Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis.

Som, Peter M.

doi:10.2214/ajr.158.5.1566697

Cited by 428 publications

(294 citation statements)

References 31 publications

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“…Detection of metastatic LN in patients with head and neck cancer is extremely relevant because it is one of the most important factors influencing the prognosis; the presence of nodal metastases reduces the five-year survival to 50% regardless of the location or size of the primary tumor (17,22). Cervical palpation is inaccurate for staging purposes, since over 15% of patients clinically staged as N0 may possess nodal metastases and L ϭ left, R ϭ right.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate presurgical imaging studies are thus needed, in an attempt to select the most appropriate surgical procedure (23). Cross-sectional imaging has been widely used in this setting and criteria for diagnosing metastatic LN include the analysis of nodal structure, clustering, shape, signs of extracapsular spread, and size (5,22,25). MRI, with its intrinsic high soft-tissue discrimination, was thought to be a superior technique for nodal imaging, but the SI or the T2 relaxation times of metastatic nodes do not differ or even overlap those obtained in normal LN (26).…”

Section: Discussionmentioning

confidence: 99%

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USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Curvo-Semedo

Diniz

Miguéis

et al. 2006

Magnetic Resonance Imaging

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Purpose:To determine the accuracy of ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) for nodal staging in patients with head and neck cancer. Materials and Methods:Twenty patients with carcinomas of the upper aerodigestive tract were prospectively enrolled. MRI was performed before and 24 -36 hours after intravenous infusion of an USPIO agent, ferumoxtran-10 (Sinerem; Guerbet, France; and Combidex; Advanced Magnetics) at a dose of 2.6 mg Fe/kg using T2-weighted spin-echo and gradient-echo sequences. Surgery was performed the same day or the day after the ferumoxtran-10 -enhanced MR examination. Based on MRI, selected nodes were surgically removed and directly correlated with pathology using hematoxylin-eosin (H&E) and Perls stainings.Results: A total of 63 nodes were studied; 36 were nonmetastatic, 25 metastatic, and two inflammatory. Ferumoxtran-10 -enhanced MRI allowed diagnosis of 24 metastatic and 30 nonmetastatic nodes, yielding a sensitivity of 96%, a specificity of 78.9%, a positive predictive value of 75%, and a negative predictive value of 96.8%, compared to 64%, 78.9%, 66.6%, and 76.9%, respectively, for nonenhanced MRI. Accuracy of ferumoxtran-10 -enhanced MRI was 85.7%. The gradient-echo T2-weighted sequence was the most accurate to detect signal loss in nonmetastatic nodes.Conclusion: USPIO-enhanced MRI is useful for nodal staging of patients with head and neck cancers. CROSS-SECTIONAL IMAGING plays an important role in the study of patients with head and neck squamous cell carcinomas, allowing detection of lymph nodes (LN) missed by physical examination, or demonstrating invasion of structures such as the skull base or the carotid arteries (1,2). Using these imaging modalities, the criteria for diagnosing metastatic nodes is mainly dimensional. Measurements include the minimum transaxial diameter, the maximum transaxial diameter or a ratio between the maximum longitudinal and the maximum axial diameters (3-7). Other parameters, such as morphological criteria or the pattern of enhancement, are regarded as less important in this setting. Nodal metastases in the head and neck are frequently smaller than 10 mm, sometimes even under 5 mm in diameter, a fact that accounts for the unsatisfactory performance of the current imaging techniques (8,9).MRI can be improved when using contrast agents suited for intravenous MR lymphography, such as the new ultrasmall superparamagnetic iron oxide (USPIO) particles, which are taken up by cells of the reticuloendothelial system of nonmetastatic LN (10 -15). As it has been shown in previous studies, iron oxide deposition leads to a decrease in the signal intensity (SI) in nonmetastatic nodes due to the T2 shortening effects, whereas metastatic nodes, devoid of macrophages, will not undergo SI changes when using T2-weighted sequences (11). The clinical use of this contrast agent is still under evaluation on phase III clinical trials (15)(16)(17)(18)(19)(20). Reports show promising results, with sensitivity and specificity value...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Curvo-Semedo

Diniz

Miguéis

et al. 2006

Magnetic Resonance Imaging

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“…When there are microscopic tumor deposits within a lymph node, detection by CT imaging is impossible. 24 Approximately 25% of all clinically occult metastases are too small to be detected by any imaging technique available. 25 In addition, the submandibular region can be difficult to assess by CT scan as enlarged or heterogeneously enhancing lymph nodes are often difficult to separate from the adjacent normal submandibular gland.…”

Section: Discussionmentioning

confidence: 99%

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

Greenberg

Naggar

et al. 2003

Cancer

164

116

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At present, storage capacities of single tank and tank farm have been greatly increasing. This change poses a real challenge for the applicability of current design standards. This article focuses on the applicability of safety spacing between tanks, which is one of the most important parameters of tank farm safety design. Taking PHAST and FDS as main research tools, the consequences of representative accidental scenarios were evaluated for different sizes of oil tanks to study the safety performance change caused by the increase of capability. The research results show that, when current standards are used to design the safety spacing between tanks, the safety performance increases as the capability increases. Considering the high property density, it is suggested that a higher safety performance objective has to be chosen when designing the safety spacing for ultra‐large oil tanks. © 2012 American Institute of Chemical Engineers Process Saf Prog, 2012.

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“…1 Complete removal of cervical lymph nodes is performed in patients with head and neck cancer for prognostic and therapeutic reasons; however, cervical lymphadectomy is associated with significant morbidity and operative time. Noninvasive imaging modalities used for detecting metastatic disease are CT, MR, and 18 F-fluoro-deoxyglucose positron emission tomography (FDG PET).…”

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confidence: 99%

Fluorescent labeled anti‐EGFR antibody for identification of regional and distant metastasis in a preclinical xenograft model

et al. 2008

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Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis.

Cited by 428 publications

References 31 publications

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

Fluorescent labeled anti‐EGFR antibody for identification of regional and distant metastasis in a preclinical xenograft model

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