Assessment of neck lymph nodes is essential in patients with head and neck cancers for predicting the patient’s prognosis and selecting the appropriate treatment. Ultrasonography is a useful imaging tool in the assessment of neck lymph nodes. Greyscale ultrasonography assesses the size, distribution, and internal architecture of lymph nodes. Doppler ultrasonography evaluates the intranodal vascular pattern and resistance of lymph nodes. Contrast-enhanced ultrasonography provides information on lymph node parenchymal perfusion. Elastography allows qualitative and quantitative assessment of lymph node stiffness. This article reviews the value of greyscale, Doppler and contrast-enhanced ultrasonography as well as elastography in the assessment of malignant nodes in the neck.

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Objective. To investigate the difference in the nodal hilus evaluated by gray scale and power Doppler sonography. Methods. One hundred ninety-two patients with proven cervical lymphadenopathy were included in the study (metastases, n = 118; tuberculosis, n = 56; and lymphoma, n = 18). Lymph nodes were evaluated by gray scale sonography for the echogenic hilus and power Doppler sonography for hilar vascularity. Results. Hilar vascularity was found even though the lymph node did not show an echogenic hilus on gray scale sonography (metastases, 59%; tuberculosis, 66%; and lymphoma, 91%). Conclusions. Sonologists should be aware that gray scale and Doppler sonography show different aspects of the hilus, and the absence of the hilus on gray scale sonography does not necessarily imply an associated absence of hilar vascularity. Key words: gray scale sonography; power Doppler sonography; hilus; cervical nodes. he role of sonography in the evaluation of neck nodes is well established. Previously, sonography of lymph nodes involved only gray scale sonography, and evaluation of the nodal hilar architecture was an essential part of the examination. The absence of a hilus was usually considered an abnormality.1,2 However, to our knowledge, the sonographic literature has not addressed whether the absence of an echogenic hilus on gray scale sonography implies the absence of hilar vasculature. With power Doppler sonography (PDS), it is now possible to evaluate intranodal vasculature.In our experience, often in abnormal nodes the echogenic hilar architecture is absent on gray scale imaging (Fig. 1), but the hilar vessels are clearly shown on PDS (Fig. 2). Because this has not been emphasized in the literature, often sonologists have presumed that the absence of the echogenic hilus on gray scale sonography also implies the absence of hilar vasculature. We were therefore interested in documenting the appearance of hilar vessels so that sonologists would be aware of the differences in nodal hilar evaluation by gray scale sonography and PDS.

Clinicians attending to patients after radiotherapy for head and neck cancers should be aware of this long-term complication of radiotherapy. A detailed clinical history and incorporation of auscultation of carotid arteries in routine follow-up of postradiotherapy patients are recommended.

Background and Purpose: To study the distribution, extent and sonographic characterisation of radiation-induced carotid artery stenosis in nasopharyngeal carcinoma (NPC) patients. Methods: The distribution of plaques, the extent of stenosis, and the sonographic characterisation of the plaque at maximum stenosis were recorded in 71 NPC patients. The results were compared with the ultrasound results of a control group of 142 patients presenting with symptoms of cerebrovascular disease or carotid bruit. Results: NPC patients had a higher incidence of carotid stenosis (77 vs. 50.7%). The common carotid arteries were most commonly affected by radiation-induced stenosis (93/142 vs. 37/284 in the control group), whereas the carotid bulb was the most commonly affected (56/284) site in the control group. Significantly more NPC patients had moderate-to-severe stenosis (21/71 vs. 27/142). Analysis of the sonographic appearance of radiation-induced and atherosclerotic plaques showed more diffuse involvement in the post-radiation group. Non-calcified plaques and intraplaque hypoechoic foci were also more frequent in the post-radiation group. Conclusions: Radiation-induced carotid stenosis is more diffuse in distribution, is associated with more severe luminal stenosis and has different sonographic plaque characterisation compared with carotid stenosis without radiation exposure.

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(1)H MR spectroscopy may be used to characterize SGTs, but a larger study is required to validate these initial results.