Fig. 3
A 71-year-old female patient histologically confirmed with follicular lymphoma. (A) Ultrasound image shows a suspicious 37 mm × 12 mm cervical lymph node (arrow), elliptical in shape with uniform cortical thickening. The hilum and hilar blood flow signal are visible, resembling a benign lymph node. (B) Contrast-enhanced ultrasound (CEUS) in the early enhancement phase shows uniform high enhancement. (C) In the late enhancement phase, rapid regression occurs, with uneven enhancement. (D) In the postvascular phase, the lymph node exhibits large perfusion defects, with residual enhancement showing a scattered, spotty distribution. This enhancement pattern is defined as the “starfield sign”—marked by heterogeneous hypoenhancement with multiple discrete, punctate enhancing foci throughout the node in the postvascular phase (10–30 min). This pattern reflects disrupted macrophage distribution and suggests malignancy. Panels a, b, c, and d correspond to schematic diagrams: (a) two-dimensional image, (b) early enhancement, (c) late enhancement, (d) postvascular phase.
