| Objective: To discuss the application value of the contrast-enhancedultrasound in differential diagnosis of the cervical tumescent lymphnodes byinvestigating their appearance in conventional 2D color Doppler andcontrast-enhanced ultrasound and then comparing with patho-consequence.Method: 97 cases with cervical tumescent lymph nodes were inspectedand then made out diagnosis by 2D color Doppler and contrast-enhancedultrasound. Before the US examination, none but only one patient withesophageal carcinoma and eight patients with lymphoma had receivedtreatment. All the patients were inspected by PHILIPS iu22 color ultrasonicapparatus, with a L9-3 transducer of 3-9 MHz , which was equiped withharmonic imaging , contrast pulse sequences(CPS) contrast imaging andauto-tracking contrast quantification (ACQ) software. In the first step, all thepatients were examined by using conventional 2D and color dopplersonography. Echo texture, longituding-transverse diameter ratio, marginsharpness, and the location of the hilus of the lymph node were used asparameters and the vascular pattern was evaluated. Such nodes were classifiedas malignant:(1) vascular pattern was peripheral type or mixed pattern，and aswell as having one above-mentioned parameter . (2) No bloodstream patternor lymphdoor pattern and having two above-mentioned parameters. And then,the gray-scale contrast-enhanced sonography was performed after intravenousinjection of the US contrast agent microbubble SonoVue. The enhancementwas classed as fllows: type I, intense homogeneous enhancement; type II, intense but inhomogeneous enhancement, with perfusion defects in theechogenic hilus; type III, intense but inhomogeneous enhancement, withperfusion defects in the nodal parenchyma; type IV, crico- enhancement, withperfusion only in the nodal perimeter . Type I was assessment asinnocence ,and typeⅡ,Ⅱ,IV were assessment as maliglant. Contrastquantitative analysis usee QLAB software, and the automatic tracingtime-strength curve was used to observe the contrast arrival time(AT), time topeak (TTP) and peak intensity(PI) . The final diagnosis of all the patientswere made by means of histological analysis of the resected specimens. Thesensitivity, specificity, and accuracy were calculated for conventional andcontrast-enhanced sonography in differentiation of lymphadenitis , lymphoidtuberculosis , lymphoma and metastatic carcinoma. SPSS17.0 was used instatistics analysis. In the quantitative analysis, the results were expressed asmeans±standard , and analyzed with Student’s t-test and u-test .Significancewas declared at the p<0.05 level.Result: Pathologic results showed that 28 of 97 the cervical tumescentlymph nodes were lymphadenitis, 11 were lymphoid tuberculosis, 16 werelymphoma, and 42 were metastatic carcinoma. The CEUS showed thatinflammatory lymph nodes appeared even significant perfusion(26/28) ,metastatic lymph nodes appeared uneven perfusion (30/42) or scarceperfusion(8/42), the lymphoma appeared even significant perfusion(8/16) orscarce perfusion (7/16), and the pattern of manifestation of lymphoidtuberculosis is multiformity, appeared even significant perfusion (7/11)oruneven perfusion(1/11) or scarce perfusion (1/11) or perimperfusion(2/11) .The sensitivity of the CEUS was 84%, the specificity was 87% and theaccuracy was 83%. The sensitivity of the conventional techniques was 58%, the specificity was 54% and the accuracy was 61%. The increase in correctdiagnosis was significant (P<0.05) when conventional ultrasound was testedagainst contrast-enhanced ultrasound. In the time-strength quantitativeanalysis the area under the curve of inflammatory lymph nodes was higherthan metastatic lymph nodes, lymphoma and lymphoid tuberculosis((P<0.05).There were no significant in the AT, TTP and PI of the inflammatory lymphnodes, lymphoid tuberculosis and metastatic lymph nodes (P>0.05) . But ATand TTP in the lymphoma were significant lower than the metastatic lymphnodes, the lymphoma and lymphoid tuberculosis(P<0.05)), and PI inlymphoma were significantly higher than the metastatic lymph nodes, thelymphoma and the lymphoid tuberculosis(P<0.05).Conclusions: The perfusion characteristics of the cervical lymph nodesafter injection of SonoVue the time-strength quantitative analysis after thelymphadenography can provide important value to differential diagnosis ofthe cervical tumescent lymph nodes. With conventional sonography andcontrast-enhanced ultrasound , we can do better in differentiations of thecervical tumescent lymph nodes. |
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