Prognostic value of ultrasound and doppler imaging in the diagnosis and treatment of peripheral tuberculous lymphadenitis

Background: Tuberculous lymphadenitis, a common form of extrapulmonary tuberculosis, poses diagnostic challenges due to its nonspecific clinical presentation. Traditional methods often require invasive procedures for confirmation, underscoring the need for reliable noninvasive techniques. Ultrasonography (US), Doppler imaging, and elastography have emerged as potential diagnostic tools for evaluating lymph node pathology, enabling detailed assessment of tissue characteristics and vascularization.
Objective: This study aims to evaluate the diagnostic accuracy and clinical value of combining ultrasonography, Doppler imaging, and elastography in the noninvasive diagnosis and management of peripheral tuberculous lymphadenitis.
Methods: A total of 160 patients suspected of having tuberculous lymphadenitis underwent ultrasonography, Doppler imaging, and elastography. Documented ultrasonographic characteristics included lymph node size, central necrosis, and hypoechoic areas. Doppler imaging assessed vascularization, while elastography provided strain ratios to measure tissue stiffness, distinguishing between purulent and fibrotic lymph nodes. Diagnostic accuracy was assessed using sensitivity, specificity, and area under the ROC curve (AUC), with microbiological confirmation as the gold standard.
Results: Ultrasonography identified abnormal lymph nodes in 90% of cases, with central necrosis observed in 60.6% of cases. Doppler imaging revealed increased peripheral vascularization in 72% of cases, while elastography identified necrotic (low stiffness) and fibrotic (high stiffness) nodes in 67.2% and 10.6% of cases, respectively. The combined modalities achieved a sensitivity of 93%, specificity of 88%, and an AUC of 0.92, indicating excellent diagnostic performance. Microbiological confirmation was achieved in 88.7% of cases.
Conclusions: The integration of ultrasonography, Doppler imaging, and elastography provides a highly accurate, noninvasive approach for diagnosing tuberculous lymphadenitis, reducing the need for invasive procedures. This multimodal approach holds significant potential for improving diagnostic workflows, particularly in resource-limited settings, and guiding clinical management by distinguishing between active and chronic disease stages.