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Evaluation of Lymph Node Perfusion Using Continuous Mode Harmonic Ultrasonography With a Second-Generation Contrast Agent

Departments of Medical Diagnostic Sciences and Special Therapies (L.R., Y.K., A.T., R.S., F.F.), Pathology (S.B.), Rheumatology (U.F.), Clinical and Experimental Medicine (F.A.), and Surgery (C.R.R.), University of Padua, Padua, Italy.

Address correspondence and reprint requests to Leopoldo Rubaltelli, MD, Department of Medical Diagnostic Sciences and Special Therapies, University of Padua, Via Giustiniani 2, 35128 Padua, Italy. E-mail: leopoldo.rubaltelli{at}unipd.it.

Objective. To evaluate the contribution of continuous mode contrast-enhanced harmonic ultrasonography (CE-HUS) with a second-generation contrast agent to the characterization of superficial lymphadenopathies with respect to conventional ultrasonographic techniques (B-mode and power Doppler). Methods. Fifty-six lymph nodes from 45 patients were studied both by conventional techniques and by CE-HUS. The dimensions, intranodal architecture, margins, and location of vessels were evaluated. Subsequently, all the lymph nodes were examined by CE-HUS, and enhancement of echogenicity was evaluated. The diagnoses obtained by means of fine-needle aspiration cytologic examination, surgical biopsy, or both were compared with those obtained by ultrasonography. Results. Of the lymph nodes examined, 30 were benign and 26 were malignant (18 metastases and 8 non-Hodgkin lymphomas). The study using CE-HUS showed intense homogeneous enhancement in 28 of 30 reactive lymph nodes; perfusion defects in 17, of which 15 were neoplastic and 2 were inflammatory; intense but inhomogeneous speckled enhancement in the early arterial phase in 5 cases of lymphoma; and, last, scarce or absent intranodal enhancement in 4 metastases. The specificity, sensitivity, and accuracy of conventional techniques in differentiation between benign and malignant lymph nodes were 76%, 80%, and 78% versus 93%, 92%, and 92.8% for CE-HUS. The increase in correct diagnoses was significant (P = .05) when conventional ultrasonography was tested against CE-HUS. Conclusions. Superficial lymph nodes can be characterized as being neoplastic or benign with a high degree of diagnostic accuracy on the basis of the perfusion characteristics evaluated by CE-HUS. This technique has been shown to afford a higher degree of accuracy than currently obtainable by any other ultrasonographic technique.

Key Words: contrast media • harmonic ultrasonography • lymphatic system • neoplasms

Abbreviations: CE-HUS, contrast-enhanced harmonic ultrasonography • CT, computed tomography • FNAC, fine-needle aspiration cytologic examination • HD, Hodgkin disease • MRI, magnetic resonance imaging

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