Doppler ultrasound examination of pathologically enlarged lymph nodes.

Pathologically enlarged lymph nodes have been examined with a commercially available 10 MHz continuous-wave Doppler flowmeter. Many enlarged lymph nodes gave rise to significant Doppler-shift signals indicating increased blood flow. The signals have been spectrum analysed and the large diastolic flow components suggest that there is considerable arterio-venous shunting within lymph glands involved in leukemia, lymphoma and carcinoma. It also seems that the signals tend to diminish in response to treatment. The Doppler signals have been used in an imaging system to produce a vascular map of the region of the enlarged gland. It is suggested that these findings might be applicable to the detection of neoplastic tissues in less accessible sites.     

Real-time elastography for the differentiation of benign and malignant superficial lymph nodes: a meta-analysis

Background

Real-time elastography (RTE), as a non-invasive method, is used for the classification of benign and malignant lymph nodes (LNs) and developed as an alternative to biopsy. Elasticity score (ES) and strain ratio (SR) are used for the interpretation of RTE. We studied the performance of RTE for diagnosis of malignant LNs using meta-analysis.

Methods

PubMed, the Cochrane Library, ISI Web of Knowledge, China National Knowledge Infrastructure were searched. The studies published in English or Chinese relating to the diagnostic value of RTE for superficial LNs were collected. Hierarchical summary receiver operating characteristic (HSROC) curve was used to examine the RTE accuracy. Clinical utility of RTE for LNs was evaluated by Fagan plot analysis.

Results

A total of 9 studies which included 835 LNs were analyzed. The summary sensitivity and specificity for the diagnosis of malignant LNs were 0.74 (95% confidence interval (CI), 0.66–0.81) and 0.90 (95% CI, 0.82–0.94) for ES, and 0.88 (95% CI, 0.79–0.93) and 0.81 (95% CI, 0.49–0.95) for SR, respectively. Compared to ES, SR obviously improved the diagnostic sensitivity value. The HSROCs were 0.88 for ES and 0.91 for SR, respectively. After RTE results over the cut-off value for malignant LNs (“positive” result), the corresponding post-test probability for the presence (if pre-test probability was 50%) was 88% for ES and 82% for SR, respectively; while, in “negative” measurement, the post-test probability was 22% and 13%, respectively.

Conclusion

RTE has a high accuracy in the classification of superficial LNs and can potentially help to select suspicious LNs for biopsy.     

Evaluation of the role of sono-elastography in diagnosis of enlarged cervical lymph nodes

Purpose

Evaluation of the role of real-time elastography in differentiating between benign and malignant cervical lymph nodes (LNs), comparison with B-mode and Doppler Ultrasonography.

Ultrasound-guided aspiration cytology of enlarged lymph nodes

Cytological results of US-guided fine needle aspiration biopsies of enlarged lymph nodes from 179 patients were analyzed retrospectively. The final diagnoses were benign lymphadenopathy in 90 cases, metastasis in 56, and malignant lymphoma in 33 cases. The material was sufficient for cytological analysis in 174 cases (97.2%). Correct diagnosis of malignant (C-IV-V) and benign (C-I-II) lymphadenopathy in the whole material was possible in 80 percent of cases. Correct subtyping of lymphoma was possible in 63.6 percent of the cases. There was one (0.6%) false positive (C IV), 6 (8.5%) false negative (C-I-II), and 24 (13.8%) suspicious (C III) cytological findings. All but one of the false negative cytological findings were from superficial lymph nodes. No complications occurred. US-guided lymph node aspiration biopsy is safe and accurate in the superficial, anterior mediastinal, abdominal, and retroperitoneal lymphonodal areas. Lymph nodes with a C 0 cytological result should undergo rebiopsy and suspicious (C III) or clinically doubtful cases should be referred for a surgical biopsy.     

Abnormal cervical lymph nodes in multiple sclerosis: a preliminary ultrasound study

Background

Cervical lymph nodes are the first drainage stations of the brain and therefore play a key role in neuroinflammatory disorders such as multiple sclerosis.

Objective

The aim of this study was to evaluate, by using ultrasound imaging, cervical lymph nodes in patients with multiple sclerosis and to ascertain if such patients have any clinical features to attest their role.

Methods

We enrolled 43 patients affected by relapsing–remitting multiple sclerosis (22 drug free and 21 under treatment with natalizumab or fingolimod), who underwent ultrasound examination. The morphology, diameters and volume of cervical lymph nodes were measured. We evaluated also a control group of 20 healthy volunteers.

Results

Between-group comparisons showed that the mean anteroposterior diameters in the cervical lymph nodes on both sides of the neck were significantly different (χ ² = 19.5, p < 0.001 for right; χ ² = 20.0, p < 0.001 for left). Post hoc contrasts showed that the mean anteroposterior diameters were greater both in drug-naive (mean ± SD 0.66 ± 0.20 cm; p < 0.001) and treated patients (0.55 ± 0.24 cm; p < 0.001) compared to healthy individuals (0.36 ± 0.19 cm). Moreover, significant difference (p < 0.001) was shown on comparing the mean volume of the cervical lymph nodes on both sides of the neck in the studied groups. No significant differences emerged between the drug-free and treated patients.

Conclusion

The abnormalities shown by ultrasound in cervical lymph nodes are related to deep ones and independent of the ongoing treatment, suggesting a relationship between lymphatic drainage and disease pathology.

     

Differentiation between benign and metastatic cervical lymph nodes with ultrasound

Objective:

The differentiation between benign and metastatic lymph nodes with ultrasound (US) is based primarily on the evaluation of size, shape, margin and internal echo structure. The aim of this study is to determine whether these parameters are reliable indicators and to correlate internal echo structure and histopathological findings.

Materials and Methods:

Seventy-one nodes in 21 patients with pathologically proven oral squamous cell carcinoma were examined. The shortest diameter, the short/long diameter ratio (S/L ratio), margins and internal echo structure of the lymph node were evaluated by US. The internal echo structure was divided into six patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, centric hyperechoic and anechoic pattern. In addition, internal echo structure was correlated with histopathological findings.

Results:

In 71.4% of the metastatic nodes, the shortest diameter was more than 10 mm and the S/L ratio was higher than that of benign nodes (average 0.71). Eleven (84.6%) of the 13 lymph nodes with irregular margins were metastatic. Heterogeneous and anechoic patterns were observed in metastatic nodes, whereas homogeneous hypoechoic and eccentric hyperechoic patterns were present in benign nodes. On ultrasonography with the corresponding histopathological findings, echogenic areas in the homogeneous hyperechoic, heterogeneous and centric hyperechoic patterns of metastatic nodes proved to be necrosis or fibrosis. Eccentric hyperechoic areas in benign nodes corresponded to the hilus and surrounding fatty tissue.

Conclusions:

The shortest diameter, S/L ratio, margin and internal echo structure were considered to be critical indicators to differentiate between benign and metastatic nodes. Secondary changes caused by tumour infiltration, necrosis, or fibrosis should be assessed when metastatic lymph nodes are differentiated from benign ones by internal echo structure.     

Amyloidosis: CT appearance of calcified, enlarged periaortic lymph nodes

The radiographic demonstration of lymph node involvement in amyloidosis is rare. We report a case of calcified, enlarged perioartic and mediastinal lymph nodes detected by CT.     

Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes

PURPOSE: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes. MATERIAL AND METHODS: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears. RESULTS: A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year). CONCLUSION: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.     

Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors

OBJECTIVE: We determined whether contrast-enhanced color Doppler sonography can differentiate benign from malignant enlarged cervical lymph nodes in head and neck tumors. SUBJECTS AND METHODS: Ninety-four enlarged lymph nodes in 39 adult patients (32 men and seven women; age range, 30-81 years) were examined with B-mode sonography and with unenhanced and contrast-enhanced color Doppler sonography. All patients had carcinoma of the oral cavity. Histologically, lymphadenitis was found in 57 nodes and metastases in 37 nodes. Geometric dimension, texture, and margin of the node and detection and location of vessels were noted. Histology and imaging findings were correlated. RESULTS: The transverse-to-longitudinal diameter ratio in combination with texture and margin analysis resulted in a correct diagnosis in only approximately 79% of the nodes. With contrast-enhanced color Doppler sonography, 86% of nodes showed vessels, and 28% of nodes showed vessels with this technique exclusively. Characteristic configurations were identified: hilar vessels with branching indicated lymphadenitis (sensitivity, 98%; specificity, 100%), and predominantly peripheral vessels indicated metastases (100%, 98%). These findings changed the diagnosis in 13 nodes, changed the therapy in four patients, and led to an incorrect diagnosis in one patient. CONCLUSION: Enlarged lymph nodes can be characterized as metastatic or inflammatory with high diagnostic accuracy on the basis of their vascular architecture as seen on contrast-enhanced color Doppler sonography.     

Differentiating pelvic veins and enlarged lymph nodes: optimal CT techniques

A study was done to find the best technique of administering contrast material intravenously to enable differentiation of pelvic veins and enlarged lymph nodes on computed tomographic (CT) scans. Seventy-eight patients with suspected pelvic malignancies were evaluated with CT. After precontrast scans were obtained at a selected pelvic level, 150 mL of contrast material was injected as a two-phase bolus; images were obtained at the same level 1.5, 3, 5, and 7 minutes after initiation of the bolus. Mean pelvic venous enhancement was maximal between 3 and 7 minutes in all the patients. Venous attenuation changes did not correlate with the presence of cardiac or peripheral vascular disease, but there was significantly less enhancement in patients with diabetes mellitus. The time of maximum vein enhancement begins at 3 minutes and continues for at least 4 minutes. A delayed technique of scanning the pelvis may be preferable to rapid scanning to optimize enhancement of the pelvic veins.     

Initial experience of acoustic radiation force impulse ultrasound imaging of cervical lymph nodes

The aim of this study was to evaluate acoustic radiation force impulse imaging for cervical lymphadenopathy in routine clinical practice and to correlate the acoustic radiation force impulse values with the morphological signs and the pathological results, which were used as the reference standard. The virtual touch tissue quantification values were analyzed in 123 patients (mean age 40.8 years, range 1–81 years) with 181 cervical lymph nodes (87 benign, 94 malignant). The diagnostic performance of acoustic radiation force impulse values were evaluated with respect to sensitivity, specificity, and area under the curve using a receiver operating characteristic curve analysis. The mean virtual touch tissue quantification values of the benign lesions (2.01 ± 0.95 m/s) differed from that of the malignant lesions (4.61 ± 2.56 m/s; P < 0.001). The cutoff level for virtual touch tissue quantification value for malignancy was estimated to be 2.595 m/s. Using the receiver operating characteristic curve curves with the cutoff value, the virtual touch tissue quantification value predicted malignancy with a sensitivity of 82.9%, specificity of 93.1% and gave an areas under the curve of 0.906 (95% CI 0.857–0.954). Acoustic radiation force impulse is feasible for cervical lymph nodes and provides quantitative elasticity measurements, which may complement B-mode ultrasound and potentially improve the characterization of cervical lymph nodes.     

低管电流联合 SAFIRE 重建在颈部肿大淋巴结的双能量 CT 扫描中的应用

目的：探讨低管电流联合 SAFIRE 重建的双能量 CT 扫描在颈部肿大淋巴结诊断中的应用。方法经病理证实的50例颈部肿大淋巴结的患者,进行常规 CT 平扫及双能量动脉期扫描,将其随机分为2组,即实验组和对照组,每组25例。实验组管电压分别为100 kV 和 Sn140 kV,管电流分别为117 mAs 和109 mAs,图像重建采用 SAFIRE 迭代重建技术,值选3;对照组管电压分别为100 kV 和 Sn140 kV,管电流分别为189 mAs 和165 mAs,1.0 cm,图像重建算法采用滤波反投影(FBP)技术,其余参数均相同。由2名有经验的医师对2组图像质量进行双盲法评分,利用 Kappa 检验比较观察者间评分的一致性;采用独立样本 t 检验比较2组患者的图像质量及有效辐射剂量。结果2组患者平均 CT 值的比较无统计学差异(P >0.05);2组噪声及信噪比(SNR)的比较有统计学差异(t 分别为4.705、4.403,P 分别为0.0008、0.0007);2组对比噪声比(CNR)无统计学差异(P >0.05);2组图像主观评分一致性较好(Kappa=0.720)且无统计学差异(P >0.05);实验组容积 CT 剂量指数(CTDIvol)为(10.801±0.594)mGy,剂量长度乘积(DLP)为(270.317±5.439)mGy·cm,有效辐射剂量(ED)为(1.594±0.031)mSv,对照组 CTDIvol 为(18.870±0.356)mGy, DLP 为(464.560±1.577)mGy·cm,ED 为(2.741±0.009)mSv,实验组 ED 较对照组降低约41.8%,且2组差异均有统计学意义(P <0.05)。结论在颈部肿大淋巴结的双能量扫描中,低管电流联合 SAFIRE 迭代重建能够在保证图像质量的同时,降低受检者所接受的辐射剂量。     

Sonographic evaluation of cervical lymph nodes

OBJECTIVE: Sonography is a useful imaging tool in the evaluation of cervical lymph nodes. Gray-scale sonography and color and power Doppler sonography are commonly used in clinical practice. This article documents the common sonographic appearances of different causes of cervical lymphadenopathy. CONCLUSION: The sonographic appearances of normal nodes differ from those of abnormal nodes. Sonographic features that help to identify abnormal nodes include shape (round), absent hilus, intranodal necrosis, reticulation, calcification, matting, soft-tissue edema, and peripheral vascularity.     

超声弹性成像技术评估急性脑梗死颈动脉粥样硬化斑块稳定性

 目的 探讨应用超声弹性成像技术评估急性脑梗死患者颈动脉粥样硬化斑块稳定性,并进行早期预测。方法 选取2016年1-9月医院行颈动脉超声检查的急性脑梗死住院患者60例为急性脑梗死组,另选取门诊非急性脑梗死患者55例为对照组,采集两组患者基线资料,探查并测量颈动脉内膜厚度(intima media thickness,IMT)及斑块回声,采集相关的弹性参数(如弹性评分、弹性面积比值等)的数据并进行统计学分析。结果 急性脑梗死组IMT明显厚于对照组(1.71±0.20 vs 1.34±0.27,P<0.05);二维灰阶超声低回声斑块、等回声斑块、混合回声斑块、强回声斑块数量两组之间未出现统计学差异(P>0.05);超声弹性评分低回声斑块和混合回声斑块急性脑梗死组明显低于对照组(1.22±0.43 vs 1.73±0.78,P=0.033;2.95±0.51 vs 3.38±0.59,P=0.036);超声斑块弹性面积比值低回声斑块与混合回声斑块急性脑梗死组明显低于对照组 (1.15±0.09 vs 1.23±0.10,P=0.029;1.44±0.12 vs 1.55±0.09,P=0.010)。结论 应用超声弹性成像技术可以区别出颈动脉斑块的稳定性,为急性脑梗死提供预测价值。     

Ear, nose, and throat cancer: ultrasound diagnosis of metastasis to cervical lymph nodes

We present the results of a study on the value of ultrasound in the detection of metastasis to the cervical lymph nodes in connection with cancer of the ear, nose, and throat. Comparison of clinical, ultrasound, and histological findings for 100 patients who underwent surgery revealed that clinical examination had a sensitivity of 78% versus 92.6% for ultrasound. All 18 cases of thrombosis of the internal jugular vein were detected by ultrasound. Clinical staging of the disease was modified in 28 of these patients based on ultrasound findings, including three false positive findings. Ultrasonographic follow-up at three months for a second group of 110 patients who did not undergo neck dissection provided prognostic information, since lesion stability or progression was correlated with death in less than one year in 41 of 43 patients. Ultrasound is of primary value in providing information of an anatomic nature, including the detection of subclinical lymph nodes, volumetric evaluation, and determination of vascular connections, particularly detection of internal jugular venous thrombosis. Furthermore, for patients whose necks have been thickened as a result of radiotherapy, ultrasound allows assessment of local status.