title: Shear Wave Elastography in Head and Neck Lymph Node Assessment: Image Quality and Diagnostic Impact Compared with B-Mode and Doppler Ultrasonography.
abstract: The aim of this study was to assess the diagnostic performance of shear wave elastography (SWE) in comparison to B-mode and Doppler ultrasonography in differentiating benign from malignant head and neck lymph nodes (HNLNs). Sixty-two HNLNs from 56 patients were prospectively examined using B-mode, Doppler and SWE. The standard of reference was histopathology or cytology and follow-up. Qualitative malignant criteria (hilum infiltration, cortical hypo-echogenicity, irregular margins, abnormal vessels) were assessed on a five-point scale. Four quantitative parameters were obtained: long axis length, short axis length, short axis/long axis ratio, resistive index and maximum shear elasticity modulus (μmax). Diagnostic performance was analyzed with special emphasis on the sub-centimeter HNLN subgroup. Thirty HNLNs were malignant (48%). μmax intra-observer reproducibility was 0.899 (0.728 in sub-centimeter subgroup). Malignant HNLNs were stiffer (μmax = 72.4 ± 59.0 kPa) compared with benign nodes (μmax = 23.3 ± 25.3 kPa) (p < 0.001). Among the quantitative criteria, μmax had the highest diagnostic accuracy (area under the curve = 0.903 ± 0.042), especially in the sub-centimeter subgroup (area under the curve = 0.929 ± 0.045; p < 0.001) in which the area under the curve was significantly higher compared with the other quantitative criteria (p < 0.05). The additional use of SWE combined with B-mode tended to improve diagnostic accuracy (p > 0.05). SWE is a promising reproducible quantitative tool with which to predict malignant HNLNs, especially sub-centimeter nodes.
authors.affiliation: Department of Radiology, Hôpital d'Instruction des Armées Laveran, Marseille, France. Electronic address: florian.desmots@yahoo.fr.
authors.forename: Florian
authors.initials: F
authors.lastname: Desmots
authors.affiliation: Department of Ear, Nose and Throat Surgery, Timone University Hospital, Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fakhry
authors.affiliation: Department of Public Health Service and Medical Information, Timone University Hospital, Marseille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Department of Radiology, Timone University Hospital, Marseille, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Reyre
authors.affiliation: Department of Radiology, Timone University Hospital, Marseille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vidal
authors.affiliation: Department of Radiology, Timone University Hospital, Marseille, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Jacquier
authors.affiliation: Department of Ear, Nose and Throat Surgery, Timone University Hospital, Marseille, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Santini
authors.affiliation: Department of Radiology, Timone University Hospital, Marseille, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Moulin
authors.affiliation: Department of Radiology, Timone University Hospital, Marseille, France.
authors.forename: Arthur
authors.initials: A
authors.lastname: Varoquaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006244:Hardness; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009333:Neck; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D033081:Shear Strength; D018608:Ultrasonography, Doppler / Q000379:methods*; D055815:Young Adult
keywords: Cervical lymph nodes; Diagnosis; Head and neck diseases; Shear wave elastography; Ultrasound