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Published on: September 8, 2021
Time Windows Analysis of Perfluorobutane-Enhanced Ultrasound in Differentiating Benign vs. Malignant Superficial
Jiu-Yi Ma1, Ying Fu1, Xiang-Mei Chen2
1Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China (J.-Y.M., Y.F., L.Z., H.-Y.N., L.-G.C.).
Rationale And Objectives:
To investigate the optimal time window of the postvascular phase of perfluorobutane-enhanced ultrasound in differentiating between benign and malignant lymph nodes (LNs) in patients with superficial lymphadenopathy.
Materials And Methods:
This study retrospectively analyzed 150 suspicious LNs in the superficial area from 141 patients. All LNs were evaluated by the postvascular phase of perfluorobutane-enhanced ultrasound at a dose of 0.4-0.6 mL and a mechanical index range of 0.18-0.21. Quantitative parameters, including peak intensity (PI) and mean postvascular phase intensity (MPI), were obtained at 6, 8, and 10 min post-injection. Receiver operating characteristic (ROC) analysis was performed at each time point. Area under the curve (AUC) differences between earlier time points and the 10 min assessment were calculated with 95% confidence intervals. Diagnostic performance and classification stability were further assessed using the 10 min cutoff.
Results:
PI and MPI were significantly lower in malignant LNs than in benign LNs at all three time points. For PI, the AUCs were 0.919, 0.942, and 0.949 at 6, 8, and 10 min, respectively. For MPI, the corresponding AUCs were 0.936, 0.933, and 0.940. In the exploratory AUC based comparison with 10 min, PI at 6 min was not within the exploratory margin, whereas PI at 8 min and MPI at both 6 and 8 min were within the margin. When the 10 min cutoff was applied to earlier measurements, the 6 min assessment showed reduced sensitivity and lower classification agreement, whereas the 8 min assessment showed more stable classification relative to 10 min CONCLUSIONS: In suspicious superficial LNs evaluated with perfluorobutane enhanced ultrasound, quantitative postvascular phase assessment showed good diagnostic performance. However, the 6 min assessment showed less stable classification, while the 8 min assessment may represent a more reliable earlier observation time point under this specific imaging protocol.
