| Objective:To compare the contrast-enhanced ultrasound(CEUS)of lymphoma with superficial enlarged lymph nodes before and after chemotherapy in contrast to the clinical therapeutic response evaluation in order to find out valuable CEUS parameters.And investigate the role of parametric CEUS for superficial enlarged lymph node of lymphoma therapeutic response evaluation.Materials and methods:All forty-three patients were pathologically diagnosed with lymphoma without invasion of the bone marrow.The particular superficial enlarged lymph node of every patient was marked respectively,and all patients underwent the conventional ultrasound(US)and CEUS examination twice,before the treatment and after the first three cycles of chemotherapy,respectively.Conventional US included the maximum longitudinal diameter(L),the elasticity index(E),the resistance index(RI),and the peak systolic flow velocity(PS)of the lymph node,then paired T test was performed.CEUS characteristics of lymph nodes before the treatment and after the first three cycles of chemotherapy,including enhanced mode,homogeneous or inhomogeneous enhancement,and enhancement with or without defect,were analyzed by the X~2 test.According to the assessment of clinical therapeutic response evaluation by CT or PET/CT in patients after the first three cycles of chemotherapy,a overall response(OR)in 35 patients and no response(NR)in 8 patients was revealed.Then quantitative analysis of TIC-Analysis(GE)software package was performed.The parameters of Gamma curve(B,K,C,TtoPk,Area,ATm)and peak intensity(PI),change of peak intensity(I)were evaluated with the T test.The paired T test was performed for comparison before the treatment and after the first three cycles of chemotherapy,while the independent T test was performed for comparison among different groups.Receiver operating characteristic(ROC)curve was performed to evaluate the diagnostic performance.Results:There was a significant difference in the maximum longitudinal diameter(L)of the conventional US parameters in both OR group and NR group(P<0.05),and there was a significant difference in PS of OR group(P<0.05).Other parameters in the two group were not statistically significant(P>0.05).The difference of CEUS characteristics of lymph nodes before the treatment and after the first three cycles of chemotherapy,including enhanced mode,homogeneous or inhomogeneous enhancement,and enhancement with or without defect,was not statistically significant(P>0.05).Compared with the quantitative parameters of CEUS before and after the first three cycles of chemotherapy,the difference of Area,PI and I in OR group was statistically significant(P<0.05),and there was no significant difference in residual parameters(P>0.05).The difference of NR group was not statistically significant(P>0.05).Compared with OR and NR group of CEUS quantitative parameters,there was statistical significance in Cpre?Areain?PIin?Iin??Area??PI??I(P<0.05).ROC curve was constructed to assess the accuracy of those parameters for the prediction of the therapeutic responses.The ROC curve showed that the therapeutic response could be well predicted only by the parameters of?I.The?I area under the ROC curve(AUC)was 0.889(95%confidence interval,0.712-1.000),which the diagnostic performance was regarded as almost high.The best cut-off value of the?I was 2.858 by coordinating the points of the ROC curve,and the predicted sensitivity and specificity of the?I was 91.4and 87.5%,respectively.Ineffectiveness of therapeutic response could be well predicted by the parameters of Cpre?Areain?PIin?Iin??Area??PI,with AUC 0.754,0.891,0.861,0.818,0.925,0.832,respectively.It can be seen that?Area has the highest diagnostic performance,with cut-off value-60.310,sensitivity 75%and specificity 100%.Conclusions:Quantitative analysis of CEUS may be a useful and objective method and CEUS parameters as area under the Gamma curve(AUC),peak intensity(PI),change of peak intensity(I)play an important role in lymphoma therapeutic response evaluation. |
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