The value of multimodal ultrasonography in differential diagnosis of tuberculous and non-tuberculous superficial lymphadenitis

Abstract

Background To investigate the value of multimodal ultrasonography in differentiating tuberculosis from other lymphadenopathy. Methods Sixty consecutive patients with superficial lymphadenopathy treated at our hospital from January 2017 to December 2018 were categorized into four types based on the color Doppler ultrasound, five types based on contrast-enhanced ultrasound, and five types based on elastography. Sensitivity and specificity were calculated of all the three imaging, including color Doppler examination, contrast-enhanced ultrasound and one individual multimodal method, for detecting lymph nodes. Results A total of 60 patients were included in the final analysis. Of those, Mycobacterium tuberculosis was positive in 38 patients and negative in 22 patients. Among the 38 patients who were positive for Mycobacterium tuberculosis, of which 23 had a history of pulmonary tuberculosis, accounting for 60.53% of the positive cases, and the remaining patients did not combine lesions of other organs. Among the 60 superficial lymph nodes, 63.3% presented with tuberculous lymphadenitis. The sensitivity, specificity, and accuracy of the color Doppler examination were 73.68%, 68.18%, and 71.67%, respectively. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound were 89.47%, 63.64% and 80.00%, respectively. The sensitivity, specificity and accuracy of the elastography were 63.16%, 63.64% and 63.33%, respectively. The sensitivity, specificity and accuracy of one individual multimodal method were 42.11%, 95.45% and 61.67%, respectively. The sensitivity, specificity and accuracy of all modes combined were 100.00%, 27.27% and 73.33%, respectively. Conclusion Multimodal ultrasonography has high predictive value for the differential diagnosis of superficial tuberculous lymphadenitis.

Value of Contrast-Enhanced Ultrasound in the Ultrasound Classification of Cervical Tuberculous Lymphadenitis

“…US is an important method that is used to examine cervical lymph nodes, which can accurately demonstrate the sites, pattern and extend of the disease, and US findings also show a good correlation with the pathological results of tuberculosis ( 10 , 17 , 18 ). In tuberculous lymphadenitis, MTB is engulfed by macrophages to elicit an immune response, which results in lymphadenosis and produces the typical tuberculous granulomas and caseous necrosis ( 19 , 20 ).…”

“…According to prior studies, CEUS has been supposed to be a promising and less invasive method which is based on the application of intravenous contrast agent. In some cases, the nature of CTL lesion could be predicted through the characterization of blood perfusion reflected by CEUS ( 9 , 10 , 23 ). In our study, the US classification of CTL was further improved by the blood perfusion pattern of CEUS.…”

“…Previous studies have reported that CEUS is an effective method to examine microvascular perfusion in lesions, and it has significantly improved our ability to identify necrotic areas. The blood flow enhancement patterns, diagnosis, and differential diagnosis of CTL have been intensively studied ( 8 – 10 ). Furthermore, CEUS has been used to diagnose and classify pancreatic cystic lesions, cystic renal tumors, and other diseases ( 11 , 12 ).…”

Tuberculosis conundrum - current and future scenarios: A proposed comprehensive approach combining laboratory, imaging, and computing advances

“…Multimodal ultrasound imaging: Multimodal ultrasound imaging combines several US modalities simultaneously: Color Doppler US, US elastography, and contrast-enhanced ultrasound (discussed shortly). It differentiates tuberculous from non-tuberculosis superficial tuberculous lymphadenitis with 100.00% sensitivity and a 94.12% positive predictive value[ 45 ].…”

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…When using multiparametric ultrasound, the majority of superficial lymph nodes showed marginal blood flow during Color Doppler Imaging. When using CEUS, marginal/annular enhancement, separation enhancement, and heterogeneous enhancement was observed [42]. When using elastography, either type 1-Red or yellowgreen or type 2-Blue < 45% have been described.…”