Article Figures & Data
Figures
- Fig. 1.
Box-and-whisker plot presenting the scatterplot of mean apparent diffusion coefficients in all lymph nodes and subcentimeter and supracentimeter lymph nodes.
- Fig. 2.
ROC curves were created for all lymph nodes and subcentimeter and supracentimeter lymph nodes. The cutoff ADC values were 0.851 × 10−3 mm2/s, 0.884 × 10−3 mm2/s, and 0.851 × 10−3 mm2/s for all lymph nodes and subcentimeter and supracentimeter lymph nodes and were used to differentiate malignant from benign lymph nodes. The best results obtained were sensitivities of 91.3%, 100%, and 100%, specificities of 91.1%, 80.4%, and 91.8%, respectively. The areas under the curve were 0.97, 0.96, and 0.99.
- Fig. 3.
A 60-year-old male patient with pathologically proved squamous cell carcinoma of the hypopharynx. A, The axial T2-weighted MR image shows an infiltrative neoplasm in the right pyriform apex of the hypopharynx (curved arrow) and enlarged lymph nodes in the bilateral level III, showing heterogeneous signal intensity (arrow and arrowhead). B, The axial postgadolinium fat-suppressed T1-weighted FSE image reveals mild peripheral enhancement in the right pyriform apex tumor (curved arrow) and heterogeneous enhancement in bilateral level III lymph nodes (arrow and arrowhead). C, The ADC value within the right level III lymph node measured 0.712 × 10−3 mm2/s (arrowhead), and the left level III lymph node measured 0.659 × 10−3 mm2/s (arrow). D, Corresponding H&E-stained histopathologic slide shows intranodal tumor cell metastasis (arrow) (original magnification, ×20).
- Fig. 4.
A 59-year-old male patient with pathologically proved squamous cell carcinoma of the hypopharynx and metastatic lymphadenopathy of the right level V lymph nodes. A, The axial T2-weighted MR image shows a subcentimeter lymph node with high signal intensity at right level V (arrow). B, The axial postgadolinium fat-suppressed T1-weighted image reveals moderate enhancement in the right pyriform apex tumor (arrowhead) and heterogeneous enhancement in the right level V lymph nodes (arrow). C, The ADC value was 0.811 × 10−3 mm2/s (arrow) in the right level V lymph node.
- Fig. 5.
A 28-year-old female patient with pathologically proved squamous cell carcinoma of the right tongue body with right level I lymph node metastasis. A, The axial T2-weighted MR image shows no necrotic change of the right level I lymph node (arrow). B, The axial T1-weighted MR image shows normal configuration and size of the right level I lymph node with fatty content in its hilar region (arrow). C, The axial postgadolinium fat-suppressed T1-weighted FSE image reveals homogeneous enhancement of the right level I lymph node (arrow). D, The ADC value within the right level I lymph node measured 0.839 × 10−3 mm2/s (arrow).
Tables
- Table 1:
Tumor location, clinical tumor stages, and nodal stages according to TSE MR imaging, histopathology, and DWI
Patient No. Primary Tumor Location Clinical Tumor Stage Nodal Stage TSE Histopathology DWI 1 Buccal T1 N0 N0 N0 2 Oropharynx (palate) T2 N2b N2b N0 3 Buccal T3 N2b N1 N1 4 Tongue T1 Nx N0 N0 5 Mouth floor T1 N0 N0 N0 6 Tongue T2 N0 N0 N0 7 Tongue T4a N2b N2c N2c 8 Tongue T1 N1 N0 N1 9 Tongue T2 N0 N0 N0 10 Hypopharynx and epiglottis T2 N1 N0 N1 11 Tongue T1 N0 N0 N0 12 Palate T4a N2b N0 N0 13 Tongue T1 N0 N0 N0 14 Tongue T4a N2b N0 N0 15 Tongue T2 N0 N0 N0 16 Tongue T3 N2c N0 N2c 17 Tongue T2 N0 N0 N0 18 Tongue T4a N2b N2b N2b 19 Tongue T2 N0 N2b N2b 20 Hypopharynx and pyriform sinus T4a N1 N2b N1 21 Retromolar T4b N2b N2b N2b 22 Hypopharynx and pyriform sinus T2 N2c N2c N2c Patient No. Age (yr) Sex Lesion Lymph Nodea LN Size (cm) ADC (×10−3 mm2/s)a 18 44 M Tongue cancer LN3 0.84 0.715 ± 0.126 LN6 1.08 0.635 ± 0.143 LN13 0.63 0.460 ± 0.165 LN14 0.78 0.735 ± 0.067 LN16 0.60 0.678 ± 0.193 20 59 M Hypopharynx cancer LN1 0.56 0.811 ± 0.069 7 44 M Tongue cancer LN4 1.44 0.753 ± 0.089 LN5 0.89 0.884 ± 0.207 LN13 0.36 0.723 ± 0.162 LN15 0.74 0.437 ± 0.221 LN19 0.44 0.666 ± 0.270 22 60 M Hypopharynx cancer LN1 1.04 0.655 ± 0.090 LN2 1.36 0.731 ± 0.082 LN3 1.35 0.751 ± 0.127 LN4 1.58 0.659 ± 0.073 LN5 1.82 0.712 ± 0.154 LN6 1.72 0.598 ± 0.028 21 50 M Oral cancer LN2 0.85 0.676 ± 0.139 LN7 0.50 0.816 ± 0.094 3 51 M Buccal cancer LN14 0.99 0.559 ± 0.043 19 28 F Tongue cancer LN2 0.55 0.839 ± 0.057 LN6 0.67 0.875 ± 0.090 LN7 1.84 0.851 ± 0.109 Note:—LN indicates lymph node.
↵a Mean ± SD.
LN(a) group LN Diameter (cm) B/M ADC Cutoff Value (×10−3 mm2/s) ADC Value (×10−3mm2/s)a Benign Malignant Sensitivity (%) Specificity (%) P AUCb Benign Malignant All 0.27–2.89 146/23 0.851 1.086 ± 0.222 (0.578–1.932) 0.705 ± 0.118 (0.437–0.884) 91.3 91.1 <.0001 0.97 (0.93–0.99) Subcentimeter 0.27–0.99 97/14 0.884 1.076 ± 0.238 (0.578–1.932) 0.705 ± 0.141 (0.437–0.884) 100 80.4 <.0001 0.95 (0.90–0.98) Supracentimeter 1.00–2.89 49/9 0.851 1.105 ± 0.188 (0.771–1.494) 0.705 ± 0.077 (0.598–0.851) 100 91.8 <.0001 0.97 (0.92–0.99)
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