Power Doppler sonography to differentiate tuberculous cervical lymphadenopathy from nasopharyngeal carcinoma

BACKGROUND AND PURPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcinoma are common in Asians and are often indistinguisha ble clinically, Because their treatment depends on prompt diagnosis, we und ertook this study to evaluate if power Doppler sonography could distinguish these two pathologic abnormalities. The intranodal vascular appearances of tuberculous neck nodes are compared with benign reactive neck nodes and me tastatic nodes from nasopharyngeal carcinoma. METHODS: The appearances of power Doppler sonograms of 42 tuberculous nodes were compared with 28 metastatic nodes from nasopharyngeal carcinoma and 2 7 benign reactive nodes, The intranodal distribution of vessels and the int ranodal vascular resistance of vessels were compared among these three grou ps. All examinations were performed by the same sonologist (A,A,), who had more than 3 years' scanning experience, and all data analysis was performed by the same investigator (M.Y.), RESULTS: The intranodal vascular distribution in tuberculous nodes was vari ed and simulated both benign and malignant disease, Avascularity of nodes a nd displacement of hilar vascularity were frequent in tuberculous nodes, Me tastatic nodes from nasopharyngeal carcinoma (resistive index [RI], 0.81 +/ - 0.09; pulsatile index [PI], 1.91 +/- 0.81) had a higher vascular resistan ce than did tuberculous nodes (RI, 0.71 +/- 0.11; PI, 1.34 +/- 0.55), Tuber culous nodes had a higher vascular resistance than did reactive nodes (RI, 0.66 +/- 0.09; PI, 1.10 +/- 0.26), CONCLUSION: Avascularity, displaced hilar vessels, and low intranodal vascu lar resistance are clues that may suggest the tuberculous nature of neck no des. However, there is overlap of appearance between tuberculous nodes, ben ign reactive neck nodes, and metastatic nodes. Thus, histologic analysis is often required for a definitive diagnosis.