Ultraschall in der Diagnostik maligner Lymphome

Abstract

Ultrasound is most useful in detecting and characterizing peripheral and abdominal lymph nodes and infiltration of solid organs. B-mode criteria, such as size, shape, number, distribution architecture, echogenicity and delineation of margins are the basis for characterizing lymph nodes. Additionally color coding techniques such as color Doppler, B-flow and contrast-enhanced ultrasound (CEUS) contribute to the evaluation of the nodal vasculature and vessel architecture. Whenever possible high frequency probes should not only be used for evaluating peripheral lymph nodes but also for lymphatic infiltration of solid organs, especially the spleen. The CEUS technique will be of additional benefit in detecting characterizing potential lymphatic organ infiltration. Ultrasound is an ideal tool for guided punctures, for which core biopsies should be preferred over fine needle aspiration biopsy and CEUS can also be used for proving residual viable tissue after chemotherapy or radiation therapy.

Sonography of Peripheral Lymph Nodes Part 2: Doppler Criteria and Typical Findings of Distinct Entities

“…The contrast medium behavior of lymph nodes in the case of malignant lymphomas and the different benign lymphadenopathies has only been minimally examined to date. However, the few results show that similarly to B-mode and color/ power Doppler sonography, contrast-enhanced ul-trasound seems to show significant overlapping between malignant lymphomas and inflammatory lymph nodes [20,21]. Necrotic zones and liquefied areas in lymph nodes, as particularly known in the case of squamous cell carcinoma, bacterial abscessforming lymphadenitis, and tuberculosis, can be effectively visualized with contrast-enhanced ultrasound as circumscribed vascularization defects because ultrasound contrast media remain strictly intravascular (20, own observation).…”

“…When planning a diagnostic puncture, such as fluid aspiration in the case of colliquating lymphadenitis, or to avoid a necrotic zone during core biopsy, it can be advantageous to be able to detect necrotic zones and liquefied areas with high sensitivity (20, own observation). It should also be taken into consideration that the use of ultrasound contrast media is currently only possible "off label" [20,21]. Due to the insufficient data, contrast-enhanced ultrasound is not (yet) recommended for clinical use in peripheral lymph nodes in the current EFSUMB guidelines [20].…”

“…Bei den Perfusionsmustern wird einerseits die Hyperperfusion als Kriterium angegeben [18], andere Autoren fanden Inhomogenitäten und die Hypoperfusion als Zeichen [19]. Das Kontrastmittelverhalten von Lymphknoten bei malignen Lymphomen und den unterschiedlichen benignen Lymphadenopathien wurde bislang wenig untersucht, wobei sich an den spärlichen Ergebnissen zeigt, dass ähnlich wie im B-Bild und der Farb/Powerdopplersonografie, kontrastmittelsonografisch eine deutliche Überschneidung zwischen malignen Lymphomen und entzündlichen Lymphknoten vorzuliegen scheint [20,21] [20], eigene Beobachtung). Zu bedenken ist auch, dass die Anwendung von Ultraschallkontrastmitteln derzeit nur "off-label" möglich ist [20,21].…”

“…Das Kontrastmittelverhalten von Lymphknoten bei malignen Lymphomen und den unterschiedlichen benignen Lymphadenopathien wurde bislang wenig untersucht, wobei sich an den spärlichen Ergebnissen zeigt, dass ähnlich wie im B-Bild und der Farb/Powerdopplersonografie, kontrastmittelsonografisch eine deutliche Überschneidung zwischen malignen Lymphomen und entzündlichen Lymphknoten vorzuliegen scheint [20,21] [20], eigene Beobachtung). Zu bedenken ist auch, dass die Anwendung von Ultraschallkontrastmitteln derzeit nur "off-label" möglich ist [20,21]. Aufgrund der unzureichenden Datenlage wird die Kontrastmittelsonografie an peripheren Lymphknoten in den aktuellen EF-SUMB Guidelines für den klinischen Einsatz (noch) nicht empfohlen [20].…”

“…Most malignant lymphomas often affect the peripheral lymph node stations, while such a finding is a rarity in the case of plasmacytoma. Affected lymph nodes are frequently enlarged and have a particularly hypoechoic structure [21,30]. The normal sonographic lymph node architecture can be preserved (often in the case of CLL) or can be altered ( • " Fig.…”