Differential Diagnosis of Lymph Node Lesions. A Semiquantitative Approach with Power Doppler Sonography

Rationale And Objectives: To assess the value of power Doppler for distinguishing reactive from malignant lymph node disease.

Methods: In a prospective study, 48 untreated patients with palpable cervical lymph node enlargement (n = 211) underwent examination with power Doppler sonography. The perfusion sites were subdivided into three groups: central, peripheral, and hilar perfusion. In addition, the authors qualified the intensity of perfusion using a semiquantitative scale from 0 (no perfusion) to III (high perfusion). Finally, the overall perfused lymph node area was measured and the percentage of perfused nodal area was calculated.

Results: Power Doppler sonography showed perfusion in 183 of 211 lymph nodes. Histologic examination revealed 67 reactively enlarged lymph nodes, 72 metastases, and 44 lymphomas. Reactively enlarged lymph nodes showed characteristically intense hilar perfusion (82.1%), whereas nodal metastases exhibited mainly peripherally located flow (84.7%) of grade intensity I to III. Lymph nodes invaded by malignant lymphoma were highly perfused, displaying color signals in the center as well as in the nodal periphery (90.9%).

Conclusions: The perfusion patterns of lymph nodes provide useful additional information in the differential diagnosis of cervical lymphadenopathy.