The value of Doppler sonography in differential diagnosis of cervical lymphadenopathy

Abstract

In this prospective study we evaluate Doppler spectral parameters in lymphomatous, reactive, metastatic and acute inflammatory lymph nodes & evaluated the pulsed Doppler sonography as a technique to distinguish between different causes of cervical lymphadenopathy. Spectral Doppler analysis with measurement of resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV) &End diastolic velocity (EDV) was performed in 100 patients with cervical lymphadenopathy. The results of Doppler analysis were compared with findings of cytology & histology or with clinical presentation & follow up. T-test was used to assess statistical significance of differences in Doppler parameters between groups of patients. Significant differences in RI & PI were shown between all groups of patients except between lymphomatous & reactive lymph nodes. Specificity of 100% for metastatic nodal involvement was shown for cutoff values RI>0.80 & PI > 1.80 . A positive predictive value (PPV) of 100% for acute lymphadenitis was shown for cutoff values RI < 0.50 & PI < 0.60. An EDV > 10 cm/s has 100% negative predictive value for nodal metastasis, & EDV < 2cm/s has 100% specificity & PPV for metastases . Although there exist differences in RI, PI, PSV & EDV between different nodal diseases, unfortunately, only extreme cutoff values may occasionally be helpful in differential diagnosis. Doppler spectral analysis is a valuable noninvasive adjunct which can help in differentiation between metastatic, lymphomatous, acute inflammatory & reactive lymphadenopathy, but cannot eliminate the need for biopsy in the majority of cases.