Mariam Ismail Abdelraouf Ahmed,  <br/><br/>
Role of Grey Scale Transabdominal Ultrasound, Duplex Doppler Ultrasound and Shear Wave Elastography in  the Characterization of Endo-abdominal  lymphadenopathy compared to histopathological  assessment / 
 دور الموجات الصوتية عبر البطن و الموجات فوق الصوتية المزدوجة و الدوبلر و تصوير المرونة بموجة القص فى توصيف امراض الغدد الليمفاوية المختلفة و مقارنتة بفحص الانسجة 
by Mariam Ismail Abdelraouf Ahmed ; Supervisors Prof. Dr. Maha Sayed HasabAllah, Prof. Dr. Hany Mofeed Shehab, Dr. Yasmine Mohamed Gaber.  
 - 109 pages :   illustrations ;  25 cm. +   CD. 
<br/><br/>Thesis (Ph.D)-Cairo University, 2025. 
<br/><br/>Bibliography: pages 83 -107.  
<br/><br/> Background: Differentiating benign from malignant lymph nodes (LNs) is considered <br/>a clinical dilemma, necessitating histopathological diagnosis in most cases. Shear wave <br/>elastography (SWE), which assesses tissue stiffness, adds to the diagnostic power of <br/>ultrasound (US). <br/>Aim: to determine the role of transabdominal US, Doppler examination, and SWE in <br/>characterizing endo-abdominal LNs of different etiologies. <br/>Patients and methods: This cross-sectional study included 75 patients with intra-<br/>abdominal LNs with confirmed histopathological diagnosis. Demographic, clinical, and <br/>laboratory findings were analyzed. US features for characterization of LNs were <br/>evaluated, including the LNs' size, shape, echogenicity, and Doppler density. Elasticity <br/>estimates were color-coded to generate a quantitative SWE image for stiffness (kPa) <br/>and velocity (m/sec). The mean value of 3 consecutive measurements in the same LN <br/>was used for statistical analysis. <br/>Results: Among the patients included, 50 (66.6%) had inflammatory LNs (32 (64%) <br/>were TB lymphadenitis), while 25 (33.4%) had malignant LNs. Malignant LNs <br/>presented sonographically as a mass lesion (p=0.021) and had higher Doppler density <br/>and maximum velocity (p=0.002 and 0.016, respectively). SWE speed and velocity <br/>were significantly higher in the malignant LNs (p=0.027 and 0.032, respectively), <br/>compared to inflammatory LNs, but didn’t differ from TB lymphadenitis.  A cut-off <br/>value of 30.7 Kpa achieved 56% sensitivity and 76% specificity, (AUC=0.65) for the <br/>prediction of malignancy. SWE correlated weakly with LN size (r=0.3, p=0.029).  <br/>Conclusion: SWE along with grey scale and color Doppler US, is a simple, safe, non-<br/>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 <br/>ﯾﻤﻜﻦ أن ﯾﻜﻮن ﻋﻼﻣﺔ ﻋﻠﻰ ﺣﺎﻻت ﻣﺮﺿﯿﺔ ﻛﺎﻣﻨﺔ ﻣﺨﺘﻠﻔﺔ. ﺗﻌﺘﺒﺮ ﺗﻘﻨﯿﺔ ﺗﺼﻮﯾﺮ اﻟﻤﺮوﻧﺔ ﺑﻤﻮﺟﺔ اﻟﻘﺺ ﺗﻘﻨﯿﺔ <br/>ﺣﺪﯾﺜﺔ ﺗُﻈﮭﺮ ﺻﻼﺑﺔ اﻷﻧﺴﺠﺔ ﻣﻦ ﺧﻼل ﺗﺼﻮﯾﺮ ﻣﻠﻮن أو ﻗﯿﺎﺳﺎت ﺳﺮﻋﺔ اﻟﻤﻮﺟﺎت اﻟﻘﺼﯿﺮة ﻋﺒﺮ اﻟﻜﺸﻒ ﻋﻦ <br/>اﻟﺘﻐﯿﺮات ﻓﻲ إزاﺣﺔ اﻷﻧﺴﺠﺔ أو ﺳﺮﻋﺘﮭﺎ. وﻋﻨﺪ دﻣﺠﮭﺎ ﻣﻊ اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﺛﻨﺎﺋﯿﺔ اﻷﺑﻌﺎد، <br/>ﻓﺈﻧﮭﺎ ﺗُﺤﺴﻦ ﻣﻦ اﻟﺪﻗﺔ اﻟﺘﺸﺨﯿﺼﯿﺔ ﺑﺸﻜﻞ ﻛﺒﯿﺮ، ﻣﻤﺎ ﯾُﻌﺰز اﻟﻘﺪرة ﻋﻠﻰ اﻟﺘﻤﯿﯿﺰ ﺑﯿﻦ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ اﻟﺤﻤﯿﺪة <br/> واﻟﺨﺒﯿﺜﺔ.<br/><br/>ھﺪﻓﺖ ھﺬه اﻟﺪراﺳﺔ إﻟﻰ ﺗﻘﯿﯿﻢ دور اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ، وﻓﺤﺺ                                                                                              <br/>دوﺑﻠﺮ/اﻟﺪوﺑﻠﻜﺲ وﺗﻘﻨﯿﺔ اﻟﺘﺼﻮﯾﺮ اﻟﻤﺮن ﺑﻤﻮﺟﺔ اﻟﻘﺺ ﻓﻲ ﺗﻮﺻﯿﻒ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﺑﺎﻟﺒﻄﻦ ذات اﻷﺳﺒﺎب <br/>اﻟﻤﺨﺘﻠﻔﺔ. ﺗﺸﻤﻞ اﻟﺪراﺳﺔ 75 ﻣﺮﯾﻀﺎً وﺗﻢ ﺗﺠﻤﯿﻊ اﻟﻤﺮﺿﻲ اﻟﻤﺘﺮددﯾﻦ ﻋﻠﻰ ﻣﺮﻛﺰ اﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق <br/>اﻟﺼﻮﺗﯿﺔ ﺑﻘﺴﻢ اﻷﻣﺮاض اﻟﻤﺘﻮطﻨﺔ ﺑﺎﻟﻘﺼﺮ اﻟﻌﯿﻨﻲ وﺗﻢ ﺗﺼﻨﯿﻔﮭﻢ ﻻﺣﻘﺎً إﻟﻰ ﻣﺠﻤﻮﻋﺘﯿﻦ: ﻏﺪد ﻟﯿﻤﻔﺎوﯾﺔ ﺧﺒﯿﺜﺔ <br/> واﻟﺘﮭﺎﺑﯿﺔ، ﺑﻨﺎًء ﻋﻠﻰ ﻧﺘﺎﺋﺞ ﻓﺤﺺ اﻟﻌﯿﻨﺔ اﻟﻤﺄﺧﻮذة ﻣﻦ ﻧﺴﯿﺞ اﻟﻐﺪد اﻟﻠﯿﻤﻔﺎوﯾﺔ.<br/>ﺑﻌﺪ اﻟﺤﺼﻮل ﻋﻠﻰ ﻣﻮاﻓﻘﺔ ﻣﺴﺘﻨﯿﺮة، وأﺧﺬ اﻟﺘﺎرﯾﺦ اﻟﻤﺮﺿﻲ اﻟﻜﺎﻣﻞ، وإﺟﺮاء اﻟﻔﺤﺺ اﻟﺴﺮﯾﺮي، وﺟﻤﻊ ﻧﺘﺎﺋﺞ <br/>اﻟﺘﺤﺎﻟﯿﻞ اﻟﻤﻌﻤﻠﯿﺔ، ﺧﻀﻊ ﺟﻤﯿﻊ اﻟﻤﺮﺿﻰ ﻟﻔﺤﺺ ﺷﺎﻣﻞ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻋﺒﺮ اﻟﺒﻄﻦ. ﺗﻢ إﺟﺮاء ﻓﺤﺺ <br/>دﻗﯿﻖ ﻟﻠﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ، ﺷﻤﻞ اﻟﻤﻜﺎن، اﻟﺤﺠﻢ، اﻟﻌﺪد، اﻟﺸﻜﻞ. ﺗﻼ ذﻟﻚ إﺟﺮاء ﻓﺤﺺ دوﺑﻠﺮ/دوﺑﻠﻜﺲ ﻟﺘﻘﯿﯿﻢ وﺟﻮد <br/> أوﻋﯿﺔ دﻣﻮﯾﺔ ﻓﻲ اﻟﻐﺪد اﻟﻠﯿﻤﻔﺎوﯾﺔ، وﻛﺜﺎﻓﺘﮭﺎ، وﺗﻮزﯾﻌﮭﺎ.<br/><br/>ﺗﻢ ﺗﻘﯿﯿﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ اﻟﻤﺘﻀﺨﻤﺔ ﺑﺎﺳﺘﺨﺪام اﻟﺘﺼﻮﯾﺮ اﻟﻤﺮن ﺑﻤﻮﺟﺔ اﻟﻘﺺ ﺣﯿﺚ ﺗﻢ ﻗﯿﺎس ﺻﻼﺑﺔ اﻷﻧﺴﺠﺔ <br/>  واﺳﺘﺨﺪام ﻣﺘﻮﺳﻂ ﺛﻼث ﻗﯿﺎﺳﺎت ﻣﺘﺘﺎﻟﯿﺔ ﻟﻠﻐﺪة اﻟﻠﻤﻔﺎوﯾﺔ ﻧﻔﺴﮭﺎ ﻓﻲ اﻟﺘﺤﻠﯿﻞ اﻹﺣﺼﺎﺋﻲ.<br/><br/>ﺗﻢ أﺧﺬ ﻋﯿﻨﺎت اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ إﻣﺎ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻋﺒﺮ اﻟﺒﻄﻦ، أو ﺑﺎﻟﻤﻨﻈﺎر اﻟﺠﺮاﺣﻲ، أو ﻣﻨﻈﺎر <br/>اﻟﻘﺼﺒﺎت اﻟﮭﻮاﺋﯿﺔ ﺣﺴﺐ اﻟﺤﺎﻟﺔ اﻟﺴﺮﯾﺮﯾﺔ. وﻗﺪ اﻋﺘُﺒﺮ اﻟﻔﺤﺺ اﻟﻨﺴﯿﺠﻲ ھﻮ اﻟﻤﻌﯿﺎر اﻷﺳﺎﺳﻲ ﻟﺘﺸﺨﯿﺺ ﺗﻀﺨﻢ <br/> اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ.<br/>أظﮭﺮت اﻟﻨﺘﺎﺋﺞ أن اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﻟﺪﯾﮭﻢ ﻏﺪد ﻟﻤﻔﺎوﯾﺔ ﺧﺒﯿﺜﺔ ﻛﺎﻧﻮا ﻏﺎﻟﺒﺎً ﻣﻦ اﻟﺬﻛﻮر، أﻛﺒﺮ ﺳﻨﺎً، ﻣﺪﺧﻨﯿﻦ، <br/> وﯾﻌﺎﻧﻮن ﻣﻦ ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم ﻣﻘﺎرﻧﺔً ﺑﺎﻟﻤﺠﻤﻮﻋﺔ اﻻﻟﺘﮭﺎﺑﯿﺔ.<br/><br/><br/> 109 <br/><br/>ﻓﯿﻤﺎ ﯾﺘﻌﻠﻖ ﺑﺎﻟﻔﺤﺺ اﻟﻌﺎم اﻟﺸﺎﻣﻞ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻟﻠﺒﻄﻦ، ﻗﺪ ﻛﺎن ﻣﻌﻈﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ اﻟﺨﺒﯿﺜﺔ ﻋﻠﻰ <br/> ﺷﻜﻞ ﻛﺘﻞ، وﺑﮭﺎ ﻧﺴﺒﺔ أﻛﺒﺮ ﻣﻦ اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ ﺑﻔﺤﺺ اﻟﺪوﺑﻠﺮ.<br/><br/>وﻋﻨﺪ ﻣﻘﺎرﻧﺔ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﻓﻲ ﺣﺎﻻت اﻟﺪرن ﻣﻊ اﻟﻐﺪد اﻟﺨﺒﯿﺜﺔ، ﻛﺎﻧﺖ اﻟﻐﺪد ﻓﻲ ﺣﺎﻻت اﻟﺪرن ﺗﺘﻮاﺟﺪ أﻛﺜﺮ ﻓﻲ <br/>اﻷﻏﺸﯿﺔ ﻣﺎ ﺑﯿﻦ اﻷﻣﻌﺎء وﺑﮭﺎ أوﻋﯿﺔ دﻣﻮﯾﺔ ﻣﺘﻮاﺟﺪة أﻛﺜﺮ ﻓﻲ أطﺮاف اﻟﻐﺪة اﻟﻤﺘﻀﺨﻤﺔ ﺑﯿﻨﻤﺎ ﺗﺘﻮاﺟﺪ اﻷوﻋﯿﺔ <br/> اﻟﺪﻣﻮﯾﺔ ﺑﺎﻟﻐﺪد اﻟﺨﺒﯿﺜﺔ ﺑﻤﻨﺘﺼﻒ اﻟﻐﺪد.<br/><br/>ﻛﺎﻧﺖ ﺻﻼﺑﺔ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ أﻋﻠﻰ ﺑﺸﻜﻞ ﻣﻠﺤﻮظ ﻓﻲ اﻟﻌﻘﺪ اﻟﺨﺒﯿﺜﺔ ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻌﻘﺪ اﻻﻟﺘﮭﺎﺑﯿﺔ وﻋﻨﺪ ﻗﯿﻤﺔ ﺣﺪﯾﺔ ﺗﺒﻠﻎ <br/> 30.75kPa ، ﯾﻤﻜﻦ ﻟﺘﺼﻮﯾﺮ اﻟﻤﺮوﻧﺔ ﺑﻤﻮﺟﺔ اﻟﻘﺺ اﻟﺘﻨﺒﺆ ﺑﺨﺒﺎﺛﺔ اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ.<br/><br/>ﻛﻤﺎ ﻟﻮﺣﻆ وﺟﻮد ﻋﻼﻗﺔ ارﺗﺒﺎط ﺿﻌﯿﻔﺔ، وﻟﻜﻦ ذات دﻻﻟﺔ إﺣﺼﺎﺋﯿﺔ ﺑﯿﻦ ﻣﺘﻮﺳﻂ ﺳﺮﻋﺔ ﻣﻮﺟﺔ اﻟﻘﺺ ﻓﻲ اﻟﻐﺪد <br/> اﻟﻠﻤﻔﺎوﯾﺔ وﺣﺠﻤﮭﺎ.<br/><br/>اﺳﺘﻨﺘﺠﺖ اﻟﺪراﺳﺔ ان اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ﻟﻠﺒﻄﻦ ﺗﻌﺘﺒﺮ وﺳﯿﻠﺔ ﺑﺴﯿﻄﺔ وآﻣﻨﺔ وﻏﯿﺮ ﺗﺪاﺧﻠﯿﺔ <br/>ﻟﻠﻜﺸﻒ ﻋﻦ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﺑﺎﻟﺒﻄﻦ وﺗﻮﺻﯿﻔﮭﺎ. وﺗُﻌﺪ ﺗﻘﻨﯿﺔ اﻟﺘﺼﻮﯾﺮ اﻟﻤﺮن ﺑﻤﻮﺟﺔ اﻟﻘﺺ أداة ﻣﻔﯿﺪة ﯾﻤﻜﻦ <br/>اﺳﺘﺨﺪاﻣﮭﺎ ﺑﺠﺎﻧﺐ اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ ودوﺑﻠﺮ اﻟﻤﻠﻮن ﻓﻲ ﺗﻘﯿﯿﻢ اﻟﻐﺪد اﻟﻠﻤﻔﺎوﯾﺔ ﺑﺎﻟﺒﻄﻦ ﺣﯿﺚ <br/> ﺗﺴﺎھﻢ ﻓﻲ اﺧﺘﯿﺎر اﻟﻌﻘﺪ اﻷﻛﺜﺮ اﺷﺘﺒﺎھﺎً، إﻻ أﻧﮭﺎ ﻻ ﯾﻤﻜﻦ أن ﺗﺤﻞ ﻣﺤﻞ اﻟﻔﺤﺺ اﻟﻨﺴﯿﺠﻲ ﻟﻠﻐﺪد اﻟﻤﺘﻀﺨﻤﺔ. 
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<br/><br/><br/>Text in English and abstract in Arabic & English. 
<br/><br/><label>Subjects--Topical Terms: </label><br/>Lymphoproliferative 
<br/><br/><label>Subjects--Geographic Terms: </label><br/>امراض الغدد الليمفاوية 
<br/><br/><label>Subjects--Index Terms: </label>abdominal ultrasound  SWE  lymph nodes  malignant  inflammatory 
<br/><br/><label>Dewey Class. No.: </label>616.42