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. 2012 Jul;41(5):396-404.
doi: 10.1259/dmfr/57281042. Epub 2012 Jan 12.

Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists

P T de Souza Figueiredo  1 , A F Leite, F R Barra, R F Dos Anjos, A C Freitas, L A Nascimento, N S Melo, E N S Guerra
Affiliations

Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists

P T de Souza Figueiredo et al. Dentomaxillofac Radiol. 2012 Jul.

Abstract

Objectives: The aim of the study was to verify the concordance of contrast-enhanced CT (CECT) and MRI evaluation among four radiologists in detecting metastatic cervical lymph nodes of oral cancer patients.

Methods: Ten patients underwent clinical and imaging examinations (CECT and MRI). Four radiologists, two oral and maxillofacial radiologists (OMRs) and two medical radiologists (MRs), independently analysed the images twice. Cohen's kappa index and Wilcoxon signed-rank test were used to verify the concordance between all analyses.

Results: Regarding the interobserver agreement, the OMRs presented excellent kappa values for determining the regional lymph nodes (N-stage) in both CECT and MRI. The MRs presented moderate agreement for CECT evaluation at the first reading, but no concordance was found for the other analyses. When each imaging modality was analysed separately, kappa values were higher between all examiners. Greater variability was demonstrated between N-stage evaluation using different examinations. All radiologists were able to identify a greater number of metastatic lymph nodes in CECT than in MRI, except one MR, but no significant difference was found for all readers. The differences between the number of metastatic lymph nodes among all radiologists were not statistically significant. Moderate intraobserver agreement was observed for CECT and MRI evaluation, except for one MR.

Conclusions: The differences found between the N-stage performed by OMRs and MRs support the necessity of a multidisciplinary approach in the imaging evaluation of metastatic nodes. Further studies are necessary to confirm which imaging modality should be employed when evaluating neck areas.

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Figures

Figure 1
Figure 1
Two cases of metastatic lymph nodes (white arrows) not clinically detected and detected in contrast-enhanced CT (CECT) and MRI. (a) Two metastatic lymph nodes detected in CECT, one defined by increased size and presence of central necrosis (right side) and the other defined by increased size and round shape (left side). (b) One metastatic lymph node detected in MRI, defined by increased size, round shape and the presence of central necrosis (right side)
Figure 2
Figure 2
Patient with two metastatic lymph nodes with central necrosis detected in both contrast-enhanced CT (a) and MRI (b) (white arrows) but not clinically detected
Figure 3
Figure 3
Number of metastatic lymph nodes detected by the four radiologists [oral and maxillofacial radiologists (OMRs) and medical radiologists (MRs)] in both contrast-enhanced CT (CECT) and MRI
Figure 4
Figure 4
Patient with metastatic lymph node detected only in contrast-enhanced CT (CECT) (a) (white arrow) but not in MRI (b). Note the increased size and the presence of central necrosis in the CECT
See this image and copyright information in PMC

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