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AJNR - American Journal of Neuroradiology

Published ahead of print on April 10, 2008
doi: 10.3174/ajnr.A1088

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MR Imaging Criteria for the Prediction of Extranodal Spread of Metastatic Cancer in the Neck

Y. Kimura^a, M. Sumi^a, N. Sakihama^b, F. Tanaka^b, H. Takahashi^b and T. Nakamura^a

^a Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
^b Department of Otolaryngology, Nagasaki University School of Medicine, Nagasaki, Japan

View larger version (56K): [in this window] [in a new window]   Fig 1. A 63-year-old man with tongue carcinoma. A, Axial T1-weighted (TR/TE = 500/15) image shows an ENS-positive metastatic node (asterisk) at level II. Note the vanishing border sign (arrows) with obliteration of the fat layer between the node and the neighboring sternocleidomastoid muscle. B, Axial fat-suppressed T2-weighted (TR/TE = 4674/80 ms) image shows the flare sign that is around and extending from the same ENS-positive metastatic node (asterisk) as in A. Note that high-intensity signals are present in the interstitial tissues between the sternocleidomastoid muscle and the subcutaneous fat (arrows). C, Coronal fat-suppressed T2-weighted (TR/TE = 4674/80 ms) image shows the flare sign (arrows) caudal to the same ENS-positive metastatic node (asterisk) as in A and B.

View larger version (137K): [in this window] [in a new window]   Fig 2. A 51-year-old man with upper gingival carcinoma. Gadolinium-enhanced axial T1-weighted (TR/TE = 500/15) image shows the irregular boundary (shaggy margin, arrows) of contrast-enhanced metastatic nodes with ENS (asterisk) at levels II and III.

View larger version (12K): [in this window] [in a new window]   Fig 3. Comparison of nodal sizes of ENS-positive and -negative metastatic nodes in the neck. Graph (boxplots) shows distributions of short-axis diameters of ENS-negative (–) (n = 130) and ENS-positive (+) (n = 47) metastatic nodes in the necks from 109 patients with head and neck cancers. The horizontal line is a median (50th percentile) of the measured volumes; the tops and bottoms of the boxes represent the 25th and 75th percentiles, respectively, and whiskers indicate the range from the largest to smallest observed data points within the 1.5 interquartile range presented by the box. The short-axis diameters of ENS (+) metastatic nodes are significantly greater than those of ENS (–) metastatic nodes (P value, Mann-Whitney U test).