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Contrast-Enhanced Color Doppler Sonography for Evaluation of Enlarged Cervical Lymph Nodes in Head and Neck Tumors

Jörg D. Moritz1, Arwed Ludwig2 and Jörg-W. Oestmann3

1 Department of Pediatric Radiology, University Hospital of Giessen, Abteilung Kinderradiologie, Justus-Liebig-Universität Giessen, Feulgenstra. 12, 35392 Giessen, Germany.
2 Department of Oral and Maxillofacial Surgery, University Hospital of Göttingen, Robert Koch Stra. 40, 37075 Göttingen, Germany.
3 Charité, Campus Virchow Hospital, Strahlenklinik und Poliklinik, Augustenburger Platz 1, 13353 Berlin, Germany.



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  		Fig. 1A. —55-year-old woman with two lymph node metastases from carcinoma of oral cavity. Unenhanced color Doppler sonogram shows two neighboring lymph node metastases with inhomogeneous echo texture and poorly defined margins (arrowheads). In smaller lymph node some peripheral vessels (arrows) are identifiable, whereas in larger node no vessels are detectable.

 


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  		Fig. 1B. —55-year-old woman with two lymph node metastases from carcinoma of oral cavity. Contrast-enhanced color Doppler sonogram shows significantly more vessels at periphery (arrows) of smaller lymph node. Moreover, in larger node one vessel at periphery (arrow) is identifiable. Arrowheads indicate lymph node.

 


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  		Fig. 2A. —74-year-old man with carcinoma of oral cavity and reactively enlarged submandibular lymph node. Unenhanced color Doppler sonogram shows lymph node with homogeneous hypoechogenic texture and well-defined margins (arrowheads). Surrounding vessels are seen but no hilar vessels are detectable.

 


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  		Fig. 2B. —74-year-old man with carcinoma of oral cavity and reactively enlarged submandibular lymph node. Contrast-enhanced color Doppler sonogram shows typical hilar vessels (arrow). Arrowheads indicate lymph node.

 


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  		Fig. 3A. —61-year-old man with carcinoma of oral cavity. Comparison of reactively enlarged lymph node (A, B) and lymph node metastasis (C, D). Unenhanced color Doppler sonogram shows two lymph nodes (arrowheads), which both appear to be reactively enlarged. Arrows indicate hilar vessels.

 


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  		Fig. 3B. —61-year-old man with carcinoma of oral cavity. Comparison of reactively enlarged lymph node (A, B) and lymph node metastasis (C, D). Contrast-enhanced color Doppler sonogram shows typical hilar vessels (arrows) more clearly. Arrowheads indicate lymph node.

 


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  		Fig. 3C. —61-year-old man with carcinoma of oral cavity. Comparison of reactively enlarged lymph node (A, B) and lymph node metastasis (C, D). Unenhanced color Doppler sonogram shows another lymph node (arrowheads) having similar appearance to that seen in A and echogenic center (arrow) like a hilum, resulting in diagnosis of reactively enlarged lymph node.

 


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  		Fig. 3D. —61-year-old man with carcinoma of oral cavity. Comparison of reactively enlarged lymph node (A, B) and lymph node metastasis (C, D). However, contrast-enhanced color Doppler sonogram shows predominantly peripheral vessels (arrows) characteristic of metastasis. Thus, diagnosis was changed to lymph node metastasis, which was confirmed histologically. Arrowheads indicate lymph node.

 

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