Received: 28 May 2001
Revised: 5 December 2001
Accepted: 17 December 2001
Published online: 18 April 2002
© Springer-Verlag 2002
Abstract We compared Doppler
spectral parameters in acute inflam-
matory, reactive, lymphomatous, and
metastatic lymph nodes, and evaluat-
ed pulsed Doppler sonography as a
method for distinguishing between
different causes of cervical lymphad-
enopathy. Spectral Doppler analysis
with measurements of resistance in-
dex (RI), pulsatility index (PI), peak
systolic velocity (PSV), and end-dia-
stolic velocity (EDV) was performed
in 197 patients with cervical lym-
phadenopathy. Results of Doppler
analysis were compared with find-
ings of cytology and histology or
with clinical presentation and fol-
low-up. Student’s t-test was used to
assess statistical significance of dif-
ferences in Doppler parameters be-
tween groups of patients. Significant
differences for RI and PI were
shown between all groups of patients
except between lymphomatous and
reactive nodes. Specificity of 100%
for metastatic nodal involvement
was shown for cutoff values RI>0.80
and PI>1.80. A positive predictive
value (PPV) of 100% for acute lym-
phadenitis was shown for cutoff
values RI<0.50 and PI<0.60. An
EDV>9 cm/s has 100% negative pre-
dictive value for nodal metastasis,
and EDV<1 cm/s has 100% specific-
ity and PPV for metastasis. Although
there exist differences in RI, PI,
PSV, and EDV between different
nodal diseases, none of these param-
eters offer both good sensitivity and
good specificity, and only extreme
cutoff values may occasionally be
helpful in differential diagnosis.
Doppler spectral analysis is a valu-
able noninvasive adjunct which can
help in differentiation between meta-
static, lymphomatous, acute inflam-
matory, and reactive lymphadenopa-
thy, but cannot obviate biopsy in the
majority of cases.
Keywords Color Doppler · Cervical
lymphadenopathy · Differential
diagnosis
Eur Radiol (2003) 13:175–180
DOI 10.1007/s00330-002-1328-z
HEAD AND NECK
Zoran Brnic´
Andrija Hebrang
Usefulness of Doppler waveform
analysis in differential diagnosis
of cervical lymphadenopathy
Introduction
Similarly as has been demonstrated in many tumors,
analysis of blood flow may also help detect malignancy
in lymph nodes. Both the angioarchitecture [1, 2, 3, 4, 5,
6, 7, 8, 9, 10] and the hemodynamics [1, 2, 3, 4, 5, 8, 10,
11, 12, 13, 14] differ among various cervical and axillary
nodal diseases. Blood vessel morphology in metastatic
nodes is usually deranged as internal nodal architecture
is destroyed by neoplastic infiltration. Small arteries in
metastatic nodes may be destroyed by tumor tissue [5],
whereas severe inflammation causes dilatation of intran-
odal vessels due to local humoral agents.
The reliability of Doppler US in differentiating malig-
nant from benign lymph nodes is still a matter of debate.
Authors who have analyzed vascular resistance in cervical
lymph nodes have mostly found higher Doppler indices in
malignant than in benign nodes [1, 3, 4, 5, 8, 11, 12, 13].
None of them have analyzed acute lymphadenitis separate-
ly from chronic inflammatory lymph nodes, whereas in
Z. Brnic´(
✉
) · A. Hebrang
Department of Diagnostic
and Interventional Radiology,
University Hospital “Merkur”,
Kopernikova 10, 10000 Zagreb, Croatia
e-mail: zoran.brnic@zg.hinet.hr
Tel.: +385-1-6682067
Fax: +385-1-2431414