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Sentinel Lymph Nodes in a Swine Model with Melanoma: Contrast-enhanced Lymphatic US¹

¹ From the Departments of Radiology (B.B.G., D.A.M., J.B.L., M.T., L.N., F.F.) and Pathology (G.F.M.), Thomas Jefferson University Hospital, 7th Floor Main Bldg, 132 S 10th St, Philadelphia, PA 19107; and Amersham Health, Oslo, Norway (A.T.). From the 2002 RSNA scientific assembly. Received November 8, 2002; revision requested January 15, 2003; final revision received June 13; accepted July 3. Supported by a grant from Amersham Health, Oslo, Norway. Address correspondence to B.B.G. (e-mail: barry.b.goldberg@jefferson.edu).

View larger version (114K): [in a new window]   Figure 1a. Long-axis US scans of a normal SLN (arrows) (a) before and (b) after subcutaneous injection of a US contrast agent. Note the increased echogenicity of the SLN due to presence of contrast agent microbubbles.

View larger version (113K): [in a new window]   Figure 1b. Long-axis US scans of a normal SLN (arrows) (a) before and (b) after subcutaneous injection of a US contrast agent. Note the increased echogenicity of the SLN due to presence of contrast agent microbubbles.

View larger version (102K): [in a new window]   Figure 2a. Progressive contrast enhancement of an SLN (arrows). Long-axis images of the SLN during real-time lymphatic US (a) 84 seconds after injection, (b) 103 seconds after injection, and (c) 127 seconds after injection.

View larger version (106K): [in a new window]   Figure 2b. Progressive contrast enhancement of an SLN (arrows). Long-axis images of the SLN during real-time lymphatic US (a) 84 seconds after injection, (b) 103 seconds after injection, and (c) 127 seconds after injection.

View larger version (114K): [in a new window]   Figure 2c. Progressive contrast enhancement of an SLN (arrows). Long-axis images of the SLN during real-time lymphatic US (a) 84 seconds after injection, (b) 103 seconds after injection, and (c) 127 seconds after injection.

View larger version (114K): [in a new window]   Figure 3. Oblique lymphatic US scan of an LC containing contrast agent microbubbles (arrows) draining into an SLN (N).

View larger version (167K): [in a new window]   Figure 4. Transverse lymphatic US scan obtained in a swine with a melanoma tumor located on the lower right lateral chest wall demonstrates a single LC (short arrows) that penetrated through an intercostal space. The contrast material-filled LC could be followed around the lateral and posterior aspects of the right kidney (K), ultimately draining into a retrocaval SLN (long arrow) that appeared uniformly echogenic. Histologic examination helped confirm the lymphatic US diagnosis of a normal SLN.

View larger version (101K): [in a new window]   Figure 5a. (a) Long-axis pulse-inversion harmonic gray-scale lymphatic US scan of a normal SLN (arrows). (b) Color Doppler image of the same node as in a demonstrates acoustic emission signals (arrows), confirming the presence of contrast agent microbubbles, and blood flow in an adjacent blood vessel (arrowheads).

View larger version (78K): [in a new window]   Figure 5b. (a) Long-axis pulse-inversion harmonic gray-scale lymphatic US scan of a normal SLN (arrows). (b) Color Doppler image of the same node as in a demonstrates acoustic emission signals (arrows), confirming the presence of contrast agent microbubbles, and blood flow in an adjacent blood vessel (arrowheads).

View larger version (144K): [in a new window]   Figure 6. Long-axis lymphatic US scan of an SLN (arrows) containing both normal parenchyma (N) and areas of melanoma tumor metastases (T).

View larger version (121K): [in a new window]   Figure 7a. (a) Long-axis lymphatic US scan of an SLN (arrows) composed primarily of melanoma tumor metastases (T), with just a small area of preserved normal parenchyma (N) demonstrating contrast enhancement. (b) Lymphoscintigram obtained after injection of 99mTc in the same swine demonstrates the injection site (I) near the primary tumor, the LC (arrows), and the SLN (N). The nuclear medicine scan has poor spatial resolution in the depiction of the LC and cannot indicate the presence of tumor deposits in the SLN. (c) Photograph of the same node (arrowheads) shows blue dye in the LCs (arrows) and a melanoma tumor (T) in the hind limb of the swine. (d) Pseudocolor map of the pathologic specimen correlates well with the lymphatic US scan. Normal lymphatic parenchyma is shown in pink, while tumor metastases are green.

View larger version (104K): [in a new window]   Figure 7b. (a) Long-axis lymphatic US scan of an SLN (arrows) composed primarily of melanoma tumor metastases (T), with just a small area of preserved normal parenchyma (N) demonstrating contrast enhancement. (b) Lymphoscintigram obtained after injection of 99mTc in the same swine demonstrates the injection site (I) near the primary tumor, the LC (arrows), and the SLN (N). The nuclear medicine scan has poor spatial resolution in the depiction of the LC and cannot indicate the presence of tumor deposits in the SLN. (c) Photograph of the same node (arrowheads) shows blue dye in the LCs (arrows) and a melanoma tumor (T) in the hind limb of the swine. (d) Pseudocolor map of the pathologic specimen correlates well with the lymphatic US scan. Normal lymphatic parenchyma is shown in pink, while tumor metastases are green.

View larger version (102K): [in a new window]   Figure 7c. (a) Long-axis lymphatic US scan of an SLN (arrows) composed primarily of melanoma tumor metastases (T), with just a small area of preserved normal parenchyma (N) demonstrating contrast enhancement. (b) Lymphoscintigram obtained after injection of 99mTc in the same swine demonstrates the injection site (I) near the primary tumor, the LC (arrows), and the SLN (N). The nuclear medicine scan has poor spatial resolution in the depiction of the LC and cannot indicate the presence of tumor deposits in the SLN. (c) Photograph of the same node (arrowheads) shows blue dye in the LCs (arrows) and a melanoma tumor (T) in the hind limb of the swine. (d) Pseudocolor map of the pathologic specimen correlates well with the lymphatic US scan. Normal lymphatic parenchyma is shown in pink, while tumor metastases are green.

View larger version (95K): [in a new window]   Figure 7d. (a) Long-axis lymphatic US scan of an SLN (arrows) composed primarily of melanoma tumor metastases (T), with just a small area of preserved normal parenchyma (N) demonstrating contrast enhancement. (b) Lymphoscintigram obtained after injection of 99mTc in the same swine demonstrates the injection site (I) near the primary tumor, the LC (arrows), and the SLN (N). The nuclear medicine scan has poor spatial resolution in the depiction of the LC and cannot indicate the presence of tumor deposits in the SLN. (c) Photograph of the same node (arrowheads) shows blue dye in the LCs (arrows) and a melanoma tumor (T) in the hind limb of the swine. (d) Pseudocolor map of the pathologic specimen correlates well with the lymphatic US scan. Normal lymphatic parenchyma is shown in pink, while tumor metastases are green.