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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:301-311, March 2003
© 2003 American Society of Neuroradiology

HEAD AND NECK

Assessment of Metastatic Cervical Adenopathy Using Dynamic Contrast-Enhanced MR Imaging

Nancy J. Fischbein^a, Susan M. Noworolski^a, Roland G. Henry^a, Michael J. Kaplan^b, William P. Dillon^a and Sarah J. Nelson^a

^a Department of Radiology, University of California, San Francisco, San Francisco, CA
^b Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA

Address reprint requests to Nancy J. Fischbein, MD, Department of Radiology, University of California, San Francisco, Box 0628, Room L-358, 505 Parnassus Avenue, San Francisco, CA 94143

BACKGROUND AND PURPOSE: Morphologic assessment by conventional imaging methods of lymph node metastases in patients with squamous cell carcinoma of the head and neck is, at best, insensitive. Doppler sonography has shown that lymph node metastases exhibit alterations in the number of vessels and blood flow. We assessed the ability of dynamic contrast-enhanced MR imaging to differentiate normal from diseased nodes in this patient population.

METHODS: Twenty-one patients with newly diagnosed squamous cell carcinoma and no previous treatment were studied with the use of a head and neck phased array surface coil. Anatomic imaging included high resolution T1-weighted, fat-saturated fast spin-echo T2-weighted, and contrast-enhanced T1-weighted imaging (0.99–1.32 mm³ voxels). The dynamic contrast-enhanced MR imaging was performed by using a 2D fast spoiled gradient recalled sequence with single dose bolus injection of contrast agent. Calculated values included time to peak, peak enhancement, maximum slope, and washout slope for the enhancement. All patients underwent neck dissection as part of their indicated treatment, and imaging results were correlated with pathologic findings.

RESULTS: Dynamic contrast-enhanced MR imaging and pathology comparisons were obtained for 68 nodes. There was significantly longer time to peak (P < .001), lower peak enhancement (P < .05), lower maximum slope (P < .01), and slower washout slope (P < .05) in the tumor-involved nodes compared with the normal nodes.

CONCLUSION: Analysis of dynamic contrast-enhanced MR imaging can differentiate normal from diseased lymph nodes in patients with squamous cell carcinoma of the head and neck.

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