Vascularization of reactively enlarged lymph nodes analyzed by color duplex sonography

Purpose: This study involved a prospective evaluation of the reliability of sonography, and especially duplex sonography, in confirmation of the benig n nature of enlarged cervical lymph nodes. Patients and Methods: In 53 untreated patients with enlarged cervical lymph nodes, B-mode, plain, and d-galactose-enhanced color duplex sonography wer e performed. The B-mode sonomorphology was analyzed for the structure of va scularization. Quantitative parameters such as maximum flow velocity, pulsa tility index, and resistive index were also assessed. The benignity of the lymph nodes was confirmed by microscopic analysis. Results: The B-mode showed 20 homogeneous lymph nodes, 23 with a central ec hogenoic line covering less than one third, and 10 with a distinct hilus si gn extending to more than one third of the lymph node diameter. Microscopic ally, the least fibrotic or chronic inflammatory changes in the parenchyma were observed in the homogeneous lymph nodes, whereas those with central ec hogeneoity had fibrotic and lipoid hilus changes. Histologically, all lymph nodes had normal afferent and efferent hilus vessels. In 37 lymph nodes, t he vessel structure could be reliably visualized by both plain and enhanced color duplex sonography, whereas in 16 it could only be demonstrated after the use of signal enhancement. Nine of 53 lymph nodes had Solbiati-(L/T-) indices below 2, which were suggestive of malignancy. Quantitative flow par ameters did not provide useful information. Conclusion: Color duplex analysis of enlarged lymph nodes is a useful metho d for assessment of benignity, especially after application of a signal-enh ancing agent.