The Clinical Investigation Of The Application Of Sonovue Enhanced Ultrasonography Diagnosis Of Oral And Maxillofacial Malignant Cervical Lymph Node Metastasis

Objective: The oral and maxillofacial malignancies is one of thecommon malignant tumors which is a serious threat to human health and lifeand the incidence rate of about5%of the incidence of systemic malignancy.The important biological characteristics of malignant tumors is the ability ofmetastasis, and cervical lymph node metastasis is more common in oral andmaxillofacial malignant metastasis, if there is cervical lymph node metastasisimpact on tumor staging, treatment and prognosis. Due to the complexanatomical relationships and physiological characteristics of oral andmaxillofacial region, its treatment is still based on the combined therapy ofsurgery, before an accurate judgment in the surgical treatment of cervicallymph node metastasis is the key to successful treatment of oral andmaxillofacial malignancies. However, the rate and accuracy of cancerdiagnosis to lymph node metastasis is still not ideal, So as to influence theformulation of treatment programs and clinical efficacy. Therefore, howtraumatic to improve the diagnostic accuracy of early lymph node metastasisis still today the research focus of the treatment of oral and maxillofacialmalignancies.Ultrasound imaging technology is one of the rapid technologicaldevelopment in the medical field. Currently, it is mature and used in thediagnosis of liver disease, and gradually in the heart, prostate and other partsare widely used,and more rapid development in the application of superficiallymph nodes. Clinical application showed that Compared with the normalDoppler ultrasound, ultrasound imaging, ultrasound contrast agent toselectively enhance tumor blood flow within the echo signal, the sensitivity toimprove by about30%, which further provides a wealth of diagnosis is based on the qualitative diagnosis of lymph node[1]. SonoVue enhancedultrasonography in the diagnosis of oral and maxillofacial malignant cervicallymph node metastasis has become the focus of attention of foreign scholars,Therefore, the diagnosis of oral and maxillofacial malignant cervical lymphnode metastasis in a preliminary study of SonoVue enhancedultrasonographydiscussion explore new methods of diagnosis of early lymphnode metastasis, explore and assess their clinical value.Materials and methods: Selected in March2010December to2011inour hospital oral and maxillofacial malignant tumors of56patients, including31males and25females, aged18to72years, mean52years old,selectedpatients had biopsy support.Suffering from gum cancer is17cases,floor ofmouth carcinoma in10cases,5cases of oropharyngeal cancer,16cases oftongue cancer,2cases of buccal cancer, three cases of laryngeal cancer,2cases of palatal carcinoma,1cases of Merkel cell carcinoma. Selected patientswith clinical examination: the lymph nodes can be touched or not touched inthe neck, all patients with ultrasound contraindications, and informed consentby the intravenous contrast agent; ultrasound were not no treatment measures;two cases of tongue cancer patients (4lymph nodes) due to illness after theangiography, preoperative chemotherapy treatment.Application Philips iU22Color Doppler Ultrasonography, first of allpreoperative ultrasonography, suspicious lymph nodes, and record theirperformance of ultrasound and subsequently underwent Color Doppler (CDFI)and power Doppler (PDI) to observe the blood form;ultrasound results, the L/S≤2, medulla deformed or missing, ill-defined, heterogeneous echo texture,peripheral or mixed blood as a diagnostic criteria to distinguish betweenmetastatic and non-metastatic lymph nodes, along with the abovetwo(inclusive) above is the metastatic lymph nodes, According to this standardto make a qualitative judgment on the selected node[2,3]. Selected lymph nodesimaging contrast agent SonoVue (SonoVue), in accordance with the specificcircumstances of the patients, the bolus type (the speed of intravenousinjection of1ml/s,2-4s) contrast agent into the antecubital vein, the dose 2.4ml, dynamic observation of selected lymph node ultrasound imagingprocess2min, the entire imaging process, image data stored in the hard drive[3]. The combination of ultrasound imaging to real-time playback, and videocontrast image analysis and processing software for imaging lymph nodeimaging findings, and to strengthen the distribution of the type of recording,classifying, and comprehensive analysis, preliminary to make a qualitativejudgment. Surface positioning the ultrasound examination of lymph nodes,intraoperative resection locate lymph nodes, a detailed record of the location,color, size, shape, texture, profile features selected suspicious lymph nodes,surgical specimens were sent to the Department of Pathology to do the biopsyto the pathologicaldiagnosed as diagnostic criteria. Using SPSS13.0statisticalsoftware for statistical analysis: the pathological diagnosis and the results ofroutine ultrasound diagnosis, ultrasound imaging diagnostic results werecompared, the evaluation of conventional ultrasound and acoustic Dirkultrasound angiography in the diagnosis of neck metastatic and non-metastaticlymph nodes, the sensitivity of specificity, and between the two groups werecompared using the X2test, P <0.05for the difference was statisticallysignificant.Results: Selected56patients ultrasound examination detected a total of147lymph nodes, lymph node nature of the pathologic results of thediagnostic criteria.1Pathological examination confirmed the results: metastatic lymph node62and non-metastatic lymph node85.2Rroutine ultrasound results: According to the conventional ultrasounddiagnostic criteria for metastatic lymph node67, non-metastatic lymph node80;117control pathology in line with the lymph nodes, metastatic lymph node46and the non-metastatic lymph nodes71,30and pathology does not matchwith the pathological diagnosis of the coincidence rate of79.6%(117/147),the misdiagnosis rate is20.4%(30/147), routine ultrasound examination ofmetastatic and non-metastatic lymph nodes, sensitivity, specificity, accurateare74.2%(46/62),83.5%(71/85),79.6%(117/147). 3The selected lymph node contrast-enhanced ultrasound performance forfour types:①, after even enhanced: the whole lymph node significant andeven strengthened;②, lymphatic the door is not uniform enhanced:significant increase in essence, perfusion even, but in the central high echolymphatic door see irregular form low or no perfusion area;③,the essence ofuneven enhanced: the essence of the significant increase in focal low or noperfusion area;④, weak enhanced: the whole lymph node weak increase, andpour the uniform or not even. References to other documents according to thelymph node imaging contrast agent perfusion distribution site will strengthenthe distribution type is divided into the following four types: typeⅠ:homogeneous enhancement type, type II: heterogeneous enhancement hilar,type III: the essence of inhomogeneous enhancement type, type Ⅳ: weakenhanced.4On the basis of the diagnostic criteria for the transfer and non-transfer ofordinary ultrasound, the performance of SonoVue ultrasound contrasthomogeneous enhancement uneven and lymph-door to strengthen the type oflymph nodes to determine non-metastatic lymph nodes, imaging performanceis the essence of inhomogeneous enhancement and weak enhanced type oflymph node to determine the metastatic lymph nodes; According to the abovecriteria, CEUS diagnosis: metastatic lymph node55, the non-metastatic lymphnode92; and pathology meet the lymph nodes133, including53metastaticlymph nodes, non-metastatic lymph nodes80,14inconsistent with thepathological and the pathological diagnosis is90.4%(133/147), themisdiagnosis rate is9.5%, SonoVue ultrasound contrast sensitivity, specificity,and accuracy are85.4%(53/62),94.1%(80/85)90.4%(133/147).5Statistical analysis the CEUS lymph node imaging characteristics ofperformance: non-metastatic lymph nodes in51.2%(47/92) contrast theperformance of type Ⅰ,40.2%(37/92) performance Ⅱ; metastatic lymphnodes in76.4%(42/55)manifestations of type III,18.2%(10/55) IV type;pathology to determine the non-metastatic lymph nodes in56.2%(45/80)contrast the performance of type Ⅰ,40.0%(32/80) type Ⅱ;metastatic lymph nodes in70.0%(37/53) performance Ⅲ,26.4%(14/53)type IV.6Angiography before conventional ultrasound diagnosis, ultrasoundimaging diagnosis and pathological diagnosis, ultrasound sensitivity,specificity and accuracy were74.2%,83.5%,79.6%, sensitivity of SonoVueenhanced ultrasonographyspecificity, and accuracy were85.4%,94.1%,90.4%;statistical analysis, ultrasound imaging compared with conventionalultrasound and SonoVue ultrasound contrast sensitivity, specificity, andaccuracy are superior to conventional ultrasound, the twoby difference wasstatistically significant (P<0.05), ultrasound imaging is superior toconventional ultrasound (P <0.05).Conclusion:1The non-metastatic lymph node of neck ultrasound contrast enhancementmainly homogeneous enhancement and lymph-doors uneven enhanced; neckmetastatic lymph nodes mainly enhance the essence of uneven and weakenhanced type, which can provide some basis for how to distinguish betweenthe neck metastatic and non-metastatic lymph nodes of the diagnostic criteriafor setting.2SonoVue enhanced ultrasonography improves the diagnosticaccuracy of oral and maxillofacial malignant cervical lymph node metastasis,SonoVue enhanced ultrasonography is an effective way to determine whethercervical lymph node metastasis before surgery.