Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies.
OBJECTIVE
Our purpose was to depict the characteristics of the global vasculature of cervical lymphadenopathies and to clarify the efficiency of Doppler spectral analysis and power Doppler sonography in the differential diagnosis.


METHODS
Prospectively, 289 lymph node lesions underwent Doppler flow studies and were grouped as metastasis, lymphoma, tuberculosis, and benign lymphadenopathies. Sonographic assessments included vascular pattern and vascular density (presented as vascularity index) as revealed by power Doppler sonography. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. Values of both the highest and the lowest resistance were analyzed. Vascularity index, resistive index, pulsatility index, nodal size, and age were correlated.


RESULTS
Most benign lymphadenopathies (87%), tuberculous lymphadenopathies (72%), and lymphomas (71%) revealed an avascular or hilar vascular pattern. Vascular patterns of most metastatic lymphadenopathies (90%) were of spotted (26%), peripheral (11%), or mixed (53%) type. The vascularity indexes of metastatic lymphadenopathy (mean, 0.176) and lymphoma (mean, 0.122) were significantly higher than those of tuberculous and benign lymphadenopathy (mean, 0.054 and 0.042, respectively). In vascular resistance studies, the highest pulsatility index and resistive index in metastatic lymphadenopathy statistically exceeded those of benign lymphadenopathy, whereas no difference was found in the lowest values. Negative correlation was found between the vascularity index of metastatic lesions and their lowest vascular resistance, and positive correlation was found between vascularity index and nodal size in benign lymphadenopathies.


CONCLUSIONS
In addition to vascular resistance assessed traditionally with Doppler spectral analysis, vascular pattern and vascular density assessed with power Doppler sonography can better differentiate the nature of lymphadenopathies.
Department of Otolaryngology, National Taiwan University Hospital, Taipei.
C H
CH
Wu
Y L
YL
Chang
W C
WC
Hsu
J Y
JY
Ko
T S
TS
Sheen
F J
FJ
Hsieh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008198:Lymph Nodes / Q000098:blood supply / Q000000981:diagnostic imaging; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008223:Lymphoma / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000000981:diagnostic imaging; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D011673:Pulsatile Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D014388:Tuberculosis, Lymph Node / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler / Q000295:instrumentation*; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation*; D014655:Vascular Resistance / Q000502:physiology