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.
Keywords
Adolescent
Adult
Aged
80 and over
Cervical lymph nodes
clin
Diagnosis
Differential
Elastic Modulus
Elasticity Imaging Techniques
Female
Hardness
Head and neck diseases
Humans
Image Enhancement
Image Interpretation
Computer-Assisted
Lymph Nodes
Lymphatic Diseases
Lymphatic Metastasis
Male
Middle Aged
msk
Neck
Reproducibility of Results
Sensitivity and Specificity
Shear Strength
Shear wave elastography
Ultrasonography
Doppler
Ultrasound
Young Adult