Korean J Radiol.  2014 Dec;15(6):810-816. 10.3348/kjr.2014.15.6.810.

Is Diffusion-Weighted MRI Useful for Differentiation of Small Non-Necrotic Cervical Lymph Nodes in Patients with Head and Neck Malignancies?

• Lim HK
• Lee JH
• Baek HJ
• Kim N
• Lee H
• Park JW
• Kim SY
• Cho KJ
• Baek JH

• KMID: 1794654
• DOI: http://doi.org/10.3348/kjr.2014.15.6.810

Abstract

OBJECTIVE
To evaluate the usefulness of measuring the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging to distinguish benign from small, non-necrotic metastatic cervical lymph nodes in patients with head and neck cancers.
MATERIALS AND METHODS
Twenty-six consecutive patients with head and neck cancer underwent diffusion-weighted imaging (b value, 0 and 800 s/mm2) preoperatively between January 2009 and December 2010. Two readers independently measured the ADC values of each cervical lymph node with a minimum-axial diameter of > or = 5 mm but < 11 mm using manually drawn regions of interest. Necrotic lymph nodes were excluded. Mean ADC values were compared between benign and metastatic lymph nodes after correlating the pathology.
RESULTS
A total of 116 lymph nodes (91 benign and 25 metastatic) from 25 patients were included. Metastatic lymph nodes (mean +/- standard deviation [SD], 7.4 +/- 1.6 mm) were larger than benign lymph nodes (mean +/- SD, 6.6 +/- 1.4 mm) (p = 0.018). Mean ADC values for reader 1 were 1.17 +/- 0.31 x 10-3 mm2/s for benign and 1.25 +/- 0.76 x 10-3 mm2/s for metastatic lymph nodes. Mean ADC values for reader 2 were 1.21 +/- 0.46 x 10-3 mm2/s for benign and 1.14 +/- 0.34 x 10-3 mm2/s for metastatic lymph nodes. Mean ADC values between benign and metastatic lymph nodes were not significantly different (p = 0.594 for reader 1, 0.463 for reader 2).
CONCLUSION
Measuring mean ADC does not allow differentiating benign from metastatic cervical lymph nodes in patients with head and neck cancer and non-necrotic, small lymph nodes.

Keyword

Diffusion weighted imaging; Metastasis; Head and neck cancer; Lymph node

MeSH Terms

Adult
Aged
Aged, 80 and over
Diffusion Magnetic Resonance Imaging
Female
Head and Neck Neoplasms/pathology/*radiography
Humans
Lymph Nodes/pathology/*radiography
Lymphatic Metastasis
Male
Middle Aged
Necrosis
Patients
Sensitivity and Specificity

Figure

• 

  Fig. 1 Box-and-whisker plot of measured ADC values for benign and metastatic lymph nodes as assessed by two readers. ADC = apparent diffusion coefficient, LN = lymph node

• 

  Fig. 2 Squamous cell carcinoma of base of tongue in 69-year-old man. Axial T2-weighted (A) and gadolinium-enhanced, axial T1-weighted fat saturated (B) images show 6.3-mm size lymph node at right level III (arrows). This lymph node (arrows) shows high signal intensity on diffusion-weighted imaging at b = 800 s/mm2 (C), as well as low apparent diffusion coefficient (ADC) value on ADC map (D). Regions of interest (red color) were drawn freehand over lymph node on diffusion-weighted imaging (E, arrow). Measured ADC value is 0.54 × 10-3 mm2/s according to reader 1 and 0.74 × 10-3 mm2/s according to reader 2, and which are under threshold for malignancy in previously published studies. On histopathologic examination (F), almost all of area of this lymph node was seen to be covered with metastatic deposit (asterisk) (original magnification, × 150).

• 

  Fig. 3 Squamous cell carcinoma of mobile tongue in 61-year-old man. Axial T2-weighted (A) and gadolinium-enhanced, axial T1-weighted fat saturated (B) images show 8.2-mm size lymph node at left level II (arrows). This lymph node shows high signal intensity on diffusion-weighted imaging at b = 800 s/mm2 (C), and high apparent diffusion coefficient (ADC) value on ADC map (D). Regions of interest (red color) were drawn freehand over lymph node (E, arrow). Measured ADC value is 1.22 × 10-3 mm2/s according to reader 1 and 1.10 × 10-3 mm2/s according to reader 2, and which are above threshold for malignancy in previously published studies, and, therefore, are thought to be benign lymph node. However, on histopathologic examination (F), partially involved metastatic foci (asterisk) are observed (original magnification, × 150).

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