Shear Wave Elastography in Head and Neck Lymph Node Assessment: Image Quality and Diagnostic Impact Compared with B-Mode and Doppler Ultrasonography

Florian Desmots , Nicolas Fakhry , Julien Mancini , Anthony Reyre , Vincent Vidal , Alexis Jacquier (1, 2) , Laure Santini , Guy Moulin , Arthur Varoquaux

1 Department of Radiology, Assistance Publique des Hôpitaux de Marseille
2 CRMBM - Centre de résonance magnétique biologique et médicale

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

Domains: Computer Science [cs]; Medical Imaging; Life Sciences [q-bio]; Human health and pathology; Cardiology and cardiovascular system; Life Sciences [q-bio]; Bioengineering; Imaging

Florian Desmots, Nicolas Fakhry, Julien Mancini, Anthony Reyre, Vincent Vidal, et al.. Shear Wave Elastography in Head and Neck Lymph Node Assessment: Image Quality and Diagnostic Impact Compared with B-Mode and Doppler Ultrasonography. Ultrasound in Medicine & Biology, 2016, 42 (2), pp.387--398. ⟨10.1016/j.ultrasmedbio.2015.10.019⟩. ⟨hal-03591723⟩