Abstract
Introduction
To describe the unique MRI findings of superior cervical ganglia (SCG) that may help differentiate them from retropharyngeal lymph nodes (RPLNs).
Methods
A retrospective review of post-treatment NPC patients from 1999 to 2012 identified three patients previously irradiated for NPC that were suspected of having recurrent nodal disease in retropharyngeal lymph nodes during surveillance MRI. Subsequent surgical exploration revealed enlarged SCG only; no retropharyngeal nodal disease was found.
A cadaveric head specimen was also imaged with a 3T MRI before and after dissection. In addition, SCG were also harvested from three cadaveric specimens and subjected to histologic analysis.
Results
The SCG were found at the level of the C2 vertebral body, medial to the ICA. They were ovoid on axial images and fusiform and elongated with tapered margins in the coronal plane. T2-weighted (T2W) signal was hyperintense. No central elevated T1-weighted (T1W) signal was seen within the ganglia in non-fat-saturated sequences to suggest the presence of a fatty hilum. Enhancement after gadolinium was present. A central “black dot” was seen on axial T2W and post-contrast images in two of the three SCG demonstrated. Histology showed the central black line was comprised of venules and interlacing neurites within the central portion of the ganglion.
Conclusions
The SCG can be mistaken for enlarged RPLNs in post-treatment NPC patients. However, there are features which can help differentiate them from RPLNs, preventing unnecessary therapy. These imaging findings have not been previously described.
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Abbreviations
- RPLN:
-
Retropharyngeal lymph node
- SCG:
-
Superior cervical ganglion/ganglia
- NPC:
-
Nasopharyngeal cancer
- ICA:
-
Internal carotid artery
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Acknowledgments
We would like to acknowledge Dr. Mark Khoo (Mount Elizabeth Hospital Novena, Singapore) for his kind assistance in the cadaveric dissection.
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We declare that all human and animal studies have been approved by the National Healthcare Group Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that the Institutional Review Board waived consent for this study.
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We declare that we have no conflict of interest.
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Loke, S.C., Karandikar, A., Ravanelli, M. et al. Superior cervical ganglion mimicking retropharyngeal adenopathy in head and neck cancer patients: MRI features with anatomic, histologic, and surgical correlation. Neuroradiology 58, 45–50 (2016). https://doi.org/10.1007/s00234-015-1598-1
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DOI: https://doi.org/10.1007/s00234-015-1598-1