HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by King, A. D. Articles by van Hasselt, A. C. Search for Related Content PubMed PubMed Citation Articles by King, A. D. Articles by van Hasselt, A. C.

Necrosis in Metastatic Neck Nodes: Diagnostic Accuracy of CT, MR Imaging, and US¹

¹ From the Departments of Diagnostic Radiology and Organ Imaging (A.D.K., A.T.A., E.H.Y.Y.), Anatomical and Cellular Pathology (G.M.K.T.), and Surgery (A.C.V., A.C.v.H.), Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing St, Shatin, New Territories, Hong Kong SAR, China; and Oral Maxillofacial Surgery Center, St Teresa’s Hospital, Kowloon, Hong Kong SAR, China (E.W.H.T.). Received January 29, 2003; revision requested April 21; final revision received July 17; accepted August 13. Address correspondence to A.D.K. (e-mail: b834756@mailserv.cuhk.hk).

PURPOSE: To compare the diagnostic accuracy of computed tomography (CT), magnetic resonance (MR) imaging, and ultrasonography (US) in the detection of necrosis in metastatic cervical nodes from patients with head and neck squamous cell carcinoma.

MATERIALS AND METHODS: Twenty-seven patients (age range, 39–85 years; mean age, 62 years) with squamous cell carcinoma in the head and neck underwent CT, MR imaging, and US. Three radiologists evaluated the images for nodal necrosis. The results of each modality were analyzed for sensitivity, specificity, and accuracy. Pathologic analysis of the surgical resection served as the reference standard. The three modalities were compared for specificity and sensitivity with the McNemar test.

RESULTS: Pathologic examination revealed 903 nodes, of which 89 were malignant. Of the malignant nodes, 43 were necrotic. Analysis of the detection of necrosis in the 89 malignant nodes showed an accuracy, sensitivity, and specificity of 92%, 91%, and 93% for CT; 91%, 93%, and 89% for MR imaging; and 85%, 77%, and 93% for US, respectively. All imaging modalities failed to depict necrotic areas of 3 mm or smaller in three nodes, and necrosis was missed in an additional seven nodes with US and in one node with CT. Necrosis could not be distinguished from other components of malignancy, such as viable tumor and scar tissue, in seven nodes (CT, 3; MR imaging, 5; US, 3). The sensitivity of both MR imaging and CT was significantly better than that of US (P = .0082 and P = .0339, respectively). There was no significant difference in sensitivity (P = .3173) between MR imaging and CT, or in the specificity of the three modalities.

CONCLUSION: MR imaging is comparable to CT for the detection of necrosis. The sensitivity of MR imaging and CT is better than that of US.

© RSNA, 2004

Index terms: Head and neck neoplasms, CT, 262.12112, 271.12112 • Head and neck neoplasms, MR, 262.1214, 271.1214 • Head and neck neoplasms, US, 262.12981, 271.12981 • Lymphatic system, diseases, 276.37

This article has been cited by other articles:

				V. Vandecaveye, F. De Keyzer, V. Vander Poorten, P. Dirix, E. Verbeken, S. Nuyts, and R. Hermans Head and Neck Squamous Cell Carcinoma: Value of Diffusion-weighted MR Imaging for Nodal Staging Radiology, April 1, 2009; 251(1): 134 - 146. [Abstract] [Full Text] [PDF]

				R. Tagaya, N. Kurimoto, H. Osada, and A. Kobayashi Automatic Objective Diagnosis of Lymph Nodal Disease by B-Mode Images From Convex-Type Echobronchoscopy Chest, January 1, 2008; 133(1): 137 - 142. [Abstract] [Full Text] [PDF]

				L. Rubaltelli, S. Corradin, A. Dorigo, A. Tregnaghi, F. Adami, C. R. Rossi, and R. Stramare Automated Quantitative Evaluation of Lymph Node Perfusion on Contrast-Enhanced Sonography Am. J. Roentgenol., April 1, 2007; 188(4): 977 - 983. [Abstract] [Full Text] [PDF]

				S. H. Choi, M. H. Han, W. K. Moon, K. R. Son, J.-K. Won, J.-H. Kim, B. J. Kwon, D. G. Na, H.-J. Weinmann, and K.-H. Chang Cervical Lymph Node Metastases: MR Imaging of Gadofluorine M and Monocrystalline Iron Oxide Nanoparticle-47 in a Rabbit Model of Head and Neck Cancer Radiology, December 1, 2006; 241(3): 753 - 762. [Abstract] [Full Text] [PDF]

				Y. Kawai, M. Sumi, and T. Nakamura Turbo Short {tau} Inversion Recovery Imaging for Metastatic Node Screening in Patients with Head and Neck Cancer AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1283 - 1287. [Abstract] [Full Text] [PDF]

				M. Sumi, M. Van Cauteren, and T. Nakamura MR Microimaging of Benign and Malignant Nodes in the Neck. Am. J. Roentgenol., March 1, 2006; 186(3): 749 - 757. [Abstract] [Full Text] [PDF]