title: The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study.
abstract: OBJECTIVE
  The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to gray-scale B-mode and color Doppler ultrasound in differentiate benign versus malign superficial cervical lymph nodes.
  
  
  METHODS
  In a prospective study ultrasonography (gray scale, color and spectral Dopller, and CEUS) was performed in 61 patients (33 men, 28 women; mean age of 51.2 years, range: 18-81 years), with cervical lymphadenopathy. The nodes were examined and biopsied or surgically removed. CEUS was performed with 2.4 ml intravenous bolus of contrast agent Sono Vue and the results were registered with a special software.
  
  
  RESULTS
  Of all the nodes, 32 were benign and 29 were malignant (metastases). Solbiati index was higher in benign nodes (2.23 +/- 0.84 vs 1.50 +/- 0.48, p<0.05). Doppler parameters (vessel location, vascular pattern, pedicullum number, resistivity index, and pulsatility index) were significantly lower in benign nodes (p<0.001), and ROC analysis returned excellent results. For CEUS, derived peak intensity (DPI %) was higher in benign nodes (17.72 +/- 5.43 vs 11.76 +/- 4.88, p<0.05); regional blood volume (RBV) was also higher (849.8 +/- 467.1 vs 458.3 +/- 283.3, p<0.05). The time to peak (TTP, s) and area under the curve (AUC, cm2) were similar in both benign and malignant nodes. Enhancement pattern was the most accurate to characterize benign versus malignant nodes. Sensitivity and specificity were higher for DPI, RBV and enhancement pattern from CEUS, according to ROC analysis, compared to gray scale ultrasound, but lower than color Doppler. Analyzing the place of CEUS in lymph node evaluation we found that CEUS is most useful for the evaluation of the lymph nodes with uncertain aspect at gray scale and Doppler evaluation.
  
  
  CONCLUSIONS
  ROC analysis confirmed the higher degree of diagnostic accuracy of CEUS in comparison with conventional techniques for some parameters such as enhancement pattern. Evaluation of nodal perfusion with this method can be helpful in the differentiation of benign from malignant nodes but requires further confirmation.
authors.affiliation: 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania;
authors.forename: Laura
authors.initials: L
authors.lastname: Poanta
authors.affiliation: 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania;
authors.forename: Oana
authors.initials: O
authors.lastname: Serban
authors.affiliation: 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania;
authors.forename: Isabela
authors.initials: I
authors.lastname: Pascu
authors.affiliation: ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Sever
authors.initials: S
authors.lastname: Pop
authors.affiliation: ENT Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Marcel
authors.initials: M
authors.lastname: Cosgarea
authors.affiliation: 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Email: dfodor@umfcluj.ro.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fodor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D010743:Phospholipids; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride