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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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Rink M, Jung EM, Künzel J. The Use of Contrast-Enhanced Sonography for Therapy Monitoring of Metastatic Lymph Nodes: A Systematic Review. Curr Oncol 2023; 30:6734-6743. [PMID: 37504354 PMCID: PMC10378161 DOI: 10.3390/curroncol30070494] [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: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Metastatic cervical lymph nodes are a frequent finding in head and neck squamous cell carcinoma (HNSCC). If a non-surgical approach is primarily chosen, a therapy response evaluation of the primary tumor and the affected lymph nodes is necessary in the follow-up. Supplementary contrast-enhanced ultrasound (CEUS) can be used to precisely visualize the microcirculation of the target lesion in the neck, whereby malignant and benign findings differ in their uptake behavior. The same applies to many other solid tumors. For various tumor entities, it has already been shown that therapy monitoring is possible through regular contrast-enhanced sonography of the primary tumor or the affected lymph nodes. Thus, in some cases, maybe in the future, a change in therapy strategy can be achieved at an early stage in the case of non-response or, in the case of therapy success, a de-escalation of subsequent (surgical) measures can be achieved. In this paper, a systematic review of the available studies and a discussion of the potential of therapy monitoring by means of CEUS in HNSCC are presented.
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Affiliation(s)
- Maximilian Rink
- 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
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
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Rink M, Krassler J, Symeou L, Fischer R, Jung EM, Künzel J. [Use of Contrast enhanced Ultrasound (CEUS) in the Head and Neck Area: Update]. Laryngorhinootologie 2023; 102:450-463. [PMID: 37267968 DOI: 10.1055/a-1994-5141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the help of contrast enhanced ultrasound, the diagnostic accuracy of conventional sonography can be increased in many areas of otorhinolaryngology. Vascularisation and tissue perfusion can be objectified through the examination. This offers promising approaches for example to monitor the therapy of metastatic cervical lymph nodes or in the treatment of vascular malformations. Contrast Enhanced Ultrasound (CEUS) also offers great potential for differential diagnosis, for example of thyroid nodules. Valid threshold values for the quantitative time intensity curve (TIC) analysis of cervical pathologies are currently still not available. Further studies are necessary. As there is currently no license for the use of contrast enhanced ultrasound in otorhinolaryngology patients must be informed about its off-label use before the examination. This article is intended to provide an overview of the current possibilities and to serve as an introduction to the topic.
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Cocco G, Ricci V, Ricci C, Naňka O, Catalano O, Corvino A, Boccatonda A, Serafini FL, Izzi J, Vallone G, Cantisani V, Iannetti G, Caulo M, Ucciferri C, Vecchiet J, Pizzi AD. Ultrasound imaging of the axilla. Insights Imaging 2023; 14:78. [PMID: 37166516 PMCID: PMC10175532 DOI: 10.1186/s13244-023-01430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. To the best of our knowledge, in the pertinent literature, a detailed sonographic protocol to comprehensively assess the axillary region in daily practice is lacking. In this sense, the authors have briefly described the anatomical architecture of the axilla-also using cadaveric specimens-to propose a layer-by-layer sonographic approach to this challenging district. The most common sonographic pathological findings-for each and every anatomical compartment of the axilla-have been accurately reported and compared with the corresponding histopathological features. This ultrasound approach could be considered a ready-to-use educational guidance for the assessment of the axillary region. CRITICAL RELEVANCE STATEMENT: Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. The aim of this review article was to describe the anatomical architecture of the axilla, also using cadaveric specimens, in order to propose a layer-by-layer sonographic approach to this challenging district.
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Affiliation(s)
- Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Costantino Ricci
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Ondřej Naňka
- First Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic
| | - Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, Naples, Italy
| | - Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples Parthenope, Naples, Italy.
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio, Italy
| | - Francesco Lorenzo Serafini
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti, Italy
- Unit of Radiology, Santissima Annunziata Hospital, Chieti, Italy
| | - Jacopo Izzi
- Unit of Radiology, Santissima Annunziata Hospital, Chieti, Italy
| | - Gianfranco Vallone
- Department Life and Health V. Tiberio, Università Degli Studi del Molise, Campobasso, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology, Anatomo-Pathology, Sapienza-University of Rome, Rome, Italy
| | - Giovanni Iannetti
- Ospedale S. Spirito, Università Degli Studi Chieti-Pescara, Chieti, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti, Italy
| | - Claudio Ucciferri
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Jacopo Vecchiet
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Andrea Delli Pizzi
- Unit of Radiology, Santissima Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, University G. d'Annunzio, Chieti, Italy
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Zhang W, Yang G, Xu J, Ni T, Tang W, Zhou M. Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes. BMC Surg 2023; 23:71. [PMID: 36991353 DOI: 10.1186/s12893-023-01964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
AIM Summarized the incidence of bleeding after ultrasound-guided coarse needle biopsy (US-CNB) of benign cervical lymph nodes. METHODS We retrospectively examined the clinical and follow-up records of 590 patients with benign cervical lymph node disease who underwent US-CNB at our hospital during February 2015-July 2022 and were confirmed to have the disease by CNB and surgical pathology. The number of cases, types of diseases, and degree of bleeding of all patients with bleeding after US-CNB were statistically analyzed. RESULTS Of the 590 patients, bleeding was noted in 44 cases(7.46%), and the infectious lymph node bleeding rate was 9.48%. Infectious lymph nodes were more likely to bleed than noninfectious lymph nodes after CNB, ,x2 = 8.771; P = 0.003, Lymph nodes with pus were more likely to bleed than solid lymph nodes after CNB, x2 = 4.414; P = 0.036,. CONCLUSION The bleeding of all patients after CNB was minor bleeding. Infected lymph nodes bleed more frequently than noninfected lymph nodes. Lymph nodes with mobility and a large pus cavity, are more likely to bleed after CNB.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang.
- Department of Pathology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital), No.208 Huancheng East Road, 310003, Hangzhou, Zhejiang, China.
| | - Gaoyi Yang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Jianping Xu
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Tu Ni
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Wei Tang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Meiling Zhou
- Department of Pathology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital), No.208 Huancheng East Road, 310003, Hangzhou, Zhejiang, 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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Liu N, Chen Y, Wang Y, Huang W, Zhan L, Du Z, Zhong Z, Wu Z, Shen Y, Deng X, Ni S, Tang L. A combination of ultrasound and contrast-enhanced ultrasound improves diagnostic accuracy for the differentiation of cervical tuberculous lymphadenitis from primary lymphoma. Clin Hemorheol Microcirc 2023; 85:261-275. [PMID: 37599529 DOI: 10.3233/ch-231876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To present a method combining ultrasound (US) and contrast-enhanced ultrasound (CEUS) features for differential diagnosis of cervical tuberculous lymphadenitis (CTL) and primary lymphoma. METHODS A total of 155 patients with CTL (n = 49) and lymphoma (n = 106) who underwent US and CEUS were retrospectively included. The features extracted from US and CEUS and the significant clinical data were created three models using the least absolute shrinkage and selection operator and logistic regression analysis. The diagnostic performance of the models was assessed using the area under the curve (AUC). RESULTS The combined model outperformed US model and CEUS model in distinguish CTL from lymphoma achieved favorable performances in training set and validation set with AUCs of 0.958 and 0.946 as well as high accuracies (91.7% and 87.2%), sensitivities (95.9% and 84.4%) and specificities (82.4% and 93.3%). Delong's test showed that among the three models, combined model was significantly different from the other two models in training set (p = 0.011 and 0.029, respectively) and validation set (p = 0.018 and 0.001, respectively). CONCLUSIONS A combination of US and CEUS achieved good diagnostic performance in differentiating lymphoma and CTL, which might aid in clinical decision-making.
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Affiliation(s)
- Naxiang Liu
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yaoqin Wang
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Weiqin Huang
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Lili Zhan
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Zhongshi Du
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Zhaoming Zhong
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Zhougui Wu
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Youhong Shen
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaohong Deng
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shixiong Ni
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Lina Tang
- Department of Ultrasound, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Wang T, Xu M, Xu C, Wu Y, Dong X. Comparison of microvascular flow imaging and contrast-enhanced ultrasound for blood flow analysis of cervical lymph node lesions. Clin Hemorheol Microcirc 2023; 85:249-259. [PMID: 37694358 DOI: 10.3233/ch-231860] [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: 09/12/2023]
Abstract
OBJECTIVE To compare the diagnostic value of microvascular flow imaging (MVFI) with that of contrast-enhanced ultrasound (CEUS) for the analysis of blood flow in benign and malignant cervical lymph nodes. MATERIAL AND METHODS As a prospective study, 95 cervical enlarged lymph nodes (43 benign and 52 malignant) were observed in 95 patients using conventional ultrasonography (including gray and Color Doppler Flow Imaging), CEUS, and MVFI. Two researchers evaluated vascular parameters of MVFI (vascular distribution, internal vascular features, vascular index) and CEUS (enhancement mode, enhancement type) and compared the diagnostic effects of MVFI and CEUS.All results were compared with pathological findings. RESULTS There were significant differences in the vascular distribution and internal vascular features of benign and malignant lymph nodes on MVFI (P < 0.05). The vascular distribution of benign lymph nodes was mainly of the central and avascular types, the internal blood vessels were mostly normal, the vascular distribution of malignant lymph nodes was mainly mixed, the internal vessels were mainly tortuous and displaced. The optimal cut-off value of the benign and malignant lymph node vascular index (VI) was 15.55%, and the area under the receiver operating characteristic curve (AUC) of the VI was 0.876. There were also significant differences in the enhancement mode and types of benign and malignant lymph nodes in CEUS (P < 0.05). The benign lymph nodes showed centrifugal perfusion, and the enhancement types were mostly type I and type II. Most malignant lymph nodes showed centripetal or mixed perfusion, and the enhancement types were usually type III and type IV. The accuracy, sensitivity, and specificity of CEUS in the diagnosis of lymph node lesions were 84.2%, 84.6% and 83.7%, respectively, and the AUC was 0.845. The accuracy, sensitivity, and specificity of MVFI in the diagnosis of lymph node lesions were 85.3%, 84.6%, and 86.0%, respectively, and the AUC was 0.886. CONCLUSION Both CEUS and MVFI are valuable in differentiating benign and malignant lesions of lymph nodes and have a similar diagnostic performance; however, MVFI is less invasive and simpler than CEUS. Therefore it is preferred for auxiliary examination of enlarged lymph nodes that are difficult to diagnose by conventional ultrasound.
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Affiliation(s)
- Tianqi Wang
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Mingda Xu
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Changyu Xu
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuqing Wu
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaoqiu Dong
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Liu N, Tang L, Chen Y, Wang Y, Huang W, Du Z, Shen Y, Wu Z, He T, Su G, Xie W, Chen Y. A Combination of Contrast-Enhanced Ultrasound and Thyroglobulin Level in Fine-Needle Aspirates Improves Diagnostic Accuracy for Metastatic Lymph Nodes of Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2431-2443. [PMID: 34971466 DOI: 10.1002/jum.15926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with thyroglobulin (Tg) levels in fine-needle aspirates (FNA) washout fluid (FNA-Tg) in diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC) patients. METHODS Data from 190 LNs in 167 patients suspected of metastasis from the US between November 2018 and September 2020 were included. All subjects underwent FNA, CEUS, and FNA-Tg examinations. The final outcomes were confirmed by histopathological or cytological examination or follow-up imaging. Data were analyzed using the Wilcoxon rank-sum or chi-squared test. The diagnostic efficacy of FNA, CEUS, and FNA-Tg in diagnosing LNs was compared. RESULTS A cutoff value of 6.15 ng/ml (AUC 0.925, 95% confidence interval (CI) 0.885-0.966) successfully identified metastatic LNs. FNA missed 58 LN metastases, of these, 94.8% (55/58) were correctly diagnosed using the combination of CEUS and FNA-Tg. FNA-Tg showed higher sensitivity (90.2%), NPV (86.1%) and accuracy (88.9%) than either FNA (48.2, 57.4 and 69.5%, respectively) or CEUS (82.1, 67.7 and 70.5%, respectively) alone. The combination of CEUS, FNA and FNA-Tg resulted in maximal sensitivity (100%) and NPV (100%) but reduced specificity (51.3%) and overall diagnostic accuracy (80.0%). After adding FNA-Tg to discordant samples between CEUS and FNA, 81.9% of LNs (77/94) were correctly diagnosed. CONCLUSIONS The combination of FNA, FNA-Tg and CEUS was found to be a promising imaging tool in detecting metastatic LNs in PTC patients.
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Affiliation(s)
- Naxiang Liu
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Lina Tang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yaoqin Wang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Weiqin Huang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhongshi Du
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Youhong Shen
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhougui Wu
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Tongmei He
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Guangjian Su
- Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Wenting Xie
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yunchao Chen
- Department of Ultrasound, Xiang'an Hospital of Xiamen University, Xiamen, 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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Ding S, Xiong P, Zuo J. Value of contrast-enhanced ultrasound in predicting early lymph-node metastasis in oral cancer. Dentomaxillofac Radiol 2022; 51:20210293. [PMID: 34731028 PMCID: PMC8925872 DOI: 10.1259/dmfr.20210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To explore the value of contrast-enhanced ultrasound (CEUS) in predicting early lymph node metastasis in clinically node-negative oral cancer patients. METHODS We recruited 42 patients (a total of 70 lymph nodes) with clinically node-negative oral cancer in the study. All of them received both conventional ultrasound (B-mode and power Doppler) and CEUS before operation and then they were taken for pathological examination to analyze the diagnostic accuracy. And their CEUS data were analyzed qualitatively and quantitatively. RESULTS The sensitivity and specificity of CEUS in the diagnosis of cervical lymph node metastasis of oral cancer were 82.7 and 82.9%, respectively. The accuracy of conventional ultrasound was only 67.1% while that of CEUS was up to 82.9%. The area under the cure (AUC) of CEUS in detecting lymph node metastasis was 0.828, which was higher than the 0.614 by conventional ultrasound, with statistically significant differences observed (p < 0.05). Most of the metastatic lymph nodes were characterized by inhomogeneous enhancement and the peak intensity (PI) of the metastatic group was lower than that of the non-metastatic group (p < 0.05). CONCLUSIONS Compared with conventional ultrasound, CEUS may have higher clinical value for predicting early lymph node metastasis in clinically node-negative oral cancer patients. And quantitative parameters obtained from CEUS may provide valuable information in the diagnosis of cervical lymph node metastasis.
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Affiliation(s)
- Shiwen Ding
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaxin Zuo
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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12
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Zhuang L, Ming X, Liu J, Jia C, Jin Y, Wang J, Shi Q, Wu R, Jin L, Du L. Comparison of lymphatic contrast-enhanced ultrasound and intravenous contrast-enhanced ultrasound in the preoperative diagnosis of axillary sentinel lymph node metastasis in patients with breast cancer. Br J Radiol 2022; 95:20210897. [PMID: 34797694 PMCID: PMC8822558 DOI: 10.1259/bjr.20210897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES This study aimed to compare diagnostic efficiency for axillary sentinel lymph node (SLN) metastasis between lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (ICEUS) in patients with breast cancer. We also examined whether adding ICEUS to LCEUS could improve the diagnostic accuracy of LCEUS. METHODS Sixty-nine patients with breast cancer were recruited preoperatively. All patients underwent LCEUS followed by ICEUS, and the enhancement pattern of one SLN was analysed for each patient. The targeted SLN was marked with wire and excised during surgery. The imaging diagnosis was compared with the histopathological result. Diagnostic efficiency was compared among LCEUS, ICEUS, and the combination of LCEUS and ICEUS. RESULTS The sensitivity values for LCEUS, ICEUS, and the combination of LCEUS and ICEUS were 86.2%, 82.6% and 93.1%, respectively. Specificity values for the three methods were 95.0%, 92.5% and 87.5%, respectively. Accuracy values for the three methods were 91.3%, 88.4% and 89.9%, respectively. The area under the receiver operating characteristic (ROC) curve for LCEUS was 0.906, and there was no significant difference among LCEUS, ICEUS, and the combination of LCEUS and ICEUS (p = 0.752). CONCLUSIONS LCEUS may represent an accurate method for predicting SLN metastasis preoperatively. Our findings suggest that adding ICEUS to LCEUS for SLN evaluation in patients with breast cancer is unnecessary. ADVANCES IN KNOWLEDGE This is the first study in which both LCEUS and ICEUS were performed for the same lymph node and the first to compare the diagnostic efficiency of LCEUS, ICEUS, and the combination of LCEUS + ICEUS.
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Affiliation(s)
- Lingling Zhuang
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xu Ming
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yubiao Jin
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jing Wang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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13
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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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14
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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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15
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Shi XQ, Zhang H, Liu X, Dong Y, Yang P, Qian L. Feasibility and efficiency of contrast enhanced ultrasound real time guided fine needle aspiration for sentinel lymph node of breast cancer. Clin Hemorheol Microcirc 2022; 80:267-279. [PMID: 34719485 DOI: 10.3233/ch-211226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To assess the feasibility and efficiency of contrast-enhanced ultrasound (CEUS) real-time guided fine needle aspiration (FNA) for sentinel lymph node (SLN) of breast cancer. MATERIALS AND METHODS This retrospective study reviewed 21 breast cancer patients who scheduled for surgical resection performed CEUS real-time guided SLN-FNA and intraoperative SLN biopsy (SLNB). The success rate of CEUS real-time guided SLN-FNA was analyzed. The FNA diagnostic efficiency of SLN metastasis was analyzed compared to SLNB. RESULTS Twenty-six SLNs were detected by intradermal CEUS whereas 130 SLNs were detected by SLNB. The median SLNs detected by intradermal CEUS (n = 1) and by SLNB (n = 5) was significantly difference (p < 0.001). All 26 CE-SLNs of 21 patients were successfully performed intradermal CEUS dual image real-time guided SLN-FNA including 5 SLNs of 4 patients which were difficult to distinguish in conventional ultrasound. Compared to SLNB, FNA found 2 of 5 cases of SLN metastasis, the diagnosis sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, false positive rate and Yoden index were 40%, 100%, 100%, 84.2%, 60%, 0%and 40%, respectively. CONCLUSION SLN-FNA real-time guided by dual CEUS image mode was technically feasible. Patients with a positive SLN-FNA should be advised to ALND without intraoperative SLNB according to Chinese surgeon and patients' conservatism attitude. But a negative SLN-FNA did not obviate the need of conventional SLNB because of the high false negative rate.
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Affiliation(s)
- Xian-Quan Shi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huiming Zhang
- Department of Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xi Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yunyun Dong
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peipei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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16
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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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17
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Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizon. Cancers (Basel) 2021; 13:cancers13184554. [PMID: 34572781 PMCID: PMC8465736 DOI: 10.3390/cancers13184554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
The lymphatic system is an anatomically complex vascular network that is responsible for interstitial fluid homeostasis, transport of large interstitial particles and cells, immunity, and lipid absorption in the gastrointestinal tract. This network of specially adapted vessels and lymphoid tissue provides a major pathway for metastatic spread. Many malignancies produce vascular endothelial factors that induce tumoral and peritumoral lymphangiogenesis, increasing the likelihood for lymphatic spread. Radiologic evaluation for disease staging is the cornerstone of oncologic patient treatment and management. Multiple imaging modalities are available to access both local and distant metastasis. In this manuscript, we review the anatomy, physiology, and imaging of the lymphatic system.
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18
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Toki A, Niikura H, Mori N, Shigeta S, Nagai T, Tokunaga H, Shimada M, Yaegashi N. Establishment of a Diagnostic Method for Pelvic Sentinel Lymph Node Metastasis by Contrast-Enhanced Ultrasound in Uterine Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2107-2116. [PMID: 34052062 DOI: 10.1016/j.ultrasmedbio.2021.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
This study investigated the usefulness of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in distinguishing metastasis of pelvic sentinel lymph nodes (SLNs) in patients with gynecological cancer. We examined 74 SLNs of patients with endometrial cancer (n = 26) and cervical cancer (n = 11). Patients underwent US and CEUS followed by SLN biopsy; US and CEUS results were evaluated visually and quantitatively and compared between pathological metastasis-negative and -positive groups. To support CEUS results, the microvessel density of SLNs was evaluated immunohistochemically. Seventeen positive and 40 negative SLNs were evaluable. Margin and enhancement patterns by visual assessment revealed significant differences (p = 0.046 and 0.022, respectively). In quantitative time-intensity curve analyses, the weakest peak intensities (PImin), PI ratio and PI difference indicated significant differences (p = 0.045, p < 0.001 and p < 0.001, respectively). The areas under the receiver operating characteristic curves (AUCs) were 0.64, 0.82 and 0.83, respectively. The most effective PI ratio from the AUC was 1.3 (sensitivity = 82%, specificity = 70%), and the PI difference from the AUC was 20 (sensitivity = 88%, specificity = 70%). Microvessel density was significantly lower in metastatic lesions than in other areas. The quantitative analysis of CEUS seemed to be a reasonable method for distinguishing lymph node metastasis in patients with gynecological cancer.
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Affiliation(s)
- Asami Toki
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hitoshi Niikura
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shogo Shigeta
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomoyuki Nagai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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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: 11] [Impact Index Per Article: 3.7] [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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Huang S, Zhao Y, Jiang X, Lin N, Zhang M, Wang H, Zheng A, Ma X. Clinical Utility of Contrast-enhanced Ultrasound for the Diagnosis of Lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:869-879. [PMID: 33487474 DOI: 10.1016/j.ultrasmedbio.2020.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Abstract
This meta-analysis aimed to evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in identifying lymphazdenopathy. PubMed, Web of Science, Embase and the Cochrane Library were searched for relevant articles through September 2020. A total of 16 articles, which included 1787 participants, were analyzed. The summary sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio of CEUS for diagnosing lymphadenopathy were 0.88 (0.86-0.90), 0.90 (0.88-0.92), 6.04 (3.67-9.95), 0.15 (0.10-0.21) and 47.38 (23.45-95.66), respectively. The summary receiver operating characteristic (SROC) area under the curve (AUC) was 0.9405. After omitting outliers identified in a bivariate box plot and forest plot, heterogeneity was decreased, and the pooled sensitivity and specificity were 0.87 (0.84-0.90) and 0.87 (0.84-0.90), respectively. Furthermore, the SROC AUC was 0.9327. In conclusion, CEUS has the potential to be a valuable tool for characterizing lymphadenopathy and could provide clinical decision support.
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Affiliation(s)
- Siyang Huang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan, Chengdu, China
| | - Yunuo Zhao
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xian Jiang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan, Chengdu, China
| | - Nan Lin
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mingxuan Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Aiping Zheng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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21
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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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Ling W, Nie J, Zhang D, Yang Q, Jin H, Ou X, Ma X, Luo Y. Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis of Cervical Lymph Node Metastasis in Nasopharyngeal Carcinoma (NPC) Patients. Front Oncol 2020; 10:972. [PMID: 32766127 PMCID: PMC7379866 DOI: 10.3389/fonc.2020.00972] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: The aim of the study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant cervical lymph nodes in patients with nasopharyngeal carcinoma (NPC). Material and Methods: A total of 144 NPC patients with enlarged superficial cervical lymph nodes underwent CEUS examination. The comparison of CEUS image characteristics between malignant and benign cervical lymph nodes was performed in this study as well. We analyzed parameters of the time–intensity curve (TIC), which includes time to peak (TP), area under the gamma curve (AUC), and peak intensity (PI). Furthermore, receiver operating characteristic (ROC) curve analysis was also investigated to evaluate the diagnostic value of CEUS. Result: We conducted 144 lymph node examinations in total, where 64 cases were biopsy-proven benign nodules and 80 cases were biopsy-proven metastatic nodules. The vast majority of the benign nodes displayed centrifugal perfusion (96.88%, 62/64) and homogeneous enhancement (93.75%, 60/64), while most of the malignant nodes showed centripetal perfusion (92.50%, 74/80) and inhomogeneous 80.00% (64/80). In addition, quantitative analysis showed that CEUS parameters including PI, TP, and AUC in benign lymph nodes (12.51 ± 2.15, 23.79 ± 11.80, and 1110.33 ± 286.17, respectively) were significantly higher than that in the malignant nodes (10.51 ± 2.98, 16.52 ± 6.95, and 784.09 ± 340.24, respectively). The assistance of the three aforementioned parameters and CEUS image characteristics would result in an acceptable diagnostic value. Conclusion: Our results suggest that imaging perfusion patterns as well as quantitative parameters obtained from CEUS provide valuable information for the evaluation of cervical lymph nodes in NPC patients.
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Affiliation(s)
- Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Ji Nie
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Dingyue Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qianru Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hongyu Jin
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuejin Ou
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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Nie J, Ling W, Yang Q, Jin H, Ou X, Ma X. The Value of CEUS in Distinguishing Cancerous Lymph Nodes From the Primary Lymphoma of the Head and Neck. Front Oncol 2020; 10:473. [PMID: 32373513 PMCID: PMC7186353 DOI: 10.3389/fonc.2020.00473] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/16/2020] [Indexed: 02/05/2023] Open
Abstract
Aim: The purpose of this study was to assess the ability of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of cancerous lymph nodes. Methods: Contrast-enhanced ultrasonography was performed in the cervical nodules of included patients, and the diagnoses were confirmed by pathological examination. Contrast-enhanced ultrasonography images and parameters of head and neck lymphomas were compared with those of cancerous lymph nodes. Besides, receiver operating characteristic curve was operated to access the diagnostic value of CEUS. Results: Finally, a total of 63 head and neck lymphomas and 80 cervical cancerous lymph nodes were enrolled in this study. Results showed that the CEUS images of lymphoma were mainly characterized by homogeneous enhancement (71.43%), and approximately half of them were centripetal perfusion (58.73%), whereas most CEUS images of cancerous lymph nodes were inhomogeneous enhancement (82.50%) and centripetal perfusion (92.50%). Quantitative analysis of CEUS parameters indicated that PI (derived peak intensity) and AUC (area under the curve) of lymphomas were both lower than those of cancerous lymph nodes (PI: 8.78 vs. 10.51, AUC: 652.62 vs. 784.09, respectively) (P < 0.05). Receiver operating characteristic analysis showed that the sensitivity of CEUS parameters in the differential diagnosis was significant (80.00%), although the specificity was not high (47.62%). When parameters were combined with the image features, the accuracy of diagnosis was greatly improved (from 0.655 to 0.899). Conclusion: Contrast-enhanced ultrasonography could be a promising tool for the differential diagnosis of head and neck lymphomas and cancerous lymph nodes.
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Affiliation(s)
- Ji Nie
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Qianru Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hongyu Jin
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuejin Ou
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
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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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Preliminary study of real-time three-dimensional contrast-enhanced ultrasound of sentinel lymph nodes in breast cancer. Eur Radiol 2019; 30:1426-1435. [PMID: 31776739 DOI: 10.1007/s00330-019-06494-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/31/2019] [Accepted: 10/03/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the clinical value of real-time three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the detection of sentinel lymph nodes (SLNs) and drainage lymphatics in breast cancer patients. METHOD The prospective study was performed in women with pathology-confirmed T1/2 breast cancer between June 2016 and December 2017 who underwent sentinel lymph node biopsy and 3D-CEUS. The number, size, location, enhancement pattern of SLNs, and the lymphatic drainage patterns were reviewed. The routes, location of SLNs, and lymph channels (LCs) on the surface were marked. All patients underwent blue dye-guided sentinel lymph node biopsy (SLNB) finally. RESULTS According to the postoperative pathology findings and the blue dye staining of the lymphatic drainage routes, there are six patterns of lymphatic drainage routes and the coincidence rate of the 3D-CEUS was 97.4%; the sensitivity, specificity, positive predictive value, negative predictive value, the LN detection rate, and the correct diagnosis rate of the 3D-CEUS were 75%, 93.0%, 81.8%, 89.9%, 95.3%, and 87.7%, respectively. CONCLUSION 3D-CEUS is a new feasible and useful approach to detect the SLNs and LCs. 3D-CEUS can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes. KEY POINTS • The three-dimensional contrast-enhanced ultrasound can detect the sentinel lymph nodes. • The three-dimensional contrast-enhanced ultrasound can show the stereo direction of sentinel lymph nodes and lymph drainage routes. • The three-dimensional contrast-enhanced ultrasound can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes.
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Mozzini C, Pesce G, Casadei A, Girelli D, Soresi M. Ultrasound as First Line Step in Anaemia Diagnostics. Mediterr J Hematol Infect Dis 2019; 11:e2019066. [PMID: 31700591 PMCID: PMC6827602 DOI: 10.4084/mjhid.2019.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 12/25/2022] Open
Abstract
This review covers the role of ultrasonography as an essential non-invasive diagnostic approach when facing patients with anaemia, a common clinical problem. Abdomen ultrasound is well recognised as a first-line examination in the setting of blood loss, both acute and chronic. Less is clear about the additional opportunities, given by ultrasound in anaemia, due to the many other possible causes. Here we provide information on the utility of ultrasound in different contexts and a practical guide for clinicians facing anaemic patients.
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Affiliation(s)
- Chiara Mozzini
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Giancarlo Pesce
- Sorbonne Universitè INSERM UMR-S1136 Institut Pierre Louis d’ Epidemiologie et de Sanitè Publique, Team EPAR F75012, Paris, France
| | - Alder Casadei
- Ultrasound Association of South-Tyrol, Bolzano Health District, Piazza W.A. Loew-Cadonna 12, 39100 Bolzano, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Maurizio Soresi
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Via del Vespro, 141-90127 Palermo, Italy
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Sim JK, Lee JY, Hong HS. Differentiation Between Malignant and Benign Lymph Nodes: Role of Superb Microvascular Imaging in the Evaluation of Cervical Lymph Nodes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3025-3036. [PMID: 30945325 DOI: 10.1002/jum.15010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study aimed to assess the value of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) for distinguishing between benign and malignant cervical lymph nodes (LNs) and to compare SMI with power Doppler ultrasound (PDUS). METHODS Power Doppler ultrasound and SMI examinations were performed for patients' cervical LNs. The distribution of feeding vessels, number, and appearance of internal vessels were analyzed by 2 readers, and the results of PDUS and SMI were compared. Interobserver agreement was assessed. A subgroup analysis was performed to assess differences in vascular patterns between metastasis and tuberculous lymphadenitis and between Kikuchi disease and lymphoma. The diagnostic performance for distinguishing between benign and malignant LNs was calculated. RESULTS In total, 147 patients with 147 cervical LNs (85 benign and 62 malignant) were assessed. Interobserver agreement was moderate to strong for SMI. There were significant differences in the vascular patterns between benign and malignant LNs on SMI (distribution, number, and appearance, all P < .001), but not on PDUS. In the subgroup analysis, SMI showed a significant difference in the vascular patterns observed between metastasis and tuberculous lymphadenitis (distribution, P = .012; number, P = .014; and appearance, P = .005). Superb Microvascular Imaging detected significantly greater numbers of vessels in lymphoma than in Kikuchi disease (P = .012). The sensitivity of SMI was significantly greater than that of PDUS in distinguishing malignant from benign LNs (86.9% versus 54.1%; P < .001). CONCLUSIONS Superb Microvascular Imaging yields more detailed information about nodal vessels than does PDUS by enabling visualization of small nodal vessels. Superb Microvascular Imaging is useful and feasible for differentiating between malignant and benign cervical LNs.
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Affiliation(s)
- Joo Kyung Sim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Abstract
CLINICAL/METHODICAL ISSUE Daily tasks in sonographic diagnostics include detection and characterization of peripheral and abdominal lymph nodes. STANDARD RADIOLOGICAL METHODS In addition to the B‑mode methods, color-coded Doppler sonography (CCDS) plays an important role in the evaluation of lymph nodes. METHODICAL INNOVATIONS Contrast-enhanced ultrasound (CEUS) has become a standard procedure in vascular and organ diagnostics. Tissue perfusion can be recorded visually and retrospectively in real time using time-dependent intensity analysis. The contrast agent dosage depends primarily on the location of the lymph nodes and the type and frequency of the transducer. Vascular and tumor cell density, intranodal pressure due to increased vascular permeability and preservation or destruction of the capsule must be taken into account when interpreting the findings. PERFORMANCE The indication for CEUS results from the B‑mode and CCDS findings and plays an important role especially in the verification of vitality before and after therapy. Uneven or apparently non-perfused areas allow a targeted puncture of vital tumor tissue. ACHIEVEMENTS Especially in abdominal lymph nodes, CEUS has a high diagnostic reliability. It is not always possible to differentiate between inflamed lymph nodes and lymph nodes altered by lymphoma filtration. PRACTICAL RECOMMENDATIONS CEUS helps to better assess the dignity of lymph nodes by visualizing their micro- and macrovascularization. After frustrated puncture, vital areas can be specifically biopsied. CEUS is particularly valuable in assessing the success of therapy.
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Affiliation(s)
- H-P Weskott
- Ultraschall Ambulanz, Klinikum Siloah-Oststadt-Heidehaus, Klinikum Region Hannover, Stadionbrücke 4, 30459, Hannover, Deutschland.
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Ma X, Ling W, Xia F, Zhang Y, Zhu C, He J. Application of Contrast-Enhanced Ultrasound (CEUS) in Lymphomatous Lymph Nodes: A Comparison between PET/CT and Contrast-Enhanced CT. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:5709698. [PMID: 30809108 PMCID: PMC6364116 DOI: 10.1155/2019/5709698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/24/2018] [Accepted: 01/03/2019] [Indexed: 02/06/2023]
Abstract
Purpose We described imaging characteristics of different types of lymphomas using contrast-enhanced ultrasound (CEUS) and summarized some simple criteria to distinguish between normal lymph nodes and lymphomatous lymph nodes for clinical diagnosis. Materials and methods Sixty-one lymphoma patients from 2014 to 2015 with 140 suspicious lymph nodes, who had been confirmed by histology and underwent chemotherapy, were enrolled in our study. The responses to chemotherapy were recorded by PET/CT, contrast-enhanced CT, or CEUS. Results We summarized the CEUS enhancement patterns as two types when detecting lymphomatous lymph nodes, which could be the specific diagnostic criteria: (1) rapid well-distributed hyperenhancement, with 83.1% lesions exhibiting a fast-in hyperenhancement pattern in the arterial phase, and (2) rapid heterogeneous hyperenhancement, with 16.9% lesions exhibiting heterogeneous in the arterial phase. Particularly, we found that all the suspicious lesions of indolent lymphomas were rapid well-distributed hyperenhancement. CEUS successfully identified 117 lymphomatous lymph nodes, while PET/CT and contrast-enhanced CT detected 124 and 113 lymphomatous lymph nodes, respectively. CEUS had an accuracy of 83.57%, and the accuracy of PET/CT and contrast-enhanced CT was 88.57% and 80.71%, respectively (p=0.188). The false-negative rate was 16.43%, 11.43%, and 19.29%, respectively (p=0.188). Conclusion CEUS could be a useful tool in detecting lymphomatous nodes. A rapid well-distributed hyperenhancement pattern in CEUS could be a useful diagnostic criterion in both aggressive lymphoma and indolent lymphoma. These results can help us distinguish between lymphomatous and benign lymph nodes and make better diagnostic and therapeutic decisions.
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Affiliation(s)
- Xuelei Ma
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fan Xia
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yifan Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenjing Zhu
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jialing He
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Mei M, Ye L, Quan J, Huang P. Contrast-enhanced ultrasound for the differential diagnosis between benign and metastatic superficial lymph nodes: a meta-analysis. Cancer Manag Res 2018; 10:4987-4997. [PMID: 30464599 PMCID: PMC6208530 DOI: 10.2147/cmar.s174751] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Contrast-enhanced ultrasound (CEUS) is a new technique used to distinguish benign from metastatic superficial lymph nodes (LNs) with variable accuracy. The objective of this meta-analysis was to evaluate the accuracy of CEUS for the diagnosis of superficial metastatic LNs. Methods A comprehensive literature search of PubMed, Web of Science, Medline, Embase, and the Cochrane Library was performed until April 2018. Nine articles reporting the diagnosis of 436 LNs by CEUS were investigated. The Mantel–Haenszel and DerSimonian–Laird methods were used to analyze pooled sensitivity, specificity, diagnostic OR, positive likelihood ratio (LR), and negative LR, and a summary receiver operating characteristic (SROC) curve was also evaluated. Results The pooled sensitivity and specificity of CEUS for the differential diagnosis of benign and metastatic superficial LNs were 0.88 (95% CI, 0.83–0.92) and 0.80 (95% CI, 0.74–0.85), respectively. The pooled positive LR, negative LR, and diagnostic OR were 4.36 (95% CI, 2.38–7.99), 0.17 (95% CI, 0.10–0.31), and 32.75 (95% CI, 11.08–96.84), respectively. SROC area under the curve (AUC) was 0.9288. The subgroup analysis excluding outliers implied that the heterogeneity was almost eliminated, and the pooled sensitivity and specificity were 0.87 (95% CI, 0.81–0.92) and 0.79 (95% CI, 0.71–0.85), respectively. The SROC AUC was 0.8950. Conclusion CEUS, a novel imaging modality for the characterization of superficial LNs, shows a high sensitivity and specificity in the diagnosis of superficial metastatic LNs. The different diagnostic standards, contrast agents, and contrast modes contribute to a considerable level of heterogeneity among studies. A uniform standard for distinguishing between benign and metastatic LNs is needed for further clinical application.
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Affiliation(s)
- Mei Mei
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China,
| | - Ligang Ye
- Department of Emergency, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Juan Quan
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China,
| | - Pintong Huang
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China,
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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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Targeted ultrasound and fine-needle aspiration cytology for sentinel node diagnostics in early-stage melanoma: a validation study. Melanoma Res 2018; 28:319-325. [DOI: 10.1097/cmr.0000000000000448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Oikawa SI, Shiga K, Saito D, Katagiri K, Ikeda A, Tuchida K, Miyaguchi J, Ishida K, Sugai T. Association between contrast-enhanced ultrasonography and histopathological findings of the metastatic lymph nodes of patients with head and neck cancer: A preliminary study. Oncol Lett 2018. [PMID: 29541182 PMCID: PMC5835891 DOI: 10.3892/ol.2018.7835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to investigate the usefulness of contrast-enhanced ultrasonography (CEUS) and a newly developed analysis software for the detection of microcapillary network distribution in lymph nodes of patients with head and neck cancer (HNC) by comparing the CEUS and histopathological findings. Patients that were diagnosed with HNC between February and September 2016 were enrolled. A total of five patients underwent resection of the primary tumor and neck dissection as their initial treatment. The cervical lymph nodes of these patients were analyzed by CEUS intraoperatively, and their surgical specimens were examined histopathologically. The patients were diagnosed using a combination of physical examination, computed tomography, magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography. For CEUS examination, the microbubble contrast agent Sonazoid™ was injected into a peripheral vein. Video images of the metastatic lymph nodes were captured, and these were subjected to analysis by a newly developed image-analysis software. It was possible to perform intraoperative CEUS of metastatic lymph nodes and obtain accurate matched sections for histopathological examination. Hematoxylin and eosin and cluster of differentiation (CD)34 staining revealed that the software was able to accurately detect capillary vessels in metastatic lymph nodes. However, a number of perfusion deficits were observed in these lymph nodes. In conclusion, by using CEUS with the analysis software, the density and distribution of blood vessels in the metastatic lymph nodes of patients with HNC was revealed. Although the present study was limited and preliminary, it was concluded that this method may be useful to evaluate and to map the capillary vessels in the metastatic lymph nodes of patients with HNC.
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Affiliation(s)
- Shin-Ichi Oikawa
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Daisuke Saito
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Katsunori Katagiri
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Aya Ikeda
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Kodai Tuchida
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Jun Miyaguchi
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Kazuyuki Ishida
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
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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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Gvetadze SR, Xiong P, Li J, Lv M, Li J, Yang X, Ilkaev KD, Sun J. Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:495-499. [DOI: 10.1016/j.oooo.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 12/27/2022]
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Linta N, Baron Toaldo M, Bettini G, Cordella A, Quinci M, Pey P, Galli V, Cipone M, Diana A. The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats. BMC Vet Res 2017; 13:141. [PMID: 28545570 PMCID: PMC5445396 DOI: 10.1186/s12917-017-1061-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures. RESULTS Forty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46-13.52 s) and benign (4.52 s - range 2.87-6.06 s) pulmonary lesions. CONCLUSIONS CEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels. Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.
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Affiliation(s)
- N. Linta
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - G. Bettini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Cordella
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Quinci
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - P. Pey
- ANTECH Imaging Services, 17672-B Cowan Avenue, Irvine, CA 92614 USA
| | - V. Galli
- Freelance sonographer, Rome, Italy
| | - M. Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
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Dietrich CF, Dong Y, Froehlich E, Hocke M. Dynamic contrast-enhanced endoscopic ultrasound: A quantification method. Endosc Ultrasound 2017; 6:12-20. [PMID: 28218195 PMCID: PMC5331837 DOI: 10.4103/2303-9027.193595] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/05/2016] [Indexed: 12/12/2022] Open
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) has been recently standardized by guidelines and recommendations. The European Federation of Societies for US in Medicine and Biology position paper describes the use for DCE-US. Comparatively, little is known about the use of contrast-enhanced endoscopic US (CE-EUS). This current paper reviews and discusses the clinical use of CE-EUS and DCE-US. The most important clinical use of DCE-US is the prediction of tumor response to new drugs against vascular angioneogenesis.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Germany
| | - Yi Dong
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Germany
| | | | - Michael Hocke
- Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Academic Teaching Hospital of the University of Jena, Germany
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Tan S, Miao LY, Cui LG, Sun PF, Qian LX. Value of Shear Wave Elastography Versus Contrast-Enhanced Sonography for Differentiating Benign and Malignant Superficial Lymphadenopathy Unexplained by Conventional Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:189-199. [PMID: 27925679 DOI: 10.7863/ultra.16.01014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy of shear wave elastography (SWE) and contrast-enhanced sonography in the differential diagnosis of superficial lymphadenopathy with abnormal imaging findings, which could not be otherwise confirmed by conventional sonography. METHODS Forty-two enlarged superficial lymph nodes in 42 patients who met the screening criteria for this study were evaluated by both contrast-enhanced sonography and SWE. All lymph nodes underwent both methods using biopsy pathologic findings as a reference standard. RESULTS The maximum elastic modulus, mean elastic modulus, and standard deviation of the elastic modulus were the main distinguishing features on SWE; they were significantly higher in malignant lesions than benign ones. The threshold value for the maximum elastic modulus was set at 37.9 kPa, and the sensitivity, specificity, and accuracy of differential diagnosis of superficial lymph nodes were 81.8%, 80.0%, and 81.0%, respectively. The diagnosis of benignity and malignancy by this index was statistically significant (P < .001). The lymph nodes were divided into benign and malignant groups according to different types based on the degree and range of intensity on contrast-enhanced sonography: intense or moderate homogeneous enhancement (n = 26) and heterogeneous, low homogeneous, or absent enhancement (n = 16). The sensitivity, specificity, and accuracy of contrast-enhanced sonography were 27.3%, 50.0%, and 38.1%. There was no statistically significant difference in the values between the benign and malignant groups (χ2 = 2.295; P = .130). CONCLUSIONS Compared with contrast-enhanced sonography, SWE has better diagnostic value and efficiency in differentiation of superficial lymph nodes unexplained by conventional sonography. When conventional sonography cannot differentiate malignant superficial lymph nodes from benign ones, SWE is a useful adjunctive tool for assessment of lymph nodes.
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Affiliation(s)
- Shi Tan
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, 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
| | - Peng-Fei Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Cui Z, Gao Y, Wang W, Zhu Z, Zhang Y, Ma Z. Evaluation of Neck Lymph Node Metastasis on Contrast-Enhanced Ultrasound: An Animal Study. Clin Exp Otorhinolaryngol 2016; 10:109-114. [PMID: 27416741 PMCID: PMC5327590 DOI: 10.21053/ceo.2015.01284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/03/2015] [Accepted: 03/10/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives To assess the performance of contrast-enhanced ultrasound (CEUS) intended to differentiate hyperplastic from malignant neck lymph nodes in an animal model. Methods Twenty-four New Zealand rabbits were randomly divided into two groups: neck lymph node metastasis group (12 rabbits) and reactive hyperplastic lymph node group (12 rabbits). Tongue VX2 carcinoma with cervical lymph node metastasis was induced in 12 rabbits by injecting VX2 carcinoma suspension into the left tongue submucosa. Hyperplastic neck lymph nodes were induced by injecting egg yolk in the submandibular region of the rabbits in hyperplastic group. CEUS were performed in both groups before and after intravenous administration of SonoVue. The site, number, echogenicity, longitudinal and transverse nodal dimensions, patterns of enhancement of the neck lymph nodes were observed and recorded. Results In both groups only one lymph node was found in the left (tumor) side of the neck. CEUS found 12 of 12 metastatic lymph nodes in metastasis group, and diagnosed 11 of 12 lymph nodes as metastatic. Histopathologic analysis revealed metastatic lesions in all 12 rabbits, each with one lymph node, and all 12 lymph nodes in hyperplastic group is inflammation lymph nodes. All 12 cases in the hyperplastic group showed centripetal homogeneous enhancement while in the metastasis group one case showed centripetal homogeneous enhancement, three cases showed centrifugal heterogeneous enhancement, and eight cases showed diffused heterogeneous enhancement. Only one lymph node was dissected on the left side of the neck in each rabbit in both groups. Conclusion CEUS can play a role in discriminating metastatic from hyperplastic lymph nodes in head and neck carcinoma.
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Affiliation(s)
- Zheng Cui
- Department of Ultrasound Diagnosis, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Gao
- Department of Otorhinolaryngology-Head and Neck Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weihua Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenghua Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhaoxin Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
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Jin Y, He YS, Zhang MM, Parajuly SS, Chen S, Zhao HN, Peng YL. Value of contrast-enhanced ultrasonography in the differential diagnosis of enlarged lymph nodes: a meta-analysis of diagnostic accuracy studies. Asian Pac J Cancer Prev 2016; 16:2361-8. [PMID: 25824765 DOI: 10.7314/apjcp.2015.16.6.2361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis. MATERIALS AND METHODS Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct 2?2 contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. RESULTS The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant. CONCLUSIONS CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.
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Affiliation(s)
- Ya Jin
- Department of Ultrasound in West China Hospital, University of Sichuan, Chengdu, China E-mail :
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Transcutaneous Ultrasound: Elastographic Lymph Node Evaluation. Current Clinical Applications and Literature Review. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 42:16-30. [PMID: 26489365 DOI: 10.1016/j.ultrasmedbio.2015.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/12/2015] [Accepted: 09/04/2015] [Indexed: 12/11/2022]
Abstract
Distinguishing malignant versus benign lymphadenopathies is a major diagnostic dilemma in clinical medicine. Metastatic deposits in normal-sized lymph nodes (LNs) can be smaller than a millimeter, thus presenting a diagnostic challenge. In most clinical settings, however, enlarged LNs detected on imaging need to be classified as malignant or benign. Ultrasound seems to be a very reliable method for LN characterization because of the high resolution, especially in the subcutaneous areas. However, B-mode and Doppler-ultrasound criteria for characterization of a lymphadenopathy as benign or malignant are lacking specificity. Newer methods such as elastography seem to be valuable for identifying metastatic deposits within LNs and may help discriminate malignant and benign LNs. This review summarizes the different elastographic methods available and provides an overview of the relevant publications. According to the literature, elastography can be used for identifying metastatic deposits, to guide fine needle aspiration and to non-invasively choose the most suspicious LN of a group of enlarged LNs for targeted biopsy.
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Rizzo G, Raffeiner B, Coran A, Ciprian L, Fiocco U, Botsios C, Stramare R, Grisan E. Pixel-based approach to assess contrast-enhanced ultrasound kinetics parameters for differential diagnosis of rheumatoid arthritis. J Med Imaging (Bellingham) 2015; 2:034503. [PMID: 27014713 DOI: 10.1117/1.jmi.2.3.034503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/13/2015] [Indexed: 12/15/2022] Open
Abstract
Inflammatory rheumatic diseases are the leading causes of disability and constitute a frequent medical disorder, leading to inability to work, high comorbidity, and increased mortality. The standard for diagnosing and differentiating arthritis is based on clinical examination, laboratory exams, and imaging findings, such as synovitis, bone edema, or joint erosions. Contrast-enhanced ultrasound (CEUS) examination of the small joints is emerging as a sensitive tool for assessing vascularization and disease activity. Quantitative assessment is mostly performed at the region of interest level, where the mean intensity curve is fitted with an exponential function. We showed that using a more physiologically motivated perfusion curve, and by estimating the kinetic parameters separately pixel by pixel, the quantitative information gathered is able to more effectively characterize the different perfusion patterns. In particular, we demonstrated that a random forest classifier based on pixelwise quantification of the kinetic contrast agent perfusion features can discriminate rheumatoid arthritis from different arthritis forms (psoriatic arthritis, spondyloarthritis, and arthritis in connective tissue disease) with an average accuracy of 97%. On the contrary, clinical evaluation (DAS28), semiquantitative CEUS assessment, serological markers, or region-based parameters do not allow such a high diagnostic accuracy.
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Affiliation(s)
- Gaia Rizzo
- University of Padova , Department of Information Engineering, G. Gradenigo 6/A, Padova 35131, Italy
| | - Bernd Raffeiner
- General Hospital of Bolzano , Rheumatology Unit, Via Lorenz Boehler 5, Bolzano 39100, Italy
| | - Alessandro Coran
- University of Padova , Department of Medicine, Via Giustiniani 2, Padova 35128, Italy
| | - Luca Ciprian
- Nursing Home Giovanni XXIII , Via Giovanni XXIII 7, Monastier di Treviso (TV) 31050, Italy
| | - Ugo Fiocco
- University of Padova , Department of Medicine, Via Giustiniani 2, Padova 35128, Italy
| | - Costantino Botsios
- University of Padova , Department of Medicine, Via Giustiniani 2, Padova 35128, Italy
| | - Roberto Stramare
- University of Padova , Department of Medicine, Via Giustiniani 2, Padova 35128, Italy
| | - Enrico Grisan
- University of Padova , Department of Information Engineering, G. Gradenigo 6/A, Padova 35131, Italy
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Fröhlich E, Muller R, Cui XW, Schreiber-Dietrich D, Dietrich CF. Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:179-96. [PMID: 25614391 DOI: 10.7863/ultra.34.2.179] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Dynamic contrast-enhanced ultrasound (US) imaging, a technique that uses microbubble contrast agents with diagnostic US, has recently been technically summarized and reviewed by a European Federation of Societies for Ultrasound in Medicine and Biology position paper. However, the practical applications of this imaging technique were not included. This article reviews and discusses the published literature on the clinical use of dynamic contrast-enhanced US. This review finds that dynamic contrast-enhanced US imaging is the most sensitive cross-sectional real-time method for measuring the perfusion of parenchymatous organs noninvasively. It can measure parenchymal perfusion and therefore can differentiate between benign and malignant tumors. The most important routine clinical role of dynamic contrast-enhanced US is the prediction of tumor responses to chemotherapy within a very short time, shorter than using Response Evaluation Criteria in Solid Tumors criteria. Other applications found include quantifying the hepatic transit time, diabetic kidneys, transplant grafts, and Crohn disease. In addition, the problems involved in using dynamic contrast-enhanced US are discussed.
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Affiliation(s)
- Eckhart Fröhlich
- Department of Internal Medicine I, Karl-Olga-Krankenhaus Stuttgart, Academic Teaching Hospital of the University of Ulm, Germany (E.F.); Tropical Health Solutions Pty, Ltd, and Anton-Breinl Center, James Cook University, Townsville City, Queensland, Australia (R.M.); Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, and Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany (X.-W.C., D.S.-D., C.F.D.)
| | - Reinhold Muller
- Department of Internal Medicine I, Karl-Olga-Krankenhaus Stuttgart, Academic Teaching Hospital of the University of Ulm, Germany (E.F.); Tropical Health Solutions Pty, Ltd, and Anton-Breinl Center, James Cook University, Townsville City, Queensland, Australia (R.M.); Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, and Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany (X.-W.C., D.S.-D., C.F.D.)
| | - Xin-Wu Cui
- Department of Internal Medicine I, Karl-Olga-Krankenhaus Stuttgart, Academic Teaching Hospital of the University of Ulm, Germany (E.F.); Tropical Health Solutions Pty, Ltd, and Anton-Breinl Center, James Cook University, Townsville City, Queensland, Australia (R.M.); Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, and Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany (X.-W.C., D.S.-D., C.F.D.)
| | - Dagmar Schreiber-Dietrich
- Department of Internal Medicine I, Karl-Olga-Krankenhaus Stuttgart, Academic Teaching Hospital of the University of Ulm, Germany (E.F.); Tropical Health Solutions Pty, Ltd, and Anton-Breinl Center, James Cook University, Townsville City, Queensland, Australia (R.M.); Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, and Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany (X.-W.C., D.S.-D., C.F.D.)
| | - Christoph F Dietrich
- Department of Internal Medicine I, Karl-Olga-Krankenhaus Stuttgart, Academic Teaching Hospital of the University of Ulm, Germany (E.F.); Tropical Health Solutions Pty, Ltd, and Anton-Breinl Center, James Cook University, Townsville City, Queensland, Australia (R.M.); Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, and Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany (X.-W.C., D.S.-D., C.F.D.).
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Contrast-enhanced ultrasound (CEUS) facilitated US in detecting lateral neck lymph node metastasis of thyroid cancer patients: diagnosis value and enhancement patterns of malignant lymph nodes. Eur Radiol 2014; 24:2513-9. [PMID: 25005826 DOI: 10.1007/s00330-014-3288-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/29/2014] [Accepted: 06/24/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the value of CEUS as a non-invasive tool in detecting lateral neck metastasis (LNM) and the enhancement patterns of malignant lymph nodes (LN) for thyroid cancer patients. METHODS Eighty-two consecutive patients, who underwent both preoperative non-enhanced US and CEUS examinations, were retrospectively reviewed. All patients underwent lateral neck dissection (LND). Enhancement patterns of 102 collected LNs matching to CEUS findings were analyzed. RESULTS CEUS detected LNM in 53 of 65 patients, showing a higher sensitivity and accuracy than that of conventional US (p = 0.109 and p = 0.154, respectively). Thirteen patients' surgical procedures were altered by CEUS findings, including nine true positive and four false positive cases. Five patients' surgical procedures were altered by conventional US findings, including two true positive and three false positive cases. Heterogeneous enhancement, perfusion defects, microcalcification, and centripetal/hybrid enhancement were all specific criteria for malignant LNs in univariate analysis. In multivariate analysis, only heterogeneous enhancement and centripetal/hybrid enhancement were significantly related to LN metastasis (p = 0.000 and p = 0.037, respectively). CONCLUSIONS CEUS may be a potential tool to facilitate conventional US in detecting LNM. Heterogeneous enhancement and centripetal/hybrid enhancement are useful criteria to distinguish between malignant and benign LNs. KEY POINTS • CEUS findings facilitated conventional US in detecting LNM. • Heterogeneous, centripetal/hybrid enhancement, microcalcification and perfusion defects were specific criteria of malignant LNs. • Heterogeneous and centripetal/hybrid enhancement were significantly related to LN metastasis in multivariate analysis.
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Dudau C, Hameed S, Gibson D, Muthu S, Sandison A, Eckersley RJ, Clarke P, Cosgrove DO, Lim AK. Can contrast-enhanced ultrasound distinguish malignant from reactive lymph nodes in patients with head and neck cancers? ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:747-754. [PMID: 24462154 DOI: 10.1016/j.ultrasmedbio.2013.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/01/2013] [Accepted: 10/16/2013] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to investigate the utility of contrast-enhanced ultrasound in differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. A consecutive series of 17 patients with known head and neck malignancy scheduled for neck surgery and lymph node clearance were recruited for contrast-enhanced ultrasound evaluation. Sonographic signal intensity as a function of time, comparing features of time to peak, time to arrival and time to wash-out, was quantified. The selected node was removed surgically and submitted for histology. Contrast-enhanced ultrasound examination had 100% sensitivity and 85.7% specificity for lymph node involvement. Functional analysis revealed contrast peaks significantly earlier in the malignant nodes (mean ± standard deviation) of 24.14 ± 2.7 s compared with 29.33 ± 3.4 s (p = 0.0128). Contrast-enhanced ultrasound holds promise in the detection and characterization of metastatic nodes that would not be diagnosed as abnormal on the basis of conventional ultrasound criteria.
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Affiliation(s)
- Cristina Dudau
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom.
| | - Shema Hameed
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Daren Gibson
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Senthil Muthu
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Ann Sandison
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Rob J Eckersley
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Peter Clarke
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - David O Cosgrove
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Adrian K Lim
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
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Giacomini CP, Jeffrey RB, Shin LK. Ultrasonographic Evaluation of Malignant and Normal Cervical Lymph Nodes. Semin Ultrasound CT MR 2013; 34:236-47. [DOI: 10.1053/j.sult.2013.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Slaisova R, Benda K, Jarkovsky J, Petrasova H, Szturz P, Valek V. Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy. Eur J Radiol 2013; 82:693-8. [DOI: 10.1016/j.ejrad.2012.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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Cui X, Ignee A, Nielsen MB, Schreiber-Dietrich D, De Molo C, Pirri C, Jedrzejczyk M, Christoph DF. Contrast enhanced ultrasound of sentinel lymph nodes. J Ultrason 2013; 13:73-81. [PMID: 26675994 PMCID: PMC4613570 DOI: 10.15557/jou.2013.0006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/05/2012] [Accepted: 12/06/2012] [Indexed: 12/12/2022] Open
Abstract
Sentinel lymph nodes are the first lymph nodes in the region that receive lymphatic drainage from a primary tumor. The detection or exclusion of sentinel lymph node micrometastases is critical in the staging of cancer, especially breast cancer and melanoma because it directly affects patient's prognosis and surgical management. Currently, intraoperative sentinel lymph node biopsies using blue dye and radioisotopes are the method of choice for the detection of sentinel lymph node with high identification rate. In contrast, conventional ultrasound is not capable of detecting sentinel lymph nodes in most cases. Contrast enhanced ultrasound with contrast specific imaging modes has been used for the evaluation and diagnostic work-up of peripherally located suspected lymphadenopathy. The method allows for real-time analysis of all vascular phases and the visualization of intranodal focal “avascular” areas that represent necrosis or deposits of neoplastic cells. In recent years, a number of animal and human studies showed that contrast enhanced ultrasound can be also used for the detection of sentinel lymph node, and may become a potential application in clinical routine. Several contrast agents have been used in those studies, including albumin solution, hydroxyethylated starch, SonoVue®, Sonazoid® and Definity®. This review summarizes the current knowledge about the use of ultrasound techniques in detection and evaluation of sentinel lymph node.
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Affiliation(s)
- XinWu Cui
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
| | | | - Dagmar Schreiber-Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
| | - Chiara De Molo
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
| | - Clara Pirri
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
| | - Maciej Jedrzejczyk
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
| | - Dietrich F Christoph
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim, Germany
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