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Fig. 3. —38-year-old woman with papillary thyroid carcinoma who received false-negative diagnosis on basis of our criterion. Unenhanced transverse T1-weighted MR image (TR/TE, 700/13; excitations, 2) obtained at level of sternal notch shows metastatic lymph nodes (N) in pretracheal and paratracheal regions. Although fatty tissue in left tracheoesophageal groove (arrowhead) is preserved, invasion of left recurrent laryngeal nerve by metastatic nodes was identified at surgery. B = brachiocephalic vein, E = esophagus, T = trachea, 1 = left common carotid artery, 2 = left subclavian artery, 3 = brachiocephalic artery.