title: Neck lymph nodes: prediction by computer-assisted contrast medium analysis?
abstract: Several criteria in B-scan and colour-coded Doppler ultrasound have been shown to discriminate malignant transformation of cervical lymph nodes. All these parameters tend to be operator dependent. We describe the first use of computer-assisted analysis of contrast-enhanced ultrasound images evaluating cervical lymphadenopathy in differentiation between benign and malignant lesions. The results from sonography were compared with the histologic findings in 60 patients. Subjective sonomorphologic parameters were evaluated and compared with quantitative criteria obtained from computer analysis after intravenous contrast medium (SonoVue) application to estimate diagnostic impact. Our results confirm that malignant lymph nodes are round in shape (p < 0.001) and show peripheral perfusion (p = 0.0089). Dynamic parameters revealed that malignant nodes were characterized by contrast medium wash-in time (p = 0.0487). However, the contrast-related criteria did not improve the pretherapeutic prediction of malignancy. Although contrast medium kinetics provided statistically significant new criteria for identifying malignant lymph nodes, differentiating between malignant and inflammatory changes in lymph nodes remains a diagnostic challenge.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. johannes.zenk@hno.imed.uni-erlangen.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Zenk
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bozzato
authors.forename: Joachim
authors.initials: J
authors.lastname: Hornung
authors.forename: Frank
authors.initials: F
authors.lastname: Gottwald
authors.forename: Christina
authors.initials: C
authors.lastname: Rabe
authors.forename: Sandra
authors.initials: S
authors.lastname: Gill
authors.forename: Heinrich
authors.initials: H
authors.lastname: Iro
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D003936:Diagnosis, Computer-Assisted; D003937:Diagnosis, Differential; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008199:Lymphadenitis / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D045423:Microbubbles; D009333:Neck / Q000000981:diagnostic imaging* / Q000473:pathology; D010743:Phospholipids; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride