Distribution of intranodal vessels in differentiating benign from metastatic neck nodes.
OBJECTIVE
Recent studies report high accuracy of power Doppler sonography in the differentiation of benign from malignant cervical lymphadenopathy. This study was undertaken to identify which of the parameters used in Doppler sonography of cervical lymph nodes is accurate and readily applicable in routine clinical practice.


METHODS
We reviewed the power Doppler ultrasound examinations of 50 patients with cytologically proven metastatic nodes from nasopharyngeal carcinoma and 50 patients with proven reactive lymphadenopathy. All the examinations had been performed by an experienced sonologist, and intranodal vascular distribution and resistance were evaluated during real-time ultrasound. Twenty metastatic nodes and 40 reactive nodes were less than 10 mm in maximum transverse diameter. The vascular patterns of lymph nodes were classified into three categories: (1) hilar; (2) capsular; (3) hilar and capsular. The resistive index (RI) and pulsatility index (PI) were measured by spectral Doppler.


RESULTS
Although metastatic nodes (RI, 0.81 +/- 0.11; PI, 1.89 +/- 0.89) tended to have higher intranodal vascular resistance than reactive nodes (RI, 0.65 +/- 0.08; PI, 1.07 +/- 0.26), there was considerable overlap of the resistance parameters between benign and malignant nodes. Most of the metastatic nodes showed the presence of capsular vascularity (capsular, 16%; capsular and hilar, 78%), whereas the majority of the reactive nodes showed hilar vascularity (98%), and the difference was significant.


CONCLUSIONS
The distribution of intranodal vascularity appears to be more useful than RI or PI in differentiating benign from malignant cervical lymphadenopathy. It is also easier to evaluate the distribution and the results are therefore readily applicable in routine clinical practice.
Department of Diagnostic Radiology and Organ Imaging, The Hong Kong Polytechnic University, Shatin, N.T., Hong Kong. aniltahuja@cuhk.edu.hk
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Metreweli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply* / Q000000981:diagnostic imaging; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D014655:Vascular Resistance