[Contrast-enhanced ultrasound in the diagnostic workup of lymph nodes].

CLINICAL/METHODICAL ISSUE: Daily tasks in sonographic diagnostics include detection and characterization of peripheral and abdominal lymph nodes. STANDARD RADIOLOGICAL
METHODS: In addition to the B‑mode methods, color-coded Doppler sonography (CCDS) plays an important role in the evaluation of lymph nodes. METHODICAL INNOVATIONS: Contrast-enhanced ultrasound (CEUS) has become a standard procedure in vascular and organ diagnostics. Tissue perfusion can be recorded visually and retrospectively in real time using time-dependent intensity analysis. The contrast agent dosage depends primarily on the location of the lymph nodes and the type and frequency of the transducer. Vascular and tumor cell density, intranodal pressure due to increased vascular permeability and preservation or destruction of the capsule must be taken into account when interpreting the findings. PERFORMANCE: The indication for CEUS results from the B‑mode and CCDS findings and plays an important role especially in the verification of vitality before and after therapy. Uneven or apparently non-perfused areas allow a targeted puncture of vital tumor tissue. ACHIEVEMENTS: Especially in abdominal lymph nodes, CEUS has a high diagnostic reliability. It is not always possible to differentiate between inflamed lymph nodes and lymph nodes altered by lymphoma filtration. PRACTICAL RECOMMENDATIONS: CEUS helps to better assess the dignity of lymph nodes by visualizing their micro- and macrovascularization. After frustrated puncture, vital areas can be specifically biopsied. CEUS is particularly valuable in assessing the success of therapy.