Fig 1.

Images from the case of an 83-year-old woman with upper gingival cancer.

A, Contrast-enhanced axial CT scan shows reactive node (arrow; short-axis diameter, 4 mm) in level I.

B, Gray scale sonogram of the same node as that shown in A shows reactive node exhibiting normal hilar echogenicity (arrows).

C, Doppler sonogram shows blood flow signals (arrow) overlapping hilar echogenicity.

D, Contrast-enhanced axial CT scan, obtained 10 months after the examinations that produced negative results (shown in A–C), shows metastatic node (arrow; short-axis diameter, 8 mm) exhibiting central nodal necrosis.

E, Gray scale sonogram of the same node as that shown in D shows metastatic node without hilar echogenicity.

F, Doppler sonogram shows abnormal blood flow signals in periphery (arrows). No hilar blood flow signal intensity is seen.