Lymph Nodes of Patients with Regional Metastases from Head and Neck Squamous Cell Carcinoma as a Predictor of Pathologic Outcome: Size Changes at CT before and after Radiation Therapy
Hiroya Ojiria,
Anthony A. Mancusob,
William M. Mendenhallc and
Scott P. Stringerd
a Department of Radiology, the Jikei University School of Medicine, Tokyo, Japan
b Department of Radiology, University of Florida College of Medicine, Gainesville, FL
c Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
d Department of Otorhinolaryngology, University of Florida College of Medicine, Gainesville, FL
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FIG 1. Images in a 46-year-old man with a carcinoma at the base of his tongue (T4N3[3, 3]). (The percentage decrease ratio was calculated as in follows: % decrease ratio = (1 - b/a) x 100, where a and b are the dimensions shown in images A and B, respectively.
A, Pre-RT contrast-enhanced CT image reveals enlarged level 2 lymph nodes (N) on both sides. The one on the right measures 54 x 33 mm, and that on the left, 57 x 45 mm. The nodes contain focal areas of low attenuation. An infiltrative mass involves the lower part of the base of the tongue.
B, Post-RT contrast-enhanced CT image shows a marked decrease in the size of the lymph nodes. The decrease ratio of the largest dimension of the nodes is 59% on the right and 51% on the left. The patient underwent planned post-RT neck dissection on both sides. The surgical specimens were negative on both sides.
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FIG 2. Images in a 64-year-old man with metastatic neck disease from an unknown primary squamous cell carcinoma (TXN2A).
A, Pre-RT contrast-enhanced CT image reveals an enlarged (27 x 22 mm) level 2 lymph node (N) on the left.
B, Post-RT contrast-enhanced CT image shows a small residual mass (arrow) (decrease ratio of the largest dimension of the node, 52%). The patient underwent left neck dissection after this study. The specimen from the left hemineck was negative.
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FIG 3. Images in a 52-year-old man with tongue base carcinoma (T2N2B).
A, Pre-RT contrast-enhanced CT image shows the enlarged (34 x 24 mm) level 2 lymph node (N) on the right. The node contains a focal area of low attenuation.
B, Post-RT contrast-enhanced CT image reveals a minimal decrease in the size of the lymph node (decrease ratio of the largest dimension of the node, 6%). The surgical specimen from planned post-RT neck dissection at level 2 of the right hemineck was positive.
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FIG 4. Images in a 78-year-old woman with pyriform sinus carcinoma (T2N2A).
A, Pre-RT contrast enhanced CT image shows an enlarged (40 x 25 mm) level 4 lymph node (N) on the right. The nodal mass distorts the adjacent right internal jugular vein (J).
B, Post-RT contrast-enhanced CT image shows a slight increase in the size of the lymph node (decrease ratio of the largest dimension, -20%). The internal attenuation is generally lower on this image than on the image in A. The specimen from the right hemineck was positive.
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