Diagnostic performance of MRI relative to CT for metastatic nodes of head and neck squamous cell carcinomas

Abstract

Purpose:To compare the diagnostic abilities of magnetic resonance imaging (MRI) and computed tomography (CT) based on the architectural changes in the nodal parenchyma. Materials and Methods:We retrospectively studied histologically proven 70 metastatic and 52 reactive nodes in the necks of 38 patients with head and neck squamous cell carcinomas who had undergone both CT and MRI. We assessed the detectability of the architectural changes in the nodal parenchyma that were suggestive of cancer focus (cancer nest, necrosis, and keratinization). The diagnostic abilities of CT and MRI were assessed by three observers separately for the small (Ͻ10 mm in minimum axis diameter) and large (Ն10 mm) nodes.Results: MRI was significantly more effective than CT in diagnosing small metastatic nodes, yielding 83% sensitivity, 88% specificity, and 86% accuracy. However, the diagnostic abilities of MRI and CT were similar for large metastatic nodes; MRI yielded 100% sensitivity, 98% specificity, and 99% accuracy. receiver operating characteristic analysis also indicated that the Az values were significantly higher for MRI than for CT (0.927 vs. 0.822, P ϭ 0.00054) for the detection of small nodes. Conclusion:MRI is superior to CT in the diagnosis of metastatic nodes from head and neck squamous cell carcinomas. THE PRESENCE of metastatic lymph node(s) in the neck significantly reduces the 5-year disease-specific survival in patients with head and neck squamous cell carcinomas (1). Therefore, staging of neck metastasis is a crucial step in managing patients with head and neck squamous cell carcinoma (2). Imaging has greatly contributed to the diagnosis of neck diseases in patients with head and neck cancers. For example, advances in cross-sectional imaging, including helical computed tomography (CT) and magnetic resonance imaging (MRI), have enabled detailed evaluation of both metastatic nodes in the necks and the primary lesions of patients with head and neck carcinomas (3). Compared to conventional CT, the helical CT improved the spatial resolution of the images and could offer information on the nodes, such as nodal size and architectures (4,5). Both nodal size and nodal necrosis have been widely used as criteria for metastatic nodes (6,7). A recent study using the receiver operating characteristic (ROC) curve analysis demonstrated that the performance of CT in detecting metastatic nodes was moderate, with the minimum axis diameter being a better size criterion compared with the maximum axial diameter (8). Nodal necrosis, the other diagnostic criterion, is identified on contrastenhanced CT as a low-attenuated focal defect with or without enhancement of the nodal periphery (9).MRI was expected to improve the ability to diagnose metastatic nodes in the neck. However, Curtin et al (10) demonstrated that the performance of MR was equivalent to or less effective than that of CT in the diagnosis of metastatic nodes in the neck. Given the fact that a necrotic focus is identified as a focal defect on contrastenhanced T1-weighted image...

Differentiation between benign and malignant palatal tumors using conventional MRI: a retrospective analysis of 130 cases

“…This is the most prevalent infiltration route for palatal malignancies and usually results in destroyed or widened neural pathways on MRI. As documented in previous studies, 13,23 morphologic criteria for indicating pathologic lymph nodes usually include irregular contour or visualized necrosis. Enlargement of cervical lymph nodes at level II may be suggestive of but not definitive for metastasis because enlargement can also be caused by hyperplasia or inflammation.…”

“…Adjacent structure involvement, including bone invasion, perineural extension, and metastasis to lymph nodes, has considerable implications for predicting the prognosis and determining the therapeutic strategy for malignant palatal tumors. 12,[22][23][24] The palate is innervated by the maxillary branches of the trigeminal nerve and facial nerve. 12,25 Generally, malignant palatal tumors, especially mucoepidermoid carcinomas as found in this study, can spread perineurally through the greater and lesser palatine foramina to the pterygopalatine fossa.…”

Extranodal spread in the neck: MRI detection on the basis of pixel‐based time‐signal intensity curve analysis

“…Recent advances in magnetic resonance imaging (MRI) techniques have greatly improved their performance in evaluating neck diseases in patients with HNCs (3–5). An ENS‐positive node may be defined on MR images as a metastatic node with indistinct nodal margins, irregular nodal capsular enhancement, and infiltration into the adjacent fat or muscle (6, 7).…”

Observing stage-shifts in head and neck squamous cell carcinoma from initial clinical outpatient staging to definite clinical tumour board staging using radiological and endoscopical investigations: will less do?

“…To the best of our knowledge, there are no other studies that have investigated the value of the outpatient department staging in relation to the final staging outcome of the tumour board review. Most studies have focused on the diagnostic value of a particular imaging test related to the results of histopathological outcomes 15,17–19 . We explicitly chose for the final staging during the tumour board review as reference standard, as this is the outcome on which treatment decisions are actually made in daily practice.…”

“…Most studies have focused on Outpatient staging compared to tumour board staging in HNSCC 359 the diagnostic value of a particular imaging test related to the results of histopathological outcomes. 15,[17][18][19] We explicitly chose for the final staging during the tumour board review as reference standard, as this is the outcome on which treatment decisions are actually made in daily practice. Histopathological results as reference only become available after the initiation of surgical treatment.…”