Skip to main content

Advertisement

Log in

Role of diffusion-weighted MR imaging in cervical lymphadenopathy

  • Head and Neck
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The role of diffusion-weighted magnetic resonance imaging (MRI) for differentiation between various causes of cervical lymphadenopathy was evaluated. In a prospective study, 31 untreated patients (22 males and nine females, aged 5–70 years) with 87 cervical lymph nodes underwent diffusion-weighted MRI before performance of neck dissection (n=14), surgical biopsy (n=9) or core biopsy (n=8). Diffusion-weighted MR images were acquired with a b factor of 0 and 1,000 s/mm2 using single-shot echo-planar sequence. Apparent diffusion coefficient (ADC) maps were reconstructed for all patients. The signal intensity of the lymph nodes was assessed on images obtained at b=0 or 1,000 s/mm2 and from the ADC maps. The ADC value of lymph nodes was also calculated. On the ADC map, malignant nodes showed either low (n=52) or mixed (n=20) signal intensity and benign nodes revealed high (n=13) or low (n=2) signal intensity. The mean ADC value of metastatic (1.09±0.11×10−3 mm2/s) and lymphomatous (0.97±0.27×10−3 mm2/s) lymph nodes was significantly lower than that of benign (1.64±0.16×10−3 mm2/s) cervical lymph nodes (P<0.04). When an ADC value of 1.38×10−3 mm2/s was used as a threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with an accuracy of 96%, sensitivity of 98%, specificity of 88%, positive predictive value of 98.5% and negative predictive value of 83.7%. The smallest detected lymph node was 0.9 cm. In conclusion, diffusion-weighted MRI with ADC mapping is a new promising technique that can differentiate malignant from benign lymph nodes and delineate the solid viable part of the lymph node for biopsy. This technique provides additional useful physiological and functional information regarding characterization of cervical lymph nodes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–d
Fig. 2a–d
Fig. 3a–d
Fig. 4a–d
Fig. 5a–d
Fig. 6a–d
Fig. 7a–d
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Curtin HD, Ishwaran H, Mancouso AA, Dalley RW, Caudry DJ, McNeil BJ (1998) Comparison of CT and MR imaging in staging of neck metastsis. Radiology 207:123–130

    PubMed  CAS  Google Scholar 

  2. Castelijns JA, van den Brekel MW (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738

    Article  PubMed  Google Scholar 

  3. Kaji A, Mohuchy T, Swartz JD (1997) Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR 18:220–249

    Article  PubMed  CAS  Google Scholar 

  4. Fischbein N, Noworolski S, Herny R, Kaplan M, Dillon W, Nelson S (2003) Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 24:301–311

    PubMed  Google Scholar 

  5. Ishikawa M, Anzai Y (2004) MR imaging of lymph nodes in the head and neck. Neuroimag Clin North Amer 14:679–694

    Article  Google Scholar 

  6. King AD, Tse GM, Ahuja AT, Yuen EH, Vlantis AC, To EW, van Hasselt AC (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology 230:720–726

    Article  PubMed  Google Scholar 

  7. Chang VF, Fan YF, Khoo JB (1996) MRI features of central necrosis in metastatic disease. Clin Radiol 51:103–109

    Article  PubMed  Google Scholar 

  8. Ferreira T (2003) Comments on Castelijns and van den Brekel: Imaging of lymphadenopathy in the neck. Eur Radiol 13:2236

    Article  PubMed  Google Scholar 

  9. Rowley H, Grant E, Roberts T (1999) Diffusion MR imaging. Theory and application. Neuroimag Clin North Amer 9:343–361

    CAS  Google Scholar 

  10. Wang J, Takashima S, Takayama F et al (2001) Head and neck lesions: characterization with diffusion-weighted echoplanar MR imaging. Radiology 220:621–630

    Article  PubMed  CAS  Google Scholar 

  11. Sumi M, Takagi Y, Uetani M et al (2002) Diffusion-weighted echoplanar MR imaging of the salivary glands. AJR Am J Roentgenol 178:959–965

    PubMed  Google Scholar 

  12. Sakai O, Curtin HD, Romo LV, Som PM (2000) Lymph node pathology. Benign proliferative, lymphoma and metastatic disease. Radiol Clin North Amer 38:979–998

    Article  CAS  Google Scholar 

  13. Markkola AT, Aronen HJ, Paavonen T et al (1996) Spin lock and magnetization transfer imaging of head and neck tumors. Radiology 200:369–375

    PubMed  CAS  Google Scholar 

  14. Yoshino N, Yamada I, Ohbayashi N et al (2001) Salivary gland and lesions: evaluation of apparent diffusion coefficient with split echo diffusion weighted MT imaging-initial results. Radiology 211:837–842

    Article  Google Scholar 

  15. Hudgins PA, Anzai Y, Morris M, Lucas M (2002) Ferumoxtran-10, a superparamagentic iron oxide as a magnetic resonance enhancement agent for imaging lymph nodes: a phase 2 dose study. AJNR Am J Neuroradiol 23:649–656

    PubMed  Google Scholar 

  16. Sumi M, Sakiham N, Sumi T et al (2003) Discrimination of metastatic lymph nodes with diffusion MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol 24:1627–1634

    PubMed  Google Scholar 

  17. Herneth AM, Czerny C, Krestan C (2003) Role of diffusion weighted MRI in the characterization of lymph node metastasis. XVI International Congress of Head and Neck Radiology, Frankfurt (Abstract)

  18. Gray L, MacFall J (1998) Overview of diffusion imaging. MR Clin North Amer 6:125–138

    CAS  Google Scholar 

  19. Anderson JR, Tumours I ( 1985) General features, types and examples. In: Anderson JR (ed) Muir’s textbook of pathology, 20th edn. Edward Arnold, London, pp. 121–149

    Google Scholar 

  20. Abdel Razek A, Tawfik A, Rizk N (2002) Role of diffusion trace MR imaging in differentiation between viable and necrotic head and neck tumors. Abstracts of the 88th Scientific Assembly and Annual Meeting of the Radiologic Society of North America, Chicago, p. 431

  21. Sigal R, Vogl T, Casselman J et al (2002) Lymph node metastasis from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sirerem MR)—results of a phase-III multicenter clinical trial. Eur Radiol 12:1104–1113

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmed Abdel Khalek Abdel Razek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abdel Razek, A.A.K., Soliman, N.Y., Elkhamary, S. et al. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 16, 1468–1477 (2006). https://doi.org/10.1007/s00330-005-0133-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-005-0133-x

Keywords

Navigation