Original Investigations

Evaluation of Metastases and Reactive Lymph Nodes in Doppler Sonography Using an Ultrasound Contrast Enhancer

MÄURER, JÜRGEN MD^*; WILLAM, CARSTEN MD^†; SCHROEDER, RALF MD^*; HIDAJAD, NICO MD^*; HELL, BERTHOLD MD^‡; BIER, JÜRGEN MD^‡; WEBER, SEPP MD^§; FELIX, ROLAND MD^*

Editor(s): Runge, Val M. MD; Allison, David J. BSc, MD, MRCP, FRCR; Bradley, William G. Jr. MD, PhD, FACR; Claussen, Claus D. MD; Dietrich, Rosalind B. MB, ChB; Dondelinger, Robert F.; Eckelman, William C. PhD; Felix, Roland MD; Finn, Paul MD; Gore, John C. PhD; Gourtsoyiannis, Nicholas C. MD; Imhof, Herwig MD; Krestin, Gabriel P. MD; Lamont, A. C. FRCR; Lufkin, Robert B. MD; Manelfe, Claude MD; Muller, Robert N. PhD; Muroff, Lawrence R. MD, FACR; Nelson, Kevin L. MD; Passariello, Roberto MD; Pettigrew, Roderic I. PhD, MD; Ross, Jeffrey S. MD; Rossi, Plinio MD, FACR; Smith, Francis W. MD; Speck, Ulrich MD; Stark, David D. MD; Strauss, H. William MD; Struyven, Julien L. MD; Sze, Gordon K. MD; Tweedle, Michael F. PhD; Van Voorthuisen, ; Wood, Michael L. PhD; Worthington, Brian S. MD

Author Information

From *Strahlenklinik und Poliklinik, the †Department of Medicine, Division of Nephrology, and the ‡Department of Maxillar Oral Facial Surgery, Medizinische Fakultät der Humboldt Universität zu Berlin; and§ Schering AG, Berlin, Germany.

Reprint requests: Jürgen Mäurer, MD, Strahlenklinik und Poliklinik, Charité Virchow Klinikum, Medizinische Fakultät der Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

Received January 28, 1997 and accepted for publication, after revision, March 31, 1997.

INVESTIGATIVE RADIOLOGY 32(8):p 441-446, August 1997.

Abstract

RATIONALE AND OBJECTIVES

The authors conducted a prospective study in D-galactose signal-enhanced Doppler sonography of lymph nodes to investigate new aspects in differentiating malignant from reactive lymph nodes of patients with suspected malignancy of the neck.

METHODS

Twenty-one patients with suspected squamous epithelial cell carcinoma metastases of the neck were examined by Doppler sonography before and after administration of an ultrasound signal-enhancing agent, consisting of d-galactose microbubbles. Qualitative sonomorphology, peak flow rates, and pulsatility and resistive indices were assessed.

RESULTS

Compared with conventional Doppler, enhanced Doppler sonography gave detailed additional information about vascularization of metastases or reactive lymph nodes. Signal-enhanced Doppler of metastases showed a relatively characteristic pattern of vascularity, therefore facilitating differential diagnoses and allowing better discrimination from surrounding tissue, demonstrated by the infiltration of neighboring vessels in the neck. Concerning reactive lymph nodes, vascularization could be stated and measured in many cases only after signal enhancement. Evaluating peak velocities and pulsatility and resistive indices could not differentiate significantly malignant from reactive lymph nodes.

CONCLUSIONS

Administration of a D-galactose-based signal-enhancer helps to differentiate malignant from reactive lymph nodes of the neck. It is superior to conventional Doppler by improving evaluation of the vascularity and could be of use for staging procedures.

Article Keywords

Keywords
Doppler sonography, ultrasound, lymph node metastasis, reactive lymph node, D-galactose signal enhancement, differential diagnosis.

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Evaluation of Metastases and Reactive Lymph Nodes in Doppler Sonography Using an Ultrasound Contrast Enhancer