Thesis (Ph.D)-Cairo University, 2025.

Bibliography: pages 83 -107.

Background: Differentiating benign from malignant lymph nodes (LNs) is considered
a clinical dilemma, necessitating histopathological diagnosis in most cases. Shear wave
elastography (SWE), which assesses tissue stiffness, adds to the diagnostic power of
ultrasound (US).
Aim: to determine the role of transabdominal US, Doppler examination, and SWE in
characterizing endo-abdominal LNs of different etiologies.
Patients and methods: This cross-sectional study included 75 patients with intra-
abdominal LNs with confirmed histopathological diagnosis. Demographic, clinical, and
laboratory findings were analyzed. US features for characterization of LNs were
evaluated, including the LNs' size, shape, echogenicity, and Doppler density. Elasticity
estimates were color-coded to generate a quantitative SWE image for stiffness (kPa)
and velocity (m/sec). The mean value of 3 consecutive measurements in the same LN
was used for statistical analysis.
Results: Among the patients included, 50 (66.6%) had inflammatory LNs (32 (64%)
were TB lymphadenitis), while 25 (33.4%) had malignant LNs. Malignant LNs
presented sonographically as a mass lesion (p=0.021) and had higher Doppler density
and maximum velocity (p=0.002 and 0.016, respectively). SWE speed and velocity
were significantly higher in the malignant LNs (p=0.027 and 0.032, respectively),
compared to inflammatory LNs, but didn’t differ from TB lymphadenitis. A cut-off
value of 30.7 Kpa achieved 56% sensitivity and 76% specificity, (AUC=0.65) for the
prediction of malignancy. SWE correlated weakly with LN size (r=0.3, p=0.029).
Conclusion: SWE along with grey scale and color Doppler US, is a simple, safe, non-
invasive, and effective tool for assessing intra-abdominal lymph nodes.

ﯾﻌﺪ ﺗﻀﺨﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ھﻮ ﺣﺎﻟﺔ ﺷﺎﺋﻌﺔ ﻓﻲ اﻟﻤﻤﺎرﺳﺔ اﻟﻄﺒﯿﺔ اﻟﯿﻮﻣﯿﺔ وذات أھﻤﯿﺔ ﺗﺸﺨﯿﺼﯿﺔ ﻛﺒﯿﺮة، ﺣﯿﺚ
ﯾﻤﻜﻦ أن ﯾﻜﻮن ﻋﻼﻣﺔ ﻋﻠﻰ ﺣﺎﻻت ﻣﺮﺿﯿﺔ ﻛﺎﻣﻨﺔ ﻣﺨﺘﻠﻔﺔ. ﺗﻌﺘﺒﺮ ﺗﻘﻨﯿﺔ ﺗﺼﻮﯾﺮ اﻟﻤﺮوﻧﺔ ﺑﻤﻮﺟﺔ اﻟﻘﺺ ﺗﻘﻨﯿﺔ
ﺣﺪﯾﺜﺔ ﺗُﻈﮭﺮ ﺻﻼﺑﺔ اﻷﻧﺴﺠﺔ ﻣﻦ ﺧﻼل ﺗﺼﻮﯾﺮ ﻣﻠﻮن أو ﻗﯿﺎﺳﺎت ﺳﺮﻋﺔ اﻟﻤﻮﺟﺎت اﻟﻘﺼﯿﺮة ﻋﺒﺮ اﻟﻜﺸﻒ ﻋﻦ
اﻟﺘﻐﯿﺮات ﻓﻲ إزاﺣﺔ اﻷﻧﺴﺠﺔ أو ﺳﺮﻋﺘﮭﺎ. وﻋﻨﺪ دﻣﺠﮭﺎ ﻣﻊ اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﺛﻨﺎﺋﯿﺔ اﻷﺑﻌﺎد،
ﻓﺈﻧﮭﺎ ﺗُﺤﺴﻦ ﻣﻦ اﻟﺪﻗﺔ اﻟﺘﺸﺨﯿﺼﯿﺔ ﺑﺸﻜﻞ ﻛﺒﯿﺮ، ﻣﻤﺎ ﯾُﻌﺰز اﻟﻘﺪرة ﻋﻠﻰ اﻟﺘﻤﯿﯿﺰ ﺑﯿﻦ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ اﻟﺤﻤﯿﺪة
واﻟﺨﺒﯿﺜﺔ.

ھﺪﻓﺖ ھﺬه اﻟﺪراﺳﺔ إﻟﻰ ﺗﻘﯿﯿﻢ دور اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ، وﻓﺤﺺ
دوﺑﻠﺮ/اﻟﺪوﺑﻠﻜﺲ وﺗﻘﻨﯿﺔ اﻟﺘﺼﻮﯾﺮ اﻟﻤﺮن ﺑﻤﻮﺟﺔ اﻟﻘﺺ ﻓﻲ ﺗﻮﺻﯿﻒ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﺑﺎﻟﺒﻄﻦ ذات اﻷﺳﺒﺎب
اﻟﻤﺨﺘﻠﻔﺔ. ﺗﺸﻤﻞ اﻟﺪراﺳﺔ 75 ﻣﺮﯾﻀﺎً وﺗﻢ ﺗﺠﻤﯿﻊ اﻟﻤﺮﺿﻲ اﻟﻤﺘﺮددﯾﻦ ﻋﻠﻰ ﻣﺮﻛﺰ اﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق
اﻟﺼﻮﺗﯿﺔ ﺑﻘﺴﻢ اﻷﻣﺮاض اﻟﻤﺘﻮطﻨﺔ ﺑﺎﻟﻘﺼﺮ اﻟﻌﯿﻨﻲ وﺗﻢ ﺗﺼﻨﯿﻔﮭﻢ ﻻﺣﻘﺎً إﻟﻰ ﻣﺠﻤﻮﻋﺘﯿﻦ: ﻏﺪد ﻟﯿﻤﻔﺎوﯾﺔ ﺧﺒﯿﺜﺔ
واﻟﺘﮭﺎﺑﯿﺔ، ﺑﻨﺎًء ﻋﻠﻰ ﻧﺘﺎﺋﺞ ﻓﺤﺺ اﻟﻌﯿﻨﺔ اﻟﻤﺄﺧﻮذة ﻣﻦ ﻧﺴﯿﺞ اﻟﻐﺪد اﻟﻠﯿﻤﻔﺎوﯾﺔ.
ﺑﻌﺪ اﻟﺤﺼﻮل ﻋﻠﻰ ﻣﻮاﻓﻘﺔ ﻣﺴﺘﻨﯿﺮة، وأﺧﺬ اﻟﺘﺎرﯾﺦ اﻟﻤﺮﺿﻲ اﻟﻜﺎﻣﻞ، وإﺟﺮاء اﻟﻔﺤﺺ اﻟﺴﺮﯾﺮي، وﺟﻤﻊ ﻧﺘﺎﺋﺞ
اﻟﺘﺤﺎﻟﯿﻞ اﻟﻤﻌﻤﻠﯿﺔ، ﺧﻀﻊ ﺟﻤﯿﻊ اﻟﻤﺮﺿﻰ ﻟﻔﺤﺺ ﺷﺎﻣﻞ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻋﺒﺮ اﻟﺒﻄﻦ. ﺗﻢ إﺟﺮاء ﻓﺤﺺ
دﻗﯿﻖ ﻟﻠﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ، ﺷﻤﻞ اﻟﻤﻜﺎن، اﻟﺤﺠﻢ، اﻟﻌﺪد، اﻟﺸﻜﻞ. ﺗﻼ ذﻟﻚ إﺟﺮاء ﻓﺤﺺ دوﺑﻠﺮ/دوﺑﻠﻜﺲ ﻟﺘﻘﯿﯿﻢ وﺟﻮد
أوﻋﯿﺔ دﻣﻮﯾﺔ ﻓﻲ اﻟﻐﺪد اﻟﻠﯿﻤﻔﺎوﯾﺔ، وﻛﺜﺎﻓﺘﮭﺎ، وﺗﻮزﯾﻌﮭﺎ.

ﺗﻢ ﺗﻘﯿﯿﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ اﻟﻤﺘﻀﺨﻤﺔ ﺑﺎﺳﺘﺨﺪام اﻟﺘﺼﻮﯾﺮ اﻟﻤﺮن ﺑﻤﻮﺟﺔ اﻟﻘﺺ ﺣﯿﺚ ﺗﻢ ﻗﯿﺎس ﺻﻼﺑﺔ اﻷﻧﺴﺠﺔ
واﺳﺘﺨﺪام ﻣﺘﻮﺳﻂ ﺛﻼث ﻗﯿﺎﺳﺎت ﻣﺘﺘﺎﻟﯿﺔ ﻟﻠﻐﺪة اﻟﻠﻤﻔﺎوﯾﺔ ﻧﻔﺴﮭﺎ ﻓﻲ اﻟﺘﺤﻠﯿﻞ اﻹﺣﺼﺎﺋﻲ.

ﺗﻢ أﺧﺬ ﻋﯿﻨﺎت اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ إﻣﺎ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻋﺒﺮ اﻟﺒﻄﻦ، أو ﺑﺎﻟﻤﻨﻈﺎر اﻟﺠﺮاﺣﻲ، أو ﻣﻨﻈﺎر
اﻟﻘﺼﺒﺎت اﻟﮭﻮاﺋﯿﺔ ﺣﺴﺐ اﻟﺤﺎﻟﺔ اﻟﺴﺮﯾﺮﯾﺔ. وﻗﺪ اﻋﺘُﺒﺮ اﻟﻔﺤﺺ اﻟﻨﺴﯿﺠﻲ ھﻮ اﻟﻤﻌﯿﺎر اﻷﺳﺎﺳﻲ ﻟﺘﺸﺨﯿﺺ ﺗﻀﺨﻢ
اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ.
أظﮭﺮت اﻟﻨﺘﺎﺋﺞ أن اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﻟﺪﯾﮭﻢ ﻏﺪد ﻟﻤﻔﺎوﯾﺔ ﺧﺒﯿﺜﺔ ﻛﺎﻧﻮا ﻏﺎﻟﺒﺎً ﻣﻦ اﻟﺬﻛﻮر، أﻛﺒﺮ ﺳﻨﺎً، ﻣﺪﺧﻨﯿﻦ،
وﯾﻌﺎﻧﻮن ﻣﻦ ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم ﻣﻘﺎرﻧﺔً ﺑﺎﻟﻤﺠﻤﻮﻋﺔ اﻻﻟﺘﮭﺎﺑﯿﺔ.


109

ﻓﯿﻤﺎ ﯾﺘﻌﻠﻖ ﺑﺎﻟﻔﺤﺺ اﻟﻌﺎم اﻟﺸﺎﻣﻞ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻟﻠﺒﻄﻦ، ﻗﺪ ﻛﺎن ﻣﻌﻈﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ اﻟﺨﺒﯿﺜﺔ ﻋﻠﻰ
ﺷﻜﻞ ﻛﺘﻞ، وﺑﮭﺎ ﻧﺴﺒﺔ أﻛﺒﺮ ﻣﻦ اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ ﺑﻔﺤﺺ اﻟﺪوﺑﻠﺮ.

وﻋﻨﺪ ﻣﻘﺎرﻧﺔ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﻓﻲ ﺣﺎﻻت اﻟﺪرن ﻣﻊ اﻟﻐﺪد اﻟﺨﺒﯿﺜﺔ، ﻛﺎﻧﺖ اﻟﻐﺪد ﻓﻲ ﺣﺎﻻت اﻟﺪرن ﺗﺘﻮاﺟﺪ أﻛﺜﺮ ﻓﻲ
اﻷﻏﺸﯿﺔ ﻣﺎ ﺑﯿﻦ اﻷﻣﻌﺎء وﺑﮭﺎ أوﻋﯿﺔ دﻣﻮﯾﺔ ﻣﺘﻮاﺟﺪة أﻛﺜﺮ ﻓﻲ أطﺮاف اﻟﻐﺪة اﻟﻤﺘﻀﺨﻤﺔ ﺑﯿﻨﻤﺎ ﺗﺘﻮاﺟﺪ اﻷوﻋﯿﺔ
اﻟﺪﻣﻮﯾﺔ ﺑﺎﻟﻐﺪد اﻟﺨﺒﯿﺜﺔ ﺑﻤﻨﺘﺼﻒ اﻟﻐﺪد.

ﻛﺎﻧﺖ ﺻﻼﺑﺔ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ أﻋﻠﻰ ﺑﺸﻜﻞ ﻣﻠﺤﻮظ ﻓﻲ اﻟﻌﻘﺪ اﻟﺨﺒﯿﺜﺔ ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻌﻘﺪ اﻻﻟﺘﮭﺎﺑﯿﺔ وﻋﻨﺪ ﻗﯿﻤﺔ ﺣﺪﯾﺔ ﺗﺒﻠﻎ
30.75kPa ، ﯾﻤﻜﻦ ﻟﺘﺼﻮﯾﺮ اﻟﻤﺮوﻧﺔ ﺑﻤﻮﺟﺔ اﻟﻘﺺ اﻟﺘﻨﺒﺆ ﺑﺨﺒﺎﺛﺔ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ.

ﻛﻤﺎ ﻟﻮﺣﻆ وﺟﻮد ﻋﻼﻗﺔ ارﺗﺒﺎط ﺿﻌﯿﻔﺔ، وﻟﻜﻦ ذات دﻻﻟﺔ إﺣﺼﺎﺋﯿﺔ ﺑﯿﻦ ﻣﺘﻮﺳﻂ ﺳﺮﻋﺔ ﻣﻮﺟﺔ اﻟﻘﺺ ﻓﻲ اﻟﻐﺪد
اﻟﻠﻤﻔﺎوﯾﺔ وﺣﺠﻤﮭﺎ.

اﺳﺘﻨﺘﺠﺖ اﻟﺪراﺳﺔ ان اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻟﻠﺒﻄﻦ ﺗﻌﺘﺒﺮ وﺳﯿﻠﺔ ﺑﺴﯿﻄﺔ وآﻣﻨﺔ وﻏﯿﺮ ﺗﺪاﺧﻠﯿﺔ
ﻟﻠﻜﺸﻒ ﻋﻦ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﺑﺎﻟﺒﻄﻦ وﺗﻮﺻﯿﻔﮭﺎ. وﺗُﻌﺪ ﺗﻘﻨﯿﺔ اﻟﺘﺼﻮﯾﺮ اﻟﻤﺮن ﺑﻤﻮﺟﺔ اﻟﻘﺺ أداة ﻣﻔﯿﺪة ﯾﻤﻜﻦ
اﺳﺘﺨﺪاﻣﮭﺎ ﺑﺠﺎﻧﺐ اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ودوﺑﻠﺮ اﻟﻤﻠﻮن ﻓﻲ ﺗﻘﯿﯿﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﺑﺎﻟﺒﻄﻦ ﺣﯿﺚ
ﺗﺴﺎھﻢ ﻓﻲ اﺧﺘﯿﺎر اﻟﻌﻘﺪ اﻷﻛﺜﺮ اﺷﺘﺒﺎھﺎً، إﻻ أﻧﮭﺎ ﻻ ﯾﻤﻜﻦ أن ﺗﺤﻞ ﻣﺤﻞ اﻟﻔﺤﺺ اﻟﻨﺴﯿﺠﻲ ﻟﻠﻐﺪد اﻟﻤﺘﻀﺨﻤﺔ.

Issues also as CD.

Text in English and abstract in Arabic & English.