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Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph
Zuhal Bayramoglu1, Emine Caliskan1, Zeynep Karakas2,3
11 Department of Radiology, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey.
Insights
Superb microvascular imaging (SMI) and shear wave elastography (SWE) effectively differentiate malignant lymphoma and acute lymphadenitis from normal lymph nodes in children. SWE shows higher efficiency in distinguishing lymphoma from lymphadenitis compared to SMI.
Area of Science:
- Pediatric Radiology
- Oncology Imaging
- Diagnostic Ultrasound
Background:
- Accurate differentiation of pediatric lymphadenopathy is crucial for timely diagnosis and treatment.
- Malignant lymphoma and acute lymphadenitis present similar sonographic features, posing diagnostic challenges.
- Novel imaging techniques are needed to improve diagnostic accuracy in pediatric lymph node evaluation.
Purpose of the Study:
- To evaluate the diagnostic utility of a vascularity index (VI) from superb microvascular imaging (SMI) and shear wave elastography (SWE) parameters in differentiating pediatric malignant lymphoma and acute lymphadenitis from normal lymph nodes.
- To compare the efficacy of SMI-derived VI with SWE-derived elasticity and velocity, and grayscale ultrasonography-derived shape index (SI) in lymph node characterization.
Main Methods:
- A retrospective analysis of multiparametric lymph node evaluation was conducted.
- Histopathological examination confirmed malignant lymphoma, while clinical and laboratory findings diagnosed acute lymphadenitis.
- Vascularity index (VI) via SMI, elasticity and velocity via SWE, and shape index (SI) via grayscale ultrasonography were calculated and compared across study groups.
Main Results:
- The study evaluated 45 malignant lymphoma, 72 acute lymphadenitis, and 146 normal lymph nodes.
- A VI cut-off of >15% achieved 95% accuracy in differentiating lymphoma from normal nodes; elasticity cut-off of >17 kPa yielded 99% accuracy.
- For differentiating lymphoma from lymphadenitis, optimal cut-offs for VI, elasticity, velocity, and SI were 15%, 17 kPa, 2.45 m/s, and 65%, respectively, with diagnostic accuracies of 83%, 87%, 88%, and 68%.
Conclusions:
- Vascularity index (VI) from superb microvascular imaging (SMI) and shear wave elastography (SWE) parameters are valuable in distinguishing malignant lymphoma and acute lymphadenitis from normal lymph nodes.
- SWE demonstrates superior efficiency compared to SMI in differentiating malignant lymph nodes from acute lymphadenitis.
- Vascularity index derived from SMI represents a novel Doppler parameter for differentiating both lymphoma from lymphadenitis and lymphadenitis from normal lymph nodes.
Objective:
To determine the diagnostic utility of a vascularity index via superb microvascular imaging in lymph nodes of children with malignant lymphoma and acute lymphadenitis compared to normal lymph nodes.
Methods:
We performed a retrospective study for multiparametric lymph node (LN) evaluation. Malignant lymphoma diagnosed via histopathological examination and lymph nodes receiving an acute lymphadenitis diagnosis based on clinical and laboratory findings constituted the study subgroups. We calculated a shape index [SI (percent of shortest to longest diameter)] using grayscale ultrasonography and elasticity and velocity values via shear wave elastography (SWE) as well as a vascularity index (VI) using superb microvascular imaging (SMI) for comparison with normal lymph nodes.
Results:
45 lymph nodes diagnosed with malignant lymphoma, 72 lymph nodes diagnosed with acute lymphadenitis and 146 normal lymph nodes were evaluated. For differentiating lymphoma from normal lymph nodes, vascularity index cut-off values higher than 15% represented a diagnostic accuracy of 95%; cut-off elasticity values higher than 17 kPa exhibited a diagnostic accuracy of 99%. Optimal VI, elasticity, velocity and SI cut-off values in differentiating lymphoma from lymphadenitis were 15%, 17 kPa, 2.45 m sn-1 (p < 0.001) and 65% (p < 0.002) with calculated diagnostic accuracies of 83, 87, 88 and 68%, respectively.
Conclusion:
Vascularity index values obtained via superb microvascular imaging and SWE would be reasonably useful in differentiating malignant lymphoma and acute lymphadenitis from normal LNs. SWE would be more efficient in distinguishing malignant lymph nodes from acute lymphadenitis compared with superb microvascular imaging. Advances in knowledge: Vascularity index by superb microvascular imaging would be a novel Doppler parameter in differentiating both lymphoma from lymphadenitis and also lymphadenitis from normal lymph nodes.
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