The aim of this study was to systematically compare a comprehensive array of magnetic resonance (MR) imaging features in terms of their sensitivity and specificity to diagnose cervical lymph node metastases in patients with thyroid cancer.
Materials and methods
The study included 41 patients with thyroid malignancy who underwent surgical excision of cervical lymph nodes and had preoperative MR imaging ≤4weeks prior to surgery. Three head and neck neuroradiologists independently evaluated all the MR images. Using the pathology results as reference, the sensitivity, specificity and interobserver agreement of each MR imaging characteristic were calculated.
On multivariate analysis, no single imaging feature was significantly correlated with metastasis. In general, imaging features demonstrated high specificity, but poor sensitivity and moderate interobserver agreement at best.
Commonly used MR imaging features have limited sensitivity at correctly identifying cervical lymph node metastases in patients with thyroid cancer. A negative neck MR scan should not dissuade a surgeon from performing a neck dissection in patients with thyroid carcinomas.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
van den Brekel MW, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384
Gross ND, Weissman JL, Talbot JM et al (2001) MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope 111:1905–1909
Feinmesser R, Freeman JL, Noyek AM, Birt BD (1987) Metastatic neck disease. A clinical/radiographic/pathologic correlative study. Arch Otolaryngol Head Neck Surg 113:1307–1310
Mizowaki T, Nishimura Y, Shimada Y et al (1996) Optimal size criteria of malignant lymph nodes in the treatment planning of radiotherapy for esophageal cancer: evaluation by computed tomography and magnetic resonance imaging. Int J Radiat Oncol Biol Phys 36:1091–1098
Krestan C, Herneth AM, Formanek M, Czerny C (2006) Modern imaging lymph node staging of the head and neck region. Eur J Radiol 58:360–366
Friedman M, Shelton VK, Mafee M et al (1984) Metastatic neck disease. Evaluation by computed tomography. Arch Otolaryngol Head Neck Surg 110:443–447
Stevens MH, Harnsberger R (1988) Computed tomography in evaluating metastatic neck disease. Arch Otolaryngol Head Neck Surg 114:1041
Close LG, Merkel M, Vuitch MF et al (1989) Computed tomographic evaluation of regional lymph node involvement in cancer of the oral cavity and oropharynx. Head Neck 11:309–317
Mancuso AA, Maceri D, Rice D, Hanafee W (1981) CT of cervical lymph node cancer. AJR Am J Roentgenol 136:381–385
Som PM (1987) Lymph nodes of the neck. Radiology 165:593–600
King AD, Tse GM, Ahuja AT et al (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology 230:720–726
Som PM (1992) Detection of metastasis in cervical lymph nodes: CT and Mr criteria and differential diagnosis. AJR Am J Roentgenol 158:961–969
de Bondt RB, Nelemans PJ, Bakers F et al (2009) Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes. Eur Radiol 19:626–633
Huber PJ (1965) The behaviour of maximum likelihood estimates under nonstandard conditions. Proc Fifth Berkeley Symp Math Stat Probab 1:221–233
White H (1982) Maximum likelihood estimation of misspecified models. Econometrica 50:1–25
Park JS, Son KR, Na DG et al (2009) Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol 192:66–72
Choi JS, Kim J, Kwak JY et al (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878
Amdur RJ, Mazzaferri EL (2005) Intravenous iodinated contrast effects iodine uptake for months. In: Amdur RJ, Mazzaferri EL (eds) Essentials of thyroid cancer management, 1st edn. Springer, New York, pp 211–213
Johnson NA, LeBeau SO, Tublin ME (2011) Imaging surveillance of differentiated thyroid cancer. Radiol Clin N Am 49:473–487
Choi WH, Chung YA, Han EJ et al (2011) Clinical value of integrated [18f]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in the preoperative assessment of papillary thyroid carcinoma: comparison with sonography. J Ultrasound Med 30:1267–1273
Jeong HS, Baek CH, Son YI et al (2006) Integrated 18f-fdg pet/ct for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol 65:402–407
Christensen CR, Glowniak JV, Brown PH, Morton KA (2000) The effect of gadolinium contrast media on radioiodine uptake by the thyroid gland. J Nucl Med Technol 28:41–44
Takashima S, Sone S, Takayama F et al (1998) Papillary thyroid carcinoma: MR diagnosis of lymph node metastasis. AJNR Am J Neuroradiol 19:509–513
Conflict of interest
The authors have no disclosure.
Ethical standards were respected and the Institute/Hospital Ethical Review Board has approved the study.
About this article
Cite this article
Chen, Q., Raghavan, P., Mukherjee, S. et al. Accuracy of MRI for the diagnosis of metastatic cervical lymphadenopathy in patients with thyroid cancer. Radiol med 120, 959–966 (2015). https://doi.org/10.1007/s11547-014-0474-0
- Thyroid cancer
- Neck dissection
- Metastatic lymph nodes