Vascularity and Grey-Scale Sonographic Features of Normal Cervical Lymph Nodes: Variations with Nodal Size

Ying, Michael; Ahuja, Anil T.; Brook, Fiona; Metreweli, Constantine

doi:10.1053/crad.2000.0680

Cited by 53 publications

(35 citation statements)

References 23 publications

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“…Published studies on color and power Doppler of normal lymph nodes have reported the visualization of the hilar vessels and, on occasion, visualization of the principal perihilar branches. 9,11,12 In a recent study of normal cervical lymph nodes, Ying et al 11 found no vascularity in more than half of the nodes that had a maximum transverse diameter between 2 and 4 mm.…”

Section: Discussionmentioning

confidence: 98%

High‐sensitivity power Doppler imaging of normal superficial lymph nodes

Stramare

Tregnaghi

Fittà

et al. 2004

J of Clinical Ultrasound

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Section: Discussionmentioning

confidence: 98%

High‐sensitivity power Doppler imaging of normal superficial lymph nodes

Stramare

Tregnaghi

Fittà

et al. 2004

J of Clinical Ultrasound

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“…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. 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.…”

Section: 1011mentioning

confidence: 99%

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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“…CT sometimes cannot detect cervical lymph nodes that are smaller than 0.5cms as most cervical nodes are aligned with their long axis parallel to the long axis of the body and because CT demonstrates only the transverse plane of the nodes in which plane all nodes appears to be round. 6 4. Finally, CT and MRI are expensive and not readily accessible for repeated use during follow up of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…6 In our study 78% of malignant nodes showed L/S < 2, 79% of reactive nodes showed L/S > 2 and 61% of tubercular nodes showed L/S < 2, the p value for the L/S ratio was 0.001, which showed the association to be highly significant LYMPH NODE BORDER-Sharp and Unsharp Border: Sharp borders in malignancy is due to the infiltrating tumour cells which replaces normal lymphoid tissues and it causes an increasing acoustic impedance difference between lymph nodes and surrounding tissues whereas unsharp borders in malignant nodes indicate invasion into adjacent structures. But in benign because of edema or active inflammation of the surrounding tissues, they will have unsharp borders.…”

Section: Shape and L/s Ratiomentioning

confidence: 99%

Evaluation of Cervical Lymphnodes by Ultrasonography in Correlation With Fnac

Singh¹,

Hegde²,

Sakalecha³

et al. 2015

jemds

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AIMS AND OBJECTIVES:To study and differentiate neoplastic (Malignant) and nonneoplastic (Reactive and tubercular)cervical lymph nodes by High resolution ultrasonography. To correlate the diagnostic accuracy of ultrasound with FNAC in differentiating neoplastic (malignant) and nonneoplastic (reactive and tubercular) cervical lymphadenopathy. MATERIAL AND METHODS: Data was collected from a total of 100 cases referred for ultrasound of neck to the Department of Radiodiagnosis, Sri R. L. Jalappa Hospital and Research Center over a period of 24 months from January 2012 to January 2014, with 5-10 MH linear transducer using SEIMENS G 40/G 50/ Acuson Ax 300 ultrasound equipment. Lymph nodes were assessed using grey scale and colour Doppler parameters like: nodal level and site, size, shape, L/S ratio, border, hilum, echotexture, necrosis, matting and angioarchitecture [hilar vessels, capsular vessels (peripheral) and mixed flow]. A provisional diagnosis was suggested after the ultrasound examination and these findings were correlated with Fine Needle Aspiration Cytology/ Histopathological findings. RESULTS: In our study out of 45 non neoplastic nodes (reactive and tubercular) only 41 nodes were identified as nonneoplastic (reactive/ tubercular) on ultrasound prior to FNAC/ histopathology. Out of 55 possible neoplastic (malignant nodes) detected on ultrasound only 46 lymph nodes turned out to be neoplastic on FNAC/ histopathology. Lymph node with oval shape (L/S ratio > 2) echogenic hilum, homogenous echotexture and hilar vascularity were considered as significant parameters in detecting non-neoplastic (reactive) lymph nodes, which showed matting with soft tissue edema were considered nonneoplastic lymphnodes (Tubercular lymphnodes). Nodes which were Round shape (L/S ratio < 2), absent hilum, heterogeneous echotexture, hilar, capsular vessels and mixed vascularity were considered as significant parameters in detecting neoplastic (malignant) lymph nodes. Correlation of sonographic findings with Fine Needle Aspiration Cytology/ Histopathological findings was performed. Sensitivity and Specificity of ultrasound in differentiating neoplastic from non-neoplastic cervical lymphadenopathy was found to be 90% and 74% respectively. CONCLUSIONS: This study concludes that: 1) High resolution ultrasonographic examination proved as a valuable primary investigation to identify lymph nodes and differentiate nonneoplastic and neoplastic lymphadenopathy. 2) Combination of ultrasonographic features with vascular pattern of the lymph nodes have a high sensitivity, specificity in differentiating neoplastic and non-neoplastic lymphadenopathy.

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Vascularity and Grey-Scale Sonographic Features of Normal Cervical Lymph Nodes: Variations with Nodal Size

Cited by 53 publications

References 23 publications

High‐sensitivity power Doppler imaging of normal superficial lymph nodes

High‐sensitivity power Doppler imaging of normal superficial lymph nodes

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

Evaluation of Cervical Lymphnodes by Ultrasonography in Correlation With Fnac

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