Microvascular Imaging of Normal and Malignant Cervical Lymph Nodes With Super-Resolution Ultrasound Imaging Using...

Ultrasound is central to lymph node assessment and guides targeted biopsy. However, conventional Doppler has limited sensitivity to slow microvascular flow. Super-resolution ultrasound imaging using erythrocytes (SURE) is a fast, contrast-free technique that previously demonstrated feasibility in normal axillary and inguinal lymph nodes, but not in malignant lymph nodes or in the anatomically challenging cervical region. This feasibility study evaluated whether SURE could visualize the microvascular architecture in malignant cervical lymph nodes in patients with head and neck cancer or lymphoma, with an exploratory qualitative and quantitative comparison with normal cervical lymph nodes.

This preliminary feasibility study included five malignant cervical lymph nodes and five sonographically normal cervical lymph nodes. Conventional B-mode and Doppler images were obtained for qualitative comparison, followed by SURE acquisitions reconstructed into intensity and velocity maps. Exploratory quantitative parameters included vascular density, vessel diameter and peak flow velocity.

SURE depicted the microvasculature in malignant cervical lymph nodes in greater detail than Doppler. Normal lymph nodes showed organized hilar branching patterns, whereas malignant lymph nodes showed heterogeneous and disorganized vascular patterns with focal avascular regions. In this small exploratory cohort, vascular density appeared lower in malignant than in normal lymph nodes (p = 0.009), while no statistically significant differences were observed in vessel diameter or peak flow velocity.

SURE was feasible for fast, contrast-free microvascular imaging of malignant cervical lymph nodes. The findings are exploratory, and further methodological optimization and larger validation studies, including clinically indeterminate lymph nodes, are required to establish clinical utility.