The Value Of Virtual Touch Tissue Imaging Quantification And Contrast-Enhanced Ultrasound In The Differential Diagnosis Of Superficial Lymph Nodes

Objective To investigate the value of Virtual Touch tissue quantification（VTIQ）and contrast-enhanced ultrasound（CEUS）technique in differential diagnosis of superficial lymph nodes,and then compare the efficacy of the two techniques.Methods The VTIQ and CEUS data of 118 patients with superficial lymphadenopathy were retrospectively analyzed,all lymph nodes use ultrasound-guided core-needle biopsy findings as a reference standard.Put the transducer to select the maximum long axis of lymph nodes and then switched to the VTIQ quality mode to confirm the validity of the region of interest（ROI）.The shear wave velocity（SWV）of the lymph nodes was measured intensively in the velocity mode and maximum（Vmax）,mean（Vmean）,minimum（Vmin）,standard deviation(V_SD)of SWV was obtained.ROC was used to obtain the cutoff value of each parameter and confirm the best diagnostic indicator.According to previous studies,four nodal enhancement patterns of CEUS was defined:1)homogeneous enhancement,2)inhomogeneous enhancement with perfusion defects,3)lack of enhancement.The first enhancement pattern was considered benign lymph node,the others were considered malignant lymph node.Results A total of 118 patients included 37 benign and 81 malignant,Specifically,33reactive hyperplasia,4 tuberculosis,20 lymphoma and 61metastatic lymph nodes.In CEUS,there were 81.1%（30/37）showed category 1 enhancement and 18.9%（7/37）showed category 2 enhancement.In malignant lymph nodes,there were 60.5%（49/81）showed category 2 enhancement,13.6%（11/81）showed category 3 enhancement,and25.9%（21/81）showed category 1 enhancement.The differences of CEUS enhancement patterns were significantly between benign and malignant lymph nodes（P<0.05）.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 74.1%,81.1%,76.3%,89.6%,and 58.8%,respectively.The Vmax,Vmean,Vmin and V_SD of benign lymph nodes were（2.83±0.76）m/s,（2.28±0.57）m/s,（1.75±0.44）m/s,（0.38±0.20）m/s,respectively.The Vmax,Vmean,Vmin and V_SD of malignant lymph nodes were（5.31±1.64）m/s,（3.91±1.07）m/s,（2.92±0.74）m/s,（0.74±0.39）m/s,respectively.The differences of Vmax,Vmean,Vmin and V_SDwere significantly between benign and malignant lymph nodes（P<0.05）.According to ROC curve analysis,the Vmax in the lymph nodes was best value for differential diagnosis of superficial lymph nodes.With a cutoff value of Vmax was3.36m/s,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 87.7%,83.8%,86.4%,92.2%,and 75.6%,respectively.Compare the sensitivity,specificity and accuracy between VTIQ and CEUS in differential diagnosis of superficial lymph nodes,the specificity was no significant difference（P>0.05）,the sensitivity and accuracy was significant difference（P<0.05）.Conclusions Both VTIQ and CEUS have application value in the differential diagnosis of superficial lymph nodes,and VTIQ has a better diagnostic value and efficiency in differentiation of superficial lymph nodes.