Diagnostic Value of Arrival Time Parametric Imaging Using Contrast-Enhanced Ultrasonography in Superficial Enlarged Lymph Nodes.

OBJECTIVE: The aim of this study was to evaluate the value of arrival-time parametric imaging for differential diagnosis of superficial enlarged lymph nodes. METHODS: Patients with lymphadenopathy who received contrast-enhanced ultrasonography (CEUS) and biopsy were included in this study. Following CEUS, a prototype software of the arrival-time parametric imaging system was used to analyze the video footage. Arrival-time patterns during the arterial phase were evaluated. The quantitative parameters including arrival time of periphery, arrival time of center, and the travel time (△T) were calculated. RESULTS: A total of 145 lymph nodes were analyzed. Arrival-time parametric imaging showed that 80.3% of metastatic lymph nodes and 68.4% of lymphoid tuberculosis presented a centripetal perfusion pattern, 76.5% of lymphoma showed complete homogeneous enhancement, and 81.2% of reactive lymph nodes had centrifugal patterns. The arrival time of periphery (sec) of metastatic lymph nodes was substantially earlier than that of lymphoma (11.0 ± 3.1 versus 12.6 ± 3.6; P < .05). The arrival time of center (sec) of metastatic lymph nodes was obviously later than that of lymphoma and reactive lymph nodes (13.4 ± 3.3 versus 10.5 ± 2.9 and 10.6 ± 1.5; P < .05). The travel time (△T) (sec) in metastatic lymph nodes was substantially longer than in reactive lymph nodes and lymphoma (4.2 ± 2.1 versus 2.3 ± 1.6 and 2.9 ± 2.5; P < .05). At a △T cutoff value of 2.75 seconds (using the receiver operating characteristic curve), the sensitivity and specificity in differentiating metastatic lymph nodes from benign lymph nodes (lymphoid tuberculosis and reactive lymph nodes) were 78.9% and 64.7%, respectively. CONCLUSIONS: Enhanced patterns and parameters of arrival-time parametric imaging during CEUS could provide more information for the differential diagnosis of enlarged superficial lymph nodes.

Analysis of Contrast-Enhanced Ultrasound Perfusion Patterns and Time-Intensity Curves for Metastatic Lymph Nodes From Lung Cancer: Preliminary Results.

OBJECTIVES: To retrospectively summarize the similarities and differences in contrast-enhanced ultrasound (US) findings for lymph node metastasis from adenocarcinoma, squamous carcinoma, and small cell lung cancer. METHODS: Patients who had received contrast-enhanced US examinations and had a histologic diagnosis of supraclavicular lymph node metastasis from lung cancer were included. The perfusion patterns on contrast-enhanced US images and time-intensity curve parameters were analyzed for the different pathologic types. The microvascular density and microvascular diameter were evaluated. RESULTS: Totally, 61 patients were enrolled in this study, including 26 cases with lung squamous carcinoma, 26 with lung adenocarcinoma, and 9 with small cell lung cancer. Contrast-enhanced US perfusion showed no significant differences in enhancement uniformity during the arterial phase and in the presence of unenhanced areas of metastatic lymph nodes with the 3 different pathologic origins (P > .05), but fewer unenhanced areas could be seen in metastatic lymph nodes from adenocarcinoma. The analysis of the time-intensity curve parameters showed that there were significant differences in the peak intensity between metastatic lymph nodes from lung squamous carcinoma and lung adenocarcinoma (P < .05). The microvascular density of metastatic lymph nodes from adenocarcinoma was significantly higher than that of metastatic lymph nodes from squamous carcinoma and small cell lung cancer (P < .001; P = .0444), whereas the microvascular diameter of metastatic lymph nodes from adenocarcinoma was significantly smaller than that from squamous carcinoma and small cell lung cancer (P = .0277; P < .001). CONCLUSIONS: Effects of the pathologic diagnosis should be considered when analyzing quantitative parameters of metastatic lymph nodes during contrast-enhanced US examinations, even in the same organ.

Diagnostic Value of Contrast-Enhanced Ultrasonography and Time-Intensity Curve in Differential Diagnosis of Cervical Metastatic and Tuberculous Lymph Nodes.

OBJECTIVES: To evaluate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of tuberculous and metastatic lymph nodes. METHODS: Nineteen cervical tuberculous lymph nodes and 43 cervical metastatic lymph nodes were investigated. The CEUS perfusion patterns and parameters of time-intensity curve (TIC) were analyzed. Diagnostic accuracy and consistency of two physicians were compared before and after CEUS and TIC analysis. RESULTS: Conventional ultrasonography showed no significant differences between tuberculous and metastatic lymph nodes. Concentric enhancement at the arterial phase of CEUS occurred in 15 of 19 (78.9%) tuberculous lymph nodes and 42 of 43 (97.7%) metastatic lymph nodes (P < .05). For the TIC curve, a steep descending curve with an apparent notch was commonly found in tuberculous lymph nodes (13 of 16). Although a shallow descending curve was common (40 of 43) in metastatic lymph nodes, most did not have a notch on the curve (39 of 43) (P < .01). The k-value and the peak intensity (PI) value of tuberculous lymph nodes were significantly higher and the △PI value was significantly lower than that of metastatic lymph nodes (P < .05, respectively). Kappa values for the diagnosis consistency of the two physicians before and after CEUS and TIC analysis were 0.582 and 0.761, respectively. Diagnostic accuracy before and after CEUS and TIC analysis was 47.4% (28 of 59) and 96.6% (57 of 59), respectively (P < .001). CONCLUSIONS: Contrast-enhanced ultrasonography with TIC analysis is helpful in differentiating tuberculous from metastatic lymph nodes.

Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions.

OBJECTIVE: To investigate differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and arterial phase enhanced hepatic inflammatory lesions in patients without liver cirrhosis using contrast-enhanced ultrasound (CEUS). METHODS: ICC and hepatic inflammatory lesions cases with CEUS and pathological diagnosis between Sep 2013 and Oct 2016 were investigated retrospectively. Imaging features of conventional ultrasound and CEUS were analyzed. The parameters of time intensity curve (TIC), including the arrival time, peak intensity (PI) in the lesions, the starting time for washout, and the intensity difference at 3 min (ΔI3) after contrast agent infection between the lesion and the liver parenchyma, were compared between ICC and hepatic inflammatory lesions. RESULTS: Twenty-five ICC and fifteen inflammatory patients were included in this study. Seventeen ICC (68.0%) and two inflammatory cases (13.3%) showed bile duct dilatation on conventional ultrasound. Using CEUS, three ICC cases (12.0%) were misdiagnosed as inflammatory lesions and three inflammatory lesions (20.0%) as ICC; two ICC (8.0%) and one inflammatory case (6.7%) could not be made definite diagnosis. Washout started at 34.5±3.5 s and 61.5±12.9 s for ICC and inflammatory lesions respectively (P<0.001). The intensity difference between lesion and liver parenchyma at 3 min after contrast agent injection was 10.8±3.1 dB in ICC and 4.2±2.3 dB in inflammatory group (P<0.001). The sensitivity and specificity differentiating ICC and inflammatory lesions were 76% and 87% if the cut-off value of the intensity difference was 7.7 dB. CONCLUSIONS: Combined with TIC analysis, and particularly with the characteristic of the early-starting and obvious washout in ICC, CEUS can be useful in differential diagnosis between hepatic inflammatory lesions and ICC.

Study on the characteristics of contrast-enhanced ultrasound and its utility in assessing the microvessel density in ovarian tumors or tumor-like lesions.

Angiogenesis is a critical factor in tumor growth and metastasis, and microvessel density (MVD) was an important parameter for assessing vessels in tumors. However, radiologic assessment of tumor vascularity is not yet well established. In our study, we aimed at investigating the efficacy of contrast-enhanced ultrasonography (CEUS) in exploring the vascularity of the ovarian tumors or tumor-like lesions to assess the relationship between the parameters of the peak intensity (PI) and area under curve (AUC) on CEUS and MVD in ovarian masses. Compared to the contrast-enhanced ultrasound technique, conventional ultrasound shows limitation in differentiating benign and malignant ovarian tumors. The former is promising in improving the sensitivity of detecting small vessels and blood flow in ovarian tumors. Our results showed clear differences in enhancement patterns between benign and malignant ovary tumors or tumor-like lesions. The PI and AUC in the malignant tumors were significantly higher than those in the benign tumors or tumor-like lesions (p=0.001 and =0.01, respectively). The MVD was 43.1 ± 20.4 in the benign tumors or tumor-like lesions and was 65.3 ± 22.3 in the malignant ones (p= 0.01). In both the benign and malignant groups, the PI and AUC were correlated significantly with the MVD (r=0.595, p = 0.001; r =0.533, p = 0.003, respectively). The PI and AUC in CEUS can reflect the MVD in ovarin tumors. The PI and AUC of the ovarian masses in the contrast transvaginal sonography show significant correlation with the angiogenesis and may help in assessing tumor vascularity in ovarian masses.