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Cervical Lymph Node Metastases: Diagnosis at Sonoelastography—Initial Experience¹

¹ From the Departments of Diagnostic Imaging and Nuclear Medicine (A.L., T.H., T.S., K.T.), Otolaryngology–Head and Neck Surgery (R.A., S.T., J.I.), and Therapeutic Radiology and Oncology (M.H.), Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Ill (M.F.I.); and Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tenn (A.B.B.). Received December 13, 2005; revision requested January 25, 2006; revision received March 22; accepted April 20; final version accepted July 17. Supported by grant-in-aid #17659366 from the Ministry of Education, Culture, Sports, Science and Technology of Japan. Address correspondence to A.L., Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, CCC-1118 MCN, 1161 21st Ave, South Nashville, TN 37232-2675 (e-mail: Andrej.lyshchik{at}vanderbilt.edu).

View larger version (18K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Patient flow diagram. LN = lymph node.

View larger version (196K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Metastatic lymph nodes. (a) Gray-scale sonogram obtained in 64-year-old man with papillary thyroid cancer shows two hypoechoic metastatic lymph nodes (arrows) with a short-axis diameter of 6 mm, a short-to-long-axis diameter ratio greater than 0.5, and an absent hyperechoic hilum. (b) On corresponding US elastogram, lymph nodes (arrows) are very visible, are substantially darker than surrounding muscle, and have irregular and moderately distinct borders. Strain indexes are 2.5 and 7.8 for the right and left nodes, respectively.

View larger version (129K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Metastatic lymph nodes. (a) Gray-scale sonogram obtained in 64-year-old man with papillary thyroid cancer shows two hypoechoic metastatic lymph nodes (arrows) with a short-axis diameter of 6 mm, a short-to-long-axis diameter ratio greater than 0.5, and an absent hyperechoic hilum. (b) On corresponding US elastogram, lymph nodes (arrows) are very visible, are substantially darker than surrounding muscle, and have irregular and moderately distinct borders. Strain indexes are 2.5 and 7.8 for the right and left nodes, respectively.

View larger version (194K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Benign lymph nodes. (a) Gray-scale sonogram obtained in 48-year-old woman with follicular adenoma of thyroid gland shows a chain of benign lymph nodes (arrows) with a short-axis diameter of 5 mm and a short-to-long-axis diameter ratio smaller than 0.5. (b) On corresponding US elastogram, the lymph nodes (arrows) are partially visible and brighter than surrounding muscle and have irregular and somewhat distinct borders. Strain indexes are 0.3 and 0.7 for the right and left nodes, respectively.

View larger version (156K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Benign lymph nodes. (a) Gray-scale sonogram obtained in 48-year-old woman with follicular adenoma of thyroid gland shows a chain of benign lymph nodes (arrows) with a short-axis diameter of 5 mm and a short-to-long-axis diameter ratio smaller than 0.5. (b) On corresponding US elastogram, the lymph nodes (arrows) are partially visible and brighter than surrounding muscle and have irregular and somewhat distinct borders. Strain indexes are 0.3 and 0.7 for the right and left nodes, respectively.

View larger version (194K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: Metastatic lymph node with incomplete metastatic involvement. (a) Gray-scale sonogram obtained in 53-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 7 mm, a short-to-long-axis diameter ratio smaller than 0.5, and a visible hyperechoic hilum. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. The strain index for this lymph node is 0.7. (c) Power Doppler sonogram shows prominent hilar vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US. (d) Histologic sample shows incomplete metastatic involvement of papillary thyroid cancer (arrows). (Hematoxylin-eosin stain; original magnification, x10.)

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: Metastatic lymph node with incomplete metastatic involvement. (a) Gray-scale sonogram obtained in 53-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 7 mm, a short-to-long-axis diameter ratio smaller than 0.5, and a visible hyperechoic hilum. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. The strain index for this lymph node is 0.7. (c) Power Doppler sonogram shows prominent hilar vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US. (d) Histologic sample shows incomplete metastatic involvement of papillary thyroid cancer (arrows). (Hematoxylin-eosin stain; original magnification, x10.)

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 4c: Metastatic lymph node with incomplete metastatic involvement. (a) Gray-scale sonogram obtained in 53-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 7 mm, a short-to-long-axis diameter ratio smaller than 0.5, and a visible hyperechoic hilum. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. The strain index for this lymph node is 0.7. (c) Power Doppler sonogram shows prominent hilar vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US. (d) Histologic sample shows incomplete metastatic involvement of papillary thyroid cancer (arrows). (Hematoxylin-eosin stain; original magnification, x10.)

View larger version (175K): [in this window] [in a new window] [Download PPT slide]   Figure 4d: Metastatic lymph node with incomplete metastatic involvement. (a) Gray-scale sonogram obtained in 53-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 7 mm, a short-to-long-axis diameter ratio smaller than 0.5, and a visible hyperechoic hilum. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. The strain index for this lymph node is 0.7. (c) Power Doppler sonogram shows prominent hilar vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US. (d) Histologic sample shows incomplete metastatic involvement of papillary thyroid cancer (arrows). (Hematoxylin-eosin stain; original magnification, x10.)

View larger version (201K): [in this window] [in a new window] [Download PPT slide]   Figure 5a: Metastatic lymph node with central necrosis. (a) Gray-scale sonogram obtained in 57-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 9 mm, a short-to-long-axis diameter ratio smaller than 0.5, an absent hyperechoic hilum, and mixed echogenicity. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. (c) Power Doppler sonogram shows prominent peripheral vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US.

View larger version (151K): [in this window] [in a new window] [Download PPT slide]   Figure 5b: Metastatic lymph node with central necrosis. (a) Gray-scale sonogram obtained in 57-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 9 mm, a short-to-long-axis diameter ratio smaller than 0.5, an absent hyperechoic hilum, and mixed echogenicity. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. (c) Power Doppler sonogram shows prominent peripheral vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US.

View larger version (125K): [in this window] [in a new window] [Download PPT slide]   Figure 5c: Metastatic lymph node with central necrosis. (a) Gray-scale sonogram obtained in 57-year-old man with papillary thyroid cancer shows metastatic lymph node (arrows) with a short-axis diameter of 9 mm, a short-to-long-axis diameter ratio smaller than 0.5, an absent hyperechoic hilum, and mixed echogenicity. (b) On corresponding US elastogram, the lymph node (arrows) is barely visible, has the same brightness as the surrounding muscle, and has very irregular and indistinct borders. (c) Power Doppler sonogram shows prominent peripheral vascularization. Arrows point to the lymph node. Area inside square outline is the region of interest for power Doppler US.