Diffusion-Weighted Magnetic Resonance Imaging in Characterization of Neck Lymph Nodes in Head and Neck Cancer
International Journal of Medical Imaging
Volume 8, Issue 1, March 2020, Pages: 6-15
Received: Dec. 15, 2019; Accepted: Dec. 30, 2019; Published: Jan. 7, 2020
Views 462      Downloads 92
Usama Elsaied Ghieda, Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Ahmed Abdul-Raheem Badr, Radiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
Article Tools
Follow on us
Aim: to prospectively determine if diffusion weighted magnetic resonance imaging can help in discrimination between benign and malignant lymph nodes in patients with head and neck cancer, using histological results as the standard of reference. Patients & Methods: 40 patients complaining of palpable cervical lymph nodes with unknown primary malignancy or having known head and neck cancer. MRI neck study was done for all patients, including pre and post contrast sequences and DWI. Histopathology was done for all patients. Statistical analysis of the differences in ADC values for benign and malignant nodes was performed, together with further analysis of the differences between the ADC values of metastatic lymph nodes and lymphoma. Results: 30 patients were histopathological proved malignant lymphadenopathy (20 metastatic from head and neck malignancy and 10 primary lymphomas) and 10 patients were histopathological proved benign lymphadenopathy (1 acute reactive lymphadenitis, 1 chronic granulomatous inflammation, 4 chronic non-specific inflammation & 4 reactive lymphoid hyperplasia). A statistically significant difference between ADC values of benign and malignant cervical nodes was reported with a threshold ADC value equal to 1.30 ×10-3 mm2/sec was identified. The ADC value for lymphoma was less than that for metastatic carcinoma, with high specificity and sensitivity values and a threshold ADC value equal to 0.9 ×10-3 mm2/sec was identified. Conclusion: MR diffusion imaging is helpful non-invasive method in differentiation between benign and malignant lymph nodes, and to the same extent differentiation between the variant types of malignant lymphadenopathy.
Diffusion-weighted Imaging (DWI), Apparent Diffusion Coefficient (ADC), Cervical Lymphadenopathy, Benign, Malignant, Reactive, Metastatic, Lymphoma
To cite this article
Usama Elsaied Ghieda, Ahmed Abdul-Raheem Badr, Diffusion-Weighted Magnetic Resonance Imaging in Characterization of Neck Lymph Nodes in Head and Neck Cancer, International Journal of Medical Imaging. Vol. 8, No. 1, 2020, pp. 6-15. doi: 10.11648/j.ijmi.20200801.12
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sambandan T, Christefi Mapel R. Review of cervical lymphadenopathy. JIADS 2011; 2: 31-33.
Curtin HD, Ishwaran H, Mancouso AA, Dalley RW, Caudry DJ, McNeil BJ. Comparison of CT and MR imaging in staging of neck metastasis. Radiology 1998; 207: 123–130.
Castelijns JA, van den Brekel MW. Imaging of lymphadenopathy in the neck. Eur Radiol 2002; 12: 727–738.
Kaji A, Mohuchy T, Swartz JD. Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR 1997; 18: 220–249.
Fischbein N, Noworolski S, Herny R, Kaplan M, Dillon W, Nelson S. Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 2003; 24: 301–311.
Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 2009; volume 72 (3): 381–7.
King AD, Ahuja AT, Yeung DK, et al. Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. Radiology 2007; 245: 806–813.
Jakobsen J, Hansen O, Jorgensen E, and Bastholt L. Lymph node metastasis from laryngeal and pharyngeal carcinomas- calculation of burden of metastasis and its impact on prognosis. Acta Oncologica 1998; 37: 489-575.
Kehrl W, Wenzel S, Niendorf A. Effect of various form of metastatic lymph node involvement om prognosis of squamous epithelial carcinomas of the upper aerodigestive tract. Laryngo-Rhino-Otolgie, 1998; 77: 569-575.
Leemans CR, Tiwari R, Nauta J, Van Der Waal I and Snow GB. Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastasis as a prognostic factor.
Thoeny HC, De Keyzer F, Claus FG, Sunaert S, Hermans R. Gustatory stimulation changes the apparent diffusion coefficient of salivary glands: initial experience. Radiology 2005; 235 (2): 629–634.
Thoeny HC, De Keyzer F. Extracranial applications of diffusion weighted MR imaging. Eur Radiol 2007; 245: 806-813.
Thoeny HC, De Keyzer F, King AD, Diffusion weighted MR imaging of head and neck, Radiology 2012; 263: 19-32.
Grégorie, V, Lefebvre JL, Licitra F, Felip E. Squamous cell carcinoma of the head and neck: Clinical practice guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2010; 21: 184-186.
Barchetti F, Pranno N, Giraldi G, et al. Role of 3 tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma, BioMed Research International 2014, Article ID 532095, 9 pages.
Van den Brekel MW. Lymph node metastases: CT and MRI. Eur J Radiol 2000; 33: 230–238.
Takahara T, Imai Y, Yamashita T, et al. Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 2004; 22: 275–282.
Koh DM and Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007; volume 188: number 6, pages 1622–1635.
Pekçevik Y, Çukurova I, Arslan IB. Apparent diffusion coefficient for discriminating metastatic lymph nodes in patients with squamous cell carcinoma of the head and neck. Diagn Interv Radiol 2015; 21: 397–402.
Vandecaveye V, De Keyzer F, Vander Poorten V, et al. Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 2009; volume 251, number (1): pages 134–146.
Perronea A, Guerrisia P, Izzob L, D’Angelic I, Sassi S, Melea LL, Marinia M, Mazzaa D, Marinia M. Diffusion-weighted MRI in cervical lymph nodes: Differentiation between benign and malignant lesions, European Journal of Radiology 2011; 77: 281–286.
Sumi M, Van Cauteren M, Nakamura T, et al. MR micro-imaging of benign and malignant nodes in the neck. AJR American journal of Roentgen -ology 2006; volume 186: pages 749–757.
Abdel Razek AA, Soliman NY, Elkhamary S et al. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 2006; volume 16: pages 1468-77.
Wang J, Takashima S, Kawakami F, et al. Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. Radiology 2001; volume 220: pages 621–630.
Choi KD, Jo JW, Park KP, et al, Diffusion weighted imaging of intramural hematoma in vertebral artery dissection. J Neurol Sci, 2007; volume 253: pages 81–84.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186