The Value Of Contrast-enhanced Ultrasound And Elastography In Diagnosis Of Superficial Lymphadenopathy

Objective In this paper,through the observation of contrast-enhanced ultrasound(CEUS)enlargement lymph node of superficial patterns and characteristics,evaluation of CEUS in differential diagnosis of benign and malignant superficial lymph node lesions value,combined with the histological pathology type research different sources of primary tumor metastasis lymph nodes of CEUS performance and time intensity curve(TIC)parameter characteristics,and discussed the shear wave elastography in superficial lymphadenopathy in the differential diagnosis value.Methods The 142 superficial enlarged lymph nodes(68 benign,74 malignant)confirmed by pathology were divided into the < 1 cm group,the 1-2 cm group and the > 2 cm group according to the length of the maximum diameter.The lymph nodes of the three groups were examined by conventional ultrasound and CEUS respectively.Conventional sonographic features of lymph nodes(e.g.long/short diameter,blood flow signal pattern,cortical echo,border,hilum)and CEUS perfusion pattern and morphology were recorded.Screened in pathological type cases squamous carcinoma and adenocarcinoma metastasis of cervical lymph nodes,according to the primary tumor squamous carcinoma metastasis lymph nodes can be divided into lung squamous carcinoma group,esophageal cancer and nasopharyngeal carcinoma group,adenocarcinoma metastasis lymph nodes can be divided into groups of patients with lung adenocarcinoma,gastrointestinal carcinoma and thyroid carcinoma group,observation CEUS manifestation of lymph nodes(enhancement pattern,whether uniform enhanced,whether exist perfusion defect area),drew TIC,quantitative analysis of various parameters,and 36 cases of lymph node with acoustic radiation force impulse imaging(ARFI),quantitative analysis of the hardness of benign and malignant lymph nodes.Results Among the benign lymph nodes,55.88%(38/68)showed uniform hyperenhancement,and 26.47%(18/68)showed non-uniform enhancement(regular perfusion defects area)or annular enhancement.72.97%(54/74)of malignant lymph nodes showed non-uniform enhancement(irregular perfusion defect area),and 14.86%(11/74)showed weak enhancement.Conventionalultrasound and CEUS in the diagnosis of 142 cases of superficial lymph nodes accuracy were69.49%,78.26%,conventional ultrasound diagnosis < 1 cm,1 ? 2 cm,> 2 cm accuracy of three groups of lymph nodes were 62.16%,69.49%,78.26%,the accuracy of CEUS in the diagnosis of respectively 81.08%,86.44%,86.95%,the diagnosis accuracy of conventional ultrasound and CEUS for 1 ? 2 cm lymph nodes had statistically significant(P < 0.05).There were no statistically significant differences in CEUS enhancement morphology,uniform enhancement,presence of perfusion defects area and TIC parameters in lymph nodes with metastatic squamous cell carcinoma(all P > 0.05).Among adenocarcinoma metastatic lymph nodes,75%(12/16)of thyroid cancer metastatic lymph nodes and 20%(2/10)of digestive tract adenocarcinoma metastatic lymph nodes had no enhanced area(P <0.05),and lung adenocarcinoma metastatic lymph nodes had lower TPH and PI than thyroid cancer metastatic lymph nodes(P <0.05).The mean SWV value of benign lymph nodes(2.09±0.42)m/s and that of malignant lymph nodes(3.21±0.77)m/s(P <0.05)were found by shear wave elastography.The critical value of 2.71m/s suggested that the sensitivity,specificity and accuracy of malignant lymph nodes were 80%,100%and 90%,respectively.Conclusion CEUS has a high value in the differential diagnosis of > 1cm lymph nodes.Observation of the characteristics of the perfusion defect area in lymph nodes is conducive to the differential diagnosis of metastatic lymph nodes and benign lymph nodes.The combination of CEUS manifestations and TIC parameters with histopathology and pathology can help to determine the primary metastatic lymph nodes of adenocarcinoma.Taking 2.71m/s as the critical value of SWV was helpful to distinguish benign and malignant lymph nodes.