Murilo Bicudo Cintra1, Hilton Ricz2, Mahmood F Mafee3, Antonio Carlos Dos Santos4. 1. MD, PhD, Head and Neck Radiology, Radiology Division, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil. 2. MD, PhD, Professor of Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil. 3. MD, FACR, University of California San Diego (UC San Diego) Health System in La Jolla, San Diego, CA, USA. 4. MD, PhD, Professor of Neuroradiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
Abstract
OBJECTIVE: To examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes. MATERIALS AND METHODS: Using DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection. RESULTS: Relative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes (p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes (p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%). CONCLUSION: Although DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.
OBJECTIVE: To examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes. MATERIALS AND METHODS: Using DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection. RESULTS: Relative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes (p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes (p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%). CONCLUSION: Although DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.
Entities:
Keywords:
Diffusion magnetic resonance imaging; Lymph nodes/diagnostic imaging; Lymphatic metastasis/diagnostic imaging; Magnetic resonance imaging/methods
Authors: Nancy J Fischbein; Susan M Noworolski; Roland G Henry; Michael J Kaplan; William P Dillon; Sarah J Nelson Journal: AJNR Am J Neuroradiol Date: 2003-03 Impact factor: 3.825
Authors: Rodolfo Mendes Queiroz; Lucas Giansante Abud; Thiago Giansante Abud; Cecília Hissae Miyake; Antonio Carlos Dos Santos Journal: Radiol Bras Date: 2017 Nov-Dec
Authors: J Y Yu; D Zhang; X L Huang; J Ma; C Yang; X J Li; H Xiong; B Zhou; R K Liao; Z Y Tang Journal: J Med Syst Date: 2020-02-26 Impact factor: 4.460
Authors: Francisco Carlos da Silva; Gabriel Antonio Nascentes; Antonio Carlos Oliveira Meneses; Dalmo Correia Filho Journal: Radiol Bras Date: 2019 Jan-Feb