The application of ultrasound shear wave elastography in the prediction of paradoxical upgrading reaction in tuberculous lymphadenitis. a pilot study

Abstract

Paradoxical upgrading reaction (PUR) indicates the unanticipated deterioration during therapy in patients with tuberculous lymphadenitis. We investigated the diagnostic performance of the ultrasonography and shear wave elastography (SWE) in predicting the therapeutic response of peripheral tuberculous lymphadenitis. A prospective observational study was conducted from December 2017 to August 2020. Participants diagnosed with peripheral tuberculous lymphadenitis were included for a longitudinal follow-up utilizing ultrasonography with two-dimensional SWE to record sonographic features and the maximum elasticity value (Emax). We defined PUR as the development of any worsening symptoms of the pre-existing lymphadenitis within one month after the previous ultrasonography. A total of 108 sonographic and SWE examinations were performed in 20 enrollees (75% woman), and their mean (±standard deviation) age was 49.6 (±22.7) years. The area under the receiver operating characteristic curve of Emax to predict the next-month PUR was 0.906at the cut-point of 85kPa, with an accuracy of 87.0%, a sensitivity of 81.1% and a specificity of 87.9%. Multivariate analysis indicated that Emax>85kPa (OR: 24.85, 95% CI: 4.01-154.08, p<0.001), Emax increment rate >2kPa/month (OR: 15.14, 95% CI: 4.24-54.06, p<0.001), and heterogeneous echogenicity (OR: 4.37, 95% CI: 1.16-16.43, p=0.029) were independent sonographic predictors for PUR in the coming month. A high and non-declining Emax level and heterogeneous echogenicity were associated with the next-month PUR of tuberculous lymphadenitis. Ultrasonography with SWE may be a potential radiologic marker to predict the therapeutic response of tuberculous lymphadenitis.