Abstract
Aim: to prospectively determine if diffusion weighted magnetic resonance imaging can help in discrimination between benign and malignant lymph nodes in patients with head and neck cancer, using histological results as the standard of reference. Patients & Methods: 40 patients complaining of palpable cervical lymph nodes with unknown primary malignancy or having known head and neck cancer. MRI neck study was done for all patients, including pre and post contrast sequences and DWI. Histopathology was done for all patients. Statistical analysis of the differences in ADC values for benign and malignant nodes was performed, together with further analysis of the differences between the ADC values of metastatic lymph nodes and lymphoma. Results: 30 patients were histopathological proved malignant lymphadenopathy (20 metastatic from head and neck malignancy and 10 primary lymphomas) and 10 patients were histopathological proved benign lymphadenopathy (1 acute reactive lymphadenitis, 1 chronic granulomatous inflammation, 4 chronic non-specific inflammation & 4 reactive lymphoid hyperplasia). A statistically significant difference between ADC values of benign and malignant cervical nodes was reported with a threshold ADC value equal to 1.30 ×10<sup>-3</sup> mm2/sec was identified. The ADC value for lymphoma was less than that for metastatic carcinoma, with high specificity and sensitivity values and a threshold ADC value equal to 0.9 ×10<sup>-3</sup> mm2/sec was identified. Conclusion: MR diffusion imaging is helpful non-invasive method in differentiation between benign and malignant lymph nodes, and to the same extent differentiation between the variant types of malignant lymphadenopathy.
Highlights
The evaluation of cervical lymphadenopathy is important as they serve as an excellent clue to underlying problems
P < 0.05 was considered to indicate a significant difference. This prospective study was conducted on 40 patients with cervical lymphadenopathy from January 2016 to July 2016; 21 males and 19 females, their ages ranged between 11-67 years
Apparent diffusion coefficient (ADC) Values The ADC value for benign LNs ranged between 1.26×10-3 mm2/s – 2.49 x 10-3mm2/s (1.98 ± 0.32×10-3)
Summary
The evaluation of cervical lymphadenopathy is important as they serve as an excellent clue to underlying problems They could be due to infections, autoimmune disorders or malignancies (whether metastatic or lymphomas) [1]. Morphological imaging techniques such as US, CT & MRI allow the detection of enlarged cervical lymph nodes, yet none of these methods reaches the diagnosis. These imaging methods use standard parameters such as size, shape, internal architecture and pattern of enhancement [2,3,4,5]. There is an increasing need for noninvasive imaging techniques to help in discrimination between benign and malignant lymph nodes [8,9,10]
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