Does Anybody Know How We Should Measure Doppler Parameters in Lymph Nodes?

doi:10.1053/crad.2000.0588

Clinical Radiology

Volume 56, Issue 2, February 2001, Pages 124-126

https://doi.org/10.1053/crad.2000.0588 Get rights and content

Abstract

AIM: To show how currently described techniques confuse interpretation of Doppler indices in lymph node characterization

MATERIALS AND METHODS: The Doppler indices [resistivity index (RI) and pulsatility index (PI)] were obtained in 35 malignant lymph nodes by colour duplex sonography. Each node was sampled at eight different sites. Data were analysed using our own method, and methods employed in six previous studies.

RESULTS: Restistivity index values varied between 0.69 and 0.88 and PI values ranged from 1.28 to 2.34. All but two methods produced different resistance indices (P < 0.05).

CONCLUSION: Conflicting results are obtained analysing the same data using different methods. Standardized techniques should be agreed and employed in future studies.Ho, S. S. (2001). Clinical Radiology56, 124–126.

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Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer
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Cited by (17)

Can ultrasound elastography distinguish metastatic from reactive lymph nodes in patients with primary head and neck cancers?
2014, Egyptian Journal of Radiology and Nuclear Medicine
Citation Excerpt :
The commonly used high frequency sonography includes B-mode sonography, color Doppler sonography and power Doppler sonography, which can display the size, location, shape and blood flow distribution of the lesion and play important roles in the differential diagnosis of lymph nodes. However, the indices, given by these methods and reflecting the benign or malignant lesions, always overlap in large measure (4–7), therefore causing difficulties in the judgment. Elastography is based on a principle similar to manual palpation, in which the examiner detects tumors because they feel neoplatic tissues harder than surrounding tissues (8).
The purpose of this study was to evaluate the diagnostic utility of real-time elastography (RTE) in differentiating between reactive and metastatic cervical lymph nodes (LN) in patients with primary head and neck cancer in comparison with the conventional B mode and power Doppler parameters.
A total of 127 lymph nodes in 78 patients with primary head and neck cancer were examined by B-mode sonography, power Doppler ultrasound and elastography. Elastographic patterns were determined on the distribution and percentage of the lymph node area with low elasticity (hard), with pattern 1 being an absent or very small hard area to pattern 5, a hard area occupying the entire lymph node. Patterns 3–5 were considered metastatic. Ultrasound guided aspiration cytology was done for 57 lymph nodes. Excision biopsy was done for 52 lymph nodes. Eighteen lymph nodes responded to conservative treatment, and were considered reactive.
The majority (85.3%) of the metastatic lymph nodes had elastography pattern 3–5. This finding was observed in only 5% of the benign lymph nodes (P < 0.001). The elastography pattern had sensitivity of 85.3%, specificity of 95.5%, PPV of 97.2%, NPV of 78.1% and overall accuracy of 88.9% in differentiation between benign and malignant lymph nodes. On the other hand, for the B mode criteria, the best accuracy was given to abnormal hilum (83%). The accuracy of power Doppler ultrasound pattern was 70.8%.
The accuracy of sonoelastography is higher than usual B mode and power Doppler ultrasound parameters in differentiation between benign and malignant nodes. The integration of lymph node sonoelastography in the follow up of patients with known head and neck cancer may reduce the number of biopsies.
Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos)
2010, Gastrointestinal Endoscopy
Citation Excerpt :
The same approach proved useful in the current study for the differentiation between benign and malignant focal pancreatic masses, with very good specificity (88.2%) and PPV (92%). However, this approach has certain limitations because several measurements were done inside the intratumoral vessels after contrast-enhancement with SonoVue, with the highest value recorded, with previous data showing large intraobserver variability between measured indices.45 Measurements were also difficult to reproduce because intratumoral vascular signals are very small, faint, and difficult to be sampled because of tissue motion.
Contrast-enhanced power Doppler (CEPD) and real-time sonoelastography (RTSE) performed during EUS were previously described to be useful for the differential diagnosis between chronic pseudotumoral pancreatitis and pancreatic cancer.
To prospectively assess the accuracy of the combination of CEPD and RTSE to differentiate pancreatic focal masses.
Cross-sectional feasibility study.
A tertiary-care academic referral center.
The study group included 54 patients with chronic pancreatitis (n = 21) and pancreatic adenocarcinoma (n = 33).
Both imaging methods (CEPD and RTSE) were performed sequentially during the same EUS examination. Power Doppler mode examination was performed after intravenous injection of a second-generation contrast agent (2.4 mL of SonoVue), and the data were digitally recorded, comprising both the early arterial phase and venous/late phase. Three 10-second sonoelastographic videos were also digitally recorded that included the focal mass and the surrounding pancreatic parenchyma. Postprocessing analyses based on specially designed software were used to analyze the CEPD and RTSE videos. A power Doppler vascularity index was used to characterize CEPD videos, the values being averaged during a 10-second video in the venous phase. Hue histogram analysis was used to characterize RTSE videos, with the mean hue histogram values being also averaged during a 10-second video.
To differentiate chronic pancreatitis and pancreatic cancer.
The sensitivity, specificity, and accuracy of combined information provided by CEPD and RTSE to differentiate hypovascular hard masses suggestive of pancreatic carcinoma were 75.8%, 95.2%, and 83.3%, respectively, with a positive predictive value and negative predictive value of 96.2% and 71.4%, respectively.
A single-center, average size of study population.
A combination of CEPD and RTSE performed during EUS seems to be a promising method that allows characterization and differentiation of focal pancreatic masses.
Neck lymph nodes: Prediction by computer-assisted contrast medium analysis?
2007, Ultrasound in Medicine and Biology
Citation Excerpt :
Although no difference was found between PI and RI in malignant and benign lymph nodes (Benzel et al. 1996), Issing et al. (1999) reported that using a cut point of PI <0.6 for metastases increased the specificity significantly to 92%. Ho et al. (2001) studied data for RI and PI and concluded that, depending on the method chosen, there were relatively large variations in RI (0.69-0.88) and PI (1.28-2.34) in the same lymph nodes. They called for future better standardization in examination technique to ensure comparability of studies.
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: [email protected])
Can high frequency ultrasound predict metastatic lymph nodes in patients with invasive breast cancer?
2006, Radiography
Citation Excerpt :
The methods and results of these studies varied considerably. Ho et al.38 attempted to analyse the methods and results of these studies. They went on to apply each method to each of 35 metastatic lymph nodes.
Use high frequency ultrasound to predict the presence of metastatic axillary lymph nodes, with a high specificity and positive predictive value, in patients with invasive breast cancer. The clinical aim is to improve the surgical management and possible survival rate of groups of patients who would not normally have conventional axillary dissections.
The ipsilateral and contralateral axillas of 42 consecutive patients with invasive breast cancer were scanned prior to treatment using a B-mode frequency of 13 MHz and a Doppler frequency of 7 MHz. The presence or absence of an echogenic centre for each lymph node detected was recorded, measurements were also taken to determine the L/S (long axis/short axis) ratio of the node and the widest and narrowest part of the cortex. Power Doppler was also used to determine vascularity. The contralateral axilla was used as a control for each patient.
In this study of patients with invasive breast cancer, where ipsilateral lymph nodes had a cortical bulge of ≥3 mm and/or at least two lymph nodes had absent echogenic centres, all had disease spread to the axillary lymph nodes (10 patients). Sensitivity and specificity were 52.6% and 100%, respectively, positive and negative predictive values were 100% and 71.9%, respectively, the P-value was 0.001 and the Kappa score was 0.55.
This would indicate that high frequency ultrasound could be used to accurately predict metastatic lymph nodes in a proportion of patients with invasive breast cancer, which may alter patient management.
The value of multimodal ultrasound in diagnosis of cervical lymphadenopathy: can real-time elastography help identify benign and malignant lymph nodes?
2023, Frontiers in Oncology
Evaluation of Cervical Lymphadenopathy by Ultrasonography Using Color and Power Doppler and Comparison with Histopathology
2022, Otorhinolaryngology Clinics

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RADoes Anybody Know How We Should Measure Doppler Parameters in Lymph Nodes?

Abstract

Clin Radiol

Recurrent cervical lymphadenopathy: differential diagnosis with colour duplex sonography

Eur Arch Otorhinolaryngol

Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer

AJNR

Metastatic adenopathy from nasopharyngeal carcinoma:sucessful response to radiation therapy assessed by colour duplex sonography

AJNR

Differentiation of benign and malignant cervical lymph nodes with colour Doppler sonography

AJR

Distinction between benign and malignant causes of cervical, axillary and inguinal lymphadenopathy: value of Doppler spectral waveform analysis

AJR

RA
Does Anybody Know How We Should Measure Doppler Parameters in Lymph Nodes?