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Zhao D, Feng N, He N, Chu J, Shao Y, Zhang W. Application of ultrasound multimodal imaging in the prediction of cervical tuberculous lymphadenitis rupture. Epidemiol Infect 2024; 152:e28. [PMID: 38287476 PMCID: PMC10894892 DOI: 10.1017/s0950268824000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
Lymph node tuberculosis is particularly common in regions with a high tuberculosis burden, and it has a great risk of rupture. This study aims to investigate the utility of ultrasound multimodal imaging in predicting the rupture of cervical tuberculous lymphadenitis (CTL). 128 patients with unruptured CTL confirmed by pathology or laboratory tests were included. Various ultrasonic image features, including long-to-short-axis ratio (L/S), margin, internal echotexture, coarse calcification, Color Doppler Flow Imaging (CDFI), perinodal echogenicity, elastography score, and non-enhanced area proportion in contrast-enhanced ultrasound (CEUS), were analyzed to determine their predictive value for CTL rupture within a one-year follow-up period. As a result, L/S (P < 0.001), margin (P < 0.001), internal echotexture (P < 0.001), coarse calcification (P < 0.001), perinodal echogenicity (P < 0.001), and the area of non-enhancement in CEUS (P < 0.001) were identified as significant imaging features for predicting CTL rupture. The prognostic prediction showed a sensitivity of 89.29%, specificity of 100%, accuracy of 95.31%, respectively. Imaging findings such as L/S < 2, unclear margin, heterogeneous internal echotexture, perinodal echogenicity changed, and non-enhancement area in CEUS > 1/2, are indicative of CTL rupture, while coarse calcification in the lymph nodes is associated with a favorable prognosis.
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Affiliation(s)
- Dan Zhao
- Department of Ultrasound, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, China
| | - Na Feng
- Department of Ultrasound, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, China
| | - Ning He
- Department of Ultrasound, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, China
| | - Jie Chu
- Department of Ultrasound, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, China
| | - Yaqin Shao
- Department of Ultrasound, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, China
| | - Wenzhi Zhang
- Department of Ultrasound, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, China
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Zhang YQ, Wang XY, Huang Y. The findings on the CEUS of diffuse large B cell lymphoma in abdomen: A case report and literature review. Front Oncol 2023; 13:1093196. [PMID: 36816980 PMCID: PMC9932890 DOI: 10.3389/fonc.2023.1093196] [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: 11/08/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background PET-CT is the first choice for the imaging diagnosis of intraperitoneal lymphomas. Contrast-enhanced ultrasound (CEUS) is rare in the diagnosis of intraperitoneal nodal lymphoma. Case summary A 62-year-old man was admitted for examination with "right upper abdominal pain". Ultrasound was used to refer to the masses in the hilar region, spleen, and anterior sacral region respectively. The masses were all hypoechoic, and blood flow signals could be detected by CDFI. Laboratory tests of CA125 were within normal limits. CEUS examination was performed on the three masses respectively. The three masses showed different perfusion patterns. Thickened vessels appeared around the mass in the hilar region, a peripheral centrally directed perfusion pattern was observed in the splenic mass, and blood supply vessels appeared in the center of the presacral mass with a significant filling defect. They all showed a contrast pattern with rapid clearance and hypoenhancement compared with the surrounding areas. Ultrasound guided needle biopsy revealed non-Hodgkin's lymphoma, diffuse large B-cell lymphoma, non-germinal center origin. After biopsy, the patient was treated with R-CHOP regimen for chemotherapy, and the tumor disappeared by routine ultrasound review after 5 cycles of chemotherapy. Conclusion To the best of our knowledge, this report is the first to describe the findings of CEUS in intraperitoneal nodal lymphoma. CEUS has various manifestations in intraperitoneal nodal lymphoma. Future studies are still needed to explore the diagnostic features of CEUS in intraperitoneal nodal lymphoma.
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Guo Q, Sun C, Chang Q, Wang Y, Chen Y, Wang Q, Li Z, Niu L. Contrast-enhanced ultrasound-based nomogram for predicting malignant involvements among sonographically indeterminate/suspicious cervical lymph nodes in patients with differentiated thyroid carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1579-1589. [PMID: 35577662 DOI: 10.1016/j.ultrasmedbio.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
This prospective study was aimed at assessing the value of nomograms based on conventional and contrast-enhanced ultrasound (CEUS) features in the pre-operative diagnosis of sonographically indeterminate/suspicious lymph node metastasis (LNM) in patients with differentiated thyroid carcinoma (DTC). A total of 72 cervical LNs from 47 patients with DTC from January to June 2018 were included in the primary data set, and 30 LNs from 15 patients with DTC from July to August 2018 were included in the external validation data set. The LNs of the included patients were preoperatively evaluated by conventional ultrasound (US) and CEUS. Each included LN was labeled by puncture localization with carbon nanoparticle suspension injection (Canalin) under US guidance and dissected separately to ensure the one-to-one correspondence between ultrasonic features and pathology status. Univariate logistic regression analysis was used to identify risk factors for LNM. A nomogram was used to construct a prediction model for cervical metastatic LNs. Round shape, absence of hilar structure, peripheral or mixed blood flow and centripetal or mass enhancement were risk factors for lymph node metastases. The area under the receiver operating characteristic curve of the nomogram model based on conventional US and CEUS features was 0.93 (95% confidence interval: 0.872-0.985), which was superior to that of the nomogram based on conventional US features(0.85, 95% confidence interval: 0.707-0.989). CEUS features can provide incremental benefit in the diagnosis of LNM among DTC cohorts. Nomograms based on conventional US and CEUS features can predict LN status with high accuracy.
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Affiliation(s)
- Qianqian Guo
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China
| | - Chao Sun
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China
| | - Qing Chang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China
| | - Yong Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China
| | - Yu Chen
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China
| | - Qian Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China
| | - Zhengjiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijuan Niu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No. 17, Chaoyang District, Beijing 100021, China.
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Qu L, Chen Q, Luo N, Zhao P, Zou Q, Mei X, Liu Z, Yi W. 3D reconstruction based novel methods are more effective than traditional clinical assessment in breast cancer axillary lymph node metastasis prediction. Sci Rep 2022; 12:12425. [PMID: 35858979 PMCID: PMC9300607 DOI: 10.1038/s41598-022-16380-3] [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: 12/30/2021] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
The status of axillary lymph node metastases determines the treatment and overall survival of breast cancer (BC) patients. Three-dimensional (3D) assessment methods have advantages for spatial localization and are more responsive to morphological changes in lymph nodes than two-dimensional (2D) assessment methods, and we speculate that methods developed using 3D reconstruction systems have high diagnostic efficacy. This exploratory study included 43 patients with histologically confirmed BC diagnosed at Second Xiangya Hospital of Central South University between July 2017 and August 2020, all of whom underwent preoperative CT scans. Patients were divided into a training cohort to train the model and a validation cohort to validate the model. A 3D axillary lymph node atlas was constructed on a 3D reconstruction system to create various methods of assessing lymph node metastases for a comparison of diagnostic efficacy. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic values of these methods. A total of 43 patients (mean [SD] age, 47 [10] years) met the eligibility criteria and completed 3D reconstruction. An axillary lymph node atlas was established, and a correlation between lymph node sphericity and lymph node metastasis was revealed. By continuously fitting the size and characteristics of axillary lymph nodes on the 3D reconstruction system, formulas and models were established to determine the presence or absence of lymph node metastasis, and the 3D method had better sensitivity for axillary lymph node assessment than the 2D method, with a statistically significant difference in the correct classification rate. The combined diagnostic method was superior to a single diagnostic method, with a 92.3% correct classification rate for the 3D method combined with ultrasound. In addition, in patients who received neoadjuvant chemotherapy (NAC), the correct classification rate of the 3D method (72.7%) was significantly higher than that of ultrasound (45.5%) and CT (54.5%). By establishing an axillary lymph node atlas, the sphericity formula and model developed with the 3D reconstruction system achieve a high correct classification rate when combined with ultrasound or CT and can also be applied to patients receiving NAC.
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Affiliation(s)
- Limeng Qu
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Na Luo
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.,Department of General Surgery, The First People's Hospital of Changde City, Changde, China
| | - Piao Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Xilong Mei
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziru Liu
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.
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Zhang W, Chu J, Yang G, Ni T. Correlation between physical characteristics of biopsy specimen and disease of cervical lymph node after contrast-enhanced ultrasound. BMC Surg 2022; 22:223. [PMID: 35690851 PMCID: PMC9188253 DOI: 10.1186/s12893-022-01671-3] [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: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the correlation between physical characteristics and disease of cervical lymph node biopsy specimens after contrast-enhanced ultrasound. Methods All patients were biopsied after CEUS, 235 patients were divided into three groups A, B and C according to the physical characteristics of specimens: 92 patients in group A were complete tissue specimens; 113 patients in group B were discontinuous tissue specimens. There were 30 patients in group C, including a small number of tissue and floc, purulent and bloody specimens. Pathological examination, pathogen culture examination and Gene X-Pert MIB examination were completed for all patients in the three groups, and statistical analysis was conducted on the integrity and traits of the specimens. Results Group A included 92 intact tissue specimens, 21 with reactive hyperplasia, 17 with lymphoma, 12 with metastatic carcinoma, 13 with lymphadenopathy, 15 with necrotizing lymphadenitis, and rare lymphadenopathy. In group B, 113 patients were treated with intermittent tissue specimens, including infected lymph nodes, lymphoma in 1 case, metastatic carcinoma in 3 cases and sarcoidosis in 1 case. There were 30 patients in group C, including a small amount of tissue and floc, purulent and bloody specimens, all of which were infected lymph nodes. The χ2 value of malignant and benign lymph nodes was 42.401, p = 0.000. Conclusion The physical characteristics of cervical lymph node biopsy specimens after CEUS are correlated with the disease, which has guiding significance for postoperative specimen selection.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
| | - Jie Chu
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
| | - Gaoyi Yang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China.
| | - Tu Ni
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
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Zhao D, He N, Shao YQ, Yu XL, Chu J, Yang G. The diagnostic value of contrast-enhanced ultrasound for cervical tuberculous lymphadenitis. Clin Hemorheol Microcirc 2022; 81:69-79. [PMID: 35001882 PMCID: PMC9108573 DOI: 10.3233/ch-211355] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE: To investigate the value of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical tuberculous lymphadenitis (CTL). METHODS: The cohort study included 203 consecutive patients diagnosed with cervical lymph node. Before pathological or laboratory confirmation, all patients underwent CEUS examination, and the imaging findings were analyzed afterward. The diagnostic efficiency of the CEUS imaging findings of CTL was evaluated. RESULTS: Nighty-seven patients of the 203 (47.8%) were pathologically or laboratory confirmed with a CTL diagnosis while the remainder (52.2%) were diagnosed with non-tuberculous lymphadenitis. Regarding the imaging findings of CEUS, it was more common in CTL patients to find a pattern of heterogeneous enhancement inside the lymph nodes relative to non-tuberculous patients [81.44% (79/97) vs 15.09% (16/106), P < 0.01]. The sensitivity of the feature in diagnosis for CTL was 81.44% and the specificity was 84.91%, resepectively. Furthermore, a pattern of peripheral rim-like enhancement had been notable in CTL patients compared with non-tuberculous patients [86.60% (84/97) vs 12.26% (13/106), P < 0.01], associating with a diagnostic sensitivity of 86.60% and a specificity of 87.74%. When it came to the combination of both imaging findings mentioned above, the features were more prominent in CTL patients than compared with non-tuberculous patients [74.23% (72/97) vs 5.66% (6/106), P < 0.01], with a diagnostic sensitivity of 74.23% and a high specificity of 94.34%. Regarding area under curve (AUC) for the ROC analysis, the feature of internal heterogeneous enhancement, peripheral rim-like enhancement, and both features were 0.832, 0.872, and 0.843. CONCLUSIONS: CEUS patterns of heterogeneous enhancement and peripheral rim-like enhancement of lymph nodes are helpful characteristics for the diagnosis of CTL.
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Affiliation(s)
- Dan Zhao
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ning He
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ya-Qin Shao
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiu-Lei Yu
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jie Chu
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Gaoyi Yang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
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Zhang X, Wang L, Feng N, Ni T, Tang W. Reassessing the Value of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Cervical Tuberculous Lymphadenitis and Lymph Node Metastasis of Papillary Thyroid Carcinoma. Front Oncol 2021; 11:694449. [PMID: 34722243 PMCID: PMC8551861 DOI: 10.3389/fonc.2021.694449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/24/2021] [Indexed: 12/31/2022] Open
Abstract
Aim We aimed to evaluate the ability of contrast-enhanced ultrasonography (CEUS) to perform differential diagnosis of cervical tuberculous lymphadenitis and lymph node metastasis from papillary thyroid cancer (PTC). Methods We analyzed 102 enlarged cervical lymph nodes as diagnosed by conventional ultrasound (US) and CEUS. The US and CEUS enhancement pattern and the time intensity curve (TIC) of the metastatic lymph nodes or tuberculous lymph nodes were compared following standard pathological protocols. The TIC included peak time (TTP), peak intensity (PI), and area under the gamma curve (AUC). Results Pathological results demonstrated that 48 out of the 102 enlarged lymph nodes were lymph node metastasis from PTC, while 54 were tuberculous lymphadenitis. There was statistically significant differences in hyperechoic islands, pulse-like enhancement, and asynchronous enhancement between tuberculous lymphadenitis and lymph node metastasis (P < 0.05), but their diagnostic sensitivity and specificity were unsatisfactory. In addition, our data did not show statistically significant difference in enhancement direction, enlarged range on CEUS, and perfusion defect (P > 0.05). Similarly, quantitative parameters such as PI, TTP, and AUC did not yield significant differences between the groups. Conclusion Taken together, the present results demonstrate that CEUS can provide valuable information on lymph node blood flow, which can be used to identify tuberculous lymphadenitis and lymph node metastasis of PTC.
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Affiliation(s)
- Xu Zhang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingling Wang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Feng
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tu Ni
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Tang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Piskunowicz M, Back SJ, Darge K, Humphries PD, Jüngert J, Ključevšek D, Lorenz N, Mentzel HJ, Squires JH, Huang DY. Contrast-enhanced ultrasound of the small organs in children. Pediatr Radiol 2021; 51:2324-2339. [PMID: 33830288 PMCID: PMC8566395 DOI: 10.1007/s00247-021-05006-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
In pediatric and adult populations, intravenous contrast-enhanced ultrasound (CEUS) remains off-label for imaging of organs other than the liver and heart. This limited scope inhibits potential benefits of the new modality from a more widespread utilization. Yet, CEUS is potentially useful for imaging small organs such as the thyroid gland, lymph nodes, testes, ovaries and uterus, with all having locations and vasculature favorable for this type of examination. In the adult population, the utility of CEUS has been demonstrated in a growing number of studies for the evaluation of these small organs. The aim of this article is to present a review of pediatric CEUS of the thyroid gland, lymph nodes, testes, ovaries and uterus as well as to draw from the adult literature indications for possible applications in children.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdansk, M. Sklodowskiej-Curie 3a Street, 80-210, Gdansk, Poland.
| | - Susan J. Back
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kassa Darge
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Paul D. Humphries
- grid.424537.30000 0004 5902 9895Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jörg Jüngert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Damjana Ključevšek
- grid.29524.380000 0004 0571 7705Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Norbert Lorenz
- grid.4488.00000 0001 2111 7257Children’s Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - Hans-Joachim Mentzel
- grid.275559.90000 0000 8517 6224Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Judy H. Squires
- grid.239553.b0000 0000 9753 0008Department of Radiology, University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Dean Y. Huang
- grid.46699.340000 0004 0391 9020Department of Radiology, King’s College Hospital, Denmark Hill, London, UK
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Liu SR, Liu C, Jing HM, Miao LY, Cui LG, Qian LX, Tan S. Subcapsular Injection of Ultrasonic Contrast Agent Distinguishes between Benign and Malignant Lymph Node Lesions Exhibiting Homogeneous Enhancement in Intravenous Contrast-Enhanced Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:582-588. [PMID: 31917043 DOI: 10.1016/j.ultrasmedbio.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
We aimed to evaluate whether subcapsular injection of ultrasonic contrast agent (UCA) can distinguish between benign and malignant lymph node (LN) lesions exhibiting homogeneous enhancement in intravenous contrast-enhanced ultrasound (CEUS) images. From November 2012 to July 2015, 32 patients with superficial lymphadenopathy exhibiting homogeneous enhancement after intravenous CEUS were enrolled. A small amount of UCA was injected into LNs using a subcapsular approach, and perfusion characteristics were recorded. Using the pathology identified via core needle biopsy as the gold standard, we calculated the sensitivity, specificity and accuracy of the technique in terms of distinguishing between benign and malignant LN lesions. Pathology revealed 23 cases of true benign and 9 cases of true malignant LN lesions; the former included 2 cases of tuberculosis and 21 cases of reactive hyperplasia, and the latter included 7 lymphomas and 2 metastases. Subcapsular CEUS diagnosed 24 benign and 8 malignant LN lesions. Most lymphomas (6 of 7, 85.7%) exhibited heterogeneous perfusion, with lymphatic tract distortion in the absence of interruption. Reactive hyperplasia LNs manifested as diffuse homogeneous or brush-like perfusion from the subcapsular region to the center, without lymphatic tract distortion. Metastatic LNs had lymphatic tract interruptions. The sensitivity, specificity, consistency and positive and negative predictive values were 77.8%, 95.6%, 90.6%, 87.5% and 91.7%, respectively. For LNs exhibiting uniform enhancement in intravenous CEUS imaging, subcapsular CEUS may help to distinguish between benign and malignant lesions. In particular, lymphatic distortion without interruption may specifically indicate a lymphoma.
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Affiliation(s)
- Shi-Rong Liu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Chang Liu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Hong-Mei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Li-Ying Miao
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, Beijing, China.
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Homogeneity Parameter in Contrast-Enhanced Ultrasound Imaging Improves the Classification of Abnormal Cervical Lymph Node after Thyroidectomy in Patients with Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9296010. [PMID: 31886269 PMCID: PMC6899314 DOI: 10.1155/2019/9296010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/09/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
Objective To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. Materials and Methods Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. Results Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[−3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. Conclusion Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.
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Niu X, Jiang W, Zhang X, Ding Z, Xue H, Wang Z, Zhao C. Comparison of Contrast-Enhanced Ultrasound and Positron Emission Tomography/Computed Tomography (PET/CT) in Lymphoma. Med Sci Monit 2018; 24:5558-5565. [PMID: 30095086 PMCID: PMC6098669 DOI: 10.12659/msm.908849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background This study aimed to assess the value of contrast-enhanced ultrasound (CEUS) in the diagnosis and prognosis of lymphoma based on PET-CT. Material/Methods Our study included 88 superficial lymph nodes and 63 patients who underwent ultrasound-guided biopsy or surgery for pathology from October 2015 to March 2017. All lymph nodes were assessed by CEUS and PET-CT. CEUS and PET-CT parameters were recorded, including arrive time (AT), time to peak (TTP), base intensity (BI), peak intensity (PI), ascending slope (AS), descending slope (DS), area under the TIC curve (AUC), maximum standardized uptake value (SUVmax), and mean standardized uptake value (SUVmean). Pearson’s correlation was used to assess the associations of CEUS and PET-CT parameters. Results Of the 88 lymph nodes examined,12 were Hodgkin’s lymphoma (HL) and76 were non-Hodgkin’s lymphoma (NHL). The variations of CEUS dose parameters (ΔI, AUC, and AS) were positively correlated with PET-CT results (SUVmax and TLG). Correlation coefficients were 0.609, 0.518, 0.456, 0.630, 0.593, and 0. 532, respectively. The remaining time values (AT, TP, and ΔT) were negatively associated with PET-CT results. Correlation coefficients were −0.239, −0.272, −0.284and −0.377, −0.391, and −0.320, respectively. Conclusions Quantitative CEUS data were correlated with PET-CT values, with potential use in the diagnosis of lymphoma.
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Affiliation(s)
- Xiaoyan Niu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Wenbin Jiang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Xiaojuan Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Zhaoyan Ding
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Hongwei Xue
- Department of Lymphoma, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
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Yin S, Cui Q, Wang S, Fan Z, Yan K. Analysis of Contrast-Enhanced Ultrasound Perfusion Patterns and Time-Intensity Curves for Metastatic Lymph Nodes From Lung Cancer: Preliminary Results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:385-395. [PMID: 28877356 DOI: 10.1002/jum.14345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To retrospectively summarize the similarities and differences in contrast-enhanced ultrasound (US) findings for lymph node metastasis from adenocarcinoma, squamous carcinoma, and small cell lung cancer. METHODS Patients who had received contrast-enhanced US examinations and had a histologic diagnosis of supraclavicular lymph node metastasis from lung cancer were included. The perfusion patterns on contrast-enhanced US images and time-intensity curve parameters were analyzed for the different pathologic types. The microvascular density and microvascular diameter were evaluated. RESULTS Totally, 61 patients were enrolled in this study, including 26 cases with lung squamous carcinoma, 26 with lung adenocarcinoma, and 9 with small cell lung cancer. Contrast-enhanced US perfusion showed no significant differences in enhancement uniformity during the arterial phase and in the presence of unenhanced areas of metastatic lymph nodes with the 3 different pathologic origins (P > .05), but fewer unenhanced areas could be seen in metastatic lymph nodes from adenocarcinoma. The analysis of the time-intensity curve parameters showed that there were significant differences in the peak intensity between metastatic lymph nodes from lung squamous carcinoma and lung adenocarcinoma (P < .05). The microvascular density of metastatic lymph nodes from adenocarcinoma was significantly higher than that of metastatic lymph nodes from squamous carcinoma and small cell lung cancer (P < .001; P = .0444), whereas the microvascular diameter of metastatic lymph nodes from adenocarcinoma was significantly smaller than that from squamous carcinoma and small cell lung cancer (P = .0277; P < .001). CONCLUSIONS Effects of the pathologic diagnosis should be considered when analyzing quantitative parameters of metastatic lymph nodes during contrast-enhanced US examinations, even in the same organ.
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Affiliation(s)
- Shanshan Yin
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qiuli Cui
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihui Fan
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
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Jiang W, Xue H, Wang Q, Zhang X, Wang Z, Zhao C. Value of contrast-enhanced ultrasound and PET/CT in assessment of extramedullary lymphoma. Eur J Radiol 2017; 99:88-93. [PMID: 29362156 DOI: 10.1016/j.ejrad.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/07/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate clinical value of contrast-enhanced ultrasonography (CEUS) and PET/CT for assessment of extramedullary lymphoma, using histopathology as reference standard. METHOD A total of 63 patients with histopathologically-confirmed extramedullary lymphoma who had underwent CEUS and PET/CT examinations of suspicious lymph nodes included in the study. CEUS patterns and parameters (arrival time, peak time and intensity, base intensity, area under the time-intensity curve, ascending and descending slopes) and PET/CT parameters including maximum standardized uptake value, mean standardized uptake value, and metabolic tumor volume (MTV) were evaluated. Patients were classified into Hodgkin lymphomas (HL), non-Hodgkin lymphomas (NHL), early (stage I and II) and advanced (stage III and IV) lymphoma, B cells and T cells lymphoma, and aggressive and indolent lymphoma. The differences between the two independent samples were compared using non-parametric rank and inspection, P < 0.05 was considered statistically significant. The optimal cut-off value for parameters was used to predict the staging and pathology using Receiver Operating Characteristic (ROC) curve analysis. RESULT In the early and advanced group, the differences between △T and ascending slope (AS) were statistically significant (p = 0.010, 0.024 < 0.05). Hodgkin lymphomas (HL) or non-Hodgkin lymphomas (NHL) results were determined by optimal cut-off value of AT and TP (p = 0.001, 0.001 < 0.05). Aggressive or indolent lymphoma were determined by optimal cut-off values of Color Doppler flow resistance index (P = 0.001 < 0.05) and SUVmax (p = 0.001 < 0.05). There was no statistically significant difference between B and T cell lymphoma. And there was no statistically significant difference among the qualitative indexes. The optimal cutoff value for statistically significant indicators was calculated by ROC. CONCLUSION The quantitative parameters of CEUS and SUVmax of PET/CT are proven useful in assessment of different clinical and pathologic patterns of extramedullary lymphoma.
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Affiliation(s)
- Wenbin Jiang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
| | - Hongwei Xue
- Department of Lymphoma, The Affiliated Hospital of Qingdao University, China.
| | - Qinqin Wang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
| | - Xiaojuan Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, China.
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
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Hong YR, Luo ZY, Mo GQ, Wang P, Ye Q, Huang PT. Role of Contrast-Enhanced Ultrasound in the Pre-operative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2567-2575. [PMID: 28807450 DOI: 10.1016/j.ultrasmedbio.2017.07.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study was to prospectively evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and metastatic cervical lymph nodes in patients with papillary thyroid cancer (PTC). Three hundred nineteen cervical lymph nodes (162 metastatic from PTC and 157 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Metastatic lymph nodes more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, perfusion defects and ring-enhancing margins than benign lymph nodes at pre-operative CEUS (all p values < 0.001). The area under the receiver operating characteristic curve (AUC) for the combination of conventional US and CEUS (0.983, 95% confidence interval [CI]: 0.971-0.994) was higher than that of conventional US alone (0.929, 95% CI: 0.899-0.958) and CEUS (0.911, 95% CI: 0.876-0.947). In conclusion, CEUS is a promising tool in conjunction with conventional US for the pre-operative prediction of metastatic cervical lymph nodes in patients with PTC.
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Affiliation(s)
- Yu-Rong Hong
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Zhi-Yan Luo
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Guo-Qiang Mo
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Ping Wang
- Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Pin-Tong Huang
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China.
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Dietrich CF, Jenssen C, Arcidiacono PG, Cui XW, Giovannini M, Hocke M, Iglesias-Garcia J, Saftoiu A, Sun S, Chiorean L. Endoscopic ultrasound: Elastographic lymph node evaluation. Endosc Ultrasound 2015; 4:176-90. [PMID: 26374575 PMCID: PMC4568629 DOI: 10.4103/2303-9027.162995] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives.
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Affiliation(s)
- Christoph F Dietrich
- Department of Medicine, Caritas-Krankenhaus, Uhlandstr, Bad Mergentheim, Germany
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Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel. Eur J Radiol 2015; 84:1675-84. [PMID: 26014102 DOI: 10.1016/j.ejrad.2015.05.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications as well, so that nearly all organs have been investigated. Among them, there is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. The possibility to differentiate benign from malignant nodes in cancer patients has been investigated. A new application is in the detection of sentinel nodes after intradermal microbubble injection. The need to distinguish thyroid nodules eligible for fine needle aspiration cytology has led to the use of CEUS in thyroid examinations as well. The potential of CEUS for prostate cancer detection has been extensively investigated, with encouraging initial results. Early promise, however, has not been fulfilled. New perspective regards evaluation of the extent of prostate tissue devascularization following ablative treatments.
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Pojoga C, Ciobanu L, Badea AF, Boţan E, Caraiani C, Hagiu C, Băciuţ G, Badea R. 2D ultrasonography and contrast enhanced ultrasound for the evaluation of cavitating mesenteric lymph node syndrome in a patient with refractory celiac disease and enteropathy T cell lymphoma. BMC Gastroenterol 2013; 13:26. [PMID: 23399324 PMCID: PMC3579742 DOI: 10.1186/1471-230x-13-26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 02/06/2013] [Indexed: 12/01/2022] Open
Abstract
Background The cavitating mesenteric lymph node syndrome (CMLNS) is a rare manifestation of celiac disease, with an estimated mortality rate of 50%. Specific infections and malignant lymphoma may complicate its clinical course and contribute to its poor prognosis. Diagnosing the underlying cause of CMLNS can be challenging. This is the first report on contrast enhanced ultrasound (CEUS) findings in enteropathy associated T-cell lymphoma (EATL) complicating CMLNS in a gluten-free compliant patient with persistent symptoms and poor outcome. Case presentation We present the case of a 51-year old Caucasian male patient, diagnosed with celiac disease and CMLNS. Despite his compliance to the gluten-free diet the symptoms persisted and we eventually considered the possible development of malignancy. No mucosal changes suggestive of lymphoma were identified with capsule endoscopy. Low attenuation mesenteric lymphadenopathy, without enlarged small bowel segments were seen on computed tomography. CEUS revealed arterial rim enhancement around the necrotic mesenteric lymph nodes, without venous wash-out. No malignant cells were identified on laparoscopic mesenteric lymph nodes biopsies. The patient died due to fulminant liver failure 14 months later; the histopathological examination revealed CD3/CD30-positive atypical T-cell lymphocytes in the liver, mesenteric tissue, spleen, gastric wall, kidney, lung and bone marrow samples; no malignant cells were present in the small bowel samples. Conclusions CEUS findings in EATL complicating CMLNS include arterial rim enhancement of the mesenteric tissue around the cavitating lymph nodes, without venous wash-out. This vascular pattern is not suggestive for neoangiogenesis, as arteriovenous shunts from malignant tissues are responsible for rapid venous wash-out of the contrast agent. CEUS failed to provide a diagnosis in this case.
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Affiliation(s)
- Cristina Pojoga
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 19-21, Croitorilor Street, 400 162, Cluj-Napoca, Romania
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He N, Xie C, Wei W, Pan C, Wang W, Lv N, Wu P. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer. Eur J Radiol 2012; 81:2602-12. [DOI: 10.1016/j.ejrad.2012.03.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 10/20/2011] [Indexed: 02/06/2023]
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Knowles JA, Heath CH, Saini R, Umphrey H, Warram J, Hoyt K, Rosenthal EL. Molecular targeting of ultrasonographic contrast agent for detection of head and neck squamous cell carcinoma. ACTA ACUST UNITED AC 2012; 138:662-8. [PMID: 22801891 DOI: 10.1001/archoto.2012.1081] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the feasibility of ultrasonographic (US) imaging of head and neck cancer with targeted contrast agents both in vitro and in vivo. We hypothesize that conjugation of microbubble contrast agent to tumor-specific antibodies may improve US detection of head and neck squamous cell carcinoma (HNSCC). DESIGN Preclinical blinded assessment of anti-EGFR and anti-CD147 microbubble contrast agents for US imaging of HNSCC. SETTING Animal study. SUBJECTS Immunodeficient mice. INTERVENTION Injection of targeted microbubbles. MAIN OUTCOME MEASURE Microbubble uptake in tumors as detected by US. RESULTS In vitro assessment of anti-epidermal growth factor receptor (EGFR) and anti-CD147-targeted microbubbles in 6 head and neck cancer cell lines yielded a 6-fold improvement over normal dermal fibroblasts (P < .001). Binding of targeted agents had a positive correlation to both epidermal growth factor receptor (EGFR) (R(2) = 0.81) and CD147 (R(2) = 0.72) expression among all cell lines. In vivo imaging of flank tumors in nude mice (N = 8) yielded enhanced resolution of anti-EGFR-and anti-CD147-targeted microbubble agents over IgG control (P < .001), while dual-targeted contrast agents offered enhanced imaging over single-targeted contrast agents (P = .02 and P = .05, respectively). In a blinded in vivo assessment, targeted contrast agents increased intratumoral enhancement of flank tumors over controls. Targeted US contrast agents to both EGFR and CD147 were 100% sensitive and 87% specific in the detection of flank tumors. CONCLUSION This preclinical study demonstrates feasibility of using molecular US to target HNSCC for contrast-enhanced imaging of HNSCC tumor in vivo.
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Affiliation(s)
- Joseph A Knowles
- Department of Surgery, University of Alabama at Birmingham, 35294-0012, USA
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Niu C, Wang Z, Zuo G, Krupka TM, Ran H, Zhang P, Li P, Chen Y, Chen H, Zheng Y. Poly(Lactide-co-glycolide) ultrasonographic microbubbles carrying Sudan black for preoperative and intraoperative localization of lymph nodes. Clin Breast Cancer 2012; 12:199-206. [PMID: 22402214 DOI: 10.1016/j.clbc.2012.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/24/2011] [Accepted: 01/13/2012] [Indexed: 01/31/2023]
Abstract
Lymph node (LN) examination plays a critical role in the staging and treatment of several kinds of cancer such as lesions of the breast. However current strategies have limitations. This study aimed to develop a novel imaging agent, a polymeric ultrasonographic contrast agent carrying Sudan black (SB), for ultrasonographic imaging of the regional LNs before surgery and to directly localize the LNs during surgery. The poly(lactide-co-glycolide) (PLGA) ultrasonographic microbubbles carrying Sudan black B (SB) (SB-PLGA microbubbles) were prepared by the double emulsion method. The SB-PLGA microbubbles had a diameter of 1.5 ± 0.5 μm and the SB encapsulation efficiency was (86.2 ± 1.56%). Results from MTT assays suggested that these bubbles have little cytotoxicity to mouse macrophages after incubation. Confocal laser scanning microscopy showed that the PLGA microbubbles carrying the fluorescent dye rhodamine 6G were taken up by macrophages after 2-hour incubation. In addition, these SB-PLGA microbubbles were able to enhance ultrasonographic contrast of 12 popliteal LNs of 6 rabbits. Furthermore, the LNs were easily identifiable by the naked eye during surgery because of the blue color of the SB-PLGA microbubbles inside the LNs. By cryosectioning and hematoxylin and eosin (H&E) staining of LN tissue, our results showed that these SB-PLGA microbubbles were internalized inside the macrophages of the LNs. To conclude, the SB-PLGA microbubbles could be a suitable imaging agent for preoperative and intraoperative localization of LNs as well as for a preoperative ultrasonographically guided core needle biopsy of suspicious sentinel lymph nodes (SLNs) in cancer patients, hence enhancing treatment outcome.
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Affiliation(s)
- Chengcheng Niu
- Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Goldberg BB, Merton DA, Liu JB, Forsberg F, Zhang K, Thakur M, Schulz S, Schanche R, Murphy GF, Waldman SA. Contrast-enhanced ultrasound imaging of sentinel lymph nodes after peritumoral administration of Sonazoid in a melanoma tumor animal model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:441-453. [PMID: 21460143 DOI: 10.7863/jum.2011.30.4.441] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to compare lymphosonography (ie, contrast-enhanced ultrasound imaging [US] after interstitial injection of a US contrast agent) for the detection of sentinel lymph nodes (SLNs) in swine with naturally occurring melanoma tumors to lymphoscintigraphy using blue dye-guided surgical dissection as the reference standard. Also, we sought to determine if lymphosonography can be used to characterize SLNs. METHODS Sixty-three swine with 104 melanomas were evaluated. Contrast-specific US was performed after peritumoral injection (1 mL dose) of Sonazoid (GE Healthcare, Oslo, Norway). Lymphoscintigraphy was performed after peritumoral injections of technetium Tc 99m sulfur colloid. Peritumoral injection of 1% Lymphazurin (Ben Venue Labs, Inc, Bedford, OH) was used to guide SLN resection. The accuracy of SLN detection with the two imaging modalities was compared using the McNemar test. The SLNs were qualitatively and quantitatively characterized as benign or malignant based on the lymphosonography results with histopathology and RNA analyses used as the reference standards. RESULTS Blue dye-guided surgery identified 351 SLNs. Lymphosonography detected 293 SLNs and 11 false-positives, while lymphoscintigraphy detected 231 SLNs and 20 false-positives. The accuracy of SLN detection was 81.8% for lymphosonography, which was significantly higher than the 63.2% achieved with lymphoscintigraphy (P < .0001). The accuracy of lymphosonography for SLN characterization was 80%. When the size of the enhanced SLN was taken into consideration to characterize SLNs, the accuracy was 86%. CONCLUSIONS Lymphosonography is statistically better than lymphoscintigraphy for the detection of SLNs in this animal model. The ability to use lymphosonography as a means to characterize SLNs as benign or malignant is limited.
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Affiliation(s)
- Barry B Goldberg
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Holtel MR. Emerging Technology in Head and Neck Ultrasonography. Otolaryngol Clin North Am 2010; 43:1267-74, vii. [DOI: 10.1016/j.otc.2010.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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