Neck lymph nodes: Prediction by computer-assisted contrast medium analysis?

Zenk, Johannes; Bozzato, Alessandro; Hornung, Joachim; Gottwald, Frank; Rabe, Christina; Gill, Sandra; Iro, Heinrich

doi:10.1016/j.ultrasmedbio.2006.08.005

« Previous Next »Ultrasound in Medicine and Biology
Volume 33, Issue 2 , Pages 246-253, February 2007

Neck lymph nodes: Prediction by computer-assisted contrast medium analysis?

Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
- Address correspondence to: J. Zenk, M.D., Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Waldstrasse 1, D-91054 Erlangen, Germany.
Alessandro Bozzato
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
Joachim Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
Frank Gottwald
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
Christina Rabe
- Institute for Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
Sandra Gill
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany

Received 25 April 2006; received in revised form 3 August 2006; accepted 10 August 2006. published online 16 December 2006.

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. (E-mail: johannes.zenk@hno.imed.uni-erlangen.de)

Key Words: Ultrasound, Diagnosis, Head and neck, Tumour, Colour Doppler sonography, Ultrasound contrast media, Metastasis, Neck dissection, Power Doppler