Power-Doppler-Sonographie in der Beurteilung von residualen Lymphknotenvergrößerungen nach Therapie bei Patienten mit malignen Lymphomen und soliden Tumoren

Background: Residual mass in patients with malignant lymphoma or lymphogenously metastastasized carcinoma represent a diagnostic and thus prognostic dilemma for the treating physician. Enlarged lymph nodes after radio-/chemotherapy can consist of both vital tumor cells and of post-therapeutic scar tissue. The present study examines the value of power Doppler sonography in the evaluation of the valency of enlarged lymph nodes after therapy. Patients and methods: 62 patients suffering from malignant lymphoma or solid tumor with residual mass after completed therapy were examined by power mode sonography. The intranodal vascular patterns were divided into “more malignant” (subcapsular vessels, aberrant vessels and focally missing vessels) and „more benign” (missing flow signals, hilar flow and increased flow) according to TSCHAMMLER. Furthermore, it should be examined to what extend the largest diameter (size), the longitudinal-transverse diameter ratio (shape) and the presence of a central echogenic hilus (hilar sign) allow to give a prognosis regarding the probability of relapse in patients with residual mass in B-mode-sonography. Results: Concerning the size (lymph node < 2 cm vs. ≥ 2cm), the shape (Solbiati index < 2 vs. ≥ 2) and the hilar sign (present vs. absent), there were significant differences regarding the further survival without relapsing. We divided the intranodal flow patterns into the above mentioned types of vascularisation. Here we found significant differences regarding the further survival without relapsing (p=0,000185). Patients with residual mass showing “more malignant” flow pattern relapsed more often than patients with residual mass showing a “more benign” flow pattern. “More malignant” flow patterns were associated with a 3,52-fold higher risk for relapse. Conclusion: The analysis of vascularisation in the evaluation of residual mass in patients with malignant lymphoma rates high concerning the valency of residual mass.