Lymph Node Assessment with Multiparametric Ultrasound: Normal Values, Morphologic Patterns, and Diagnostic Algorithms

TL;DR

This paper reviews how to use ultrasound to assess lymph nodes, helping doctors distinguish between benign and malignant cases using multiple imaging techniques.

Contribution

The paper provides a comprehensive review of normal ultrasound values and multiparametric diagnostic approaches for lymph node assessment.

Findings

Multiparametric ultrasound improves diagnostic confidence in lymph node evaluation.

Combining B-mode, CDI, elastography, and CEUS reduces the need for invasive procedures.

Standardized assessment supports more consistent lymph node evaluation in clinical settings.

Abstract

Lymph nodes (LNs) are an essential part of the immune system and are frequently evaluated when infection, inflammation, or cancer is suspected. Ultrasound is the preferred first-line imaging method for LN assessment because it is non-invasive, widely available, and does not involve radiation. Accurate interpretation, however, requires knowledge of normal LN appearance and an understanding of how different disease processes may alter ultrasound findings. This article summarizes established normal values and characteristic morphologic and functional patterns of LNs using multiple ultrasound techniques. The authors aim to provide practical guidance for differentiating benign from malignant LNs in routine clinical practice. Improved standardization and multiparametric assessment may increase diagnostic confidence, reduce unnecessary invasive procedures, and support more consistent LN evaluation in oncologic and general medical settings.

Background/Objectives: Transcutaneous ultrasound (US) is the first-line imaging modality for detecting and characterizing lymph nodes (LNs), enabling further lesion discrimination regarding potential malignancy. Accurate interpretation requires both knowledge of normal reference values and a multiparametric diagnostic approach. Methods: This narrative review was based on a comprehensive literature review. Results: The article summarizes current evidence on normal LN morphology and measurements in B-mode US, color Doppler imaging (CDI), elastography, and contrast-enhanced ultrasound (CEUS). Typical sonomorphologic features of benign and malignant LNs, including size, shape, echogenicity, vascular patterns, stiffness, and perfusion characteristics, are presented alongside corresponding reference values from published studies. The diagnostic limitations and overlaps between normal, inflammatory, and malignant LNs are highlighted, emphasizing potential pitfalls in interpretation. Multiparametric ultrasound combining B-mode, CDI, elastography, and CEUS enhances diagnostic confidence, reduces the need for invasive procedures, and supports standardized LN assessment in clinical and oncologic practice. Conclusions: This article is part of a series on normal reference values in US imaging. Knowledge of normal values and integration of multiparametric findings form the basis for accurate LN characterization and reduce the need for invasive diagnostics.

Figures