MRI features of cervical nodal necrosis in metastatic disease

Chong, Vincent; Fan, Y.F.; Khoo, James B. K.

doi:10.1016/s0009-9260(96)80265-0

Cited by 64 publications

(25 citation statements)

References 6 publications

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“…Curtin et al [1] found that CT is more sensitive and accurate than MR imaging in depicting nodal necrosis. Contrast-enhanced MRI is certainly more sensitive in detecting necrosis than unenhanced MRI [7]. In this study, the ADC map could delineate and differentiate between the necrotic and solid part of the tumor much better than T2-weighted images.…”

Section: Discussionmentioning

confidence: 73%

“…Also, Herneth et al [17] reported that the mean ADC value of metastatic lymph nodes (0.59±0.27×10 −3 mm 2 /s) was statistically different from regular lymph nodes (1.21± 0.24×10 −3 mm 2 /s) in head and neck cancer patients (P<0.04). Chang et al [7] reported that a threshold ADC value of 1.22×10 −3 mm 2 /s has an 86% accuracy, 84% sensitivity and 91% specificity, 93% positive predictive value and 78% negative predictive value for differentiating benign and malignant tumors of the head and neck.…”

Section: Discussionmentioning

confidence: 99%

“…Presence of non-contrast enhancement or irregular contrast enhancement is attributed to tumor necrosis, tumor keratinzation or cystic areas inside the tumor [4,6,7]. Curtin et al [1] found that CT is more sensitive and accurate than MR imaging in depicting nodal necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Nodal metastases are detected with imaging modalities on the basis of the size and shape of the node, extracapsular tumor spread, and abnormality of internal architecture, including necrosis. The detection of nodal necrosis in patients with a primary head and neck tumor is the most reliable sign of a metastatic node [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Role of diffusion-weighted MR imaging in cervical lymphadenopathy

et al. 2006

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The role of diffusion-weighted magnetic resonance imaging (MRI) for differentiation between various causes of cervical lymphadenopathy was evaluated. In a prospective study, 31 untreated patients (22 males and nine females, aged 5-70 years) with 87 cervical lymph nodes underwent diffusion-weighted MRI before performance of neck dissection (n=14), surgical biopsy (n=9) or core biopsy (n=8). Diffusion-weighted MR images were acquired with a b factor of 0 and 1,000 s/mm2 using single-shot echo-planar sequence. Apparent diffusion coefficient (ADC) maps were reconstructed for all patients. The signal intensity of the lymph nodes was assessed on images obtained at b=0 or 1,000 s/mm2 and from the ADC maps. The ADC value of lymph nodes was also calculated. On the ADC map, malignant nodes showed either low (n=52) or mixed (n=20) signal intensity and benign nodes revealed high (n=13) or low (n=2) signal intensity. The mean ADC value of metastatic (1.09+/-0.11x10(-3) mm2/s) and lymphomatous (0.97+/-0.27x10(-3) mm2/s) lymph nodes was significantly lower than that of benign (1.64+/-0.16x10(-3) mm2/s) cervical lymph nodes (P<0.04). When an ADC value of 1.38x10(-3) mm2/s was used as a threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with an accuracy of 96%, sensitivity of 98%, specificity of 88%, positive predictive value of 98.5% and negative predictive value of 83.7%. The smallest detected lymph node was 0.9 cm. In conclusion, diffusion-weighted MRI with ADC mapping is a new promising technique that can differentiate malignant from benign lymph nodes and delineate the solid viable part of the lymph node for biopsy. This technique provides additional useful physiological and functional information regarding characterization of cervical lymph nodes.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of diffusion-weighted MR imaging in cervical lymphadenopathy

et al. 2006

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“…At magnetic resonance (MR) imaging, CNN is seen as a focal area of high signal intensity on T2-weighted images and as an area of low signal intensity on contrast material-enhanced T1-weighted images, with or without a surrounding rim of enhancement (4,5). The reported incidence of CNN in patients with NPC ranges from 20% to 42% (6)(7)(8)(9).…”

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confidence: 99%

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Lan¹,

Huang²,

Chen³

et al. 2015

Radiology

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Purpose:To evaluate the prognostic value of cervical nodal necrosis (CNN) in patients with nasopharyngeal carcinoma (NPC) with magnetic resonance (MR) imaging. Materials and Methods:This was an institutional review board-approved retrospective study of 1800 patients with newly diagnosed stage T1, 4N1, 3M0 NPC who were treated with definitive radiation therapy, with or without chemotherapy, between January 2007 and December 2009; the requirement to obtain informed consent was waived. MR images were reviewed to assess lymph node status, and patients were divided into CNN and non-CNN groups. The overall survival, disease-free survival, regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared by using the log-rank test. Results:The incidence of CNN was 44.0% (792 of 1800). After the median follow-up period of 53 months, the 5-year overall survival, disease-free survival, RRFS, and DMFS rates of the CNN and non-CNN groups were 78.8% and 91.8%, 78.2% and 91.2%, 78.6% and 91.8%, and 78.4% and 91.6%, respectively (for all rates, P , .001). The distant metastasis rate was 18.7% (148 of 792) for the CNN group versus 4.6% (46 of 1008) for the non-CNN group (P , .01). Subgroup analysis revealed similar survival outcomes between stage N1 disease with CNN and stage N2 disease without CNN, stage N2 disease with CNN, and stage N3 disease regardless of CNN. CNN, T stage, N stage, age older than 44 years, and male sex were significant independent negative prognostic factors for overall survival, disease-free survival, RRFS, and DMFS. Conclusion:CNN is an independent negative prognostic factor in patients with NPC, and it may be appropriate to investigate whether N stage should be upgraded by one level in patients with CNN.q RSNA, 2015

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