Contrast-enhanced ultrasound visualizing lymph node blood flow.

Lymph Node Checks: How New Ultrasound Tech Can Spot Trouble Earlier

Beau Callahan in Health & Wellness November 2025 • 4 min read.

"Contrast-enhanced ultrasound (CEUS) offers a more accurate way to assess lymph nodes, helping doctors make quicker, more informed decisions about biopsies and potential interventions."

Swollen lymph nodes can be alarming, often signaling infection, inflammation, or, in some cases, more serious conditions like cancer. Traditionally, doctors rely on physical exams, standard ultrasound imaging, and biopsies to determine the cause of lymph node enlargement. However, these methods have limitations. Standard ultrasounds may not always provide enough detail, and biopsies are invasive, carrying risks and requiring recovery time. Enter contrast-enhanced ultrasound (CEUS), a promising technique that offers a more detailed look inside lymph nodes.

CEUS is a type of ultrasound that uses microbubble contrast agents to enhance the visibility of blood vessels within the lymph nodes. These microbubbles are injected into the bloodstream and travel to the lymph nodes, where they reflect ultrasound waves more strongly than surrounding tissues. This allows doctors to see the patterns of blood flow and vascular structure within the nodes, providing valuable clues about their health.

A recent study published in the Journal of Thoracic Disease investigated the potential of CEUS to improve the diagnostic accuracy of lymph node assessment. The researchers found that CEUS can help differentiate between benign and malignant lymph nodes, potentially reducing the need for unnecessary biopsies and leading to earlier diagnosis and treatment.

The Science Behind the Scan: How CEUS Works

Contrast-enhanced ultrasound visualizing lymph node blood flow.

The key to CEUS lies in its ability to visualize the microvasculature of lymph nodes. Malignant lymph nodes often have abnormal blood vessel growth (angiogenesis), leading to irregular patterns of blood flow. CEUS can highlight these irregularities, making them easier to detect. Benign conditions, such as inflammation, tend to have more uniform blood flow patterns.

In the Journal of Thoracic Disease study, researchers analyzed CEUS images of 157 lymph nodes from 103 patients. They looked for specific enhancement patterns, such as: Peripheral Enhancement: Blood flow primarily around the edges of the node.

Hilar Enhancement: Blood flow concentrated in the center (hilum) of the node.
Inhomogeneous Enhancement: Irregular, patchy blood flow throughout the node.
Cycle-like Enhancement: Areas of enhancement alternating with areas of little or no enhancement.

The study revealed that certain CEUS patterns were strongly associated with either benign or malignant conditions. For example, peripheral enhancement was more common in malignant nodes, while hilar enhancement was more often seen in benign nodes. Inhomogeneous and cycle-like enhancement patterns also suggested malignancy. By combining these CEUS findings with conventional ultrasound features, doctors could more accurately assess the likelihood of malignancy.

Looking Ahead: The Future of Lymph Node Imaging

Contrast-enhanced ultrasound is not meant to replace traditional diagnostic methods entirely. But CEUS offers a valuable tool for improving the accuracy of lymph node assessment, potentially leading to earlier diagnoses, reduced need for invasive procedures, and better outcomes for patients. As CEUS technology continues to advance and more research is conducted, we can expect even greater improvements in the detection and management of lymph node abnormalities. If you have concerns about swollen lymph nodes, talk to your doctor about whether CEUS might be right for you. Remember, early detection is key.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.21037/jtd.2017.11.90, Alternate LINK

Title: Evaluation Of Supplementary Diagnostic Value Of Contrast-Enhanced Ultrasound For Lymph Node Puncture Biopsy

Subject: Pulmonary and Respiratory Medicine

Journal: Journal of Thoracic Disease

Publisher: AME Publishing Company

Authors: Jie Zhang, Xin Hao, Yang Yang, Chang-Shuai Yan, Chao Ma, Ming Xiao, Li-Shuang Gu, Yong Wang

Published: 2017-11-01

Everything You Need To Know

How does contrast-enhanced ultrasound (CEUS) improve the assessment of lymph nodes?

Contrast-enhanced ultrasound, or CEUS, improves lymph node assessment by using microbubble contrast agents. These agents enhance the visibility of blood vessels within lymph nodes during an ultrasound, allowing doctors to observe blood flow patterns and vascular structures in greater detail. This enhanced visualization helps differentiate between benign and malignant conditions, potentially reducing the need for invasive biopsies.

Could you explain the science behind how CEUS distinguishes between benign and malignant lymph nodes?

CEUS works by visualizing the microvasculature within lymph nodes. Malignant lymph nodes often exhibit abnormal blood vessel growth, known as angiogenesis, which leads to irregular blood flow patterns. CEUS highlights these irregularities using microbubble contrast agents, making them easier to detect. Benign conditions typically show more uniform blood flow patterns. By observing the enhancement patterns, doctors can better assess whether a lymph node is likely benign or malignant.

What specific enhancement patterns did the Journal of Thoracic Disease study identify as indicative of benign or malignant conditions?

The *Journal of Thoracic Disease* study identified several CEUS enhancement patterns associated with either benign or malignant conditions. Peripheral enhancement, where blood flow is primarily around the edges of the node, was more common in malignant nodes. Hilar enhancement, with blood flow concentrated in the center, was more often seen in benign nodes. Inhomogeneous enhancement, characterized by irregular, patchy blood flow, and cycle-like enhancement, featuring alternating areas of enhancement, also suggested malignancy. Combining these patterns with conventional ultrasound features improves diagnostic accuracy.

Is contrast-enhanced ultrasound (CEUS) meant to replace traditional methods for diagnosing lymph node issues?

CEUS is not intended to replace traditional diagnostic methods entirely. CEUS is a supplemental tool to improve the accuracy of lymph node assessment. It is used to obtain earlier diagnoses, reduce the need for invasive procedures like biopsies, and improve patient outcomes. If there are concerns about swollen lymph nodes, consulting a doctor about whether CEUS might be a beneficial step in the diagnostic process is recommended.

What are the potential implications of CEUS beyond improving diagnostic accuracy, and how might it evolve in the future?

CEUS is a promising technology that visualizes the microvasculature of lymph nodes. The detection of cancerous cells spreading via the lymphatic system is one potential implication. In addition to identifying the presence of malignancy, CEUS could also assist in treatment planning. By visualizing the extent and location of affected lymph nodes, surgeons could potentially use CEUS to guide surgical resections or radiation therapy planning, to target affected areas more precisely. While the use of microbubbles is considered safe, future research may explore new contrast agents or imaging techniques to improve CEUS further. CEUS could potentially be integrated with artificial intelligence (AI) algorithms to automate image analysis and improve diagnostic accuracy. AI could help identify subtle enhancement patterns and reduce variability in interpretation, making CEUS more accessible and reliable.