Imaging Modalities In Differentiating Research Articles

Diagnostic accuracy of B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography in differentiation between benign and malignant lymphadenopathy

BackgroundConventional ultrasound is used as an imaging modality for differentiation between benign and malignant lymph nodes, but with different accuracy, sensitivity, and specificity between different studies. A biopsy is the gold standard diagnosis modality but has a drawback due to its invasive nature. In general, metastatic lymph nodes present with a higher stiffness than benign lymph nodes, so ultrasound elastography could be used as an imaging modality for lymphadenopathy differentiation based on its ability to assess tissue stiffness. However, more studies should be done to assess its accuracy. Therefore, we aimed to assess the accuracy of B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography criteria in differentiation between benign from malignant lymph nodes.MethodsA cross-sectional study included 60 patients with lymphadenopathy. B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography criteria were assessed for accuracy, sensitivity, and specificity compared to the final histopathological diagnosis, whether by core biopsy, fine needle aspiration, or excision biopsy.ResultsWe assessed 60 patients in our study (20 benign and 40 malignant). Of these ultrasound criteria that achieved statistical significance, the highest accuracy was for elasticity ratio 88.9%, followed by strain ratio 83.8%. Also, the highest specificity was for an elasticity ratio of 80%, followed by strain score and strain ratio of 75% and 70%, respectively. Cortical asymmetry achieved the highest sensitivity, 100%, followed by strain ratio and elasticity ratio, with a sensitivity of 90% and 87.5%, respectively. However, cortical asymmetry had an extremely low specificity of 25%.ConclusionsUltrasound elastography criteria achieved higher accuracy compared to conventional ultrasound. So it can be used as an effective imaging modality to differentiate between benign and malignant lymph nodes.

Intestinal TB v/s Crohn’s disease –Mystery solved?

In countries like India where TB is endemic, it is extremely difficult to differentiate between Intestinal-TB and Crohn’s-disease as both have overlapping clinical, radiological, endoscopic and histological features [1-4]. Incorrect diagnosis causes increased morbidity and mortality. Hence, there is a need for an imaging test that can accurately diagnose both and can be easily integrated into existing clinical practice. We describe a new technique of CT perfusion for differentiation between the two diseases. We present 2 cases (biopsy proven) of intestinal-TB and Crohn’s-disease. The clinical, laboratory investigations, imaging and endoscopic findings will be discussed along with analysis of the perfusion parameters. The final diagnosis will be considered according to the biopsy findings. We conclude that CT perfusion is a highly sensitive and specific non invasive imaging modality for differentiation between intestinal-TB and crohn’s-disease.