Enlarged cervical lymph nodes at helical CT.

Kimura

Magnetic Resonance Imaging

et al. 2007

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...

mentioning

confidence: 99%

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

Kimura

Magnetic Resonance Imaging

et al. 2007

“…2 Although lymph node biopsy is the final method* to differentiate between benign and malignant nodes, several investigations are known to be helpful, including ultrasound and CT of nodes. 3,4 In this study, by reviewing the histopathological results of 220 lymph node biopsies and correlating the result with clinical findings and simple investigations, we attempted to develop a model predicting nodal malignancy from the age and sex of the patient, consistency of lymph node, result of Mantoux test and abdominal ultrasound.…”

mentioning

confidence: 99%

A Logistic Regression Model to Predict Nodal Malignancy among Cases With Lymphadenopathy

et al. 1998

Background: Peripheral lymphadenopathy can be caused by benign and malignant diseases. In this logistic regression model, we attempted to identify the clinical findings predicting high probability of nodal malignancy. Materials and Methods: Two hundred and twenty cases diagnosed by peripheral lymph node biopsy were studied. Of these, 164 had benign lymph node pathology, while the other 56 were malignant. The patients' medical charts were reviewed and a logistic regression model used to identify physical signs and simple investigations that will predict nodal malignancy. Results: Hard lymph node consistency, negative Mantoux test and positive abdominal ultrasound (showing hepatosplenomegaly with or without lymphadenopathy) were found to correlate with a higher probability of nodal malignancy. Conclusion: A logistic regression model is proposed to calculate the probability of lymph node malignancy at different ages and both sexes in relation to lymph node consistency, Mantoux test and abdominal ultrasound results.

J. Kathmandu Med. Coll.

“…In this study, MRI potential for diagnosis of cervical lymph node metastasis is equal to MDCT; the reason being diagnostic criteria used in the interpretation of CT and MR for lymph nodal metastases, which include any node greater than 10mm in maximum diameter, presence of central necrosis, indistinct nodal margins and loss of fatty hilum 13,14 . Various authors suggested different size criteria for staging lymph nodes with CT and MR imaging 24,25 . However, it is often diffi cult to distinguish reactive lymph node from metastatic ones using these criteria.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of multi-detector row computed tomography and magnetic resonance imaging in assessment of mandibular involvement, cervical lymph node metastases and T parameter staging of squamous cell carcinomas of tongue and floor of mouth

Kumar

Jaiswal

Kundu

2017

Background: Tongue and fl oor malignancies can be diagnosed based on biopsy and clinical examination, but diagnostic imaging is essential to confi rm and defi ne the size and extent of the disease. Objectives: The aim of this study was to recognise and understand the extent and precision of the diagnostic accuracy of multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) in mandibular tumour involvement, cervical lymph node metastases, T staging of tongue and fl oor of mouth malignancies in order to represent the proper treatment plan. Methods: Fifty patients with histologically proven squamous cell carcinomas (SCC) of tongue and fl oor of mouth malignancies underwent both multi-detector row computed tomography and magnetic resonance imaging before surgery. Two radiologists independently, unaware of the fi ndings, in consensus reviewed and interpreted all images to determine the extent of the primary tumour (T), mandibular tumour invasion and cervical lymph node metastasis. Imaging results obtained were correlated with postoperative histopathologic fi ndings that represented our reference standard. Cohen's kappa index and McNemar test were used to verify the concordance between the two radiologists and above mentioned three study parameters. Results: Magnetic resonance imaging showed superiority to multi-detector row computed tomography in the evaluation of the T parameter staging of TNM classifi cation and medullary bone involvement while multi-detector row computed tomography was more accurate compared to magnetic resonance imaging in the visualization of small cortical bone erosions. However, both the modalities demonstrated similar diagnostic performance in detection of metastatic lymph nodes. Conclusion: Multi-detector row computed tomography and magnetic resonance imaging have nearly equal potential for detecting the tumour size, mandibular infi ltration and nodal metastases.