European Radiology

, Volume 17, Issue 5, pp 1235–1241 | Cite as

Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes

  • Takashi Nakamura
  • Misa Sumi
Head and Neck


The presence of lymph node metastasis in the neck in patients with head and neck cancer is an important prognostic determinant in staging cancers and in planning surgery and chemo- and radiotherapy for the cancer patients. Therefore, metastatic nodes should be effectively differentiated from benign lymphadenopathies and nodal lymphomas. Here, we review recent advances in the diagnostic imaging of metastatic nodes in the neck, with emphasis placed on the diagnostic performance of MR imaging, Doppler sonography, and CT.


Neck Lymph node Nodal metastasis Squamous cell carcinoma Lymphoma CT Sonography MR imaging 


  1. 1.
    Anzai Y, Brunberg JA, Lufkin RB (1997) Imaging of nodal metastases in the head and neck. J Magn Reson Imaging 7:774–783PubMedCrossRefGoogle Scholar
  2. 2.
    Layland MK, Sessions DG, Lenox J (2005) The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+. Laryngoscope 115:629–639PubMedGoogle Scholar
  3. 3.
    Castelijns JA, van den Brekel MW (2001) Detection of lymph node metastases in the neck: radiologic criteria. AJNR Am J Neuroradiol 22:3–4PubMedGoogle Scholar
  4. 4.
    Steinkamp HJ, Hosten N, Richter C, Schedel H, Felix R (1994) Enlarged cervical lymph nodes at helical CT. Radiology 191:795–798PubMedGoogle Scholar
  5. 5.
    Som PM (1992) Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol 158:961–969PubMedGoogle Scholar
  6. 6.
    van den Brekel MWM, Stel HV, Castelijns JA, Nauta JJP, van der Waal I, Valk J, Meyer CJ, Snow GB (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384PubMedGoogle Scholar
  7. 7.
    Sumi M, Ohki M, Nakamura T (2001) Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR Am J Roentgenol 176:1019–1024PubMedGoogle Scholar
  8. 8.
    Yonetsu K, Sumi M, Izumi M, Ohki M, Eida S, Nakamura T (2001) Contribution of Doppler sonography blood flow information to the diagnosis of metastatic cervical nodes in patients with head and neck cancer: assessment in relation to anatomic levels of the neck. AJNR Am J Neuroradiol 22:163–169PubMedGoogle Scholar
  9. 9.
    van den Brekel MW, Castelijns JA, Snow GB (1998) The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it? AJNR Am J Neuroradiol 19:695–700PubMedGoogle Scholar
  10. 10.
    Rubaltelli L, Proto E, Salmaso R, Bortoletto P, Candiani F, Cagol P (1990) Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings. AJR Am J Roentgenol 155:1241–1244PubMedGoogle Scholar
  11. 11.
    Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220PubMedGoogle Scholar
  12. 12.
    Chikui T, Yonetsu K, Nakamura T (2000) Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol 21:561–567PubMedGoogle Scholar
  13. 13.
    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 230:720–726PubMedCrossRefGoogle Scholar
  14. 14.
    Friedman M, Roberts N, Kirshenbaum GL, Colombo J (1993) Nodal size of metastatic squamous cell carcinoma of the neck. Laryngoscope 103:854–856PubMedCrossRefGoogle Scholar
  15. 15.
    Don DM, Anzai Y, Lufkin RB, Fu YS, Calcaterra TC (1995) Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 105:669–674PubMedCrossRefGoogle Scholar
  16. 16.
    Eida S, Sumi M, Yonetsu K, Kimura Y, Nakamura T (2003) Combination of helical CT and Doppler sonography in the follow-up of patients with clinical N0 stage neck disease and oral cancer. AJNR Am J Neuroradiol 24:312–318PubMedGoogle Scholar
  17. 17.
    Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DS, McNeil BJ (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMedGoogle Scholar
  18. 18.
    Sumi M, Sakihama N, Sumi T, Morikawa M, Uetani M, Kabasawa H, Shigeno K, Hayashi K, Takahashi H, Nakamura T (2003) Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol 24:1627–1634PubMedGoogle Scholar
  19. 19.
    King AD, Tse GMK, Yuen EHY, To EWH, Vlantis AC, Zee B, Chan ABW, van Hasselt AC, Ahuja AT (2004) Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes. Eur J Radiol 52:264–270PubMedCrossRefGoogle Scholar
  20. 20.
    Sumi M, Van Cauteren M, Nakamura T (2006) MR microimaging of benign and malignant nodes in the neck. AJR Am J Roentgenol 186:749–757PubMedCrossRefGoogle Scholar
  21. 21.
    Anzai Y, Prince MR (1997) Iron oxide-enhanced MR lymphography: the evaluation of cervical lymph node metastases in head and neck cancer. J Magn Reson Imaging 7:75–81PubMedCrossRefGoogle Scholar
  22. 22.
    Baghi M, mack MG, Hambek M, Rieger J, Vogl T, Gstoettner W, Knecht R (2005) The efficacy of MRI with ultrasmall superparamagnetic iron oxide particles (USPIO) in head and neck cancers. Anticancer Res 25:3665–3670PubMedGoogle Scholar
  23. 23.
    Anzai Y, Blackwell KE, Hirschowitz SL, Rogers JW, Sato Y, Yuh WTC, Runge VM, Morris MR, McLachlan SJ, Lufkin RB (1994) Initial clinical experience with dextran-coated superparamagnetic iron oxide for detection of lymph node metastases in patients with head and neck cancer. Radiology 192:709–715PubMedGoogle Scholar
  24. 24.
    Wang J, Takashima S, Takayama F, Kawakami S, Saito A, Matsushita T, Momose M, Ishiyama T (2001) Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. Radiology 220:621–630PubMedCrossRefGoogle Scholar
  25. 25.
    Sinha S, Sinha U (2002) Functional magnetic resonance of human breast tumors: diffusion and perfusion imaging. Ann NY Acad Sci 980:95–115PubMedCrossRefGoogle Scholar
  26. 26.
    Guo AC, Cummings TJ, Dash RC, Provenzale JM (2002) Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics. Radiology 224:177–183PubMedCrossRefGoogle Scholar
  27. 27.
    Rubin JM, Bude RO, Carson PL, Bree RL, Adler RS (1994) Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US. Radiology 190:853–856PubMedGoogle Scholar
  28. 28.
    Ariji Y, Kimura Y, Hayashi N, Onitsuka T, Yonetsu K, Hayashi K, Ariji E, Kobayashi T, Nakamura T (1998) Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. AJNR Am J Neuroradiol 19:303–307PubMedGoogle Scholar
  29. 29.
    Tschammler A, Ott G, Schang T, Seelbach-Goebel B, Schwager K, Hahn D (1998) Lymphadenopathy: differentiation of benign from malignant disease—color Doppler US assessment of intranodal angioarchitecture. Radiology 208:117–123PubMedGoogle Scholar
  30. 30.
    Ahuja AT, Ying M (2004) Evaluation of cervical lymph node vascularity: a comparison of colour Doppler, power Doppler and 3-D power Doppler sonography. Ultrasound Med Biol 30:1557–1564PubMedCrossRefGoogle Scholar
  31. 31.
    Ahuja AT, Ying M (2005) Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol 184:1691–1699PubMedGoogle Scholar
  32. 32.
    Dragoni F, Cartoni C, Pescarmona E, Chiarotti F, Puopolo M, Orsi E, Pignoloni P, De Gregoris C, Mandelli F (1999) The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy: results of multivariate analysis. Cancer 85:2485–2490PubMedCrossRefGoogle Scholar
  33. 33.
    Ying M, Ahuja A, Brook F (2004) Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol 30:441–447PubMedCrossRefGoogle Scholar
  34. 34.
    Scholbach T, Scholbach J, Krombach GA, Gagel B, Maneschi P, Di Martino E (2005) New method of dynamic color Doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation. Int J Cancer 114:957–962PubMedCrossRefGoogle Scholar
  35. 35.
    Castelijns JA, van den Brekel MWM (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738PubMedCrossRefGoogle Scholar
  36. 36.
    Kellenberger CJ, Miller SF, Khan M, Gilday DL, Weitzman S, Babyn PS (2004) Initial experience with FSE STIR whole-body MR imaging for staging lymphoma in children. Eur Radiol 14:1829–1841PubMedCrossRefGoogle Scholar
  37. 37.
    Ng SH, Yen TC, Liao CT, Chang JT, Chan SC, Ko SF, Wang HM, Wong HF (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143PubMedGoogle Scholar
  38. 38.
    Pitman KT (2005) Sentinel node localization in head and neck tumors. Semin Nucl Med 35:253–256PubMedCrossRefGoogle Scholar
  39. 39.
    Takes RP, Righi P, Meeuwis CA et al (1998) The value of ultrasound with ultrasound-guided fine-needle aspiration biopsy compared to computed tomography in the detection of regional metastases in the clinically negative neck. Int J Radiat Oncol Biol Phys 40:1027–1032PubMedCrossRefGoogle Scholar
  40. 40.
    van der Brekel MW, Reitsma LC, Quak JJ et al (1999) Sonographically guided aspiration cytology of neck nodes for selection of treatment and follow-up in patients with N0 head and neck cancer. AJNR Am J Neuroradiol 20:1727–1731PubMedGoogle Scholar
  41. 41.
    de Wilt JHW, Thompson JF, Uren RF, Ka VSK, Scolyer RA, McCarthy WH, O’Brien CJ, Quinn MJ, Shannon KF (2004) Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of head and neck. Ann Surg 239:544–552PubMedCrossRefGoogle Scholar
  42. 42.
    Shah JP (1990) Patterns of cervical lymph node metastasis from squamous cell carcinomas of the upper aerodigestive tract. Am J Surg 160:405–409PubMedCrossRefGoogle Scholar
  43. 43.
    Wakisaka M, Mori H, Fuwa N, Matsumoto A (2000) MR analysis of nasopharyngeal carcinoma: correlation of the pattern of tumor extent at the primary site with the distribution of metastasized cervical lymph nodes. Preliminary results. Eur Radiol 10:970–977PubMedCrossRefGoogle Scholar
  44. 44.
    Kimura Y, Sumi M, Ichikawa Y, Kawai Y, Nakamura T (2005) Volumetric MR imaging of oral, maxillary sinus, oropharyngeal, and hypopharyngeal cancers: correlation between tumor volume and lymph node metastasis. AJNR Am J Neuroradiol 26:2384–2389PubMedGoogle Scholar
  45. 45.
    Ross G, Shoaib T, Soutar DS, Camilleri IG, Gray HW, Bessent RG, Robertson AG, MacDonald DG (2002) The use of sentinel node biopsy to upstage the clinically N0 neck in head and neck cancer. Arch Otolaryngol Head Neck Surg 128:1287–1291PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Radiology and Cancer BiologyNagasaki University School of DentistryNagasakiJapan

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