title: New method of dynamic color doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation.
abstract: Tumor growth depends on sufficient blood and oxygen supply. Hypoxia stimulates neovascularization and is a known cause for radio- and chemoresistance. The objective of this study was to investigate the use of a novel ultrasound technique for the dynamic assessment of vascularization and oxygenation in metastatic lymph nodes. Twenty-four patients (age 44-78 years) with cervical lymph node metastases of squamous cell head and neck cancer were investigated by color duplex sonography and 17 (age 46-78 years) were investigated additionally with polarography. Sonography was performed after contrast enhancer infusion under defined conditions. Intranodal perfusion data (color hue, colored area) were measured automatically by a novel software technique. This allows an evaluation of blood flow dynamics by calculating perfusion intensity--velocity, perfused area, as well as the novel parameters tissue resistance index (TRI) and tissue pulsatility index (TPI)--for each point of a complete heart cycle. Tumor tissue pO(2) was measured by means of polarographic needle electrodes placed intranodally. The sonographic and polarographic data were correlated using Pearson's test. Sonography demonstrated a statistically significant inverse correlation between hypoxia and perfusion and significant TPI and TRI changes with different N-stages. The percentage of nodal fraction with less than 10 mmHg oxygen saturation was significantly inversely correlated with lymph node perfusion (r = -0.551; p = 0.021). Nodes with a perfusion of less than 0.05 cm/sec flow velocity showed significantly larger hypoxic areas (p = 0.006). Significant differences of TPI and TRI existed between nodes in stage N(1) and N(2)/N(3) (p = 0.028 and 0.048, respectively). This new method of dynamic signal quantification allows a noninvasive and quantitative assessment of tumor and metastatic lymph node perfusion by means of commonly available ultrasound equipment.
authors.affiliation: Kinderklinik am Städtischen Klinikum St. Georg, D-04229 Leipzig, Germany. thomas.scholbach@sanktgeorge.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Scholbach
authors.forename: Jakob
authors.initials: J
authors.lastname: Scholbach
authors.forename: Gabriele A
authors.initials: GA
authors.lastname: Krombach
authors.forename: Bernd
authors.initials: B
authors.lastname: Gagel
authors.forename: Payam
authors.initials: P
authors.lastname: Maneschi
authors.forename: Ercole
authors.initials: E
authors.lastname: Di Martino
mesh_terms: D000328:Adult; D000368:Aged; D001331:Automation; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis*; D011048:Polarography; D011446:Prospective Studies; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D012984:Software; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D010100:Oxygen