title: Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy.
abstract: OBJECTIVE
  The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography compared to gray-scale B-mode and power Doppler in distinction between benign and malignant lymphadenopathy.
  
  
  METHODS
  In a prospective study ultrasonography was performed in 133 patients with superficial lymphadenopathy (73 men, 60 women; mean age of 51 years, range: 18-86 years), who were examined for palpable mass in the neck, axilla or groin (104/133) and for clinical suspicion of lymphoma on the basis of positive PET/CT (29/133). 133 nodes were examined, subsequently preoperatively localized under ultrasound guidance and surgically removed; longitudinal to transverse ratio, location of nodal vessels by power Doppler and pattern of enhancement by contrast-enhanced ultrasonography with 1.5ml intravenous bolus of sulphur hexafluoride contrast agent were documented. The ultrasound findings were compared with the histology.
  
  
  RESULTS
  Of all the nodes extirpated, 33 were benign, 100 were malignant (40 metastases, 60 lymphomas). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional techniques were 72%, 63.6%, 85.7%, 42.9%, 67.8% for longitudinal to transverse ratio; 73%, 60.6%, 84.9%, 42.6%, 68.3% for power Doppler versus 98.0%, 54.5%, 86.7%, 90.0%, 76.3% for contrast-enhanced ultrasonography according to Receiver Operating Characteristic analysis.
  
  
  CONCLUSIONS
  Receiver Operating Characteristic analysis confirmed higher degree of diagnostic accuracy of contrast-enhanced ultrasonography in comparison with conventional techniques. Evaluation of nodal perfusion after intravenous administration of microbubble contrast agent can be helpful in differentiation of benign from malignant nodes.
authors.affiliation: Department of Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Jihlavska 20, 625 00 Brno, Czech Republic. radka.slaisova@gmail.com
authors.forename: Radka
authors.initials: R
authors.lastname: Slaisova
authors.forename: Karel
authors.initials: K
authors.lastname: Benda
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.forename: Hana
authors.initials: H
authors.lastname: Petrasova
authors.forename: Petr
authors.initials: P
authors.lastname: Szturz
authors.forename: Vlastimil
authors.initials: V
authors.lastname: Valek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride