Clinical impact of short tau inversion recovery MRI on staging and management in patients with cervical lymph node metastases of head and neck squamous cell carcinomas

Abstract

Incorporation of STIR into the conventional MR protocol significantly improves the detection of cervical lymph node metastases.

Fine needle aspiration cytology of metastatic polymorphous low‐grade adenocarcinoma of the palate in a cervical lymph node

“…PLGA has a distinct natural history characterized by slow and indolent growth, with late development of cervical lymph node metastasis and often distant recurrence 3 . Cervical lymph node metastasis of PLGA is present in nearly 5% of cases at diagnosis and occurs in 10% during long follow‐up after the initial surgery 4 . Different cytological features in two lymph node metastases are reported with their differential diagnosis.…”

Improved Cervical Lymph Node Characterization among Patients with Head and Neck Squamous Cell Carcinoma Using MR Texture Analysis Compared to Traditional FDG-PET/MR Features Alone

“…It is among these FDG-PET indeterminate nodes, that is, those with SUVmax ranging from 3.5 to 7.5, that we believe MRTA adds the greatest value. Reasons for this are not entirely clear, but we hypothesize that increased STIR textural coarseness among malignant nodes, resulting from increased proton richness, edema, and necrosis from tumoral infiltration of lymph node parenchyma [ 19 , 20 ], helped discriminate benign reactive FDG-avid nodes from truly malignant lymph nodes. Since textural coarseness has been associated with an elevated risk of recurrent disease in patients with rectal cancer and a poor prognosis among patients with ovarian cancer [ 21 , 22 , 23 ], STIR textural coarseness may also serve as a biomarker for malignant nodal disease in patients with HNSCC.…”

MRI Sequences in Head & Neck Radiology – State of the Art

“…cysts, sinus tracts, fistulae or cartilaginous remnants based on location and clinical symptoms [4] sinonasal inverted papilloma convoluted cerebriform pattern on T2w and T1wC+ [6] paraganglioma "salt and pepper" appearance (30 -40 %) [7] cancer intermediate to high signal in T2w, high signal in T1wC+, mass, infiltration, inhomogeneity, necrosis perineural invasion T2w and T1w thickening and T1wC+ contrast enhancement along the cranial nerve [8] dural invasion nodular dural enhancement on T1wC+ and width of enhancement of more than 5 mm [9] mandibular bone invasion replacement of peripheral hypointense signal (cortical bone) through either tumor signal intensity on both T1w and T2w, or central hyperintense signal (medullary bone) is replaced by intermediate tumor signal [11] neoplastic invasion of laryngeal cartilages low T1w signal, similar to that of tumor T2w signal and similar to tumor T1wC+ signal [12] residual cancer after chemoradiation therapy intermediate T2 signal intensity similar to that of the untreated tumor with areas formed a focal expansible mass > = 1 cm [14] dissection high T1w signal in the vessel wall [15] TIRM/STIR, Dixon, spectral fat sat edema, swelling, tumor high signal in TIRM/STIR necrosis, cystic lesions high signal in TIRM/STIR adipose tissue (lipoma, cholesterol granuloma) suppressed signal lymph node metastasis nodal size (minimum axial diameter of 8 -9 mm in level II and 7 -8 mm for the rest of the neck), loss of hilar structure and necrosis (varying level of low-to-high signal intensity on T2w fat sat depending on keratinization, and coagulation and liquefaction necrosis) [18]; lower signal than regular or reactive lymph nodes on inverted TIRM/ STIR [16] extranodal tumor spread nodal size, shaggy margin and flare sign on T2w fat sat [19] SSFP (CISS, FIESTA), SPACE, VISTA, 3D-FLAIR cerebellopontine angles and inner ear (facial and vestibulocochlear nerves, schwannomas)…”

“…It is a useful sequence for the overview of edema, swelling, and necrosis and cystic lesions such as in infection or malignancy. Using a contrast-inverted display of TIRM/STIR images, a darker signal than regular or reactive lymph nodes (LN) may increase the sensitivity and specificity of pathologic LN detection [16]. In Dixon methods both in-phase and opposed-phase images are acquired simultaneously which can be combined mathematically to fat only and water only images.…”