Clinical Value of Contrast-Enhanced Ultrasound and Ultrasound Elastography in the Pathological Classification and Treatment Response Prediction of Cervical Tuberculous Lymphadenitis.

OBJECTIVE

Limited evidence exists on imaging-based classification and treatment response prediction in cervical tuberculous lymphadenitis (CTL). This study aimed to investigate the clinical value of contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE) in differentiating pathological subtypes of CTL and predicting response to anti-tuberculosis therapy.

METHODS

This retrospective cohort study included 120 patients with CTL confirmed by pathological examination between January 2021 and October 2025. All patients underwent CEUS and UE prior to treatment. Parameters including the non-perfusion area ratio, enhancement pattern, strain ratio, and elasticity score were recorded. Using pathological diagnosis as the reference standard, the diagnostic performance of CEUS and UE for different pathological subtypes was evaluated. Based on the lymph node volume reduction rate (VRR) at 6 months after treatment, patients were classified into a treatment-sensitive group (VRR ≥ 50%) and a treatment-insensitive group (VRR < 50%). The associations between imaging parameters and treatment response were analyzed.

RESULTS

The proportion of annular enhancement on CEUS, non-perfusion area ratio, proportion of high elasticity scores on UE, and strain ratio were significantly higher in Type II patients than in Type I and Type III patients (all P < 0.05). CEUS and UE yielded sensitivities of 87.5% and 85.0% and specificities of 87.5% and 76.3%, respectively. Strain ratio, non-perfusion area ratio, and disease duration were independent risk factors for treatment insensitivity. The predictive model combining CEUS and UE parameters showed superior performance compared with either modality alone.

CONCLUSION

CEUS and UE can noninvasively and effectively differentiate pathological subtypes of CTL, with particularly high diagnostic accuracy for Type II (caseous necrosis). We recommend incorporating CEUS and UE into the pre-treatment evaluation of CTL to guide subtype identification and risk stratification for anti-tuberculosis therapy.