Poanta Laura, Serban Oana, Pascu Isabela, Pop Sever, Cosgarea Marcel, Fodor Daniela
2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania;
ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Med Ultrason. 2014 Mar;16(1):7-14. doi: 10.11152/mu.2014.2066.161.lp1os2.
The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to gray-scale B-mode and color Doppler ultrasound in differentiate benign versus malign superficial cervical lymph nodes.
In a prospective study ultrasonography (gray scale, color and spectral Dopller, and CEUS) was performed in 61 patients (33 men, 28 women; mean age of 51.2 years, range: 18-81 years), with cervical lymphadenopathy. The nodes were examined and biopsied or surgically removed. CEUS was performed with 2.4 ml intravenous bolus of contrast agent Sono Vue and the results were registered with a special software.
Of all the nodes, 32 were benign and 29 were malignant (metastases). Solbiati index was higher in benign nodes (2.23 +/- 0.84 vs 1.50 +/- 0.48, p<0.05). Doppler parameters (vessel location, vascular pattern, pedicullum number, resistivity index, and pulsatility index) were significantly lower in benign nodes (p<0.001), and ROC analysis returned excellent results. For CEUS, derived peak intensity (DPI %) was higher in benign nodes (17.72 +/- 5.43 vs 11.76 +/- 4.88, p<0.05); regional blood volume (RBV) was also higher (849.8 +/- 467.1 vs 458.3 +/- 283.3, p<0.05). The time to peak (TTP, s) and area under the curve (AUC, cm2) were similar in both benign and malignant nodes. Enhancement pattern was the most accurate to characterize benign versus malignant nodes. Sensitivity and specificity were higher for DPI, RBV and enhancement pattern from CEUS, according to ROC analysis, compared to gray scale ultrasound, but lower than color Doppler. Analyzing the place of CEUS in lymph node evaluation we found that CEUS is most useful for the evaluation of the lymph nodes with uncertain aspect at gray scale and Doppler evaluation.
ROC analysis confirmed the higher degree of diagnostic accuracy of CEUS in comparison with conventional techniques for some parameters such as enhancement pattern. Evaluation of nodal perfusion with this method can be helpful in the differentiation of benign from malignant nodes but requires further confirmation.
本研究旨在评估超声造影（CEUS）相较于灰阶B模式和彩色多普勒超声鉴别颈部浅表淋巴结良恶性的能力。
在一项前瞻性研究中，对61例（33例男性，28例女性；平均年龄51.2岁，范围：18 - 81岁）患有颈部淋巴结病的患者进行了超声检查（灰阶、彩色和频谱多普勒以及CEUS）。对淋巴结进行检查并活检或手术切除。使用2.4 ml静脉推注造影剂声诺维进行CEUS检查，并使用专用软件记录结果。
所有淋巴结中，32个为良性，29个为恶性（转移瘤）。良性淋巴结的索尔比亚蒂指数更高（2.23±0.84对1.50±0.48，p<0.05）。多普勒参数（血管位置、血管模式、蒂的数量、阻力指数和搏动指数）在良性淋巴结中显著更低（p<0.001），ROC分析得出了出色的结果。对于CEUS，衍生峰值强度（DPI%）在良性淋巴结中更高（17.72±5.43对11.76±4.88，p<0.05）；局部血容量（RBV）也更高（849.8±467.1对458.3±283.3，p<0.05）。良性和恶性淋巴结的达峰时间（TTP，秒）和曲线下面积（AUC，平方厘米）相似。增强模式对于鉴别良性和恶性淋巴结最为准确。根据ROC分析，与灰阶超声相比，CEUS的DPI、RBV和增强模式的敏感性和特异性更高，但低于彩色多普勒。分析CEUS在淋巴结评估中的作用，我们发现CEUS对于评估灰阶和多普勒评估中表现不确定的淋巴结最为有用。
ROC分析证实，与传统技术相比，CEUS在某些参数（如增强模式）方面具有更高的诊断准确性。用这种方法评估淋巴结灌注有助于鉴别良性和恶性淋巴结，但需要进一步证实。
