Lymph nodes in the head and neck cancer: would diffusion-weighted magnetic resonance imaging solve the diagnostic dilemma?

Abstract

Background Head and neck cancer has been labeled as the fifth most common cancer. Lymph node (LN) metastases were reported as the most important predatory factor for diagnosis and selection of suitable treatment. Diffusion-weighted (DW) magnetic resonance (MR) imaging is a very important tool that gives quantitative data in several compartments. This work aims to evaluate the diagnostic value of diffusion-weighted as a part of the magnetic resonance imaging in patients with head and neck cancer to allow differentiation of lymph nodes, cancer staging, assessment of recurrence, and evaluation of the effects of oncologic therapy. Results The size of pathologically proven benign LNs ranged from 1 to 3 cm (1.71 ± 0.724) and malignant LNs ranged from 1.1 to 5.6 cm (2.54 ± 0.92) (P = 0.0103). The ADC value for benign LNs ranged from 1.26 × 10−3 to 2.49 × 10−3 (mean 1.98 × 10−3 ± 0.32 × 10−3), and malignant LNs from 0.608 × 10−3 to 2.1 × 10−3 (mean 0.971 × 10−3 ± 0.305 × 10−3) (P < 0.001) with sensitivity and a specificity of 94% and 100% respectively. The ADC value for metastatic LNs ranged from 0.70 × 10−3 to 2.10 × 10−3 (1.08 × 10−3 ± 0.31 × 10−3) while lymphomatous nodes ranged 0.608 × 10−3 to 1.16 × 10−3 (0.78 × 10−3 ± 0.17 × 10−3). In this study, a significant statistical difference was also observed between the ADC value of the SCC and lymphomatous LN (P = 0.0034) with sensitivity and a specificity of 90% and 75% respectively. Conclusion Diffusion-weighted MR imaging is an effective assist in differentiating benign and malignant lymph nodes. It acts as an indicator for recovery or recurrence after chemotherapy and radiotherapy.

Diagnostic Utility of Restriction Spectrum Imaging in Head and Neck Tumors: A Pilot Study

“…[1][2][3] Conventional diffusion-weighted imaging (DWI) can be used for the evaluation of lymph node involvement, but standardization of apparent diffusion coefficient (ADC) values can be problematic. 2 In addition, DWI can be challenging in head and neck imaging because of the heterogeneity of the tissue. 4 Changing geometric shapes, presence of thick bone structures, and numerous air-tissue boundaries may cause strong susceptibility artifacts.…”

“…Magnetic resonance imaging (MRI) is the preferred tool for investigating the primary tumor in all head and neck sites, particularly for assessing cartilage, bone, perineural, and perivascular invasion 1 . Also, detection of malignant lymph nodes in head and neck tumors is crucial because lymph node metastases are one of the most important prognostic factors and an important marker for the selection of suitable treatment in head and neck tumors 1–3 . Conventional diffusion-weighted imaging (DWI) can be used for the evaluation of lymph node involvement, but standardization of apparent diffusion coefficient (ADC) values can be problematic 2 .…”

“…1 Also, detection of malignant lymph nodes in head and neck tumors is crucial because lymph node metastases are one of the most important prognostic factors and an important marker for the selection of suitable treatment in head and neck tumors. [1][2][3] Conventional diffusion-weighted imaging (DWI) can be used for the evaluation of lymph node involvement, but standardization of apparent diffusion coefficient (ADC) values can be problematic. 2 In addition, DWI can be challenging in head and neck imaging because of the heterogeneity of the tissue.…”