Volume 6 Issue 3 - Australasian Society for Ultrasound in Medicine

More documents

Recommendations

Info

ASUM 2003 Concurrent Sessions 1100 New Investigators General Women’s Health Dr Dave Rogers ASUM Online Handbook Prof Anil Ahuja Sonography of Thyroid Nodules Mrs Margo Gill Dr Richard Price Prospective evaluation of a First Imaging of the Fat Infiltrated Trimester Screening Program for Down Liver Syndrome and Other Chromosomal Abnormalities Using Maternal Age, Dr Richard Mendelson Nuchal Translucency and Biochemistry The Role of Ultrasound in in an Australian Population the Acute Abdomen Dr Kristy Milward Dr Martin Marshall Uterine arteriovenous Malformations Assessment of the Abdominal Mrs Lorilli Jacobs Aortic Aneurysms Post Endoluminal An UltrasoundSstudy of Nipple Repair Position in Term Infant Breastfeeding Mrs Rae Roberts + Dr Tamara Walters Ultrasound of Implanon (a lost contraceptive device in the arm) 1330 Perinatal Paediatrics General Prof Wolfgang Holzgreve Dr Sven Thonell Ultrasound Assessment of the Cervix Ultrasound Assessment of in Preterm Delivery Prediction Postnatal Brain Development Mrs Karen Reid + Dr Ian Gollow Dr Sven Thonell Fetal Gastroschisis Imaging of Abdominal Pain in Dr Bev Hewitt + Dr Andrew Barker Children Obstructive Renal Disorders Dr Fiona Bettenay Mrs Margo Gill Errors of Interpretation in Renal Sydney Ultrasound for Women InitialUltrasound Experience with Fetal nasal Bone Dr Ros Thomson Assessment in the First Trimester Paediatric Abdominal Masses Ms AnnQuinton Diagnosing an Atrio-Ventricular Septal Defect in the Fetus Dr Bill Breidahl Sonography of the Finger Dr Jeff Ecker Ultrasound Imaging of the Upper Extremity Dr Frederick Joshua + Mr Rohan de-Carle Power Doppler Signal Reduction after the Application of Transducer Pressure to the Metacarpapharyngeal Joints of Rheumatoid Arthritis Patients Dr Keith Holt Imaging of Orthopaedic Problems Dr Joanne Ludlow Ovarian Ultrasound Dr Yee Leung Adnexal Masses Dr Bev Hewitt Assessment of the Endometrium Dr Roger Hart Endometrial mmanagement Dr Roger Davies Ultrasound Applications in Intervention Dr Karin Margolius Application of Radiology to Forensic Investigation Dr Michelle Atherton Ultrasound in Stress Urinary Incontinence Dr Hans Peter Dietz 3D Volume Ultrasound of Suburethral Slings Ms Tricia Mares The Value of Resistive Index Measurement in the Prediction of Clinical Outcome following Stenting for Renal Artery Stenosis 1530 Musculoskeletal Breast Developments Dr Tom Stavros Solid Breast Nodules: benign or malignant Dr Rosyln Adamson The National Breast Cancer Centre Breast Imaging Guidelines and Overview Dr Liz Wylie Breast Ultrasound of Radial Scars Dr Fiona Bettenay The Role of Ultrasounds in the Dense Breast Dr Jim Anderson Ultrasound in the Assessment of Fistula-In Ano Dr Duncan Ramsay Endoscopic Ultrasound Dr Connor Murray Ultrasound of the Vermiform Appendiz Mr Peter Coombs The Effect of Secondary Maternal Hypertension on the Fetal Rabbit: Ultrasound Assessment of Growth Mrs Louise Hollier An evaluationof colour to capsule distance in the detection of chronic allograft nephropathy SUNDAY 7TH SEPTEMBER 2003 0900 Dr Neil Macpherson “The role of ultrasonography in the identification of appendicitis: a pro-forma” John Fletcher “Colour doppler in the diagnosis of popliteal vascular entrapment” Margo Gill “Hysterosalpingo-Contrast-Sonography (HyCoSy): The Sydney Ultrasound for Women experience” Dr Suhanna Abdul-Hamid “Ultrasound diagnosis of adenomyosis 1000 Meet the Experts over brunch 8 ASUM ULTRASOUND BULLETIN VOLUME 6 NUMBER 3 AUGUST 2003
Ultrasound evaluation of neck lymph nodes Ultrasound evaluation of neck lymph nodes Michael Ying PhD; *Anil Ahuja FRCR CR; ; Fiona Brook PhD; *KT Wong FRCR Department of Optometry and Radiography adiography, , The Hong Kong Polytechnic University, , Hung Hom, Kowloon, Hong Kong SAR AR, , China *Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR AR, , China ABSTRACT Ultrasound is a useful imaging modality in the assessment of cervical lymph nodes. Grey scale sonography helps to evaluate the morphology of cervical nodes, whereas power Doppler sonography can be used to assess the vasculature of lymph nodes. The grey scale sonographic features that help distinguish the various causes of cervical lymphadenopathy include their size, shape, internal architecture, and distribution; the presence of intranodal necrosis, an echogenic hilus or calcification. The presence of adjacent soft tissue edema and matting of nodes are useful features to identify tuberculous lymphadenitis. In power Doppler sonography, vascular pattern of the lymph nodes is more useful than vascular resistance in differentiating benign from malignant cervical nodes. A good understanding of the normal lymph node anatomy, scanning equipment required and the scanning technique is essential before pathology assessment should be commenced. This article reviews these topics to provide an overview for sonography of cervical lymphadenopathy. Keywords: Ultrasound, grey scale, Doppler, cervical lymph nodes, normal, abnormal INTRODUCTION Evaluation of cervical lymphadenopathy is essential for patients with head and neck carcinomas because it helps in the assessment of prognosis and the selection of treatment 1,2 . In patients with head and neck carcinomas, the presence of a metastatic node on one side of the neck reduces the 5-year survival rate by 50%, whilst the presence of a metastatic node on both sides reduces the 5-year survival rate to 25 % 3 . Metastatic neck nodes from head and neck carcinomas are site specific. It has been reported that metastatic nodes in an unexpected site indicates that the primary tumour is more biologically aggressive 4 . The head and neck region is a common site of involvement for lymphoma compared to other parts of the body, and the cervical lymph nodes are most commonly involved 5 . Lymphoma of cervical lymph nodes is often difficult to differentiate from other metastatic cervical lymph nodes clinically. As the treatment for lymphoma and metastases is different, accurate differential diagnosis between the two conditions is essential. Tuberculous lymphadenitis is a common disease in South East Asia. However, with the increasing prevalence of acquired immune deficiency syndrome (AIDS) and an associated increase in tuberculous lymphadenitis 6, 7 , the incidence of tuberculous lymphadenitis is increasing worldwide, and thus the need for early accurate diagnosis. Ultrasound plays an important role in the evaluation of cervical lymph nodes because of its high sensitivity and specificity when combined with fine-needle aspiration cytology (FNAC) (98% and 95% respectively) 8 . It has been reported that ultrasound is superior to clinical examination in the detection of cervical lymphadenopathy with a sensitivity of 96.8% and 73.3% respectively 9 . Ultrasound is more sensitive than computed tomography (CT) in the detection of small nodes. Lymph nodes less than 5 mm in diameter are difficult to detect with CT 1 , whereas high resolution ultrasound can detect lymph nodes as small as 2 mm in diameter 10 . Neo-vascularization is commonly found in malignant lymph nodes 2, 11 , with this abnormal vascularity being different from that of normal lymph nodes. Power Doppler sonography has a high sensitivity in the detection of fine vessels. It provides additional information during sonographic examination of cervical nodes by indicating the presence/absence of vascularity, demonstrating the vascular distribution and estimating the vascular resistance of nodal vessels. NORMAL ANATOMY Cervical lymph nodes are located along the lymphatic channels of the neck. Each cervical lymph node has cortical and medullary regions, and is covered by a fibrous capsule 12, 13 . The cortex consists of lymphocytes which are densely packed together to form spherical lymphoid follicles, whereas the medulla is composed of medullary trabeculae, medullary cords and medullary sinuses. The paracortex is an intermediate area between the cortex and the medulla, where the lymphocytes return to the lymphatic system from the blood circulation. In the medulla of the lymph node, the medullary trabeculae, composed of dense connective tissue similar to the capsule, act as a framework extending from the capsule and guides blood vessels and nerves to different regions of the lymph node. The medullary cords and medullary sinuses are composed of reticulum cells. The medullary cords contain mainly plasma cells and small lymphocytes, whilst the medullary sinuses are filled with lymph and are part of the sinus system of the lymph node 12, 13 . Cervical lymph nodes contain blood vessels. The main artery enters the lymph node at the hilus, which then branches into arterioles. Some of the arterioles supply the capillary bed in the medulla and some of them run along the medullary trabeculae to the cortex where the arterioles further branch into capillaries and supply the lymphoid follicles. The rest of the arterioles run along the trabeculae and reach the capsule where they anastomose with other branches 12-14 . The venous system has a similar route as the arterial system. The venules converge to form small veins in the cortex. The small veins run along the trabeculae of the lymph node and reach the medulla where they further converge to form the main vein. The main vein leaves the lymph node at the hilus 12-14 . ASUM ULTRASOUND BULLETIN VOLUME 6 NUMBER 3 AUGUST 2003 9
Page 1: VOL 6 NUMBER 3 AUGUST 2003 Australa
Page 4 and 5: Editorial President’s message My
Page 6 and 7: Editorial Letter to the Editor Dear
Page 8 and 9: ASUM 2003 SCIENTIFIC PROGRAM FRIDAY
Page 12 and 13: Ultrasound evaluation of neck lymph
Page 20 and 21: Ultrasound of salivary glands Ultra
Page 22 and 23: Ultrasound of salivary glands Appro
Page 24 and 25: Ultrasound of salivary glands Figur
Page 26 and 27: Prenatal ultrasound diagnosis of si
Page 28 and 29: 2 ANNUAL REPORT 2002 - 2003 Counci
Page 30 and 31: 4 ANNUAL REPORT 2002 - 2003 the Ch
Page 32 and 33: 6 ANNUAL REPORT 2002 - 2003 The fu
Page 34 and 35: MR Patient Monitoring Ultrasound CT
Page 36 and 37: 8 ANNUAL REPORT 2002 - 2003 BRANCH
Page 38 and 39: 10 ANNUAL REPORT 2002 - 2003 DDU D
Page 40 and 41: 12 ANNUAL REPORT 2002 - 2003 MEMBE
Page 42 and 43: 14 ANNUAL REPORT 2002 - 2003 Past
Page 44 and 45: Key issues in the analysis of safet
Page 46 and 47: Live scanning at Annual Scientific
Page 48 and 49: Live scanning at Annual Scientific
Page 50 and 51: ○ ○ ○ ○ ○ ○ ○ ○ ○
Page 52 and 53: ○ ○ ○ ○ ○ ○ ○ ○ ○
Page 54 and 55: Book reviews comprehensive texts it
Page 56 and 57: Reports ASUM wins WFUMB 2009 at the
Page 58 and 59: Reports Exhibition Hall Toshiba B
Page 60 and 61:
Reports Joint Meeting of ASUM ( NZ
Page 62 and 63:
Notices 60 ASUM ULTRASOUND BULLETIN
Page 64 and 65:
Calendar Calendar of ultrasound eve
Page 66 and 67:
Authors’ guidelines Guidelines fo
Page 68:
He sees more than the best obstetri
show all

Volume 6 Issue 3 - Australasian Society for Ultrasound in Medicine

Create successful ePaper yourself

Delete template?

Save as template?