Accuracy of Sonographic Elastography in the Differential Diagnosis of Enlarged Cervical Lymph Nodes: Comparison with Conventional B-Mode Sonography
Farzana Alam1,
Kumiko Naito2,3,
Jun Horiguchi2,
Hiroshi Fukuda2,
Toshihiro Tachikake1 and
Katsuhide Ito1
1 Department of Radiology, Division of Medical Intelligence and Informatics,
Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima,
Japan.
2 Department of Clinical Radiology, Hiroshima University Hospital, 1-2-3,
Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
3 Present address: Hiroshima Atomic Bomb Casualty Council, Hiroshima,
Japan.
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Fig. 1 —Appearance of monitor during elastography examination of
52-year-old man. Elastogram appears on left side of box and is superimposed on
corresponding B-mode image. Corresponding B-mode image is displayed on right
side of monitor. Color scale of tissue elasticity and frequency scale appear
in center (upper and lower, respectively). Final diagnosis was metastasis.
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Fig. 2 —Drawings show typical diagrammatic appearance of five
patterns of lymph nodes. Elastographic patterns were determined on
distribution and percentage of lymph node area having high elasticity (hard):
pattern 1, absent or small hard area; pattern 2, hard area < 45% of lymph
node; pattern 3, hard area  45%; pattern 4, peripheral hard and central
soft areas; pattern 5, hard area occupying entire lymph node. Increasing
tissue hardness appears in ascending order as red, yellow, green, and
blue.
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Fig. 3 —Transverse sonogram of level 1 lymph node in 30-year-old man
with left submandibular lymphadenopathy. Elastography image on left shows
pattern 1, absent or small hard area. B-mode sonographic image on right shows
score of 5, reactive. Final diagnosis from clinical and serologic findings was
reactive lymph node.
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Fig. 4 —Longitudinal sonogram of level 2 lymph node in 33-year-old
woman with left posterior auricular lymphadenopathy. Elastography image on
left shows pattern 2, hard area < 45% of node. B-mode sonographic image on
right shows score 5, reactive. Final diagnosis from clinical and serologic
findings was reactive lymph node.
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Fig. 5 —Transverse sonogram of level 2 lymph node in 79-year-old man
with laryngeal carcinoma. Elastography image on left shows pattern 3, hard
area 45%. B-mode sonographic image on right shows score 7, metastatic.
Final diagnosis by histopathology was metastatic lymph node.
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Fig. 6 —Longitudinal sonogram of level 5 lymph node in 52-year-old
man with nasopharyngeal carcinoma. Elastography image on left shows pattern 4,
peripheral hard and central soft areas. B-mode sonographic image on right
shows score 7, metastatic. Final diagnosis by CT was metastatic lymph
node.
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Fig. 7 —Longitudinal sonogram of level 3 lymph node in 59-year-old
man with thyroid carcinoma. Elastography image on left shows pattern 5, hard
area occupying entire node. B-mode sonographic image on right shows score 8,
metastatic. Final diagnosis by histopathology was metastatic lymph node.
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Copyright © 2008 by the American Roentgen Ray Society.
), and combined evaluation (
). Area
under the curve for combined evaluation (0.970) is higher than that for B-mode
sonography (0.901) or elastography (0.873).