الفهرس 
Anatomy of cervical lymph nodesOnly 14 pages are availabe for public view
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Abstract
There are many lymph nodes located at the neck which could classified at anatomical basics or more recently at level system .
Lymphadenopathy, which is defined as an abnormality in the size or character of lymph nodes,. is a common finding in the primary care outpatient sitting, and the pathologies affect lymph nodes could classified into benign and malignant causes . And most important and annoying for both the patient and the doctor detecting either those enlarge lymph nodes are benign or malignant .
Elasticity (hardness) is a mechanical tissue characteristic that prevents tissue displacement under pressure. It varies in different types of tissue and in the same tissue in different pathologic states (inflammatory, malignant). And its determination will adds at differentiation between benign and malignant lesions .
During the past few years, sonographic elastography and some other techniques have performed digital measurements of tissue hardness.
In sonographic elastography, image representation of tissue hardness can be obtained using a conventional sonography machine with special software and a conventional ultrasound probe.
Two types of elastography are present ,static and dynamic . Static elastography is the one used to examine cervical lymph nodes .
Elastogram, is an image of relative hardness and from practical point of view , the numerical value of tissue elasticity cannot be reconstructed because the amount of pressure applied is unknown so that interpretation of the image is done at visual basics by colored scale and gray scale not at numerical basics.
For elastgram ,the machine is turned into elastogram mode ,determination of region of interest is done , slight upward and down ward compression is done ., and then representation of tissue hardness by gray scale or colored scale is made .
Elastogram is done as compartment of B mode scan .where B mode is done first to asses many points e.g. shape, size and echogenicity . Then assessment by Doppler examination is done to asses vascular pattern and resistance and this examination could give idea about if those enlarged lymph nodes are benign or malignant . And finally by elastogram .
On elastogram , we assess the pattern ,compare the size of lymph node at gray scale and elastogram , assess the stiffness value and this assessment could add at differentiation of either enlarged lymph nodes are benign or malignant .
Unfortunately in the practical life, there is many overlap in diagnostic criteria between benign and malignant lymph nodes by gray scale and Doppler sonography . So that, addition to elastography to conventional US and using them as combined evaluation (sonoelastography) will improve detection of whether detected lymph node is benign or malignant, detecting lymph node metastasis, guiding which lymph node best for biopsy, facilitating follow-up and also decrease number of unnecessary biopsy .
from other point ,sonoelastography is still new technique with no available much data about it, could not replace histopathology and at many cases biopsy still will be needed.
As a conclusion:
Sonoelastography , is a rich and rapidly developing technique that promises to improve diagnosis of either enlarged lymph nodes are benign or malignant.
As with most new technologies, diagnostic criteria and quality control mechanisms are still being established. Interested clinicians are encouraged to begin training themselves on the proper use of this emerging methodology.
At the evaluation of lymph nodes , the examination can be best performed when B-mode sonography, with its high sensitivity, and elastography, with its high specificity, are complementary. So that, in clinical practice, sonography practitioners preferred to use both methods in real time.