{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:34:23Z","timestamp":1791588863907,"version":"4.3.4"},"reference-count":118,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/cancers18061045","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:54:53Z","timestamp":1774281293000},"page":"1045","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Lymph Node Assessment with Multiparametric Ultrasound: Normal Values, Morphologic Patterns, and Diagnostic Algorithms"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9492-0141","authenticated-orcid":false,"given":"Kathleen","family":"M\u00f6ller","sequence":"first","affiliation":[{"name":"Medical Department I\/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7008-6650","authenticated-orcid":false,"given":"Christian","family":"Jenssen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Krankenhaus M\u00e4rkisch Oderland, 15344 Strausberg, Germany"},{"name":"Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Medical University, 16816 Neuruppin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1151-9935","authenticated-orcid":false,"given":"Markus Herbert","family":"Lerchbaumer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alois","family":"Hollerweger","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Barmherzige Br\u00fcder, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhvi","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjiri","family":"Dighe","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5555-0745","authenticated-orcid":false,"given":"Carla","family":"Serra","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, Via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-7790","authenticated-orcid":false,"given":"Andrea","family":"Boccatonda","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, Via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegbert","family":"Faiss","sequence":"additional","affiliation":[{"name":"Medical Department I\/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-6347","authenticated-orcid":false,"given":"Christoph Frank","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Center of Excellence and Education, Haldenweg 11A, 3626 Thun, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1055\/s-2007-1000502","article-title":"Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands","volume":"19","author":"Dietrich","year":"1998","journal-title":"Ultraschall Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1055\/s-0029-1245566","article-title":"Reference values in abdominal ultrasound\u2014Liver and liver vessels","volume":"48","author":"Sienz","year":"2010","journal-title":"Z. 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