Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China.
Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China.
Ultrasound Med Biol. 2021 Feb;47(2):252-260. doi: 10.1016/j.ultrasmedbio.2020.10.003. Epub 2020 Nov 4.
The aim of this prospective study was to evaluate the value of the combination of lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (IVCEUS) for the identification of cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC). From November 2018 to March 2019, 24 consecutive patients with PTC were evaluated. All patients underwent routine US, LCEUS and IVCEUS. Pathology was used as the gold standard. After injection of a contrast agent into the thyroid parenchyma, lymphatic vessels and lymph nodes (LNs) could be exclusively displayed as hyper-enhancement on LCEUS. Benign LNs displayed a complete bright ring (100%) and homogeneous perfusion (88.9%) on LCEUS, while displaying centrifugal perfusion (66.7%) and homogenous enhancement (88.9%) on IVCEUS. Perfusion defects (94.9%) and interruption of the bright ring (71.8%) were the two characteristic LCEUS signs for diagnosing CLNM. On IVCEUS, CLNM appeared as centripetal perfusion (59.0%) and heterogeneous enhancement (59.0%). After comparison with pathology, perfusion defect was correlated to the metastatic foci in the medulla and interruption of the bright ring to the tumor seeding in the marginal sinus (all p values <0.05). LCEUS had more value (area under the receiver operating characteristic curve [AUC] = 0.850, 95% confidence interval [CI]: 0.682-1.000) in diagnosing CLNM than IVCEUS (AUC = 0.692, 95% CI: 0.494-0.890) and routine US (AUC = 0.581, 95% CI: 0.367-0.796). The combination of LCEUS and IVCEUS has the highest diagnostic value (AUC = 0.863, 95% CI: 0.696-1.000). LCEUS had higher diagnostic value than IVCEUS and US for CLNM from PTC. The combination of LCEUS and IVCEUS has the highest diagnostic value for CLNM.
本前瞻性研究旨在评估淋巴管超声造影（LCEUS）联合静脉超声造影（IVCEUS）在识别甲状腺乳头状癌（PTC）颈部淋巴结转移（CLNM）中的价值。2018 年 11 月至 2019 年 3 月，连续评估了 24 例 PTC 患者。所有患者均接受常规超声、LCEUS 和 IVCEUS 检查。以病理为金标准。在甲状腺实质内注射造影剂后，LCEUS 可将淋巴管和淋巴结（LN）专门显示为高增强。良性 LN 在 LCEUS 上显示完全亮环（100%）和均匀灌注（88.9%），而在 IVCEUS 上显示离心灌注（66.7%）和均匀增强（88.9%）。灌注缺损（94.9%）和亮环中断（71.8%）是诊断 CLNM 的两个特征性 LCEUS 征象。在 IVCEUS 上，CLNM 表现为向心性灌注（59.0%）和不均匀增强（59.0%）。与病理比较后，灌注缺损与髓内转移灶相关，亮环中断与边缘窦内肿瘤播种相关（均 p 值<0.05）。LCEUS 对诊断 CLNM 的价值（曲线下面积 [AUC] = 0.850，95%置信区间 [CI]：0.682-1.000）高于 IVCEUS（AUC = 0.692，95%CI：0.494-0.890）和常规超声（AUC = 0.581，95%CI：0.367-0.796）。LCEUS 联合 IVCEUS 的诊断价值最高（AUC = 0.863，95%CI：0.696-1.000）。LCEUS 对 PTC 的 CLNM 诊断价值高于 IVCEUS 和 US。LCEUS 联合 IVCEUS 对 CLNM 的诊断价值最高。
