Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5767_Библиотеки_им_академика_М_И_Перельмана.pdf
16 Scrotum andTesticles
c
295
d
Fig. 16.2 (continued)
296
Table 16.2 Quantitative features of CEUS in malignant and benign tumors, non-neoplastic lesions, and normal testicular parenchyma
All benign
Parameter Malignant tumors
WIT, s 5.9 (4.6–7.8) 8.1 (6.7–12.6) 0.001 6.9 (5.2–8.6) 9.5 (7.7–17.24) 0.002 8.1 (5.9–12.0)
TTP, s 31.7 (27–35.8) 38.8
MTT, s 8.8 (6.8–11.4) 11.4 (9.4–17.8) 0.001 10.2 (7.7–12.4) 13.1 (10.8–24.4) 0.004 12.1
WOT, s 18.8 26.5
PI, dB 3.5 (2.0–5.2) 4.0 (1.4–5.4) 0.799 4.0 (2.3–5.4) 1.6 (0.6–4.2) 0.002 2.3 (1.5–3.3)
Az 140 (84–223) 177 (77–263) 0.260 180 (99–261) 102 (30–215) 0.026 104 (67–169)
AS, dB/s 0.49 (0.3–0.8) 0.4 (0.1–0.7) 0.162 0.5 (0.3–0.8) 0.1 (0.05–0.3) 0.001 0.2 (0.1–0.4)
WIT wash-in time, TTP time to the peak enhancement, MTT mean transit time, WOT wash-out time, PI peak intensity,
Az area under the curve, AS ascending slope
lesions p All tumors
0.005 33.3
(31.2–45.7)
0.001 20.6
(19.9–36.5)
(29.0–40.4)
(15.9–25.2)
Non-neoplastic
lesions p Parenchyma
43.4 (32.6–51.9) 0.009 38.2
34.3 (24.1–46.6) 0.001 23.1
A. N. Sencha et al.
(31.4–44.4)
(8.9–17.1)
(16.8–35.5)
Rare publications on quantitative analysis of
CEUS indicate its prospects for the differential
diagnosis of testicular lesions. The study [21]
reported that testicular tumors are characterized
by faster wash-in, peak intensity, and wash-out,
as compared with non-neoplastic lesions.
Additionally, malignant tumors exhibit faster
wash-in and wash-out with no difference in peak
intensity (Table16.2). However, yet a small number of publications and the lack of standardization do not permit any recommendations.
Non-neoplastic diseases of the scrotum also
benet from CEUS. Testicular torsion is rarely
reported to be examined with microbubble injection [6, 22–24]. This is probably because testicular torsion is primarily found in children and
adolescents, and UCAs were not licensed for
pediatric patients, and in many countries were
used off-label. Depending on the severity of the
spermatic cord twisting, the arterial blood supply
to the testicle is signicantly reduced or blocked.
An animal model demonstrated that the arterial
inow stops only in cases of greater than 450°
twist [25]. Considering the high sensitivity and
specicity of modern CDI and PDI (86–100%
and 98–100%, respectively) in the diagnosis of
the testicular torsion, CEUS does not provide any
additional clinically signicant information, but
reliably conrms testicular avascularity [2].
However, CEUS may be useful in small-sized
testicles when Doppler imaging fails to provide
the necessary quality of blood ow detection.
CEUS conrms the decrease or absence of the
vascular supply to the testicle, which corresponds
to hypo- or nonenhancement as compared with
the normal testicle [6] (see Chap. 20).
Acute segmental testicular infarction is wall
diagnosed with normal ultrasound if a typical
wedge-shaped lesion in a combination with the
signicant decrease or absence of vascularity
with CDI and PDI is detected [19]. But in an
atypical appearance with a rounded lesion shape,
the differential diagnosis with a hypovascular
tumor is necessary. CEUS demonstrates one or
more ischemic lobules separated by normal testicular vessels in the acute phase [2]. The subacute segmental infarction is characterized by the
annular contrast enhancement around the ischemic zone, which is associated with reactive
hyperemia and decreases with time [2]. In a
month, a hyperenhancing rim is absent, and spots
of contrast enhancement within the lesion may
appear [2].
In orchiepididymitis, the diagnosis is based on
clinical data reinforced with sonography, which
detects hypervascularization with CDI and
PDI.The increase in venous ow is usually associated with testicular inammation. CEUS conrms the obtained US data in uncomplicated
orchitis and provides valuable diagnostic information regarding complications, such as abscess,
venous infarction, spermatic vein thrombosis,
hemorrhage, etc. CEUS increases the sensitivity
in the detection of thrombosis in funiculitis and
16 Scrotum andTesticles
297
identication of postinammatory ischemic
changes in the testicular parenchyma [19].
Venous infarction of the testis is a result of a
segmental or diffuse failure of venous outow
due to inammation, which leads to necrosis and
abscess. It also may be a consequence of hypercoagulation or testicular trauma. Traditional
echography hardly differentiates arterial infarction, tumor, and venous infarction with abscess.
The study [26] reported that nonenhancing focal
lesions of a rounded shape centrally located
within the testicle were characteristic of a venous
infarction with abscess. Irregular margins and
peripheral rim-like hyperenhancement typically
accompany both venous infarction and testicular
abscess. CEUS is also benecial for the assessment of the real abscess size [6].
Scrotal trauma accompanies about 1% of all
body trauma. Blunt trauma is the most common
mechanism of injury often due to sporting activities. Penetrating injuries are rare. Scrotal
trauma usually confers bruise, hematoma,
hematocele, testicular rupture, etc. The rst line
imaging method is US with CDI and PDI.The
key point is the identication of the tunica albuginea continuity or defects. Besides, the volume
of viable testicular tissue is important, which
determines the surgery type [27]. In most cases,
CEUS denes traumatic changes with better
accuracy. It precisely reveals the nature and volume of the damage. CEUS clearly denes the
ruptured areas represented by nonenhancing
lesions of irregular linear shape and hematomas,
which appear hypoenhanced or nonenhanced
depending on the severity of the injury [8]
(Figs.16.3 and 16.4).
CEUS surpasses traditional echography in
the evaluation of both focal testicular lesions
and traumatic damage. It reliably demonstrates
the perfusion of scrotal organs in real-time. An
especially important aspect is the identication
of avascular lesions [27–30]. CEUS data in
some cases can be a signicant argument for
the tactics of “watchful observation” or puncture biopsy, which permits to avoid unwanted
orchiectomy.
Fig. 16.3 Post-traumatic cyst in the parenchyma of the testis. CEUS image identies the perfusion defect
298
A. N. Sencha et al.
Fig. 16.4 Testicular appendage cyst. CEUS image identies the perfusion defect
References
1. Müller T, Gozzi C, Akkad T, Pallwein L, Bartsch
G, Steiner H. Management of incidental impalpable intratesticular masses of < or = 5 mm in
diameter. BJU Int. 2006;98(5):1001–4. https://doi.
org/10.1111/j.1464- 410X.2006.06485.x.
2. Bertolotto M, Derchi LE, Sidhu PS, Serani G,
Valentino M, Grenier N, Cova MA.Acute segmental
testicular infarction at contrast-enhanced ultrasound:
early features and changes during follow-up. AJR
Am J Roentgenol. 2011;196(4):834–41. https://doi.
org/10.2214/AJR.10.4821.
3. Huang DY, Sidhu PS.Focal testicular lesions: colour
Doppler ultrasound, contrast-enhanced ultrasound and
tissue elastography as adjuvants to the diagnosis. Br J
Radiol. 2012;85(1):S41–53. https://doi.org/10.1259/
bjr/30029741. Special Issue.
4. Hedayati V, Sellars ME, Sharma DM, Sidhu
PS. Contrast-enhanced ultrasound in testicular
trauma: role in directing exploration, debridement
and organ salvage. Br J Radiol. 2012;85(1011):e65–8.
https://doi.org/10.1259/bjr/95600238.
5. Lock G, Schmidt C, Helmich F, Stolle E, Dieckmann
KP. Early experience with contrast-enhanced ultrasound in the diagnosis of testicular masses: a feasibility study. Urology. 2011;77(5):1049–53. https://doi.
org/10.1016/j.urology.2010.12.035.
6. Moschouris H, Stamatiou K, Lampropoulou E,
Kalikis D, Matsaidonis D. Imaging of the acute
scrotum: is there a place for contrast-enhanced ultrasonography? Int Braz J Urol. 2009;35(6):692–702.
https://doi.org/10.1590/s1677- 55382009000600008;
discussion 702–5.
7. Patel K, Sellars ME, Clarke JL, Sidhu PS. Features
of testicular epidermoid cysts on contrast-enhanced
sonography and real-time tissue elastography. J
Ultrasound Med. 2012;31(1):115–22. https://doi.
org/10.7863/jum.2012.31.1.115.
8. Valentino M, Bertolotto M, Derchi L, Bertaccini A,
Pavlica P, Martorana G, Barozzi L.Role of contrast
enhanced ultrasound in acute scrotal diseases. Eur
Radiol. 2011;21(9):1831–40. https://doi.org/10.1007/
s00330- 010- 2039- 5.
9. Schröder C, Lock G, Schmidt C, Löning T, Dieckmann
KP. Real-time elastography and contrast-enhanced
ultrasonography in the evaluation of testicular masses:
a comparative prospective study. Ultrasound Med
Biol. 2016;42(8):1807–15. https://doi.org/10.1016/j.
ultrasmedbio.2016.03.026.
10. Sidhu PS, Cantisani V, Dietrich CF, Gilja OH,
Saftoiu A, Bartels E, et al. The EFSUMB guidelines and recommendations for the clinical practice
of contrast-enhanced ultrasound (CEUS) in nonhepatic applications: update 2017 (long version).
Ultraschall Med. 2018;39(2):e2–e44. https://doi.
org/10.1055/a- 0586- 1107.
16 Scrotum andTesticles
299
11. Baxter GM, Sidhu PS.Ultrasound of urogenital system. Stuttgart: Thieme; 2004.
12. Ministerstva Zdravookhraneniya Rossiyskoy
Federatsii. Germinogennye Opuholi u Muzhchin.
Klinicheskie rekomendacii [Germinogenic tumors
in men: clinical recommendations]. Moscow:
Ministerstva Zdravookhraneniya Rossiyskoy
Federatsii; 2018. Russian. http://www.oncology.ru/
association/clinical- guidelines/2018/germinogennye_
opukholi_u_muzhchin_pr2018.pdf. Accessed 21 Feb
2021.
13. Ma W, Sarasohn D, Zheng J, Vargas HA, Bach
A.Causes of avascular hypoechoic testicular lesions
detected at scrotal ultrasound: can they be considered
benign? AJR Am J Roentgenol. 2017;209(1):110–5.
https://doi.org/10.2214/AJR.16.17333.
14. Mitkov VV, editor. Prakticheskoe rukovodstvo po
ul’trazvukovoj diagnostike [Practical guide to ultrasound diagnostics]. 2nd ed. Moscow: Vidar; 2011.
p.501–23. Russian.
15. Langer JE, Ramchandani P, Siegelman ES, Banner
MP. Epidermoid cysts of the testicle: sonographic
and MR imaging features. AJR Am J Roentgenol.
1999;173(5):1295–9. https://doi.org/10.2214/
ajr.173.5.10541108.
16. Fang C, Huang D, Sidhu PS.Scrotum: benign lesions.
In: Lyshchik A, editor. Specialty imaging: fundamentals of CEUS. 1st ed. Philadelphia, PA: Elsevier;
2019. p.254–72.
17. Rafailidis V, Robbie H, Konstantatou E, Huang
DY, Deganello A, Sellars ME, Cantisani V, Isidori
AM, Sidhu PS. Sonographic imaging of extratesticular focal lesions: comparison of grey-scale,
colour Doppler and contrast-enhanced ultrasound.
Ultrasound. 2016;24(1):23–33. https://doi.org/10.117
7/1742271X15626195.
18. Jaffer OS, Sidhu PS.Contrast-enhanced ultrasonography of the testes. Ultrasound Clin. 2013;8(4):509–23.
19. Valentino M, Bertolotto M, Martino P, Barozzi L,
Pavlica P.Incidentally detection of non-palpable testicular nodules at scrotal ultrasound: what is new?
Arch Ital Urol Androl. 2014;86(4):378–82. https://
doi.org/10.4081/aiua.2014.4.378.
20. Kachramanoglou C, Rafailidis V, Philippidou M,
Bertolotto M, Huang DY, Deganello A, et al. multiparametric sonography of hematologic malignancies
of the testis: grayscale, color Doppler, and contrastenhanced ultrasound and strain elastographic appearances with histologic correlation. J Ultrasound
Med. 2017;36(2):409–20. https://doi.org/10.7863/
ultra.16.02013.
21. Isidori AM, Pozza C, Gianfrilli D, Giannetta E,
Lemma A, Po R, etal. Differential diagnosis of nonpalpable testicular lesions: qualitative and quantitative contrast-enhanced US of benign and malignant
testicular tumors. Radiology. 2014;273(2):606–18.
https://doi.org/10.1148/radiol.14132718.
22. Kitami M. Ultrasonography of pediatric urogenital
emergencies: review of classic and new techniques.
Ultrasonography. 2017;36(3):222–38. https://doi.
org/10.14366/usg.17011.
23. Syed A, Pranay P, Chua N, Naleem A, Mahmood
I, Khan S. A case of testicular torsion demonstrated on contrast enhances ultrasound. Russ
Electron J Radiol. 2017;7(4):161–3. https://doi.
org/10.21569/2222- 7415- 2017- 7- 4- 161- 163.
24. Yusuf GT, Sidhu PS.A review of ultrasound imaging
in scrotal emergencies. J Ultrasound. 2013;16(4):171–
8. https://doi.org/10.1007/s40477- 013- 0033- x.
25. Lee FT Jr, Winter DB, Madsen FA, Zagzebski JA,
Pozniak MA, Chosy SG, Scanlan KA.Conventional
color Doppler velocity sonography versus color
Doppler energy sonography for the diagnosis of
acute experimental torsion of the spermatic cord. AJR
Am J Roentgenol. 1996;167(3):785–90. https://doi.
org/10.2214/ajr.167.3.8751701.
26. Lung PF, Jaffer OS, Sellars ME, Sriprasad S, Kooiman
GG, Sidhu PS. Contrast-enhanced ultrasound in
the evaluation of focal testicular complications secondary to epididymitis. AJR Am J Roentgenol.
2012;199(3):W345–54. https://doi.org/10.2214/
AJR.11.7997.
27. Trinci M, Cirimele V, Ferrari R, Ianniello S, Galluzzo
M, Miele V. Diagnostic value of contrast-enhanced
ultrasound (CEUS) and comparison with color
Doppler ultrasound and magnetic resonance in a case
of scrotal trauma. J Ultrasound. 2020;23(2):189–94.
https://doi.org/10.1007/s40477- 019- 00389- y.
28. Badea R, Lucan C, Suciu M, Vasile T, Gersak
M.Contrast enhanced harmonic ultrasonography for
the evaluation of acute scrotal pathology. A pictorial
essay. Med Ultrason. 2016;18(1):110–5. https://doi.
org/10.11152/mu.2013.2066.181.esy.
29. Dahiya N, Patel MD, Menias CO.Ultrasonography
of the scrotum: extratesticular. Ultrasound Clin.
2014;9(3):457–69. https://doi.org/10.1016/j.
cult.2014.03.002.
30. Lobianco R, Regine R, De Siero M, Catalano
O, Caiazzo C, Ragozzino A. Contrast-enhanced
sonography in blunt scrotal trauma. J Ultrasound.
2011;14(4):188–95. https://doi.org/10.1016/j.
jus.2011.09.003.
Lymph Nodes
AlexanderN.Sencha , EkaterinaA.Sencha ,
EllaI.Peniaeva , andYuryN.Patrunov
17
Sonography is the most common and widely
available imaging modality for the diagnosis of
lymph node (LN) abnormalities. The grayscale
US evaluates the size, shape, and structure.
Vascularization is one feature for the differentiation of reactive and malignant LN.The possibilities of CDI and PDI in the identication of
microvascularity and detection of vessels with
slow blood ow are limited. Some publications
[1] indicate the prospects of CEUS in the diagnosis of benign and malignant LN changes due to
the ability to assess LN perfusion. The sensitivity, specicity, and accuracy of CEUS in the
Supplementary Information The online version contains supplementary material available at [https://doi.
org/10.1007/978- 3- 030- 91764- 7_17].
A. N. Sencha (*)
Department of Visual and Functional Diagnostics,
Federal State Budget Institution “National Medical
Research Center for Obstetrics, Gynecology and
Perinatology n.a. V.I.Kulakov”,
Moscow, Russian Federation
E. A. Sencha
Ultrasound Diagnostics Department, Federal State
Budget Institution “Medical Diagnostic Center No.
9” of the Ministry of Defence of the Russian
Federation, Moscow, Russian Federation
E. I. Peniaeva · Y. N. Patrunov
Department of Ultrasound Diagnostics of the Center
for Radiological Diagnostics, Private Healthcare
Institution “Clinical Hospital “RZD-Medicina” of
Yaroslavl City”, Yaroslavl, Russian Federation
detection of malignant LNs reach 98%, 99%, and
99%, respectively [2].
Doppler techniques permit specication of the
vascular anatomy of the LN, while CEUS comprehensively assesses the LN perfusion, which is
especially important in the cases of local thickening of the LN cortex [3].
In CEUS of LN, the choice of a transducer,
scanning plane, and access is based on the same
principles as in traditional echography. UCA is
introduced according to the standard technique in
a dose of 2.4 or 4.8mL depending on the equipment and the probe frequency. The higher is the
transducer frequency, the higher the UCA dose is
required [4].
Normal LN typically has a single hilum and
vascular pedicle with an artery, veins, and efferent lymphatic vessels. The artery enters the LN
through the hilum, arterioles pass within trabeculae, branch as approaching the capsule. Within
the cortex, networks of arterioles, capillaries, and
venules occur near subcapsular and trabecular
sinuses and around nodules. The draining veins
pass out of the hilum. In conventional sonography, the detection of LN vessels depends on the
capabilities of the scanner. Normally, it detects
the vessels in the LN hilum [3, 5, 6]. In most
inammatory processes, the typical LN vascular
pattern remains intact [3].
The changes in the vascular pattern in LN
malignancies result from the mass effect of desmoplastic reaction and necrosis, neoplastic inl-
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
A. N. Sencha, Y. N. Patrunov (eds.), Contrast-Enhanced Ultrasound,
https://doi.org/10.1007/978-3-030-91764-7_17
301
302
A. N. Sencha et al.
tration with associated peripheral
hypervascularity, the appearance of tortuous,
aberrant, and paracapsular vessels, which pene-
vessels. It leads to peripheral hypervascularization with tortuous and aberrant vessels that supply the LN periphery and tumor foci.
trate the capsule. However, at the early stages and
the metastases of well-differentiated carcinomas,
the initial vascular pattern may remain normal
with hypervascularization due to local inammatory immune response [3].
CEUS can register all vascular changes in the
LN.The introduction of microbubbles and CDI/
PDI modes facilitates the depiction of the LN
vascular arrangement. It enables the registration
of the regular vascular pattern with branching
from the hilum to the capsule, which is typical for
reactive LNs.
With CEUS, different types of lymphadenopathy are characterized by different patterns of contrast enhancement.
Normal and reactive lymph nodes exhibit a
normal vascular pattern in the early arterial phase
(82.5%) demonstrates heterogeneous contrast
enhancement with diffuse or centripetal lling
with UCA from the periphery to the hilum [12,
13]. The enhancement of capsular vessels begins
in 10–15s after UCA injection followed by the
enhancement of aberrant and disorganized vessels within the LN, while the hilum may remain
unenhanced. In 15–25s, there appears heterogeneous enhancement of the cortex with local
hypovascular zones associated with metastatic
foci or avascular necrotic areas. In 40–60s, the
wash-out starts and hypoenhanced foci could not
be further visualized. As opposed to benign LN,
this heterogeneous centripetal or mixed enhancement pattern is characteristic of metastatic LN
(Figs.17.2, 17.3, and 17.4, Video 17.2).
(Fig. 17.1, Video 17.1). The contrast enhancement starts 10–15s after the UCA introduction
from the hilar area followed by the intense uniform centrifugal lling of the LN.This enhancement pattern is characteristic of 70–80% of
histologically intact LNs [7, 8]. Reactive hyperplasia may demonstrate uniform hyperenhance-
ment in benign and metastatic LNs [14] demon-
strated that benign lymph nodes exhibited higher
derived peak intensity than metastatic ones
(17.72±5.43% vs. 11.76±4.88%, respectively)
and higher values of regional blood volume
(849.8±467.1 vs. 458.3±283.3, respectively).
ment of the cortex, which demands the differential
diagnosis with lymphoma [9]. Heterogeneity of
contrast enhancement can be registered if necrotic
areas arise on the background of granulomatous
inammation [10].
Malignant lymph nodes with CEUS are diagnosed with high sensitivity, specicity, positivepredictive value, and low negative predictive
value. This conclusion arises from the metaanalysis [11] based on 16 studies comprising
lymphoma. It is typically divided into nonHodgkin lymphoma and Hodgkin lymphoma.
The most common histological type of nonHodgkin lymphoma is diffuse large B cell lymphoma, and the most common indolent
non-Hodgkin lymphoma is follicular lymphoma.
Hodgkin lymphoma, large B cell lymphoma, and
follicular lymphoma account for up to 80% of all
lymphomas in adults [4].
1563 LN lesions. CEUS was advised for use in
clinical practice as an excellent diagnostic tool
for the diagnosis of LN malignancies.
Lymph nodes are often affected by metastasis.
Neck LNs metastases are diagnosed with an
obscure primary tumor in 3–8% of cases, thyroid
cancer in 9–90%, and breast cancer in 19–80%
[5]. The tumor cells in metastatic LN cause distortion and destruction of regular vascular anatomy. Tumor inltration of the cortex is combined
with neoangiogenesis and an increase in capsular
challenge due to the variability of enhancement
patterns, some of which can also correspond to
reactive or metastatic LNs. In the majority of
cases (70–83%), lymphoma is characterized by
rapid homogeneous hyperenhancement.
Heterogeneous contrast enhancement is registered in only 17%, which is rare and differentiates lymphoma from metastatic LNs [4, 12].
Additionally, lymphoma often exhibits the specic “snowstorm” pattern with diffuse dotted
With CEUS, metastatic LN in most cases
The analysis of quantitative data of enhance-
The second malignancy that affects LNs is
With CEUS, the diagnosis of lymphoma is a
17 Lymph Nodes
a
303
b
Fig. 17.1 Normal axillary lymph nodes. (a) Arterial phase CEUS image with a hypoenhancing lymph node. (b) Late
phase CEUS demonstrates poor enhancement
304
A. N. Sencha et al.
a
b
Fig. 17.2 Metastatic LN.CEUS images. (a) Chaotic enhancement of the LN with hypovascular areas in the arterial
phase. (b) Hypoenhancement in the venous phase
17 Lymph Nodes
Fig. 17.3 Metastatic iliac LN.CEUS image. Chaotic heterogeneous hyperenhancement in the arterial phase
305
enhancement in the early arterial phase (Fig.17.5,
Video 17.3).
The accuracy of CEUS in the diagnosis of
lymphoma is 83.57%, which exceeds the accuracy of CE-CT (80.71%) but is lower than
PET-CT (88.57%) [4].
Reliable differences between the TIC parameters of lymphoma and metastatic LNs were
reported [12]. Lymphoma exhibited smaller peak
intensity and area under the curve (PI of
8.78 ± 2.53 dB and AUC of 652.62 ± 249.60)
than metastatic LNs (PI of 10.51± 2.98 dB and
AUC of 784.09±340.24).
Quantitative analysis of CEUS enables evaluation of the response to treatment of lymphoma
and metastatic LNs [15]. The difference in the
contrast enhancement of the neck LNs with nasopharynx cancer metastases before and after radiation therapy was reported [16]. In patients with
complete response, peak intensity (PI) was reliably higher than in patients with partial response
(34.24±3.78% vs. 25.62±2.30%). The ratio of
PI before treatment to PI during treatment (PI
Ratio) was signicantly higher in the full
response group than in the partial response group
(0.81±0.01 vs. 0.66±0.01; p=0.001). The sensitivity and specicity of in-treatment PI in predicting the therapeutic response were 94.3% and
88.2%, and the corresponding values of the PI
Ratio were 92.5% and 83.8%, respectively.
Quantitative CEUS in lymphoma patients
before and after the rst three cycles of chemotherapy demonstrates the reliable difference in
the area under the curve (AUC), peak intensity
(PI), and change of peak intensity (I) between the
groups of good responders and non-responders,
which are summarized in Table17.1 [15].
They demonstrated that the effectiveness of
the therapeutic response can be predicted by the
CEUS parameter ΔI (AUC—0.889). The values
of ΔAUC and ΔPI have the highest diagnostic
performance of ineffectiveness (AUC 0.925 and
0.832, respectively).
Besides, in LNs with focal cortical thickening,
CEUS may be used to guide a biopsy needle to
the zone of abnormal perfusion and decrease the
number of false-negative samples.
Detection of sentinel lymph nodes is a specific feature of CEUS.Sentinel LN is the first
regional lymph node, which drains the primary