Two-dimensional and three-dimensional power Doppler sonographic classification of vascular patterns in cervical lymphadenopathies.

Wu, Chih-Chung; Shih, Jin-Chung; Chang, Yih‐Leong; Lee, Shiann-Yann; Hsieh, Fon‐Jou

doi:10.7863/jum.1998.17.7.459

Cited by 52 publications

(62 citation statements)

References 18 publications

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“…Metastatic nodes from papillary carcinoma (14) were equally distributed between levels 3 and 5, and 5 of the 14 nodes had maximum transverse diameters of 1 cm or greater. Metastatic nodes from nasopharyngeal carcinoma (45) were fairly equally distributed between levels 2 and 5, and 42 had maximum transverse diameters of 1 cm or greater.…”

Section: Resultsmentioning

confidence: 99%

“…17 Reactive nodes tend to have prominent hilar vascularity 15,18 because of an increase in vessel diameter and blood flow. 14 In malignant nodes, 4 predominant abnormal vascular patterns have been described: avascular areas, displacement of vessels, increased peripheral vessels, and an aberrant course of hilar vessels. 19 The increase in peripheral nodal vascularity is due to the initial deposition of carcinoma cells in the marginal and medullary sinuses.…”

Section: 1011mentioning

confidence: 99%

“…On Doppler sonography, the patterns of vascular distribution within nodes have been described previously. [13][14][15] Normal nodes predominantly have hilar vascularity or are avascular. 16 The occurrence of vascularity in normal nodes increases with increasing size, and about 90% of normal nodes with maximum transverse diameters greater than 5 mm show hilar vascularity.…”

Section: 1011mentioning

confidence: 99%

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Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

Ahuja

Ying

King

et al. 2001

J of Ultrasound Medicine

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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.

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Section: Resultsmentioning

confidence: 99%

Section: 1011mentioning

confidence: 99%

Section: 1011mentioning

confidence: 99%

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Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

Ahuja

Ying

King

et al. 2001

J of Ultrasound Medicine

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“…The presence of central vascularity in a lymphoma lead to diagnostic problems in distinguishing reactive from On the other hand, in many previous studies, metastatic involvement of lymph nodes has frequently been associated with capsular or peripheral vascularity [5,6,9]. Na et al added more detailed descriptions: deformed radial and aberrant multifocal patterns [10].…”

Section: Discussionmentioning

confidence: 99%

“…Several papers have described the vascular patterns associated with reactive and metastatic lymph nodes [5e8]. In the majority of previous publications, the patterns were classified in general terms, e.g., peripheral pattern, hilar pattern, or mixed pattern [4,9]. More detailed classifications were introduced by Na et al [10] and Tschammler et al [11].…”

Section: Introductionmentioning

confidence: 99%

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

Białek

Jakubowski

Szczepanik

et al. 2007

Journal of Ultrasound

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KEYWORDSLymph nodes; Lymphoma; Ultrasound; Power Doppler; Vessel pattern.Abstract Purpose: To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy. Methods and materials: The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22e84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal). Results: A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III). Conclusion: The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy. Sommario Scopo: Valutazione dei possibili pattern vascolari dei linfonodi superficiali interessati da linfoma confermato da esame istologico allo scopo di ottenere un elemento aggiuntivo nella diagnosi differenziale ecografica tra patologie interessanti i linfonodi. Materiali e metodi: È stata effettuata una classificazione ecografica prospettica di pattern vascolari color e power Doppler di 55 linfonodi superficiali programmati per resezione. Sono stati selezionati per questo studio 40 pazienti con diagnosi istologica di linfoma (26 linfonodi cervicali, 13 ascellari e 1 inguinale). Il gruppo di pazienti studiato era comprensivo di 27 uomini e 13 donne, età 22e84 anni (età media: 58 anni). Risultati: È stato trovato un vaso lungitudinale con o senza ramificazioni (pattern I) in 14 linfoadenopatie; piccoli segmenti vascolari distribuiti nell'area dell'ilo o nella zona centrale del linfonodo (pattern II) in 6 linfoadenopatie. Vasi multipli, parzialmente ramificati, che entrano nel linfonodo in alcune file dal lato longitudinale (pattern III) sono stati riscontrati in 5 linfonodi mentre vasi multipli che si ramificano irregolarmente o...

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A probability prediction rule for malignant cervical lymphadenopathy using sonography

Lee

Huang

et al. 2000

Head Neck

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Background Our purpose was to weigh various sonographic parameters as predicting malignant cervical lymphadenopathy and build a reliable prediction rule. Methods One hundred and eighty‐nine cervical lymph node lesions from 125 consecutive patients were used for building the prediction model. Sonographic variables, including 15 morphologic features of B‐mode, 5 vascular parameters of color Doppler mode, along with age and sex, were analyzed with multivariate logistic regression to evaluate the joint effect of a set of independent variables. A prediction rule for malignant lymphadenopathy was established, and prospective validation was assessed on a new group consisting of 100 lymph nodes from another 60 consecutive patients. Results The association of heterogeneous content, long transverse diameter, pathologic vascular pattern, high vascular density, and older age provided the most robust prediction value. Scoring scale was designed as 1x (age) + 2x (vascularity index) + 3x (short axis) + 4x (vascular pattern) + 4x (internal echo) according to the parameter estimates of multivariate logistic regression analysis. Cut‐off value of score ≧10 as malignancy resulted in 89.2% sensitivity and 85.2% specificity. Prospective validation also showed satisfactory results (sensitivity, 82.9%; specificity, 86.2%). Conclusions By measuring only 4 sonographic parameters and age, this prediction rule could provide the physician a nonconfusing and reliable probability reference for managing cervical lymphadenopathy. © 2000 John Wiley & Sons, Inc. Head Neck 22: 223–228, 2000.

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Two-dimensional and three-dimensional power Doppler sonographic classification of vascular patterns in cervical lymphadenopathies.

Cited by 52 publications

References 18 publications

Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

A probability prediction rule for malignant cervical lymphadenopathy using sonography

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