ASSESSMENT OF VASCULARITY IN REACTIVE LYMPH-NODES BY MEANS OF D-GALACTOSE CONTRAST-ENHANCED DOPPLER SONOGRAPHY

RATIONALE AND OBJECTIVES A prospective study in signal-enhanced Dopple r sonography of lymph nodes that were assumed pretherapeutically to be benign was performed to investigate characteristic sonomorphologic fe atures and vascularity of reactively enlarged lymph nodes. METHODS. Th irty-four patients with enlarged superficial lymph nodes of the neck w ere examined first by B-scan sonography then by Doppler sonography bef ore and after administration of an ultrasound signal-enhancing agent, In B-scan sonography, lymph nodes were classified into three groups ac cording to their sonomorphologic features: (1) homogeneous parenchyma, (2) a centrally located echogenoic line, and (3) a echogenoic ''hilus reflex,'' In conventional and contrast-enhanced Doppler sonography, p eak how rate, pulsatility index, and resistive index were assessed, So nomorphologic criteria were compared with histologic findings. RESULTS . Reactively enlarged lymph nodes showed characteristic sonomorphologi c patterns correlating to their histologic features, Echogenicity of t he hilus corresponded to fibrosis (centrally located echogenoic line i n 13 nodes; 38.2%) or fatty involution of the hill (echogenoic hilus r eflex in 15 nodes; 44.1%), Administration of the galactose-based ultra sound contrast enhancer facilitated the assessment of hilar vessels, w hich projected to the echogenoic hill, respectively, actually addition ally visualized a hilar vascularity in 10 of the 34 lymph nodes compar ed with conventional Doppler, Measured Doppler indices gave not a sign ificant clue for identifying reactive lymph nodes or for differential diagnosis. CONCLUSIONS. Qualitative sonomorphologic assessment of char acteristic sonomorphologic features of reactive lymph nodes may serve as a valuable tool for examining reactively enlarged lymph nodes, Admi nistration of an ultrasound echo enhancer allows the assessment of a c haracteristic nodal vascularity in reactive lymph nodes and were super ior to conventional B-mode and conventional Doppler sonography.