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. 2009 Mar;19(3):626-33.
doi: 10.1007/s00330-008-1187-3. Epub 2008 Oct 7.

Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes

R B J de Bondt  1 , P J Nelemans, F Bakers, J W Casselman, C Peutz-Kootstra, B Kremer, P A M Hofman, R G H Beets-Tan
Affiliations

Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes

R B J de Bondt et al. Eur Radiol. 2009 Mar.

Abstract

The aim was to evaluate whether morphological criteria in addition to the size criterion results in better diagnostic performance of MRI for the detection of cervical lymph node metastases in patients with head and neck squamous cell carcinoma (HNSCC). Two radiologists evaluated 44 consecutive patients in which lymph node characteristics were assessed with histopathological correlation as gold standard. Assessed criteria were the short axial diameter and morphological criteria such as border irregularity and homogeneity of signal intensity on T2-weighted and contrast-enhanced T1-weighted images. Multivariate logistic regression analysis was performed: diagnostic odds ratios (DOR) with 95% confidence intervals (95% CI) and areas under the curve (AUCs) of receiver-operating characteristic (ROC) curves were determined. Border irregularity and heterogeneity of signal intensity on T(2)-weighted images showed significantly increased DORs. AUCs increased from 0.67 (95% CI: 0.61-0.73) using size only to 0.81 (95% CI: 0.75-0.87) using all four criteria for observer 1 and from 0.68 (95% CI: 0.62-0.74) to 0.96 (95% CI: 0.94-0.98) for observer 2 (p < 0.001). This study demonstrated that the morphological criteria border irregularity and heterogeneity of signal intensity on T2-weighted images in addition to size significantly improved the detection of cervical lymph nodes metastases.

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Figures

Fig. 1
Fig. 1
Schematic drawing of the four borders for assessment of lymph nodes
Fig. 2
Fig. 2
Transverse turbo spin-echo T2-weighted images of the neck. Examples of the four different scores on border regularity. The lymph nodes (arrows) show (A) a smooth border, (B) a lobulated border, (C) a spiculated border, and (D) an indistinct border
Fig. 3
Fig. 3
Transverse turbo spin-echo T2-weighted image of the neck showing an example of heterogeneous signal intensity (SI) in a lymph node in level II on the right side. The lymph node (arrowhead) with a homogenous SI, although a short axial diameter of 13 mm, showed no metastasis, whereas the smaller lymph node (arrow) (short axial diameter 9 mm) with a heterogeneous and eccentric area of low SI (small arrow) revealed metastasis at the pathologic examination
Fig. 4
Fig. 4
Schematic drawing of the different levels in the neck
See this image and copyright information in PMC

References

    1. Kalnins IK, Leonard AG, Sako K, et al. Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity. Am J Surg. 1977;134:450–454. doi: 10.1016/0002-9610(77)90376-2. - DOI - PubMed
    1. Jakobsen J, Hansen O, Jorgensen KE, et al. Lymph node metastases from laryngeal and pharyngeal carcinomas–calculation of burden of metastasis and its impact on prognosis. Acta Oncol. 1998;37:489–493. doi: 10.1080/028418698430467. - DOI - PubMed
    1. Kehrl W, Wenzel S, Niendorf A. [Effect of various forms of metastatic lymph node involvement on prognosis of squamous epithelial carcinomas of the upper aerodigestive tract] Laryngorhinootologie. 1998;77:569–575. doi: 10.1055/s-2007-997028. - DOI - PubMed
    1. Ganzer U, Meyer-Breiting E, Ebbers J, et al. [Effect of tumor size on lymph node metastasis and type of treatment on the prognosis of hypopharyngeal cancer] Laryngol Rhinol Otol (Stuttg) 1982;61:622–628. doi: 10.1055/s-2007-1008640. - DOI - PubMed
    1. Leemans CR, Tiwari RM, van der Waal I, et al. [Neck lymph node dissection in squamous cell carcinoma originating in the head-and-neck area; the significance for the prognosis] Ned Tijdschr Geneeskd. 1992;136:221–225. - PubMed