Magnetic resonance imaging: dynamic contrast enhancement and diffusion-weighted imaging to identify malignant cervical lymph nodes

Abstract

ObjectiveTo examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes.Materials and MethodsUsing DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection.ResultsRelative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes (p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes (p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%).ConclusionAlthough DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.

Differentiation of benign and malignant cervical lymph nodes on MRI with special emphasis on DWI

“…These 10 cases of benign lymph nodes showing homogeneous contrast enhancement were of reactive lymph nodes, out of 3 cases showing heterogeneous enhancement one was case of necrotizing lymphadenitis and 2 cases were of tuberculosis and 2 cases showing peripheral contrast enhancement were of tuberculosis with large lymph nodal mass formation. These findings correlate with the study conducted by Cintra MB et al where they found the heterogeneous contrast enhancement of lymph nodes is seen due to the presence of areas of necrosis and are more often seen in cases of malignant lesions [29] .…”

Agreement between diagnostic imaging methods for the evaluation of lymphadenopathies in HIV-infected/AIDS patients

“…Because of its ease of use, accessibility, and low cost, ultrasound examination is indicated for the evaluation of peripheral lymphadenopathies. However, computed tomography (CT) and magnetic resonance imaging (MRI) are the best methods for evaluating cavitary lymphadenopathies ( 13 - 16 ) .…”

Determination of Cervical Lymph Nodes Metastasis and Extra Nodal Extension Status by Quantitative Assessment of Border Irregularity and Apparent Diffusion Coefficient in Patients With Tongue Squamous Cell Carcinoma

“…Given the limitations of size and morphological criteria for detecting M-cLNs, the application of quantitative imaging such as diffusion-weighted imaging (DWI) or positron emission tomography imaging has been advocated 12 . Quantitative variables, determined by multiparametric MRI, can assist in identifying the morphological, 7,13 cell activity–associated, 14–18 and hemodynamic characteristics of M-cLNs 19,20 . For example, DWI is a widely used noninvasive MRI technique that can be used to assess the structure of biological tissue by measuring the diffusion of water molecules.…”

“…12 Quantitative variables, determined by multiparametric MRI, can assist in identifying the morphological, 7,13 cell activity-associated, [14][15][16][17][18] and hemodynamic characteristics of M-cLNs. 19,20 For example, DWI is a widely used noninvasive MRI technique that can be used to assess the structure of biological tissue by measuring the diffusion of water molecules. Furthermore, many studies have begun to address the value of apparent diffusion coefficient (ADC) for discriminating metastatic from nonmetastatic (NM) lymph nodes, and their results appear promising.…”