Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2021; 27(32): 5438-5447
Published online Aug 28, 2021. doi: 10.3748/wjg.v27.i32.5438
Contrast-enhanced ultrasound imaging for intestinal lymphoma
Ning-Yi Cui, Xuan-Tong Gong, Yan-Tao Tian, Yong Wang, Rui Zhang, Meng-Jia Liu, Jie Han, Bo Wang, Di Yang
Ning-Yi Cui, Xuan-Tong Gong, Yong Wang, Rui Zhang, Meng-Jia Liu, Jie Han, Bo Wang, Di Yang, Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xuan-Tong Gong, Department of Ultrasound, Fatou Community Health Service Center Chaoyang District Beijing, Beijing 100023, China
Yan-Tao Tian, Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Cui NY and Gong XT contributed equally to this work; Wang Y, Tian YT, Cui NY and Gong XT designed the research study; Zhang R, Liu MJ, Han J, Wang B and Yang D contributed analytic tools; Cui NY and Gong XT analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported by National Natural Science Foundation of China, No. 81974268; Medical and Health Science and Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-I2M-1-006; and Beijing Hope Run Special Fund of Cancer Foundation of China, No. LC2017B19 and No. LC2016A04.
Institutional review board statement: Approval of all ethical and experimental procedures and protocols was granted by the Independent Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College under Application, No. NCC2016YZ-15.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to do the examination by written consent.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Wang, MD, PhD, Professor, Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. wangyong@cicams.ac.cn
Received: April 21, 2021
Peer-review started: April 21, 2021
First decision: June 30, 2021
Revised: July 12, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 28, 2021
Processing time: 125 Days and 12.5 Hours
Abstract
BACKGROUND

Intestinal lymphoma is a rare tumor. Contrast-enhanced ultrasound (CEUS) findings of intestinal lymphoma have not been reported previously, and the relationship between CEUS and clinicopathological features and prognostic factors is still unknown.

AIM

To describe the B-mode US and CEUS features of intestinal lymphoma and investigate the correlation of CEUS and histopathological features.

METHODS

This was a single-center retrospective study. Eighteen patients with histologically confirmed intestinal lymphoma underwent B-mode US and CEUS examinations between October 2016 and November 2019. We summarized the features of B-mode US and CUES imaging of intestinal lymphoma and compared the frequency of tumor necrosis in intestinal lymphomas with reference to different pathological subtypes (aggressive or indolent) and clinical stage (early or advanced). The time–intensity curve parameters of CEUS were also compared between patients with normal and elevated serum lactate dehydrogenase.

RESULTS

In B-mode imaging, four patterns were observed in intestinal lymphoma: Mass type (12/18, 66.7%), infiltration type (1/18, 5.6%), mesentery type (4/18, 22.2%) and mixed type (1/18, 5.6%). All cases were hypoechoic and no cystic areas were detected. On CEUS, most cases (17/18, 94.4%) showed arterial hyperechoic enhancement. All cases showed arterial enhancement followed by venous wash out. A relatively high rate of tumor necrosis (11/18, 61.1%) was observed in this study. Tumor necrosis on CEUS was more frequent in aggressive subtypes (10/13, 76.9%) than in indolent subtypes (1/5, 20.0%) (P = 0.047). There were no correlations between tumor necrosis and lesion size and Ann Arbor stage. There was no significant difference in time–intensity curve parameters between normal and elevated lactate dehydrogenase groups.

CONCLUSION

B-mode US and CEUS findings of intestinal lymphoma are characteristic. We observed a high rate of tumor necrosis, which appeared more frequently in aggressive pathological subtypes of intestinal lymphoma.

Keywords: Intestinal lymphoma; Contrast enhanced ultrasound; B-mode ultrasound; Histopathological features; Lactate dehydrogenase; Quantitative diagnosis

Core Tip: This is a small pilot study that described the appearance and pattern of intestinal lymphoma on B-mode ultrasound (US) and contrast-enhanced US. We revealed an unexpected contrast-enhanced US enhancement pattern with a high rate of tumor necrosis, which was found more frequently in aggressive than in indolent subtypes. This might provide additional information for clinical diagnosis and treatment of intestinal lymphoma.