MR Imaging Criteria for the Prediction of Extranodal Spread of Metastatic Cancer in the Neck

Y. Kimura; M. Sumi; N. Sakihama; F. Tanaka; H. Takahashi; T. Nakamura

doi:10.3174/ajnr.A1088

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Fig 1.
A 63-year-old man with tongue carcinoma. A, Axial T1-weighted (TR/TE = 500/15) image shows an ENS-positive metastatic node (asterisk) at level II. Note the vanishing border sign (arrows) with obliteration of the fat layer between the node and the neighboring sternocleidomastoid muscle. B, Axial fat-suppressed T2-weighted (TR/TE = 4674/80 ms) image shows the flare sign that is around and extending from the same ENS-positive metastatic node (asterisk) as in A. Note that high-intensity signals are present in the interstitial tissues between the sternocleidomastoid muscle and the subcutaneous fat (arrows). C, Coronal fat-suppressed T2-weighted (TR/TE = 4674/80 ms) image shows the flare sign (arrows) caudal to the same ENS-positive metastatic node (asterisk) as in A and B.
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Fig 2.
A 51-year-old man with upper gingival carcinoma. Gadolinium-enhanced axial T1-weighted (TR/TE = 500/15) image shows the irregular boundary (shaggy margin, arrows) of contrast-enhanced metastatic nodes with ENS (asterisk) at levels II and III.
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Fig 3.
Comparison of nodal sizes of ENS-positive and -negative metastatic nodes in the neck. Graph (boxplots) shows distributions of short-axis diameters of ENS-negative (−) (n = 130) and ENS-positive (+) (n = 47) metastatic nodes in the necks from 109 patients with head and neck cancers. The horizontal line is a median (50th percentile) of the measured volumes; the tops and bottoms of the boxes represent the 25th and 75th percentiles, respectively, and whiskers indicate the range from the largest to smallest observed data points within the 1.5 interquartile range presented by the box. The short-axis diameters of ENS (+) metastatic nodes are significantly greater than those of ENS (−) metastatic nodes (P value, Mann-Whitney U test).

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Table 1:
Incidence (%) of MR imaging findings in the necks of patients with head and neck cancers by consensus of 2 radiologists
Vanishing Border Sign^* (T1WI) Flare Sign^* (fsT2WI) Shaggy Margin^* (CET1WI)
Present Absent Present Absent Present Absent
ENS (+) 91 6 90 7 97 0
ENS (−) 10 33 8 35 12 31
Total 101 39 98 42 109 31
Note:—T1WI indicates T1-weighted imaging; fT2WI, fat-suppressed T2-weighted imaging; CET1WI, gadolinium-enhanced T1-weighted imaging.
* The incidence of MR imaging criteria is significantly different between ENS (+) and ENS (−) necks (P < .0001, Fisher exact test).

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Table 2:

Multivariate analyses of MR imaging findings

Variable	Coefficient	95% CI	SE	Odds Ratio	P
Short-axis diameter	−0.029	−0.045 to −0.016	0.009	6.8	.017^*
Vanishing border sign	0.325	0.213 to 0.647	0.258	6.8	.350
Flare sign	−0.773	−0.952 to −0.556	0.325	8.3	.005^*
Shaggy margin	−0.334	−0.22 to −0.462	0.274	7.5	<.001^*

Note:—CI indicates confidence interval.
* Independent and significant MR imaging findings.

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Table 3:

Diagnostic ability of MR imaging criteria for ENS

MR Imaging Findings	Diagnostic Ability (%)
MR Imaging Findings	Sensitivity	Specificity	Accuracy	PPV	NPV
Flare sign (fsT2WI)	77	93	88	83	90
Shaggy margin (CET1WI)	65	99	89	86	86
Short-axis diameter
15 mm	93	66	75	61	94
16 mm	80	85	84	76	88
17 mm	78	84	81	74	87

Note:—fsT2WI indicates fat-suppressed T2-weighted imaging; CET1WI, gadolinium-enhanced T1-weighted imaging; PPV, positive predictive value; NPV, negative predictive value.