Sravanthi Mantripragada MBBS, Presenter: Nothing to Disclose

Raja Sekaran Kattumannarkudi Ramalingam MBBS, Abstract Co-Author: Nothing to Disclose

Meera Krishnakumar DMRD, MD, Abstract Co-Author: Nothing to Disclose

To determine the most accurate modality and propose a sequential protocol for cause identification of cervical lymphadenopathy.

The study popoluation consisted of 121 nodes and a control of 11 reactive nodes. USG and Strain elastography were performed with an Acuson S2000 unit. ImageJ software was used to analyse Elastographic images. MDCT was performed using a Toshiba 64 slice scanner. Based on characteristics like size, shape, reticulation, type of vascularity, hilar echogenecity, necrosis, matting, percentage of elastographic stiffness, nodes were diagnosed and compared with the final HPE diagnosis. Accuracy of each modality (USG, combination of USG & Elastography and MDCT) was estimated by calculating the sensitivity, specificity, PPV and NPV  for each aetiology (Lymphoma, TB, Metastasis and Reactive). The modalities were compared in pairs to determine the most accurate modality for cause characterization. P-values, PPV, NPV and PLR for certain characteristics of USG & MDCT which favoured some aetiologies were calculated. The data was analysed using Fisher's exact test and Pearson's Chi-squared test. A p value <0.05 was considered significant.

USG was the most accurate modality, followed by MDCT and combination of USG & Elastography, in that order. On USG: -Intranodal reticulation with posterior acoustic enhancement implies Lymphoma -Displaced vascularity or necrosis & matting implies TB -Hilar vascularity implies Reactive -Peripheral or mixed vascularity imply Metastasis On MDCT: -Heterogeneous enhancement and low attenuation centres (not necrosis) implies Metastasis -Thick nodular capsular enhancement with internal septae or matting or peripheral/multilocular enhancement or necrosis implies TB

USG is the preferred modallity for cause characterization of cervical lymphadenopathy. Elastography significantly reduces the accuracy of USG, when used in tandem, especially in cases of TB. This implies that Elastography has very limited application in the cause characterization of cervical lymphadenopathy. TB significantly reduces the accuracy of ultrasound modalities in cause determination.  

This study proposes a low-cost, low-radiation standard clinico-radiological step-by-step protocol (in fig) for approach to cervical lymphadenopathy, which is of practical application.

Mantripragada, S, Kattumannarkudi Ramalingam, R, Krishnakumar, M, Proposal of a Sequential Clinico-Radiological Protocol for Aetilogical Characterisation of Cervical Lymphadenopathy by Comparing the Accuracies of Ultrasonography (USG), Elastography and MDCT.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008429.html