Quantification of Portal Vein Vascularization Using an Automated Post-Processing Video Analysis Tool
July 8, 2024
Comparison of lung ultrasound scoring systems for the prognosis of COVID-19 in the emergency department: An international prospective cohort study.
July 8, 2024

Differential diagnosis of cervical lymphadenopathy: Integration of postvascular phase of contrast-enhanced ultrasound and predictive nomogram model

Background Distinguishing benign from malignant cervical lymph nodes is critical yet challenging. This study evaluates the postvascular phase of contrast-enhanced ultrasound (CEUS) and develops a user-friendly nomogram integrating demographic, conventional ultrasound, and CEUS features for accurate differentiation.
Authors Chen X, Ma J, Fu Y, Mei F, Tang R, Xue H, Lin Y, Wang S, Cui L.
Eur J Surg Oncol. 2024 Mar;50(3):107981.
Epub 2024 Jan 23. PMID: 38290245.
Methods We retrospectively analyzed 395 cervical lymph nodes from 395 patients between January 2020 and December 2022. The cohort was divided into training and validation sets using stratified random sampling. A predictive model, based on demographic, ultrasound, and CEUS features, was created and internally validated.
Results The training set included 280 patients (130 benign, 150 malignant nodes) and the validation set 115 patients (46 benign, 69 malignant). Relative hypoenhancement in the postvascular phase emerged as a promising indicator for MLN, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96.7 %,52.3 %, 70.0 %, 93.2 %, and 76.1 %, respectively in the training set and 95.7 %, 52.2 %, 75.0 %, 88.9%, and 74.8 % in the validation set. Age over 50 years, history of malignancy, short-axis diameter greater than 1.00 cm, focal hyperechogenicity, ill-defined borders, and centripetal perfusion were also identified as independent MLN indicators. The nomogram prediction model showed outstanding accuracy, with an area under the curve (AUC) of 0.922 (95 % CI: 0.892–0.953) in the training set and 0.914 (95 % CI: 0.864–0.963) in the validation set.
Conclusion Relative hypoenhancement in the postvascular phase of CEUS, combined with demographics and ultrasound features, is effective for identifying MLNs. The developed prediction model, with a user-friendly nomogram, can facilitate clinical decision-making.
Link (DOI) https://doi.org/10.1016/j.ejso.2024.107981
Ultrasound speciality CEUS,  Cervical Lymphadenopathy


Short-Review by Prof. Dr Julian Kuenzel; Dr Helmut Prosch:


The Chinese group from Peking evaluated the postvascular phase of CEUS perfusion in differential diagnosis of cervical lymphadenopathy, which was not in the focus of recent research. The rationale is that vascular phase CEUS pattern still shows substantial overlapping with benign disease.

The methodology of this paper is sound, and the result of statistical analysis shows promising value of postvascular relative hypoenhancement (compared to muscle) and significant improvement in differential diagnosis. The authors provide a nomogram model to be used in clinical routine.  Limitations are clearly outlined.



The study design is retrospective and monocentric. The collective is still heterogeneous including solid cancers from different primaries, lymphomas and a great variety of benign diseases. The definition of postvascular phase measurement and judgement of the relation of postvascular phase hypoenhancement compared to muscle perfusion needs further evaluation.


Personally thinking:

Looking more closely to postvascular CEUS patterns offers new insights in perfusion characteristics of cervical lymph nodes and thus could further improve diagnostics like in other organ regions e.g. liver lesions.