Cervical lymph node metastases: Diagnosis at sonoelastography - Initial experience
Cervical lymph node metastases: Diagnosis at sonoelastography - Initial experience
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DOI：
10.1148/radiol.2431052032
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发表时间：
2007-04-01
期刊：
影响因子：
19.7
通讯作者：
Togashi, Kaori
中科院分区：
文献类型：
--
作者：
Lyshchik, Andrej;Higashi, Tatsuya;Togashi, Kaori
目的：以组织学淋巴结结果为参考标准，前瞻性评估声弹性成像技术在疑似甲状腺癌或下咽癌患者鉴别良性和转移性颈淋巴结（LN）方面的准确性。 材料和方法：本研究方案经医院审查委员会批准；每位患者均签署了书面知情同意书。对 43 名连续患者（22 名男性，21 名女性；平均年龄，58 岁+/- 13 [标准差]）的 141 个周围颈淋巴结（60 个转移性，81 个无转移）进行了检查。对疑似甲状腺癌或下咽癌转诊接受手术治疗的患者进行灰阶超声检查 (US)、能量多普勒超声检查和声弹性成像检查。在灰度和能量多普勒超声中，评估了以下 LN 特征：短轴直径、短轴与长轴直径比、回声性、钙化和血管分布。使用四点评分量表来评估超声弹性图的 LN 可见度、相对亮度、边缘规律性和边缘清晰度。此外，还通过弹性图测量了 LN 和周围颈部肌肉的应变，并计算了肌肉与 LN 应变比（即应变指数）。通过单变量分析和多变量广义估计方程（GEE）回归评估了转移性受累检查标准的诊断潜力。 P < .05 表示统计显着性。结果：大于 1.5 的应变指数在转移性 LN 分类中具有很高的实用性，特异性为 98%，敏感性为 85%，总体准确性为 92%。这些结果明显优于使用最佳灰度标准（即短轴与长轴直径比大于 0.5）获得的结果，该标准具有 81% 的特异性、75% 的敏感性和 79% 的总体准确性。 结论：超声弹性成像在鉴别疑似甲状腺癌或下咽癌患者的良性和转移性颈部淋巴结方面具有较高的准确性（92%）。
Purpose: To prospectively estimate the accuracy of sonoelastography in the differentiation of benign and metastatic cervical lymph nodes (LNs) in patients suspected of having thyroid or hypopharyngeal cancer, with histologic nodal findings as the reference standard.Materials and Methods: The study protocol was approved by the hospital review board; each patient gave written informed consent. One hundred forty-one peripheral neck LNs (60 metastatic, 81 metastasis free) in 43 consecutive patients (22 men, 21 women; mean age, 58 years +/- 13 [standard deviation]) were examined. Patients referred for surgical treatment of suspected thyroid or hypopharyngeal cancer were examined with gray- scale ultrasonography (US), power Doppler US, and sonoelastography. At gray- scale and power Doppler US, the following LN characteristics were evaluated: short-axis diameter, short-to-long-axis diameter ratio, echogenicity, calcifications, and vascularity. A four-point rating scale was used to evaluate the US elastograms for LN visibility, relative brightness, margin regularity, and margin definition. In addition, strains of LN and surrounding neck muscles were measured on elastograms, and the muscle-to-LN strain ratio - that is, the strain index - was calculated. The diagnostic potential of the examined criteria for metastatic involvement was evaluated with univariate analysis and multivariate generalized estimating equation (GEE) regression. P < .05 indicated statistical significance.Results: A strain index greater than 1.5 had high utility in metastatic LN classification, with 98% specificity, 85% sensitivity, and 92% overall accuracy. These results were significantly better than those obtained by using the best gray-scale criterion - that is, a short-to-long-axis diameter ratio greater than 0.5 - which had 81% specificity, 75% sensitivity, and 79% overall accuracy.Conclusion: Sonoelastography had high accuracy (92%) in the differentiation of benign and metastatic cervical LNs in patients suspected of having thyroid or hypopharyngeal cancer.