Serial magnetic resonance imaging evaluations of irradiated superior cervical sympathetic ganglia: Not every retropharyngeal enlarging mass is a sign of malignancy

Abstract

IntroductionTo describe serial changes in irradiated superior cervical sympathetic ganglia (SCSGs) on MRI (magnetic resonance imaging) evaluation in patients with head and neck squamous cell carcinoma (HNSCC) and to find the features differentiating them from the metastatic retropharyngeal lymph nodes. Materials and methodsThis retrospective study evaluated 52 consecutive patients with definitive radiotherapy with/without chemotherapy for pathologically confirmed HNSCC and pre- and postradiation MRI follow-up evaluations. MR images of SCSGs were analyzed including enhancement pattern, margin, and the presence of intraganglionic hypointensity. ResultsMRI evaluations were performed in 36 men and 16 women with HNSCC with an average age of 58 years, range 23–80 years before irradiation (n=52), and at 6 (n=21) and 13–18 (n=52)months follow-up. Mean total radiation dose was 6351±483 cGy (range, 5640–7000 cGy). Intraganglionic hypointensity, homogeneous enhancement pattern, and well-defined margins were observed in 96%, 97%, and 97% of ganglia on the last follow-up, which showed no difference between pretreatment and 6-month follow-up (P>0.05). Mixed linear model analysis revealed significant increases in diameter and normalized T2SI of SCSGs after irradiation (P< 0.05). ConclusionsDespite of the increase in diameter and normalized T2SI of SCSGs, preservation of intraganglionic hypointensity, well-defined margins and homogeneous enhancement might be helpful for radiologists to identify SCSGs during the follow-up of HNSCC patients.