Color-coded duplex sonography of the cervical lymph nodes : improved differential diagnostic assessment after administration of the signal enhancer SH U 508A (Levovist)

The vascularity of cervical lymph nodes can be documented by means of color-coded duplex sonography and malignant and benign lymph nodes distinguished on the basis of typical patterns of vascularity. However, not all intranodal vessels can be visualized by color-coded duplex sonography, and minute vessels are detectable only after the administration of a signal enhancer. This also makes it possible to assess the morphology of cervical lymph nodes that are inaccessible on plain sonography. In the present study we examined acute and chronic inflammatory and metastatic lymph nodes as well as malignant lymphomas to determine the extent to which a specific pattern of vascularity can be detected with color-coded duplex sonography after the injection of Levovist as a signal enhancer. In addition, digital image processing was used to quantify the vascularity detected in relation to the cross-sectional area of the lymph nodes as seen at sonography and to determine whether there are any differences in lymph node types as regards an increase in the detection of vascularity. After injection of the marker a typical pattern of vascularity could be assigned to all lymph nodes examined and differences shown in quantifying vascularity: This increase was greatest in the acutely inflamed lymph nodes (36.0 +/- 5.0%) and smallest in lymph nodes with chronic inflammation (2.3 +/- 1.3%). These findings show that cervical lymph nodes of varying origin differ by virtue of their pattern of vascularity, with increased vascularity detectable after administration of a signal enhancer.