therefore, our proposed framework can guarantee efficient diagnosis for the vaccine recipients' cervical LN, and assist doctors to discriminate between COVID-related reactive lymphadenopathy and metastatic lymphadenopathy.
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Affiliation(s)
- Yue Gao
- School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China,Key Laboratory of Trustworthy Distributed Computing and Service (BUPT), Ministry of Education, Beijing, 100876, China
| | - Xiangling Fu
- School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China,Key Laboratory of Trustworthy Distributed Computing and Service (BUPT), Ministry of Education, Beijing, 100876, China,Corresponding author at: School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Yuepeng Chen
- School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China,Key Laboratory of Trustworthy Distributed Computing and Service (BUPT), Ministry of Education, Beijing, 100876, China
| | - Chenyi Guo
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, China
| | - Ji Wu
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, China
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Evaluating Different Quantitative Shear Wave Parameters of Ultrasound Elastography in the Diagnosis of Lymph Node Malignancies: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225568. [PMID: 36428661 PMCID: PMC9688428 DOI: 10.3390/cancers14225568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Shear wave elastography (SWE) has shown promise in distinguishing lymph node malignancies. However, the diagnostic accuracies of various SWE parameters that quantify tissue stiffness are yet to be demonstrated. To evaluate the pooled diagnostic accuracy of different SWE parameters for differentiating lymph node malignancies, we conducted a systematic screening of four databases using the PRISMA guidelines. Lymph node biopsy was adopted as the reference standard. Emax (maximum stiffness), Emean (mean stiffness), Emin (minimum stiffness), and Esd (standard deviation) SWE parameters were subjected to separate meta-analyses. A sub-group analysis comparing the use of Emax in cervical (including thyroid) and axillary lymph node malignancies was also conducted. Sixteen studies were included in this meta-analysis. Emax and Esd demonstrated the highest pooled sensitivity (0.78 (95% CI: 0.69-0.87); 0.78 (95% CI: 0.68-0.87)), while Emean demonstrated the highest pooled specificity (0.93 (95% CI: 0.88-0.98)). From the sub-group analysis, the diagnostic performance did not differ significantly in cervical and axillary LN malignancies. In conclusion, SWE is a promising adjunct imaging technique to conventional ultrasonography in the diagnosis of lymph node malignancy. SWE parameters of Emax and Esd have been identified as better choices of parameters for screening clinical purposes.
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Künzel J, Brandenstein M, Zeman F, Symeou L, Platz Batista da Silva N, Jung EM. Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy. Diagnostics (Basel) 2022; 12:diagnostics12081842. [PMID: 36010193 PMCID: PMC9406677 DOI: 10.3390/diagnostics12081842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.
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Affiliation(s)
- Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
- Correspondence:
| | - Moritz Brandenstein
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany; (M.B.); (N.P.B.d.S.); (E.M.J.)
| | - Florian Zeman
- Center of Clinical Studies, University Hospital of Regensburg, 93053 Regensburg, Germany;
| | - Luisa Symeou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
| | | | - Ernst Michael Jung
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany; (M.B.); (N.P.B.d.S.); (E.M.J.)
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7
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Sun Y, Wang W, Mi C, Zhang Q, Zhang K. Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes. Front Oncol 2022; 12:908085. [PMID: 35847906 PMCID: PMC9280688 DOI: 10.3389/fonc.2022.908085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate the diagnostic efficiency and diagnostic threshold of conventional US and shear-wave elastography (SWE) in superficial enlarged lymph nodes (LNs). Methods A total of 204 patients with superficial enlarged LNs were enrolled in this retrospective study aged 46.0 ± 15.2 years from March 2020 to March 2021. LNs with a long axis larger than 0.7 cm were considered as superficial enlarged. Before the histological biopsy, LNs that were considered suspicious according to both conventional US and SWE were included, while LNs with no or unclear pathological results, or with no satisfactory SWE images, were excluded. The conventional and 2-D SWE examinations were performed with Aplio i800 and Acuson sequoia equipped with i18LX5 linear-array transducer (5-18 MHz) and 10L4 linear-array transducer (4-10 MHz), respectively. Both E Median and Vs Median parameters were investigated by two senior ultrasound physicians. The pathological results were performed as the gold standard. Results Variables including transverse axis size, lymphatic hilum, L/T ratio, echogenicity, and color Doppler pattern were considered significant. The mean E Median value in benign, metastatic LNs, and lymphoma were 28.26 ± 8.87 kPa, 77.46 ± 22.85 kPa, and 50.37 ± 5.41 kPa (p <0.001), while Vs Median values were 3.02 ± 0.50 m/s, 4.87 ± 0.90 m/s, and 4.09 ± 0.22 m/s, respectively (p < 0.001). The diagnostic performance indicated the high sensitivity, specificity, PPV, NPV, and overall accuracy of conventional US combined with SWE. The optimal cutoff values of E Median and Vs Median for predicting malignant LNs were 42.90 kPa and 3.73 m/s, respectively. As AUC value, sensitivity, specificity, accuracy, PPV, and NPV revealed, the indexes of E Median were 0.976, 0.927, 0.975, 0.946, 0.983, and 0.897, respectively, while Vs Median were 0.970, 0.927, 0.963, 0.941, 0.975, and 0.895, respectively (p <0.001). The ROC curves of both E Median (AUC=0.976) Vs Median (AUC=0.970) suggested the remarkable diagnostic efficiency in distinguishing benignity between suspected malignant LNs. Conclusions Above results indicated that conventional US together with 2-D SWE could elevate the diagnostic performance. Meanwhile, the parameters of 2-D SWE including E Median and Vs Median could effectively assess malignant LNs, which provide valuable differentiating information in superficial enlarged LNs.
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Affiliation(s)
- Yanjuan Sun
- Department of Ultrasound, General Hospital of Ningxia Medical University, No. 804 South Shengli Street, Yinchuan, China
| | - Wen Wang
- Department of Ultrasound, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Chengrong Mi
- Department of Ultrasound, General Hospital of Ningxia Medical University, No. 804 South Shengli Street, Yinchuan, China
| | - Qian Zhang
- Department of Ultrasound, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Yinchuan, China
- *Correspondence: Qian Zhang, ; Kun Zhang,
| | - Kun Zhang
- Central Laboratory and Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Qian Zhang, ; Kun Zhang,
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Weimer JM, Rink M, Müller L, Arens C, Bozzato A, Künzel J. Sonografische Diagnostik im Kopf-Hals-Bereich – Teil 2: Transzervikale Sonografie. Laryngorhinootologie 2022; 101:156-175. [DOI: 10.1055/a-1667-8675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | - Julian Künzel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Regensburg
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Chen YL, Kuo YW, Wu HD, Wang JY, Wang HC. The application of ultrasound shear wave elastography in the prediction of paradoxical upgrading reaction in tuberculous lymphadenitis. a pilot study. J Formos Med Assoc 2021; 121:1696-1704. [PMID: 34953644 DOI: 10.1016/j.jfma.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Paradoxical upgrading reaction (PUR) indicates the unanticipated deterioration during therapy in patients with tuberculous lymphadenitis. We investigated the diagnostic performance of the ultrasonography and shear wave elastography (SWE) in predicting the therapeutic response of peripheral tuberculous lymphadenitis. METHODS A prospective observational study was conducted from December 2017 to August 2020. Participants diagnosed with peripheral tuberculous lymphadenitis were included for a longitudinal follow-up utilizing ultrasonography with two-dimensional SWE to record sonographic features and the maximum elasticity value (Emax). We defined PUR as the development of any worsening symptoms of the pre-existing lymphadenitis within one month after the previous ultrasonography. RESULTS A total of 108 sonographic and SWE examinations were performed in 20 enrollees (75% woman), and their mean ( ± standard deviation) age was 49.6 ( ± 22.7) years. The area under the receiver operating characteristic curve of Emax to predict the next-month PUR was 0.906 at the cut-point of 85 kPa, with an accuracy of 87.0%, a sensitivity of 81.1% and a specificity of 87.9%. Multivariate analysis indicated that Emax > 85 kPa (OR: 24.85, 95% CI: 4.01-154.08, p < 0.001), Emax increment rate >2 kPa/month (OR: 15.14, 95% CI: 4.24-54.06, p < 0.001), and heterogeneous echogenicity (OR: 4.37, 95% CI: 1.16-16.43, p = 0.029) were independent sonographic predictors for PUR in the coming month. CONCLUSIONS A high and non-declining Emax level and heterogeneous echogenicity were associated with the next-month PUR of tuberculous lymphadenitis. Ultrasonography with SWE may be a potential radiologic marker to predict the therapeutic response of tuberculous lymphadenitis.
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Affiliation(s)
- Yen-Lin Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Wen Kuo
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Yuan Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Chien Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
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Yu-rim K, Su-hyeon L, Im-mee S, Jae-un K, Jae-hwan K, Ki-dong E. Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles. Am J Vet Res 2021. [DOI: 10.2460/ajvr.82.12.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs).
ANIMALS
11 healthy Beagles.
PROCEDURES
For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined.
RESULTS
SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent.
CONCLUSIONS AND CLINICAL RELEVANCE
SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.
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Affiliation(s)
- Kang Yu-rim
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Lee Su-hyeon
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Seo Im-mee
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Ko Jae-un
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Kim Jae-hwan
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Eom Ki-dong
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
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11
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Kang YR, Lee SH, Seo IM, Ko JU, Kim JH, Eom KD. Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles. Am J Vet Res 2021:1-7. [PMID: 34727068 DOI: 10.2460/ajvr.20.12.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs). ANIMALS 11 healthy Beagles. PROCEDURES For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined. RESULTS SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent. CONCLUSIONS AND CLINICAL RELEVANCE SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.
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Affiliation(s)
- Yu-Rim Kang
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Su-Hyeon Lee
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Im-Mee Seo
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Jae-Un Ko
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Jae-Hwan Kim
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
| | - Ki-Dong Eom
- From the Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul 05029, South Korea
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12
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Wang B, Guo Q, Wang JY, Yu Y, Yi AJ, Cui XW, Dietrich CF. Ultrasound Elastography for the Evaluation of Lymph Nodes. Front Oncol 2021; 11:714660. [PMID: 34485150 PMCID: PMC8415874 DOI: 10.3389/fonc.2021.714660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
The differential diagnosis of lymphadenopathy is important for predicting prognosis, staging, and monitoring the treatment, especially for cancer patients. Conventional computed tomography and magnetic resonance imaging characterize lymph node (LN) with disappointing sensitivity and specificity. Conventional ultrasound with the advantage of high resolution has been widely used for the LN evaluation. Ultrasound elastography (UE) using color map or shear wave velocity can non-invasively demonstrate the stiffness and homogeneity of both the cortex and medulla of LNs and can detect early circumscribed malignant infiltration. There is a need of a review to comprehensively discuss the current knowledge of the applications of various UE techniques in the evaluation of LNs. In this review, we discussed the principles of strain elastography and shear wave-based elastography, and their advantages and limitations in the evaluation of LNs. In addition, we comprehensively introduced the applications of various UE techniques in the differential diagnosis of reactive LNs, lymphoma, metastatic LNs, and other lymphadenopathy. Moreover, the applications of endoscopic UE and endobronchial UE are also discussed, including their use for improving the positive rate of diagnosis of fine-needle aspiration biopsy.
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Affiliation(s)
- Bin Wang
- Department of Ultrasound, The First People's Hospital of Yueyang, Yueyang, China
| | - Qi Guo
- Department of Medical Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Yu Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ai-Jiao Yi
- Department of Ultrasound, The First People's Hospital of Yueyang, Yueyang, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chami L, Giron A, Ezziane M, Leblond V, Charlotte F, Pellot-Barakat C, Lucidarme O. Quantitative and Qualitative Approach for Shear Wave Elastography in Superficial Lymph Nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2117-2127. [PMID: 34059376 DOI: 10.1016/j.ultrasmedbio.2021.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
The diagnostic contribution of 2-D shear-wave elastography (SWE) in management of superficial lymph nodes (LNs) of any origin was evaluated in 222 patients referred for needle core biopsy. Each patient underwent conventional B-mode/Doppler ultrasound examinations (conventional ultrasound) and SWE. Quantitative SWE parameters and qualitative SWE map features were extracted. Carcinomas were found to be significantly stiffer than benign LNs (29.5 ± 32.3 kPa vs. 6.7 ± 12.3 kPa). Lymphomas exhibited intermediate stiffness (11.4 ± 5.2 kPa). Qualitative SWE analysis provided color patterns specific to histopathology (stiff rim, nodular and undetermined patterns related to malignancy and blue pattern to benignity). Adding SWE to conventional ultrasound improved the sensitivity of LN diagnosis (from 81.1% to 92.0%) but decreased its specificity (from 73.2% to 67.6%) because of the high prevalence of lymphomas compared with carcinomas. Inter-observer agreement for quantitative SWE was good (intra-class correlation coefficient = 0.82) as was inter-observer diagnostic agreement for qualitative SWE (κ = 0.65). LN location and histology type were found to influence the reported diagnostic performance of SWE.
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Affiliation(s)
- Linda Chami
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne University, Paris, France
| | - Alain Giron
- LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne University, Paris, France
| | - Malek Ezziane
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Véronique Leblond
- Department of Haematology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Frédéric Charlotte
- Department of Pathology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Claire Pellot-Barakat
- BioMaps, University Paris-Saclay, CEA, CNRS, INSERM, Service Hospitalier Frédéric Joliot, Orsay, France.
| | - Olivier Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne University, Paris, France
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14
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Qiu Y, Xing Z, Yang Q, Luo Y. Diagnostic value of supersonic shear impulse elastography for malignant cervical lymph nodes: a Bayesian analysis. Ultrasonography 2021; 41:279-290. [PMID: 34696539 PMCID: PMC8942728 DOI: 10.14366/usg.21107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/31/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to assess the diagnostic performance of supersonic impulse (SSI) elastography in differentiating malignant and benign cervical lymph nodes. Methods The Medline, Embase, and Cochrane Central databases were searched until December 1, 2020. Two different reviewers checked the studies and extracted the data. The diagnostic yields were quantitatively synthesized using a Bayesian bivariate model with an integrated nested Laplace approximation in R. Results In total, 590 patients with 892 cervical lymph nodes who underwent SSI elastography were included. The total prevalence of malignancy was 33.7% (301/892), and the four elastic modulus values (mean, maximum, minimum, and standard deviation) were significantly different between malignant and benign lymph nodes. For the mean elastic modulus, the summary estimates for sensitivity and specificity were 0.720 (95% credible interval [CrI], 0.592 to 0.824) and 0.877 (95% CrI, 0.727 to 0.969), respectively. The estimated area under the curve (AUC) was 0.845 (95% CrI, 0.672 to 0.914). For the maximum elastic modulus, the sensitivity and specificity were estimated to be 0.809 (95% CrI, 0.698 to 0.899) and 0.816 (95% CrI, 0.643 to 0.924), respectively. The estimated AUC was 0.834 (95% CrI, 0.579 to 0.938). The minimum and standard deviation of the elastic modulus and the outcomes of the positive and negative likelihood ratio, diagnostic odds ratio, and risk difference were also calculated. Conclusion SSI elastography is an acceptable imaging technique for diagnosing malignant cervical lymph nodes, and it can play a complementary role today. Both maximum and mean elastic modulus values should be taken into consideration to make a clinical judgment.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China.,Center of Thyroid & Parathyroid Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China
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15
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Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy. Jpn J Radiol 2021; 39:938-945. [PMID: 33970452 DOI: 10.1007/s11604-021-01131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic value of multimodal ultrasonography, including SWE and CEUS, for the differentiation of benign and malignant cervical lymphadenopathy. METHODS A total of 103 patients with 109 enlarged neck lymph nodes underwent SWE and CEUS. There were 25 hyperplastic lymph nodes, 66 metastatic lymph nodes, and 18 cases of lymphoma. RESULTS Using 31.6 kPa as the Emax cutoff, the sensitivity, specificity and accuracy of measurements on both benign and malignant cervical lymph nodes were 55.95%, 96%, and 65.2%, respectively. CEUS showed that lymph nodes with reactive hyperplasia mainly exhibited uniform perfusion via the lymphatic hilum (18/25; 72%; P < 0.01). The main manifestation of lymphoma was uniform perfusion through the lymphatic hila (10/18; 55.6%; P < 0.01). Metastatic lymph nodes mainly exhibited uneven perfusion (57/66; 86.4%; P < 0.01). The sensitivity, specificity, and accuracy of multimodal ultrasonography for the diagnosis of benign and malignant cervical lymphadenopathies were 90.5%, 72%, and 86.2%, respectively. CONCLUSIONS Our findings suggest that multimodal ultrasonography can detect the stiffness (elasticity), perfusion pattern, and characteristics of lymph nodes and is a valuable tool for differentiating between benign and malignant lymphadenopathies.
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Vergez S, Fakhry N, Cartier C, Kennel T, Courtade-Saidi M, Uro-Coste E, Varoquaux A, Righini CA, Malard O, Mogultay P, Thariat J, Tronche S, Garrel R, Chevalier D. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenoma. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:269-274. [PMID: 33060032 DOI: 10.1016/j.anorl.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the diagnosis and treatment of pleomorphic adenoma (PA) of the salivary glands. METHOD A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted based on the articles retrieved and the workgroup members' individual experience. Guidelines were graded A, B, C or expert opinion by decreasing level of evidence. RESULTS In clinically suspected salivary gland PA, MRI should be performed, including head and neck lymph node levels. Fine needle aspiration cytology is particularly recommended for tumours difficult to characterise by MRI. Frozen section biopsy should be performed to confirm diagnosis and adapt the surgical procedure in case of intraoperative findings of malignancy. Complete resection of the parotid PA should be performed en bloc, including margins, when feasible according to tumour location, while respecting the facial nerve. Enucleation (resection only in contact with the tumour) is not recommended. For the accessory salivary and submandibular glands, complete en bloc resection should be performed.
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Affiliation(s)
- S Vergez
- Service d'ORL et de chirurgie de la face et du cou, hôpital Larrey, institut universitaire du cancer de Toulouse Oncopole, CHU de Toulouse, Toulouse, France.
| | - N Fakhry
- Service d'ORL et chirurgie de la face et du cou, hôpital de la conception, AP-HM, Aix-Marseille Université, Marseille, France
| | - C Cartier
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - T Kennel
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - M Courtade-Saidi
- Service d'anatomie et cytologie pathologiques, institut universitaire du cancer de Toulouse Oncopole, INSERM CRCT-Équipe 11, Toulouse, France
| | - E Uro-Coste
- Service d'anatomie et cytologie pathologiques, institut universitaire du cancer de Toulouse Oncopole, INSERM CRCT-Équipe 11, Toulouse, France
| | - A Varoquaux
- Service de radiologie, hôpital de la conception, AP-HM, Marseille; AMU, Faculté de Médecine Timone CNRS-Centre for Magnetic Resonance in Biology and Medicine, Marseille, France
| | - C-A Righini
- Service d'ORL et de chirurgie de la face et du cou, CHU de Grenoble Alpes (CHUGA), Grenoble, France
| | - O Malard
- Service d'ORL et de chirurgie de la face et du cou, CHU Hôtel Dieu, Nantes, France
| | - P Mogultay
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, Caen; Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie Université, Caen, France
| | - S Tronche
- Société française d'ORL et chirurgie cervico-faciale, Strasbourg, France
| | - R Garrel
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - D Chevalier
- Service d'ORL et de chirurgie de la face et du cou, CHU de Lille, Lille, France
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Rüger H, Psychogios G, Jering M, Zenk J. Multimodal Ultrasound Including Virtual Touch Imaging Quantification for Differentiating Cervical Lymph Nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2677-2682. [PMID: 32651021 DOI: 10.1016/j.ultrasmedbio.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Defining the entity of cervical lymph nodes (LNs) is essential for the diagnosis and staging of head and neck malignancies. Virtual Touch imaging quantification (VTIQ) is a relatively new method of elastography that measures tissue stiffness quantitatively. A prospective study was conducted that included 108 patients (57 benign and 51 metastatic lymph nodes [MLNs]). Shear wave velocities (SWVs) were analyzed using VTIQ and were compared with the histopathological results. Both maximum and minimum SWVs within the LNs significantly differed between benign masses and MLNs (p < 0.001). Percentage areas of the node with SWVs >6 m/s and <3.5 m/s differed significantly (p < 0.001). Intralesional areas with SWVs ≤3.5 m/s of 0-29% (odds ratio: 93.7) and 30%-69% (odds ratio: 46.3) were predictive of malignant LNs as well as ill-defined tumor (odds ratio: 5.2). VTIQ can provide more information on the entity of cervical LNs.
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Affiliation(s)
- Holger Rüger
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany.
| | - Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University of Ioannina, Ioannina, Greece
| | - Monika Jering
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany
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18
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Aulino JM, Kirsch CFE, Burns J, Busse PM, Chakraborty S, Choudhri AF, Conley DB, Jones CU, Lee RK, Luttrull MD, Moritani T, Policeni B, Ryan ME, Shah LM, Sharma A, Shih RY, Subramaniam RM, Symko SC, Bykowski J. ACR Appropriateness Criteria ® Neck Mass-Adenopathy. J Am Coll Radiol 2020; 16:S150-S160. [PMID: 31054741 DOI: 10.1016/j.jacr.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Claudia F E Kirsch
- Panel Chair, Northwell Health, Zucker Hofstra School of Medicine at Northwell, Manhasset, New York
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David B Conley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, American Academy of Otolaryngology-Head and Neck Surgery
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | | | | | - Bruno Policeni
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, UC San Diego Health Center, San Diego, California
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19
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Guan Y, Liu S, Li AC, Pan XB, Liang ZG, Cheng WQ, Zhu XD. A Pilot Study: N-Staging Assessment of Shear Wave Elastrography in Small Cervical Lymph Nodes for Nasopharyngeal Carcinoma. Front Oncol 2020; 10:520. [PMID: 32351896 PMCID: PMC7174777 DOI: 10.3389/fonc.2020.00520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate N-staging Assessment of pretreatment Shear wave elastrography (SWE) in small cervical lymph nodes (0. 5 cm ≤ maximum diameter < 1 cm, intact capsule, no central necrosis, sCLNs) in nasopharyngeal carcinoma (NPC) patients. Methods: Pathological biopsy proven 28 NPC patients with sCLNs shown in pretreatment magnetic resonance (MR) images and 40 target lymph nodes were enrolled. All target lymph nodes were divided into metastasis and benign lymph node groups according to pathology. SWE was used to exam the real time SWE imaging of each target lymph nodes before conducting ultrasonography guided fine needle biopsy. The minimum (Emin), maximum (Emax), and mean (Emean) elasticity indices (kPa) of target lymph nodes were recorded. The SWE examination was repeated three times for the same target lymph node and each elasticity indices for statistic was determined by average of three measurements. SPSS 21.0 statistics software is used for statistical analysis. The receiver operating characteristic (ROC) curve was performed to obtain the cutoff value of elasticity indices of metastatic sCLNs. Statistical significance was assumed when the P < 0.05. Results: Nine lymph nodes were metastatic and 31 were benign. The Emin, Emax, and Emean of benign group were 8.15 ± 6.12, 25.05 ± 12.37, and 16.05 ± 8.29 kPa, respectively; Emin, Emax, and Emean of metastasis group were 11.5 ± 6.17, 41.38 ± 17.87, and 23.48 ± 6.50 kPa, respectively. The difference of the Emax and Emean between metastasis and benign group were statistically significant (P = 0.003 and 0.018). The area under the ROC curve of Emin, Emax, and Emean of metastasis lymph node were 0.685 (P = 0.095), 0.785 (P = 0.010), and 0.765 (P = 0.017), respectively. Emax of 27 kPa and Emean of 17 kPa were taken as the cutoff value of diagnosis for metastasis sCLNs: the sensitivity, specificity, and accuracy were 77.8 and 100%, 71.0 and 61.3%, 75.0 and 70.0%, respectively. Conclusions: Pretreatment SWE has high accuracy in evaluating the sCLNs in NPC patients and is helpful for accurate N-staging and survival prognosis. It can be used as a clinical supplementary examination.
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Affiliation(s)
- Ying Guan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shuai Liu
- Department of Radiotherapy Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - An-Chuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wan-Qin Cheng
- Department of Radiation Oncology, Shunde Hospital, Southern Medical University, Shunde, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
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Choi M, Yoon J, Choi M. Semi-quantitative strain elastography may facilitate pre-surgical prediction of mandibular lymph nodes malignancy in dogs. J Vet Sci 2020; 20:e62. [PMID: 31775189 PMCID: PMC6883200 DOI: 10.4142/jvs.2019.20.e62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 01/08/2023] Open
Abstract
Evaluation of mandibular lymph nodes in a patient with head and neck cancer is important for stage determination and prognosis development, and, in human medicine, the use of sonoelastography for differentiating between non-metastatic and metastatic lymph nodes has been reported. Our prospective, cross-sectional study aimed to evaluate the diagnostic performance of strain elastography and to determine elastographic cut-off values for predicting malignancy. Sixty-six mandibular lymph nodes were included (clinical healthy, n = 45; non-metastatic, n = 8; and metastatic, n = 13). Elastographic images were evaluated qualitatively (elastographic pattern) and semi-quantitatively (mean hue histogram and stiffness area ratios). Elastographic patterns were classified as grades 1 to 4, according to the percentage of high elasticity determined by visualization. The mean hue histogram was defined based on as the mean pixel color values within the lymph node. Stiffness area ratios were determined by computer program analysis of the stiff area. Among the criteria, receiver operating characteristic curve analyses revealed cut-off values for the prediction of malignancy of 92.26 for mean hue histogram (sensitivity: 100%, specificity: 92%), and 0.17 for stiffness area ratios (sensitivity: 86%, specificity of 100%). Reproducibility and repeatability were excellent. In conclusion, semi-quantitative evaluation via strain elastography holds potential for predicting lymph node malignancy.
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Affiliation(s)
- Mihyun Choi
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea.,Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Junghee Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Mincheol Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.
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21
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Sun YM, Dong H, Du ZY, Yang ZL, Zhao C, Chong J, Li P. The effect of regions-of-interest and elasticity modulus selection on differentiating benign and malignant cervical lymph nodes with shear wave elastography. Clinics (Sao Paulo) 2020; 75:e1691. [PMID: 33146349 PMCID: PMC7561066 DOI: 10.6061/clinics/2020/e1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Imaging diagnosis of cervical lymphadenopathy has conventionally used ultrasonography. Shear wave elastography (SWE) is a recent ultrasound technological advancement that has shown promise in the important medical problem of differentiating between benign and malignant cervical lymph nodes based on quantitative measurements of elasticity modulus. However, widely varying elasticity modulus metrics and regions-of-interest (ROIs) were used in existing studies, leading to inconsistent findings and results that are hard to compare with each other. METHODS Using a large dataset of 264 cervical lymph nodes from 200 patients, we designed a study comparing three elasticity modulus metrics (Emax, Emean, and standard deviation-SD) with three different ROIs to evaluate the effect of such selections. The metric values were compared between the benign and malignant node groups. The different ROI and metric selections were also compared through receiver operating characteristics curve analysis. RESULTS For all ROIs, all metric values were significantly different between the two groups, indicting their diagnostic potential. This was confirmed by the ≥0.80 area under the curve (AUC) values achieved with these metrics. Different ROIs had no effect on Emax, whereas all ROIs achieved high performance at 0.88 AUC. For Emean, the smallest ROI focusing on the area of the highest elasticity achieved the best diagnostic performance. In contrast, the larger ROIs achieved higher performances for SD. CONCLUSIONS This study illustrated the effect of elasticity modulus and ROI selection on the diagnostic performance of SWE on cervical lymphadenopathy. These new findings help guide relevant future studies and clinical applications of this important quantitative imaging modality.
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Affiliation(s)
- Yong-Mei Sun
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, No.16 Jiang Su Rd, Qingdao 266000, Shandong, China
| | - Hai Dong
- Department of Intensive Care Unit, the Affiliated Hospital of Qingdao University, No.16 Jiang Su Rd, Qingdao 266000, Shandong, China
- *Corresponding author. E-mail:
| | - Zong-Yan Du
- Department of Ultrasound, Maternity and Child Health Care of Zaozhuang, Xuecheng, Zaozhuang 277100, Shandong, China
| | - Zong-Li Yang
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, No.16 Jiang Su Rd, Qingdao 266000, Shandong, China
| | - Cheng Zhao
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, No.16 Jiang Su Rd, Qingdao 266000, Shandong, China
| | - Jing Chong
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, No.16 Jiang Su Rd, Qingdao 266000, Shandong, China
| | - Ping Li
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, No.16 Jiang Su Rd, Qingdao 266000, Shandong, China
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22
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Azizi G, Mayo ML, Azizi Y, Keller J, Malchoff C. Persistent Metastatic Thyroid Carcinoma. J Med Ultrasound 2019; 28:111-113. [PMID: 32874870 PMCID: PMC7446699 DOI: 10.4103/jmu.jmu_81_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/11/2019] [Accepted: 09/28/2019] [Indexed: 11/25/2022] Open
Abstract
The decision to biopsy small thyroid nodules (TNs) is controversial. Careful ultrasound (US) evaluation with shear wave elastography (SWE) of TN and cervical lymph nodes (LNs) may aid in the decision to biopsy and subsequently influence the extent of surgery. A 46-year-old female presented with TNs and hypothyroidism. Her target TN in the left lobe measured 4.8 mm × 4 mm × 4 mm. Fine needle aspiration biopsy of the left TN and a left neck level 6 LN was diagnostic for papillary thyroid carcinoma. In the left lateral neck posterior to the jugular vein, there was a LN with possible microcalcifications that could not be sampled due to vascular proximity. SWE examination showed high velocity suspicious for metastatic disease. In summary, risk stratification for small TNs and cervical LNs can be difficult. SWE can provide valuable information for assessing the risk for malignancy.
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Affiliation(s)
| | | | | | - James Keller
- Wilmington Pathology Associates, Wilmington, NC, USA
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Cakir B, Cuhaci Seyrek FN, Topaloglu O, Ozdemir D, Dirikoc A, Aydin C, Polat SB, Ogmen BE, Tam AA, Baser H, Kilic Yazgan A, Kilic M, Alkan A, Ersoy R. Ultrasound elastography score and strain index in different parathyroid lesions. Endocr Connect 2019; 8:1579-1590. [PMID: 31751311 PMCID: PMC6933834 DOI: 10.1530/ec-19-0443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite significant improvement in imaging quality and advanced scientific knowledge, it may still sometimes be difficult to distinguish different parathyroid lesions. The aims of this prospective study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether strain index can help to differentiate parathyroid lesions. METHODS Patients with biochemically confirmed hyperparathyroidism and localised parathyroid lesions in ultrasonography were included. All patients underwent B-mode US and USE examination. Ultrasound elastography scores and strain index of lesions were determined. Strain index was defined as the ratio of strain of the thyroid parenchyma to the strain of the parathyroid lesion. RESULTS Data of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%) parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of parathyroid hyperplasia. Median serum Ca was significantly higher in atypical parathyroid adenoma patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher in APA compared to PA patients (P < 0.001). In 221 (90.2%) of the parathyroid lesions, USE score was 1 or 2. The median SI of atypical parathyroid adenomas was significantly higher than parathyroid adenomas and hyperplasia lesions (1.5 (0.56-4.86), 1.01 (0.21-8.43) and 0.91 (0.26-2.02), respectively, P = 0.003). CONCLUSION Our study revealed that SI of parathyroid lesions as well as serum calcium, parathyroid hormone levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ultrasound elastography can be used to differentiate among parathyroid lesions and guide a surgical approach.
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Affiliation(s)
- Bekir Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - F Neslihan Cuhaci Seyrek
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
- Correspondence should be addressed to F N Cuhaci Seyrek:
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ahmet Dirikoc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Cevdet Aydin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Sefika Burcak Polat
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Berna Evranos Ogmen
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ali Abbas Tam
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Husniye Baser
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Aylin Kilic Yazgan
- Department of Pathology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Mehmet Kilic
- Department of General Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Chae SY, Jung HN, Ryoo I, Suh S. Differentiating cervical metastatic lymphadenopathy and lymphoma by shear wave elastography. Sci Rep 2019; 9:12396. [PMID: 31455777 PMCID: PMC6712052 DOI: 10.1038/s41598-019-48705-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
Shear wave elastography (SWE) is a recent technological advance of ultrasonography (US) to assess tissue stiffness. The purpose of this study is to assess tissue stiffness of malignant cervical lymph nodes (LN) with SWE, to reveal diagnostic performance of SWE in differentiating metastatic LN from lymphoma, and to assess inter-observer agreement of SWE. We assessed 62 malignant LN (24 lymphomas and 38 metastatic LN) and their median speed was 6.34 m/s and median elasticity was 69.7 kPa. Add of SWE with conventional US improved diagnostic accuracy of differentiating metastasis from lymphoma (16.13, 8.07 and 11.3% for three radiologists). Kendall’s Coefficient of Concordance of three readers for analyzing SWE patterns was 0.86. SWE can be a useful tool to discriminate metastatic cervical LN from lymphoma with improvement of diagnostic accuracy when using with conventional US.
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Affiliation(s)
- Soo Young Chae
- Department of Radiology, Korea University Guro Hospital, Seoul, 08308, Korea
| | - Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Seoul, 08308, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Seoul, 08308, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Seoul, 08308, Korea.
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Felici F, Scemama U, Bendahan D, Lavieille JP, Moulin G, Chagnaud C, Montava M, Varoquaux A. Improved Assessment of Middle Ear Recurrent Cholesteatomas Using a Fusion of Conventional CT and Non-EPI-DWI MRI. AJNR Am J Neuroradiol 2019; 40:1546-1551. [PMID: 31413008 DOI: 10.3174/ajnr.a6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recurrent middle ear cholesteatomas are commonly preoperatively assessed using MR imaging (non-EPI-DWI) and CT. Both modalities are used with the aim of distinguishing scar tissue from cholesteatoma and determining the extent of bone erosions. Inflammation and scar tissue associated with the lesions might hamper a proper delineation of the corresponding extensions on CT images. Using surgical findings as the criterion standard, we assessed the recurrent middle ear cholesteatoma extent using either uncoregistered or fused CT-MR imaging datasets and determined the corresponding accuracy and repeatability. MATERIALS AND METHODS Twenty consecutive patients with suspected recurrent middle ear cholesteatoma and preoperative CT-MR imaging datasets were prospectively included. A double-blind assessment and coregistration of the recurrent middle ear cholesteatoma extent and manual delineation of 18 presumed recurrent middle ear cholesteatomas were performed by 2 radiologists and compared with the criterion standard. "Reliability score" was defined to qualify radiologists' confidence. For each volume, segmentation repeatability was assessed on the basis of intraclass correlation coefficient and overlap indices. RESULTS For the whole set of patients, recurrent middle ear cholesteatoma was further supported by surgical results. Two lesions were excluded from the analysis, given that MR imaging did not show a restricted diffusion. Lesions were accurately localized using the fused datasets, whereas significantly fewer lesions (85%) were correctly localized using uncoregistered images. Reliability scores were larger for fused datasets. Segmentation repeatability showed an almost perfect intraclass correlation coefficient regarding volumes, while overlaps were significantly lower in uncoregistered (52%) compared with fused (60%, P < .001) datasets. CONCLUSIONS The use of coregistered CT-MR images significantly improved the assessment of recurrent middle ear cholesteatoma with a greater accuracy and better reliability and repeatability.
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Affiliation(s)
- F Felici
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - U Scemama
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - D Bendahan
- North Hospital, and CNRS, CRMBM-CEMEREM UMR 7339, 13385 (D.B., A.V.)
| | - J-P Lavieille
- La Conception University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery (J.-P.L., M.M.).,UMRT 24 IFSTTAR (J.-P.L., M.M.), Aix-Marseille University, Marseille, France
| | - G Moulin
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - C Chagnaud
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - M Montava
- La Conception University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery (J.-P.L., M.M.).,UMRT 24 IFSTTAR (J.-P.L., M.M.), Aix-Marseille University, Marseille, France
| | - A Varoquaux
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.) .,North Hospital, and CNRS, CRMBM-CEMEREM UMR 7339, 13385 (D.B., A.V.)
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Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes. PLoS One 2019; 14:e0221062. [PMID: 31415610 PMCID: PMC6695226 DOI: 10.1371/journal.pone.0221062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022] Open
Abstract
Rationale and objectives To assess the performance of shear wave elastography (SWE) and an extended model in predicting malignant cervical lymph nodes (LNs). Materials and methods 109 patients who underwent ultrasound (US) and SWE before needle biopsy were enrolled. The optimal cutoff value of elasticity indices (EIs) was determined by receiver operating characteristic (ROC) curves. The c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare extended model and traditional one. Results Malignant LNs had higher EIs than benign nodes (p < 0.001). The optimal cutoff point was 42 kilopascal, corresponding to 83.3% sensitivity, 64.7% specificity, and 68.8% overall accuracy. A multivariable logistic regression analysis confirmed that EI was an independent predictor for malignancy. The new extended prediction model had a positive NRI (0.96) and IDI (0.10) for predicting malignant neck LNs. Nevertheless, the c-statistic was not significantly different between the two models. Conclusion The parameter of SWE theoretically improve the model performance. However, its real clinical impact is minor, as the parameters of US-based model is already very robust. SWE can be considered as an adjunctive quantitative tool beyond conventional US examination.
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Comparison of Diagnostic Performance of B-Mode Ultrasonography and Shear Wave Elastography in Cervical Lymph Nodes. Ultrasound Q 2019; 35:290-296. [PMID: 31283566 DOI: 10.1097/ruq.0000000000000464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to compare the diagnostic performance of B-mode ultrasonography (US) and shear wave elastography (SWE) for differentiating benign from malignant cervical lymph nodes (LNs). This study evaluated 130 cervical LNs in 127 patients. On conventional B-mode US, short-axis and long-axis diameters, long-to-short-axis ratio, cortical morphology, border, and presence of necrosis or calcification were evaluated. Maximum elasticity value (Emax) was collected for SWE. The area under the receiver operator characteristic curve (AUC), sensitivity, and specificity of B-mode US features and SWE were compared. Final histopathologic results showed 89 benign and 41 metastatic LNs. Among the B-mode US features, cortical morphology had the highest AUC (0.884). When 54 kPa of Emax was applied as a cutoff value, the SWE showed significantly lower AUC than cortical morphology (0.734, P = 0.02). Both sensitivity and specificity for cortical morphology on B-mode US were higher than for Emax (80.5% vs 65.9%, P = 0.212 and 89.9% vs 76.4%, P = 0.026, respectively). Conventional B-mode US resulted in higher diagnostic yield than SWE in evaluating cervical LNs in our study. However, further studies on potential factors that may affect the SWE velocity are needed to validate the diagnostic value of SWE.
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Luo S, Yao G, Hong Z, Zhang S, Wang W, Zhang J, Zhang Y, Wu J, Zhang L, Cheng H, Hao Y, Li Y. Qualitative Classification of Shear Wave Elastography for Differential Diagnosis Between Benign and Metastatic Axillary Lymph Nodes in Breast Cancer. Front Oncol 2019; 9:533. [PMID: 31312611 PMCID: PMC6614346 DOI: 10.3389/fonc.2019.00533] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/03/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose: To examine diagnostic performance of qualitative shear wave elastography (SWE) for evaluation of status of axillary lymph nodes (ALN) in comparison with conventional ultrasonograghy (US) and quantitative SWE parameters. Methods: A total of 118 patients were enrolled, who were all scheduled for breast cancer surgery and core needle biopsy. Conventional US and SWE were performed before biopsy. Based on qualitative evaluation of each ALN, the SWE images were classified into four color patterns: Color Pattern 1: homogeneous; Color Pattern 2: filling defect within lymph node (LN); Color Pattern 3: homogeneous within LN with a localized colored area at the margin; and Color Pattern 4: filling defect within LN with a localized colored area at the margin. The diagnostic performances of the three methods were compared. Results: There were 60 metastatic nodes and 61 benign nodes in the 121 ALNs. Benign ALNs were presented as Color Pattern 1 while metastatic ALNs usually were presented as Color Pattern 2 to 4 (p < 0.05). The AUC of qualitative SWE classification was 0.983, higher than that of quantitative SWE parameters and conventional US (p<0.05). The highest diagnostic performance, with AUC of 0.998, could be achieved if both conventional US and qualitative SWE were applied. Conclusion: The qualitative SWE classification of ALNs proposed in our study exhibited better diagnostic performance than quantitative SWE parameters and conventional US, especially for differentiating metastatic ALNs from benign reactive ALNs. More accurate diagnosis could be reached with this new method and unnecessary biopsy might be avoided in the meantime.
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Affiliation(s)
- Shuyi Luo
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guangyu Yao
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe Hong
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shiyu Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhen Wang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingwen Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaru Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junkai Wu
- Department of Imaging Diagnostics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Cheng
- School of Biomedical Engineering, Southern Medical Uinversity, Guangzhou, China
| | - Yi Hao
- Department of Ultrasound Diagnosis, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yingjia Li
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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The Role of Ultrasound and Shear-Wave Elastography in Evaluation of Cervical Lymph Nodes. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4318251. [PMID: 31183367 PMCID: PMC6515176 DOI: 10.1155/2019/4318251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/23/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022]
Abstract
Aim To evaluate the prognostic value of ultrasound and shear-wave elastography (SWE) in diagnosing malignant cervical lymph nodes. Methods A total of 99 patients with enlarged lymph nodes (99 lymph nodes presenting as a neck mass) were examined clinically with conventional ultrasound including Doppler examination and shear-wave elastography. The results of the examinations were compared with the final diagnosis. Results There were 43 benign and 56 malignant lymph nodes in our cohort. Age and sex were significant predictors of malignancy. The standard ultrasound parameters—node size, long/short axis ratio, hilum, vascularization, and the presence of microcalcifications—were also statistically significant. Lymph node volume combined with age showed the best predictive power. The maximum stiffness found on SWE was also a significant predictor of malignancy. The combination of epidemiologic, classic ultrasound, and elastographic parameters yielded the highest sensitivity and specificity in the prediction of malignancy; however, the additional impact of elastographic parameters was low. Conclusion A combination of epidemiologic and classic ultrasound parameters can discriminate between malignant and benign lymph nodes with satisfactory sensitivity and specificity. Examining the stiffness of lymph nodes by means of SWE does not add much new predictive power.
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Sasaki Y, Ogura I. Shear wave elastography in differentiating between benign and malignant cervical lymph nodes in patients with oral carcinoma. Dentomaxillofac Radiol 2019; 48:20180454. [PMID: 30894023 DOI: 10.1259/dmfr.20180454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate shear wave elastography in differentiating between benign and malignant cervical lymph nodes in patients with oral carcinoma. METHODS 77 patients with oral squamous cell carcinoma were examined by B-mode and shear wave elastography with a 14 MHz linear transducer. The integrated shear wave elastography software allowed the operator to place regions of interest of various sizes within the elastography window, and automatically displayed shear elastic modulus data (kPa) for each region of interest. The relationship between size and shear elastic modulus of cervical lymph nodes was assessed by Pearson's rank correlation test. The shear elastic modulus of cervical lymph nodes in benign and malignant were evaluated using the Mann-Whitney U test. The analyses were used with a 5% significance level. RESULTS We plotted shear elastic modulus (X) against minimal axial diameter of cervical lymph nodes (Y), and observed a significant correlation [ Y = 0.091 X + 4.648 (R2 = 0.603, p = 0.000, N = 77)]. Furthermore, the shear elastic modulus of the malignant cervical lymph nodes (105.9 ± 5.2 kPa) was higher than that of benign (11.9 ± 4.4 kPa, p = 0.000). CONCLUSIONS The shear wave elastography is an effective technique for the objectively and quantitatively diagnosis of cervical lymph node metastases of the oral carcinoma.
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Affiliation(s)
- Yoshihiko Sasaki
- Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
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Choi HY, Seo M, Sohn YM, Hwang JH, Song EJ, Min SY, Kang HJ, Han DY. Shear wave elastography for the diagnosis of small (≤2 cm) breast lesions: added value and factors associated with false results. Br J Radiol 2019; 92:20180341. [PMID: 30817169 DOI: 10.1259/bjr.20180341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We compared the diagnostic performance of B-mode ultrasound, shear wave elastography (SWE), and combined B-mode ultrasound and SWE in small breast lesions (≤ 2 cm), and evaluated the factors associated with false SWE results. METHODS A total of 428 small breast lesions (≤ 2 cm) of 415 consecutive patients between August 2013 and February 2017 were included. The diagnostic performance of each set was evaluated using the area under the receiver operating characteristic curve (AUC) analysis. Histologic diagnosis was used as reference standard. Multivariate logistic regression analyses identified the factors associated with false SWE results. RESULTS Of 428 lesions, 142 (33.2%) were malignant and 286 (66.8%) were benign. The AUC of the combined modality was higher than that of B-mode ultrasound (0.792 vs 0.572, p < 0.001) and that of SWE was higher than that of B-mode ultrasound (0.718 vs 0.572, p < 0.001). Multivariate analysis showed that the smaller lesion size and in situ cancer were associated with false negative, and patient's age, high-risk lesion, shorter distance from the skin or chest wall, and deeper breast thickness were associated with false positive (all p < 0.05). CONCLUSIONS The addition of SWE to B-mode ultrasound could improve the diagnostic performance in ≤ 2 cm lesions. However, ultrasound lesion size, pathology, and lesion location are likely to affect the SWE value and result in false results. ADVANCES IN KNOWLEDGE Despite the diagnostic usefulness of SWE in small breast lesions (≤ 2 cm), ultrasound lesion size, pathology, and lesion location were associated with false results.
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Affiliation(s)
- Hye Young Choi
- 1 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine , Seoul , South Korea
| | - Mirinae Seo
- 1 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine , Seoul , South Korea
| | - Yu-Mee Sohn
- 1 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine , Seoul , South Korea
| | - Ji Hye Hwang
- 2 Department of Medicine, Graduate School, Kyung Hee University , Seoul , South Korea
| | - Eun Jee Song
- 1 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine , Seoul , South Korea
| | - Sun Young Min
- 3 Department of Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine , Seoul , South Korea
| | - Hye Jin Kang
- 2 Department of Medicine, Graduate School, Kyung Hee University , Seoul , South Korea
| | - Dong Yoon Han
- 2 Department of Medicine, Graduate School, Kyung Hee University , Seoul , South Korea
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Li J, Han F, Mo Y, Chen X, Li Y, Zuo F. Ultrasound Elastography supplement assessing nodal status of magnetic resonance imaging staged cervical N0 patients with nasopharyngeal carcinoma. Cancer Imaging 2019; 19:12. [PMID: 30832735 PMCID: PMC6399938 DOI: 10.1186/s40644-019-0199-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/25/2019] [Indexed: 01/20/2023] Open
Abstract
Background To determine whether ultrasound elastography can distinguish reactive or metastatic small lymph nodes (sLN) of magnetic resonance imaging (MRI) staged cervical N0 patients with nasopharyngeal carcinoma (NPC). Methods A pilot study was performed involving the diagnostic performances of conventional high-frequency ultrasound (CHFU) and/or shear wave elastography (SWE) for predicting metastases in sLN of MRI-staged N0 NPC patients with reference to the histologically-proven ultrasound guided core needle biopsy (US-CNB). The diagnosis of CHFU was based on the superficial lymph node ultrasonic criteria with the five-point-scale (FPS). The mean (Emean), minimum (Emin) and maximum (Emax) of the elasticity indices were measured by SWE at the stiffest part of the sLN in kilopascal. Diagnostic performances were analyzed using a receiver operating curve (ROC) on a per-node basis. The authenticity of this article has been validated by uploading the key raw data onto the Research Data Deposit public platform (http://www.researchdata.org.cn), with the approval RDD number as RDDA2017000447. Results All 113 cervical sLN of 49 MRI-staged cervical N0 NPC patients underwent evaluation of CHFU and SWE; 38 sLN (FPS < 2) were regarded as benign, which were excluded from subsequent analysis due to none biopsy-proven. And 75 indeterminate sLN (FPS ≥ 2) were referred to US-CNB and revealed 15 (20%) metastases. All SWE elastic indices were significantly higher in malignant sLNs than in benign sLNs (p < 0.05). Moreover, Emax exhibited the highest diagnostic value (AUC:0.733 ± 0.067, p = 0.005) with excellent measurement reproducibility (ICC: 0.786; 95%CI: 0.684, 0.864). CHFU plus SWE was superior to CHFU or SWE alone for predicting metastases in sLN of MRI-staged N0 patients with NPC (p < 0.001). Conclusions CHFU plus SWE is an optional non-invasive modality to supplement MRI in assessing cervical nodal status of patients with NPC. Electronic supplementary material The online version of this article (10.1186/s40644-019-0199-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian Li
- Department of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No.651, Dong-feng-dong Road, Guangzhou, 510060, China.
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No.651, Dong-feng-dong Road, Guangzhou, 510060, China
| | - Yunxian Mo
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No.651, Dong-feng-dong Road, Guangzhou, 510060, China
| | - Xindan Chen
- Department of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No.651, Dong-feng-dong Road, Guangzhou, 510060, China
| | - Yong Li
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No.651, Dong-feng-dong Road, Guangzhou, 510060, China
| | - Feifei Zuo
- Department of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No.651, Dong-feng-dong Road, Guangzhou, 510060, China
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Shimizu M, Weerawanich W. Sonographic diagnosis in the head and neck region: from an educational lecture presented at the 56th General Assembly and Annual Scientific Congress of the Japanese Society for Oral and Maxillofacial Radiology. Oral Radiol 2018; 35:101-126. [PMID: 30484212 DOI: 10.1007/s11282-018-0353-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/28/2018] [Indexed: 01/15/2023]
Abstract
Sonography is a simple, inexpensive, and non-invasive diagnostic modality. Although tissues behind bony structures and deep tissues are not delineated, sonography can depict superficial soft tissues very clearly. In the head and neck region, however, it has not yet been used widely, as the anatomical structures are complicated, and considerable experience is needed both to perform an examination and to make a diagnosis. To perform examinations efficiently, operators must be familiar with the sonographic system in use, and take images at standard planes. To make a correct diagnosis, operators require knowledge of the sonographic anatomy on standard planes, representative sonographic signs and artifacts, and common diseases and their typical sonographic findings. In this paper, we have explained the sonographic anatomy on standard planes, and the sonographic findings of common diseases in the oral and maxillofacial region.
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Affiliation(s)
- Mayumi Shimizu
- Department of Oral and Maxillofacial Radiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Warangkana Weerawanich
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand
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Abbasian Ardakani A, Reiazi R, Mohammadi A. A Clinical Decision Support System Using Ultrasound Textures and Radiologic Features to Distinguish Metastasis From Tumor-Free Cervical Lymph Nodes in Patients With Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2527-2535. [PMID: 29603330 DOI: 10.1002/jum.14610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/06/2018] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study investigated the potential of a clinical decision support approach for the classification of metastatic and tumor-free cervical lymph nodes (LNs) in papillary thyroid carcinoma on the basis of radiologic and textural analysis through ultrasound (US) imaging. METHODS In this research, 170 metastatic and 170 tumor-free LNs were examined by the proposed clinical decision support method. To discover the difference between the groups, US imaging was used for the extraction of radiologic and textural features. The radiologic features in the B-mode scans included the echogenicity, margin, shape, and presence of microcalcification. To extract the textural features, a wavelet transform was applied. A support vector machine classifier was used to classify the LNs. RESULTS In the training set data, a combination of radiologic and textural features represented the best performance with sensitivity, specificity, accuracy, and area under the curve (AUC) values of 97.14%, 98.57%, 97.86%, and 0.994, respectively, whereas the classification based on radiologic and textural features alone yielded lower performance, with AUCs of 0.964 and 0.922. On testing the data set, the proposed model could classify the tumor-free and metastatic LNs with an AUC of 0.952, which corresponded to sensitivity, specificity, and accuracy of 93.33%, 96.66%, and 95.00%. CONCLUSIONS The clinical decision support method based on textural and radiologic features has the potential to characterize LNs via 2-dimensional US. Therefore, it can be used as a supplementary technique in daily clinical practice to improve radiologists' understanding of conventional US imaging for characterizing LNs.
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Affiliation(s)
- Ali Abbasian Ardakani
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Reiazi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Medical Image and Signal Processing Research Core, Iran University of Medical Sciences, Tehran, Iran
| | - Afshin Mohammadi
- Solid Tumor Research Center, Faculty of Medicine, Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
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Chang W, Tang L, Lu C, Wu M, Chen M. Shear wave elastography in the evaluation of level VI lymph nodes in papillary thyroid carcinoma: combined with gray-scale ultrasound ex vivo. BMC Cancer 2018; 18:1001. [PMID: 30342491 PMCID: PMC6195959 DOI: 10.1186/s12885-018-4897-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/03/2018] [Indexed: 02/18/2023] Open
Abstract
Background The evaluation of cervical lymph nodes is very important for patients with papillary thyroid carcinoma (PTC). Conventional ultrasound is recommended to assess the status of cervical lymph nodes but the diagnostic performance is not satisfying especially in level VI lymph nodes. Recently, shear wave elastography has shown great potential in diagnosis. Therefore, this study aimed at exploring the value of shear wave elastography in ultrasound evaluation for level VI lymph nodes in papillary thyroid carcinoma. Because Hashimoto’s thyroiditis may influence the diagnostic performance, a subgroup was also analysed that included only lymph nodes from PTC without Hashimoto’s thyroiditis. Methods Eighty-Seven level VI lymph nodes from 22 consecutive patients with papillary thyroid carcinoma were evaluated by gray-scale ultrasound and SWE in condition of ex vivo before rapid frozen section. Gray-scale ultrasound and shear wave elastography indexes of metastatic and non-metastatic lymph nodes were evaluated by statistical analysis separately in all patients and in patients without Hashimoto’s thyroiditis. Indexes included long diameter, short diameter, short-to-long diameter ratio (S/L ratio), Emean, Emin, Emax and ESD. The rapid frozen section result of each lymph node was used as gold standard to evaluate the diagnostic performance of gray-scale ultrasound and combination method which combined gray-scale ultrasound and SWE. Results In all patients, significant indexes included short diameter (p = 0.009), S/L ratio (p = 0.003), Emax (p = 0.016) and ESD (p = 0.006). In patients without Hashimoto’s thyroiditis, significant indexes included short diameter (p = 0.002), S/L ratio (p = 0.003), Emean (p = 0.030), Emax (p < 0.001) and ESD (p = 0.001). Combining gray-scale ultrasound with SWE, combination method had higher AUC than gray-scale ultrasound both in all patients (0.887 vs 0.841) and patients without Hashimoto’s thyroiditis (0.925 vs 0.866). Gray-scale ultrasound had higher AUC in patients without Hashimoto’s thyroiditis than in all patients (0.866 vs 0.841), which was the same with combination method (0.925 vs 0.887). Conclusion Shear wave elastography can provide additional information for ultrasound evaluation of level VI lymph nodes in papillary thyroid carcinoma, especially in papillary thyroid carcinoma without Hashimoto’s thyroiditis.
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Affiliation(s)
- Wanying Chang
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xian Xia Road, Shanghai, 200336, China
| | - Lei Tang
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xian Xia Road, Shanghai, 200336, China
| | - Caiwei Lu
- Department of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin 2nd Road, Shanghai, 200025, China
| | - Min Wu
- Department of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin 2nd Road, Shanghai, 200025, China
| | - Man Chen
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xian Xia Road, Shanghai, 200336, China.
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Ogura I, Nakahara K, Sasaki Y, Sue M, Oda T. Usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Imaging Sci Dent 2018; 48:161-165. [PMID: 30276152 PMCID: PMC6148035 DOI: 10.5624/isd.2018.48.3.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Materials and Methods Ten patients with oral and maxillofacial diseases and 28 volunteers drawn from our student doctors were examined by shear wave elastography with a 14-MHz linear transducer using an Aplio 300 apparatus (Canon Medical Systems, Otawara, Japan). A statistical analysis of the shear elastic modulus (kPa) of healthy tissue (the sublingual gland, submandibular gland, anterior belly of the digastric muscle, and geniohyoid muscle) in the 28 volunteers was performed using 1-way repeated measures analysis of variance with the Tukey honest significant difference test. The maximum shear elastic modulus (kPa) of 8 patients with squamous cell carcinoma (SCC) and 2 patients with benign lesions was evaluated with the Mann-Whitney U test. The analysis used a 5% significance level. Results The mean shear elastic modulus of the sublingual gland (9.4±3.7 kPa) was lower than that of the geniohyoid muscle (19.2±9.2 kPa, P=.000) and the anterior belly of the digastric muscle (15.3±6.1 kPa, P=.004). The maximum shear elastic modulus of the SCCs (109.6±14.4 kPa) was higher than that of the benign lesions (46.4±26.8 kPa, P=.044). Conclusion Our results demonstrated the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Shear wave elastography has the potential to be an effective technique for the objective and quantitative diagnosis of oral and maxillofacial diseases.
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Affiliation(s)
- Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Ken Nakahara
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Yoshihiko Sasaki
- Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Mikiko Sue
- Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Takaaki Oda
- Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
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The value of shear wave elastography in predicting for undiagnosed small cervical lymph node metastasis in nasopharyngeal carcinoma: A preliminary study. Eur J Radiol 2018; 103:19-24. [PMID: 29803380 DOI: 10.1016/j.ejrad.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND To investigate the diagnostic value of shear wave elastography (SWE) in identifying cervical small lymph node metastases in nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS This prospective study was approved by the local institutional review board. From July 2014 to March 2016, 114 sLNs from 62 newly diagnosed NPC patients (47 men, 15 women) were assessed. Target small lymph nodes (sLNs), which were undiagnosed by magnetic resonance imaging (MRI), were defined as scattered cervical lymph nodes that had no evidence of central necrosis or extracapsular spread and exhibited a maximum transverse diameter ≥5 mm and <10 mm in MRI. The mean (Emean), minimum (Emin) and maximum (Emax) of the elasticity indices (EIs) were measured by SWE at the stiffest part of the sLN (kPa). Biopsy pathology was served as the reference standard. Diagnostic performances were assessed using receiver operating curve (ROC) analysis on a node-by-node basis. RESULTS Of the 114 small cervical lymph nodes, 88 (77.2%) were benign, and 26 (22.8%) were malignant. All SWE EIs were significantly higher in malignant sLNs than in benign sLNs (p < 0.001). Emean exhibited the highest diagnostic value (area under the curve = 0.879 ± 0.036) (p < 0.001) and the corresponding sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 84.6%, 83.0%, 59.5%, 94.8% and 83.3%, respectively. The intra-observer reproducibility of all SWE EIs were significant, with intra-class correlation coefficient (ICC) of 0.745 in Emean, 0.716 in Emax and 0.702 in Emin. CONCLUSION Shear wave elastography is an optional supplementary imaging modality to routine MRI examination to diagnose cervical lymph nodes in NPC patients.
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Ardakani AA, Rasekhi A, Mohammadi A, Motevalian E, Najafabad BK. Differentiation between metastatic and tumour-free cervical lymph nodes in patients with papillary thyroid carcinoma by grey-scale sonographic texture analysis. Pol J Radiol 2018; 83:e37-e46. [PMID: 30038677 PMCID: PMC6047085 DOI: 10.5114/pjr.2018.75017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/18/2017] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) is the most common thyroid cancer, and cervical lymph nodes (LNs) are the most common extrathyroid metastatic involvement. Early detection and reliable diagnosis of LNs can lead to improved cure rates and management costs. This study explored the potential of texture analysis for texture-based classification of tumour-free and metastatic cervical LNs of PTC in ultrasound imaging. MATERIAL AND METHODS A total of 274 LNs (137 tumour-free and 137 metastatic) were explored using the texture analysis (TA) method. Up to 300 features were extracted for texture analysis in three normalisations (default, 3sigma, and 1-99%). Linear discriminant analysis was employed to transform raw data to lower-dimensional spaces and increase discriminative power. The features were classified by the first nearest neighbour classifier. RESULTS Normalisation reflected improvement on the performance of the classifier; hence, the features under 3sigma normalisation schemes through FFPA (fusion Fisher plus the probability of classification error [POE] + average correlation coefficients [ACC]) features indicated high performance in classifying tumour-free and metastatic LNs with a sensitivity of 99.27%, specificity of 98.54%, accuracy of 98.90%, positive predictive value of 98.55%, and negative predictive value of 99.26%. The area under the receiver operating characteristic curve was 0.996. CONCLUSIONS TA was determined to be a reliable method with the potential for characterisation. This method can be applied by physicians to differentiate between tumour-free and metastatic LNs in patients with PTC in conventional ultrasound imaging.
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Affiliation(s)
- Ali Abbasian Ardakani
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rasekhi
- Department of Vascular and Interventional Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Mohammadi
- Department of Vascular and Interventional Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ebrahim Motevalian
- Department of Surgery, School of Medicine, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bahareh Khalili Najafabad
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Kim HJ, Choi IH, Jin SY, Park HK, Byun DW, Suh K, Yoo MH. Efficacy of Shear-Wave Elastography for Detecting Postoperative Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma. Int J Endocrinol 2018; 2018:9382649. [PMID: 30254674 PMCID: PMC6142733 DOI: 10.1155/2018/9382649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/19/2018] [Accepted: 07/29/2018] [Indexed: 11/18/2022] Open
Abstract
AIMS To evaluate shear-wave elastography (SWE) as a tool to detect postoperative cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). METHODS Forty-three LNs of 43 patients with PTC undergoing ultrasound (US) and SWE before ultrasound-guided fine-needle aspiration (FNA) for the evaluation of postoperative cervical LN recurrences were analyzed. The mean (EMean), minimum (EMin), maximum (EMax), and standard deviation (ESD) of SWE elasticity indices were measured. RESULTS Among 43 indeterminate or suspicious LNs, 12 were malignant and 31 were benign. The EMean, EMin, EMax, and ESD values were significantly higher in malignant LNs than in benign LNs (EMean: 37.1 kPa in malignant versus 11.8 kPa in benign LNs, P < 0.001; EMin: 11.3 kPa versus 5.1 kPa, P = 0.046; EMax: 50.5 kPa versus 23.7 kPa, P < 0.001; and ESD: 7.8 kPa versus 4.1 kPa, P = 0.006). EMax had the highest accuracy (93.0%) when applied with a cut-off value of 37.5 kPa. It had a positive likelihood ratio of 25.83 and a diagnostic odds ratio of 150.0. CONCLUSIONS The shear elasticity index of EMax, with higher likelihood ratios for malignant LNs, may help identify postoperative cervical LN metastasis in PTC patients with indeterminate or suspicious LNs.
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Affiliation(s)
- Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Kyoil Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Myung Hi Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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McQueen AS, Bhatia KS. Head and neck ultrasound: technical advances, novel applications and the role of elastography. Clin Radiol 2017; 73:81-93. [PMID: 28985885 DOI: 10.1016/j.crad.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/25/2023]
Abstract
High-resolution ultrasound (US) provides superb anatomical detail in the superficial anatomy of the neck and has become the first-line imaging investigation for neck lumps and a crucial component of clinical pathways. In this article, a wide range of advances in neck US are described with a focus on the emerging role of ultrasound elastography. Selected examples of clinical utility are presented across a spectrum of scenarios with discussion of newer applications, service delivery, and training issues. The changing role of the neck ultrasound practitioner and the future of the technique in the head and neck are considered.
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Affiliation(s)
- A S McQueen
- Department of Radiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK.
| | - K S Bhatia
- Department of Radiology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Künzel J, Bozzato A, Strieth S. Sonographie in der Nachsorge bei Kopf- und Halskarzinomen. HNO 2017; 65:939-952. [DOI: 10.1007/s00106-017-0411-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhao Y, Xi J, Zhao B, Xiong W, Jiang D, Yang L, Cai Z, Liu T, Jiang H, Rong S, Jin X. Preliminary Evaluation of Virtual Touch Tissue Imaging Quantification for Differential Diagnosis of Metastatic and Nonmetastatic Cervical Lymph Nodes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:557-563. [PMID: 28127781 DOI: 10.7863/ultra.16.03077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Virtual Touch tissue imaging quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) is useful for assessing tissue hardness. This study aimed to investigate the value of VTIQ in differential diagnosis of cervical lymph nodes. METHODS We retrospectively analyzed conventional sonograms and VTIQ images of 85 pathologically confirmed patients with superficial lymph node lesions. Conventional sonography was first performed, with 2-dimensional images described. Then VTIQ shear wave velocity (SWV) values of superficial lymph nodes were measured. With pathologic diagnosis as the reference standard, a receiver operating characteristic curve was generated to evaluate VTIQ efficacy in differential diagnosis of metastatic and nonmetastatic cervical lymph nodes. RESULTS Of the 85 nodes, 44 and 41 were metastatic and nonmetastatic, respectively. The latter group included 24 and 17 hematologic/lymphatic system disease and reactive hyperplastic nodes, respectively. Shear wave velocity values of metastatic nodes were significantly higher than those of their nonmetastatic counterparts (P < .001). With an area under the curve (AUC) of 0.953 and SWV cutoff of 3.27 m/s, accuracy, sensitivity, and specificity were 89.4%, 88.6%, and 90.2%, respectively, for distinguishing metastatic and nonmetastatic nodes. An AUC of 0.943 and SWV cutoff of 3.23 m/s yielded accuracy, sensitivity, and specificity of 88.2%, 88.6%, and 87.5% for differentiating metastatic from hematologic/lymphatic system disease nodes. Finally, an AUC of 0.968 and SWV cutoff of 3.27 m/s yielded accuracy, sensitivity, and specificity of 90.2%, 88.6%, and 94.1% for differentiating metastatic from reactive hyperplastic nodes. CONCLUSIONS Virtual Touch tissue imaging quantification is efficient in differential diagnosis of metastatic and nonmetastatic cervical lymph nodes.
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Affiliation(s)
- Yingyan Zhao
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Jiaying Xi
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Baozhen Zhao
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Wenfeng Xiong
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Dong Jiang
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Li Yang
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Zhuhong Cai
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Tianjia Liu
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Haibo Jiang
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
| | - Shu Rong
- Department of Nephrology, First People's Hospital, Shanghai General Hospital, affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Xiucai Jin
- Department of Ultrasonography, Changhai Hospital, affiliated with the Second Military Medical University, Shanghai, China
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Golu I, Sporea I, Moleriu L, Tudor A, Cornianu M, Vlad A, Timar R, Balas M, Amzar D, Vlad M. 2D-Shear Wave Elastography in the Evaluation of Parathyroid Lesions in Patients with Hyperparathyroidism. Int J Endocrinol 2017; 2017:9092120. [PMID: 28845158 PMCID: PMC5563409 DOI: 10.1155/2017/9092120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS 2D-shear wave elastography (2D-SWE) is a relatively new elastographic technique. The aim of the present study is to determine the values of the elasticity indexes (EI) measured by 2D-SWE in parathyroid benign lesions (adenomas or hyperplasia) and to establish if this investigation is helpful for the preoperative identification of the parathyroid adenoma. MATERIAL AND METHODS The study groups were represented by 22 patients with primary or tertiary hyperparathyroidism, diagnosed by specific tests, and 43 healthy controls, in whom the thyroid parenchyma was evaluated, in order to compare the EI of the thyroid tissue with those of the parathyroid lesions. RESULTS The mean EI measured by 2D-SWE in the parathyroid lesions was 10.2 ± 4.9 kPa, significantly lower than that of the normal thyroid parenchyma (19.5 ± 7.6 kPa; p = 0.007), indicating soft tissue. For a cutoff value of 12.5 kPa, the EI assessed by 2D-SWE had a sensitivity of 93% and a specificity of 86% (AUC = 0.949; p < 0.001) for predicting parathyroid lesions. CONCLUSION A value lower than 12.5 kPa for the mean EI measured by 2D-SWE can be used to confirm that the lesion/nodule is a parathyroid adenoma.
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Affiliation(s)
- Ioana Golu
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioan Sporea
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Lavinia Moleriu
- Department of Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Tudor
- Department of Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Marioara Cornianu
- Department of Pathology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Vlad
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Diabetes and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- *Adrian Vlad:
| | - Romulus Timar
- Department of Diabetes and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Melania Balas
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniela Amzar
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihaela Vlad
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Suh CH, Choi YJ, Baek JH, Lee JH. The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: A systematic review and meta-analysis. Eur Radiol 2016; 27:222-230. [DOI: 10.1007/s00330-016-4378-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/18/2016] [Indexed: 01/24/2023]
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