Trans-abdominal Ultrasonography, Doppler, and Shear Wave Elastography Utilized in the Characterization of Intra-abdominal Lymphadenopathy

Objective: Intra-abdominal lymphadenopathy remains a diagnostic imaging challenge. Shear wave elastography (SWE) evaluates tissue stiffness and can improve the diagnostic performance of ultrasonography (US) and Doppler. The aim of this study was to assess the role of trans-abdominal US, Doppler, and SWE in characterizing intra-abdominal lymph nodes (LNs). Materials and Methods: This cross-sectional study included 75 patients with histopathological confirmed intra-abdominal LNs. Sonographic evaluation included LN size, shape, texture, Doppler density, resistive index, and maximum velocity (Vmax). Shear wave elastography provided quantitative measurements of elasticity (kPa) and shear wave velocity (m/s). Results: Inflammatory LNs were identified in 50 patients (66.6%), including 32 cases (64%) of tuberculous lymphadenitis, while 25 patients (33.4%) had malignant LNs. Malignant LNs more commonly appeared as mass lesions ( P = .011) and demonstrated higher Doppler density ( P = .002). Elasticity and shear wave velocity were significantly higher in malignant than inflammatory LNs ( P = .027 and .032, respectively) but did not significantly differ from tuberculous lymphadenitis, when compared as a subgroup. A cutoff value of 30.7 kPa showed modest sensitivity and specificity in predicting malignant LNs. Conclusion: In this cohort, SWE showed moderate diagnostic performance, yet it may help as a non-invasive adjunct to conventional sonography, aiding differentiating malignant and inflammatory but not tuberculous LNs.