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Vascular surgeon, radiologist

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Ultrasound signs of normal and pathologic lymph nodes

Alexey Kryvenko, medical expert
Last reviewed: 06.07.2025

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Color duplex sonography criteria for lymph node evaluation

Degree of vascularization
Picture of vascular spread
Pulsation of intranodal blood flow

Signs of normal lymph nodes

Dimensions less than 1.5 cm
Oblong shape (M/P ratio more than 2)
Bright echoes in the gates
Clear boundaries
No vascularization is observed in color mode

Signs of malignant lymphoma

Spherical shape (M/P ratio less than 2)
Significant decrease in echogenicity
Frequent absence of echo in the gate
Clear boundaries
Significant hypervascularization
Arborescent intranodal vascular pattern
Intra-node IS less than 0.8

Signs of metastatic lymph node involvement in squamous cell carcinoma

Spherical shape of the node (M/P ratio less than 2)
Hypoechoic regressive changes
No echo in the gate
Fuzzy boundaries
Moderate vascularization
Uneven vascular pattern
Intra-node IS more than 0.8

Signs of acute lymphadenitis

Oblong shape (M/P ratio more than 2)
The cortex is slightly hypoechoic.
Central echoes are present
Clear boundaries
Hypervascularization
Presence of central vessels in the gates
Intra-node IS less than 0.8

Signs of chronic lymphadenitis

Oblong shape (M/P ratio significantly greater than 2)
The cortex is slightly hypoechoic.
Clear edges
Vascularization is not determined.