Evaluation of sonographic and strain elastographic findings in tubercular cervical lymphadenopathy.Evaluation of sonographic and strain elastographic findings in tubercular cervical lymphadenopathy.

Abstract Purpose–Tuberculous cervical lymphdaenopathy is the most common manifestation of extrapulmonary tuberculosis and frequently present imaging diagnostic dilemma with metastatic lymphadenopathy. Ours is observational study done to evaluate the role of sonography including Doppler and strain elastography in tubercular cervical lymphadenopathy.Methods-100 fine needle aspiration cytology/histopathological examination(FNAC/HPE) proven tubercular lymph nodes were evaluated with sonography and strain elastography Features evaluated with sonography are location, size, short/long axis diameter(S/L) ratio, presence or absence of echogenic hilum ,intra-nodal necrosis, intra-nodal calcification associated soft tissue features like periadenitis or collection and pattern of vascularity. With strain elastography(USE) color coded elastograms and strain ratio were evaluated. Results-On evaluation tubercular nodes are large size, S/L ratio >0.5, show intra-nodal necrosis and peripheral vascular pattern. 91% tuberculous lymph nodes had color coded elastograms>2 pattern which is similar to malignant lymph nodes and 99% of tuberculous lymph nodes show strain ratio< 1.99.Conclusion - Grey scale and Doppler assessment of tubercular lymph nodes reveals findings similar to that encountered in metastatic nodes, hence differentiation difficult .While strain ratio being semi-quantitative is more objective criteria of assessment compared to color coded elastograms. Hence adding semi-quantitative elastographic evaluation with US will help in further characterization of tuberculous nodes.