コウクウガン ケイブ テンイ リンパセツ ノ ケンシュツ ニ タイスル チョウオウパ サンジゲン イメージング ノ ユウヨウセイ
The Utility of Three Dimensional Ultrasonographic Imaging for Detecting the Cervical Lymph Node Metastasis with Oral Cancer
菅原, 千恵子 徳島大学大学院ヘルスバイオサイエンス研究部口腔顎顔面放射線医学分野
Three dimensional ultrasonographic imaging was performed for the cervical lymphadenopathy. Forty lymph nodes with suspicion of metastatic lymphadenopathy out of 20 patients with oral cancers were served for the present study. We could not judge the presence/absence of the metastasis by routine B mode or power Doppler imaging alone. Out of the 40 lymph nodes, 18 metastatic lymphadenopathies were proved histopathologically. Additionally, 11 lymph nodes out of 8 patients with nonspecific reactive lymphadenopathies were included as the control. The pattern of the circumferential blood flow of the lymph nodes was reviewed by the three-dimensional maximum intensity projection (3D MIP) view that was obtained from 3D power Doppler imaging. They were divided into 4 categories ; linear blood flow, mesh like blood flow, spotty blood flow and no circumferential flow. The spotty flow was almost exclusively found in the metastatic lymph nodes. Its accuracy, sensitivity and specificity, positive predictive value and negative predictive value for detecting metastatic lymphadenopathy were 0.73, 0.44, 0.95, 0.89, and 0.68, respectively. This spotty flow was situated at the marginal portion and/or around the lymph nodes by the analysis of the two-dimensional display. We could not differentiate whether it was arterial or venous flow. As the three dimensional sonographic imaging is the time-consuming technique compared to the routine B mode or power Doppler imaging, we cannot routinely perform it. However, it would play a supplementary role for detecting lymph node metastasis, especially if we cannot judge them by the two dimensional imaging alone.
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