[Value of contrast-enhanced ultrasound vs. CT and MRI in palpable enlarged lymph nodes of the head and neck].
OBJECTIVE
To compare the value of B-mode-, plain and contrast enhanced color Doppler ultrasound, CT and MRI with respect to their diagnostic accuracy in palpable enlarged cervical lymph nodes.


METHODS
Thirty patients (18 - 90 years old) with palpable enlarged lymph nodes of the head and neck underwent B-mode-ultrasound, plain and contrast enhanced color Doppler, CT and MRI (gold standard: histologic analysis in 22 and clinical follow up for at least six months in eight patients). The criteria of malignancy were maximal and minimal lymph node diameter, M/Q-ratio, various morphologic criteria (necrosis, hilus line, internal structure, contour, contrast enhancement), spectral Doppler indices, and vascular architecture in color Doppler.


RESULTS
The highest sensitivity (= 1.00, specificity = 0.07 - 0.15) was obtained measuring the lymph node diameter independent on the used imaging modality (ultrasound, CT, MRI), the highest specificity (= 1.00, sensitivity = 0.71) analyzing the vascularity of the lymph node by plain color Doppler. The highest diagnostic (= 0.93) accuracy was delivered by contrast enhanced color Doppler analysis of the vascularity. Sensitivity (= 0.94) and specificity (= 0.92) of this imaging modality were only slightly inferior to the top values. Fisher's exact test revealed significant values in differentiating malignant from benign lymph nodes for B-mode- and MR-analysis of the M/Q-ratio (p < 0001/p < 0.05), B-mode morphology (p < 0.00005), plain and contrast enhanced color Doppler analysis of the vascularity (p < 0.0001/p < 0.000005), MR-morphology (p < 0.0001), and CT-morphology (p < 0.005).


CONCLUSIONS
CT is inferior to MRI, B-mode-ultrasound and contrast-enhanced color Doppler in the differential diagnosis of selectively analyzed, palpably enlarged cervical lymph nodes using the criteria of our study. The analysis of the MR-morphology revealed a slightly inferior diagnostic accuracy to B-mode morphology and color Doppler analysis of the vascularity.
Schröder
R-J
RJ
Klinik für Strahlenheilkunde, Charité, Campus Virchow-Klinikum, Humboldt-Universität Berlin. ralf-schroeder@charite.de
Rost
B
B
Hidajat
N
N
Rademaker
J
J
Felix
R
R
Mäurer
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D018615:Ultrasonography, Doppler, Color