European Radiology

, Volume 16, Issue 7, pp 1468–1477 | Cite as

Role of diffusion-weighted MR imaging in cervical lymphadenopathy

  • Ahmed Abdel Khalek Abdel RazekEmail author
  • Nermin Yehia Soliman
  • Sahar Elkhamary
  • Mousa K. Alsharaway
  • Ali Tawfik
Head and Neck


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.


Diffusion MR imaging Cervical lymph nodes Head and neck 


  1. 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 207:123–130PubMedGoogle Scholar
  2. 2.
    Castelijns JA, van den Brekel MW (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738PubMedCrossRefGoogle Scholar
  3. 3.
    Kaji A, Mohuchy T, Swartz JD (1997) Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR 18:220–249CrossRefPubMedGoogle Scholar
  4. 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 24:301–311PubMedGoogle Scholar
  5. 5.
    Ishikawa M, Anzai Y (2004) MR imaging of lymph nodes in the head and neck. Neuroimag Clin North Amer 14:679–694CrossRefGoogle Scholar
  6. 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 230:720–726PubMedCrossRefGoogle Scholar
  7. 7.
    Chang VF, Fan YF, Khoo JB (1996) MRI features of central necrosis in metastatic disease. Clin Radiol 51:103–109CrossRefPubMedGoogle Scholar
  8. 8.
    Ferreira T (2003) Comments on Castelijns and van den Brekel: Imaging of lymphadenopathy in the neck. Eur Radiol 13:2236PubMedCrossRefGoogle Scholar
  9. 9.
    Rowley H, Grant E, Roberts T (1999) Diffusion MR imaging. Theory and application. Neuroimag Clin North Amer 9:343–361Google Scholar
  10. 10.
    Wang J, Takashima S, Takayama F et al (2001) Head and neck lesions: characterization with diffusion-weighted echoplanar MR imaging. Radiology 220:621–630PubMedCrossRefGoogle Scholar
  11. 11.
    Sumi M, Takagi Y, Uetani M et al (2002) Diffusion-weighted echoplanar MR imaging of the salivary glands. AJR Am J Roentgenol 178:959–965PubMedGoogle Scholar
  12. 12.
    Sakai O, Curtin HD, Romo LV, Som PM (2000) Lymph node pathology. Benign proliferative, lymphoma and metastatic disease. Radiol Clin North Amer 38:979–998CrossRefGoogle Scholar
  13. 13.
    Markkola AT, Aronen HJ, Paavonen T et al (1996) Spin lock and magnetization transfer imaging of head and neck tumors. Radiology 200:369–375PubMedGoogle Scholar
  14. 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 211:837–842CrossRefGoogle Scholar
  15. 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 23:649–656PubMedGoogle Scholar
  16. 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 24:1627–1634PubMedGoogle Scholar
  17. 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)Google Scholar
  18. 18.
    Gray L, MacFall J (1998) Overview of diffusion imaging. MR Clin North Amer 6:125–138Google Scholar
  19. 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. 121–149Google Scholar
  20. 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. 431Google Scholar
  21. 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 12:1104–1113PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ahmed Abdel Khalek Abdel Razek
    • 2
    Email author
  • Nermin Yehia Soliman
    • 2
  • Sahar Elkhamary
    • 2
  • Mousa K. Alsharaway
    • 1
  • Ali Tawfik
    • 1
  1. 1.ENT & Head & Neck Surgery Departments, Faculty of MedicineMansoura UniversityMansouraEgypt
  2. 2.Diagnostic Radiology Department, Faculty of MedicineMansoura UniversityMansouraEgypt

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