shu-508 and Head-and-Neck-Neoplasms

Proof of intranodal vessels in lymph nodes of the head and neck region and their association to specific types of vascularisation enables categorization of lymph nodes and improves preoperative predictability of tissue dignity. In many lymph nodes imaged by colour duplex sonography no intranodal vascularisation can be found. The purpose of the study was to find out if sonographic categorisation of lymph nodes, which do not show intranodal vessels in normal colour duplex sonography, is enabled with the contrast amplifier Levovist.. In 30 patients with metastasis in lymph nodes, malignant lymphomas or inflammatory lymph nodes with no or poor intranodal vascularisation, we administered Levovist, a contrast amplifier given intravenously, during colour duplex sonography.. Intranodal vascularisation could be visualized in all cases by the use of Levovist contrast amplifier during the sonographic investigation.. Use of the contrast amplifier Levovist leads to an improvement of the categorisation of lymph nodes. Especially inflammatory lymph nodes show more intranodal vessels in the hilus area, whereas metastatic lymph node vessels show no link to the hilus area. Preoperative diagnostic procedures may take advantage of this new technique.

Topics: Contrast Media; Diagnosis, Differential; Head and Neck Neoplasms; Hodgkin Disease; Humans; Image Enhancement; Lymph Nodes; Lymphadenitis; Lymphatic Metastasis; Lymphoma; Neovascularization, Pathologic; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Duplex

The vascularity of cervical lymph nodes can be documented by means of color-coded duplex sonography and malignant and benign lymph nodes distinguished on the basis of typical patterns of vascularity. However, not all intranodal vessels can be visualized by color-coded duplex sonography, and minute vessels are detectable only after the administration of a signal enhancer. This also makes it possible to assess the morphology of cervical lymph nodes that are inaccessible on plain sonography. In the present study we examined acute and chronic inflammatory and metastatic lymph nodes as well as malignant lymphomas to determine the extent to which a specific pattern of vascularity can be detected with color-coded duplex sonography after the injection of Levovist as a signal enhancer. In addition, digital image processing was used to quantify the vascularity detected in relation to the cross-sectional area of the lymph nodes as seen at sonography and to determine whether there are any differences in lymph node types as regards an increase in the detection of vascularity. After injection of the marker a typical pattern of vascularity could be assigned to all lymph nodes examined and differences shown in quantifying vascularity: This increase was greatest in the acutely inflamed lymph nodes (36.0 +/- 5.0%) and smallest in lymph nodes with chronic inflammation (2.3 +/- 1.3%). These findings show that cervical lymph nodes of varying origin differ by virtue of their pattern of vascularity, with increased vascularity detectable after administration of a signal enhancer.

Topics: Carcinoma, Squamous Cell; Contrast Media; Diagnosis, Differential; Head and Neck Neoplasms; Humans; Inflammation; Lymph Nodes; Lymphatic Diseases; Lymphatic Metastasis; Lymphoma; Neck; Polysaccharides; Ultrasonography, Doppler, Color

Because of the slow flow in the venous spaces of large-vessel hemangiomas, demonstration of color flow signals with conventional color Doppler or power Doppler sonography may be difficult. We report the case of a 22-year-old female patient with a soft tissue tumor containing multiple fluid-filled spaces in the right supraclavicular region. Gray-scale, color, and power Doppler sonography could not differentiate between cystic lymphangioma and large-vessel hemangioma. The intravenous echo-enhancing contrast agent Levovist was administered, and a significant echo-enhancing effect on color and power Doppler imaging was demonstrated in the fluid-filled spaces and lasted for about 3 minutes. Histopathologic study of the excised tumor confirmed the sonographic diagnosis of hemangioma. Levovist appears useful in depicting slow flow in a large-vessel hemangioma.

Topics: Adult; Contrast Media; Diagnosis, Differential; Female; Head and Neck Neoplasms; Hemangioma; Humans; Lymphangioma, Cystic; Polysaccharides; Ultrasonography, Doppler, Color

This study involved a prospective evaluation of the reliability of sonography, and especially duplex sonography, in confirmation of the benign nature of enlarged cervical lymph nodes.. In 53 untreated patients with enlarged cervical lymph nodes, B-mode, plain, and d-galactose-enhanced color duplex sonography were performed. The B-mode sonomorphology was analyzed for the structure of vascularization. Quantitative parameters such as maximum flow velocity, pulsatility index, and resistive index were also assessed. The benignity of the lymph nodes was confirmed by microscopic analysis.. The B-mode showed 20 homogeneous lymph nodes, 23 with a central echogenoic line covering less than one third, and 10 with a distinct hilus sign extending to more than one third of the lymph node diameter. Microscopically, the least fibrotic or chronic inflammatory changes in the parenchyma were observed in the homogeneous lymph nodes, whereas those with central echogeneoity had fibrotic and lipoid hilus changes. Histologically, all lymph nodes had normal afferent and efferent hilus vessels. In 37 lymph nodes, the 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 parameters did not provide useful information.. Color duplex analysis of enlarged lymph nodes is a useful method for assessment of benignity, especially after application of a signal-enhancing agent.

Topics: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; Carcinoma, Squamous Cell; Contrast Media; Feasibility Studies; Female; Head and Neck Neoplasms; Humans; Hyperplasia; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck; Polysaccharides; Prospective Studies; Pulsatile Flow; Reproducibility of Results; Ultrasonography, Doppler, Color; Vascular Resistance