D-galactose-based signal-enhanced color Doppler sonography of breast tumors and tumorlike lesions

RATIONALE AND OBJECTIVES

This study sought to evaluate prospectively the diagnostic potential of unenhanced and enhanced color Doppler and power Doppler for the differentiation of tumors and tumorlike lesions of the breast.

METHODS

Ninety-two patients with 110 tumors or tumorlike lesions of the breast were investigated by unenhanced and enhanced color and power Doppler ultrasound. The sonomorphologic aspects of vascularization were analyzed. In addition, maximal systolic frequency shift, resistance, and pulsatility indices were determined.

RESULTS

In 15 (24%) of 63 primary carcinomas, 15 (68%) of 22 fibroadenomas, and all (100%) of 14 postoperative lesions, the sonomorphologic analysis for the differential diagnosis of breast tumors was improved after contrast enhancement in color Doppler mode. In comparing unenhanced color Doppler to power Doppler, the latter was found to be slightly superior (sensitivity, 60% vs. 67%; specificity, 39% vs. 45%, respectively); after enhancement, both modes were equivalent (sensitivity, 100% vs. 100%; specificity, 95% vs. 95%, respectively). Signal enhancement resulted in a significant improvement in sensitivity and specificity (P < 0.01). Typical signs of malignancy were irregular vessel calibers, serpiginous courses, penetration of the tumor's margin, and irregular reticular vascularization. The quantitative parameters proved not to be helpful for the differential diagnosis of breast tumors.

CONCLUSIONS

By improved analysis of the vascularization pattern, d-galactose-enhanced color Doppler sonography was found to provide more reliable differential diagnostic information than unenhanced Doppler ultrasound in tumors and tumorlike lesions of the breast.

Evaluation of metastases and reactive lymph nodes in Doppler sonography using an ultrasound contrast enhancer

RATIONALE AND OBJECTIVES

The authors conducted a prospective study in D-galactose signal-enhanced Doppler sonography of lymph nodes to investigate new aspects in differentiating malignant from reactive lymph nodes of patients with suspected malignancy of the neck.

METHODS

Twenty-one patients with suspected squamous epithelial cell carcinoma metastases of the neck were examined by Doppler sonography before and after administration of an ultrasound signal-enhancing agent, consisting of D-galactose microbubbles. Qualitative sonomorphology, peak flow rates, and pulsatility and resistive indices were assessed.

RESULTS

Compared with conventional Doppler, enhanced Doppler sonography gave detailed additional information about vascularization of metastases or reactive lymph nodes. Signal-enhanced Doppler of metastases showed a relatively characteristic pattern of vascularity, therefore facilitating differential diagnoses and allowing better discrimination from surrounding tissue, demonstrated by the infiltration of neighboring vessels in the neck. Concerning reactive lymph nodes, vascularization could be stated and measured in many cases only after signal enhancement. Evaluating peak velocities and pulsatility and resistive indices could not differentiate significantly malignant from reactive lymph nodes.

CONCLUSIONS

Administration of a D-galactose-based signal-enhancer helps to differentiate malignant from reactive lymph nodes of the neck. It is superior to conventional Doppler by improving evaluation of the vascularity and could be of use for staging procedures.

Ultrasonography of acute epitrochlear lymphadenitis

While the clinical symptomatology and radiographic findings of acute suppurative infection of the epitrochlear lymph nodes of the arm have been previously described, ultrasonographic findings have not been reported. This case report demonstrates that sonographic identification of enlarged epitrochlear lymph nodes immediately confirms the diagnosis. We summarize the clinical, radiological, and sonographic findings of acute suppurative infection of the epitrochlear lymph nodes.

Radiographic analysis of the arteries of human lumbar lymph nodes

Twenty-seven cadavers (12 male, 15 female aged 28 to 94 years, average 75 years) were dissected to analyze the arterial supply of the lumbar lymph nodes with angiography and an image processor-analyzer. The lymph nodes on the left side of the abdominal aorta fused to form several elongated nodes. The lymph nodes on the right side remained separated. A few lymph nodes aggregated below the bifurcation of the abdominal aorta. They received a few branches directly from the abdominal aorta or from the renal, gonadal and/or iliac arteries, which anastomosed with each other to form an arterial arc. This anastomosis gave small paired twigs to the parenchyma continuously. In the case of well developed lymph nodes dorsal to the inferior vena cava, a vessel from the lower abdominal aorta passed upward to supply them. The diameter of these vessels in the angiogram was 0.09-0.27 mm, measured with the image processor-analyzer. These results show that the lumbar lymph nodes do not receive a single artery through the hilus, but through several branches, whose anastomoses form a collateral system associated with the abdominal aorta.

Exuberant blood flow in enlarged lymph nodes: findings on color flow Doppler

Ten cases of adenopathy, 7 inflammatory and 3 lymphomatous in origin, with visible increased blood flow on color flow Doppler examination are presented. Although the ultrasonic demonstration of blood vessels in enlarged lymph nodes, both inflammatory and tumoral, is not new [1-5], we believe that this is the 1st definitive documentation with color flow Doppler. In some cases the degree of flow was striking, reflecting high velocity flow. This occurred both with inflammatory and lymphomatous nodes and we present our findings 1st to bring attention to them and 2nd to stimulate further investigation of the phenomenon.