Parameters for Contrast-Enhanced Ultrasound (CEUS) of Enlarged Superficial Lymph Nodes for the Evaluation of Therapeutic Response in Lymphoma: A Preliminary Study

Lei Xin, Zhimei Yan, Xiaojuan Zhang, Yichen Zang, Zhaoyan Ding, Hongwei Xue, Cheng Zhao, Lei Xin, Zhimei Yan, Xiaojuan Zhang, Yichen Zang, Zhaoyan Ding, Hongwei Xue, Cheng Zhao

Abstract

BACKGROUND The aims of this preliminary study were to evaluate contrast-enhanced ultrasound (CEUS) imaging and the therapeutic response of enlarged superficial lymph nodes in patients with lymphoma before and after chemotherapy and to determine the most useful CEUS response parameters. MATERIAL AND METHODS Forty-three patients with lymphoma, with 43 enlarged superficial lymph nodes, underwent CEUS and conventional ultrasound (US), before treatment and after the first three cycles of chemotherapy. Clinical responses included overall response (OR) and no response (NR). Imaging parameters by time-intensity curve (TIC) included basic intensity (B), wash-out slope and/or decent slope (K), wash-in slope or rise slope (C), time to peak (TTP), area under the gamma curve (Area), arrive time(ATM), peak intensity (PI), change of peak intensity (I) were compared. And receiver operating characteristic (ROC) curve analysis was operated. RESULTS Quantitative parameters of CEUS before and after the first three cycles of chemotherapy showed a significant difference in the AreaΔ, PID, and IΔ in the OR group compared with NR group (P<0.05). There was a significant difference in the Cpre, Areain, PIin, Iin, AreaΔ, PIΔ, and IΔ in the OR group compared with NR group (P<0.05). The effectiveness of the therapeutic response was predicted by the CEUS parameters of IΔ (P<0.05). And ΔArea has the highest diagnostic performance of ineffectiveness. CONCLUSIONS The findings of this study have shown that quantitative analysis by CEUS may be a useful, and objective, imaging method for the evaluation of the therapeutic response of enlarged superficial lymph nodes in lymphoma before and after chemotherapy.

Conflict of interest statement

Conflict of interest

None.

Figures

Figure 1
Figure 1
Parameters of the receiver operating characteristic (ROC) curve for effective of therapeutic response.
Figure 2
Figure 2
Parameters of the receiver operating characteristic (ROC) curve for lack of effective therapeutic response.

References

    1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. Cancer J Clin. 2016;66(2):115–32.
    1. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86.
    1. Plosker GL, Figgitt DP. Rituximab: A review of its use in non-Hodgkin’s lymphoma and chronic lymphocytic leukaemia. Drugs. 2003;63(8):803–43.
    1. Squillaci E, Antonicoli M, Manenti G, et al. Real-time ultrasound elastography for assessment of response to brentuximab vedotin treatment in relapsed and refractory Hodgkin lymphoma. Eur Rev Med Pharmacol Sci. 2016;20(8):1628–35.
    1. Kocaman O, Ince AT. Endosonography and elastography in the diagnosis of esophageal tuberculosis. Turkish J Gastroenterol. 2013;24(3):290–91.
    1. Chen S, Lin X, Chen X, et al. Noninvasive evaluation of benign and malignant superficial lymph nodes by virtual touch tissue quantification: A pilot study. J Ultrasound Med. 2016;35(3):571–75.
    1. Cao X, Xue J, Zhao B. Potential application value of contrast-enhanced ultrasound in neoadjuvant chemotherapy of breast cancer. Ultrasound Med Biol. 2012;38(12):2065–71.
    1. Peng C, Liu LZ, Zheng W, et al. Can quantitative contrast-enhanced ultrasonography predict cervical tumor response to neoadjuvant chemotherapy? Eur J Radiology. 2016;85(11):2111–18.
    1. Williams R, Hudson JM, Lloyd BA, et al. Dynamic microbubble contrast-enhanced US to measure tumor response to targeted therapy: A proposed clinical protocol with results from renal cell carcinoma patients receiving antiangiogenic therapy. Int J Med Radiol. 2011;260(2):581–90.
    1. Strouthos C, Lampaskis M, Sboros V, et al. Indicator dilution models for the quantification of microvascular blood flow with bolus administration of ultrasound contrast agents. IEEE Trans Ultrason Ferroelectr Freq Control. 2010;57(6):1296–310.
    1. Pei XQ, Liu LZ, Zheng W, et al. Contrast-enhanced ultrasonography of hepatocellular carcinoma: correlation between quantitative parameters and arteries in neoangiogenesis or sinusoidal capillarization. Eur J Radiol. 2012;81(3):e182–88.
    1. Wang JW, Zheng W, Liu JB, et al. Assessment of early tumor response to cytotoxic chemotherapy with dynamic contrast-enhanced ultrasound in human breast cancer xenografts. Ultrasound Med Biol. 2013;39(5):S81–82.
    1. Wei X, Li Y, Zhang S, et al. The role of contrast-enhanced ultrasound (CEUS) in the early assessment of microvascularization in patients with aggressive B-cell lymphoma treated by rituximab-CHOP: A preliminary study. Clin Hemorheology Microcirc. 2014;58(2):363–76.
    1. Hutchings M, Loft A, Hansen M, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood. 2006;107(1):52–59.
    1. Hutchings M, Mikhaeel NG, Fields PA, et al. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol. 2005;16(7):1160–68.
    1. Raizer JJ, Rademaker A, Evens AM, et al. Pemetrexed in the treatment of relapsed/refractory primary central nervous system lymphoma. Cancer. 2012;118(15):3743–48.
    1. Krol AD, Le CS, Snijder S, et al. Primary extranodal non-Hodgkin’s lymphoma (NHL): the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry. Ann Oncol. 2003;14(1):131–39.
    1. Horn H, Schmelter C, Leich E, et al. Follicular lymphoma grade 3B is a distinct neoplasm according to cytogenetic and immunohistochemical profiles. Haematologica. 2011;96(9):1327–34.
    1. Wahlin BE, Yri OE, Kimby E, et al. Clinical significance of the WHO grades of follicular lymphoma in a population-based cohort of 505 patients with long follow-up times. Br J Haematol. 2012;156(2):225–33.
    1. Freedman A. Follicular lymphoma: 2014 update on diagnosis and management. Am J Hematol. 2014;89(4):429–36.
    1. Hiddemann W, Cheson BD. How we manage follicular lymphoma. Leukemia. 2014;28(7):1388–95.
    1. Hicks RJ, MacManus MP, Seymour JF. Initial staging of lymphoma with positron emission tomography and computed tomography. Semin Nucl Med. 2005;35(3):165–75.

Source: PubMed

3
Abonner