CONTRAST ENHANCED SONOGRAPHY IN CHARACTERIZATION OF ENLARGED LYMPH NODES OF THE NECK IN CHILDREN

Purpose: Purpose. We compare contrast-enhanced ultrasonography to conventional US in charakterization of benign and malignant enlarged lymph nodes of the neck in children.

Methods and Materials: Ninety-seven enlarged superficial lymph nodes in 46 children (21 girls and 25 boys; age range, 1–16 years) were evaluated using Color Doppler (CD), Power Doppler before and after contrast agent (Levovist) administration (CEUS). The patterns of intranodal flow were identified: hilar vessels with branching running at the long axis of the lymph node with branches to the cortex, indicated lymphadenitis (sensitivity 94%, specificity 100%). Of the neoplastic lymph nodes, 90% showed predominantly peripheral vessels. Histologically, lymphadenitis was found in 62 nodes, metastases in 24 nodes, HL in 6 and NHL in 5 cases. Geometric dimension, architecture, and margin of the node and detection and localisation of vessels were observed. The ultrasound diagnoses were compared to the final diagnoses based on clinical tests, surgical and histological examination.

Results: The transverse- to- longitudinal diameter ratio in combination with architecture and margin analysis resulted in a correct diagnosis in only approximately 80% of the nodes. With contrast- enhanced CD and PD, 90% of nodes showed vessels, and 30% of nodes demonstrated vessels with this technique exclusively.

Conclusions: Enlarged peripferal lymph nodes in children can be categorized as inflammatory or neoplastic with high diagnostic accuracy on the basis of their vascular patterns as seen on contrast- enhancend Color Doppler US.