Clinical value of imaging for lymph nodes evaluation with particular emphasis on ultrasonography

Abstract

Enlarged or irregular lymph nodes (LNs) are clinical and imaging findings in a large variety of malignant and non-malignant diseases. A comprehensive diagnostic work up is usually necessary in order to differentiate the benign or the malignant nature of the altered LNs. The diagnosis has to be made using all clinical information and, if necessary, assessed LNs need to be biopsied and further, histologically or microbiologically characterized. However, imaging techniques, and particularly ultrasonography (US), are essential on the way to the final diagnosis, from initial detection and characterization to follow-up of biopsy guidance. Computed-tomography (CT) and/or magnetic resonance imaging (MRI) are of great value for oncological diseases staging and treatment monitoring. Imaging techniques are helpful in distinguishing between benign and malignant LNs disease as well as between LNs metastases and lymphoma in most cases. Furthermore, imaging can define the extent and distribution of malignant diseases. It may assist, through the use of particular techniques such as elastography, to identify the most suspicious LN to be biopsied and to guide targeted biopsies from the most suspicious areas. It also serves as the main tool for the evaluation of treatment response in malignant diseases. The quality of LNs imaging has remarkably improved in recent years. New methods, such as contrast-enhanced ultrasonography (CEUS), elastography, positron emission tomography (PET)/PET-CT, as well as diffusion weighted imaging (DWI) in MRI, have already led to substantial changes in clinical practice. This review describes the most recent imaging techniques for LNs assessment, and their particular clinical value, with a special emphasis on the role of US techniques. Strengths and weaknesses of different imaging tools are discussed comprehensively, highlighting the importance of a corroborative attitude for successful management of each particular case.

Zusammenfassung

Vergrößerte oder abnorme Lymphknoten (LK) finden sich bildgebend bei einer Vielzahl maligner und nicht-maligner Krankheitsbilder. Zur Klärung der Dignität ist regelhaft eine umfassende diagnostische Aufarbeitung erforderlich, die neben einer gründlichen Anamnese und klinischen Untersuchung in vielen Fällen auch eine mikrobiologische und histologische Untersuchung von Biopsaten einschließen wird. Bildgebende Verfahren und insbesondere die Sonografie sind essenzielle Bestandteile des diagnostischen Vorgehens – von der Detektion über die Charakterisierung bis hin zur gezielten Durchführung der Biopsie. Computertomografie (CT) und/oder Magnetresonanztomografie (MRT) haben einen großen Stellenwert für das Staging und die Therapieüberwachung. Bildgebende Methoden werden auch mit dem Ziel eingesetzt, zwischen benignen und malignen Lymphknoten sowie zwischen Karzinommetastasen und malignem Lymphombefall zu differenzieren. Bei malignen Erkrankungen können darüber hinaus Ausmaß und Verteilungmuster evaluiert werden. Elastografische Methoden können diejenigen Lymphknoten oder Lymphknotenareale definieren, aus denen eine bildgebend gestützte Biopsie am Erfolg versprechendsten ist. Bildgebung ist auch die wichtigste Grundlage für die Bewertung des Therapieansprechens. Die Qualität der LK-Bildgebung hat sich in den letzten Jahren deutlich verbessert. Neue Methoden wie kontrastverstärkte Sonografie (CEUS), Elastografie, Positronenemissionstomografie (PET) und PET-CT sowie diffusionsgewichtete MRT-Bildgebung haben bereits in der klinischen Praxis Gewicht erlangt. Unter besonderer Berücksichtigung sonografischer Verfahren beschreibt diese Übersicht die aktuellen Methoden der LK-Bildgebung sowie ihren Stellenwert in der klinischen Praxis und empfiehlt unter Berücksichtigung der spezifischen Stärken und Schwächen der verfügbaren Methoden ihren komplementären Einsatz.

Schlüsselworter

Bildgebung - kontrastverstärkte Sonografie - Elastografie - Computertomografie - Magnetresonanztomografie - diffusionsgewichtete Bildgebung - Positronenemissionstomografie

Key words

imaging - contrast-enhanced ultrasound - elastography - computed tomography - magnetic resonance imaging - diffusion weighted imaging - positron emission tomography

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