Comparison of Dynamic Helical CT and Dynamic MR Imaging in the Evaluation of Pelvic Lymph Nodes in Cervical Carcinoma
Wei Tse Yang1,
Wynnie Wai Man Lam1,
Mei Yung Yu2,
Tak Hong Cheung3 and
Constantine Metreweli1
1
Department of Diagnostic Radiology and Organ Imaging, Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
2
Department of Anatomical and Cellular Pathology, Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
3
Department of Obstetrics and Gynecology, Chinese University of Hong Kong,
Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Fig. 1A. —31-year-old woman with right hypogastric lymph node metastasis found
at pathology. Unenhanced axial CT scan of pelvis shows round mildly hypodense
nodule (arrow) in right hypogastric region.
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Fig. 1B. —31-year-old woman with right hypogastric lymph node metastasis found
at pathology. Arterial phase axial CT scan obtained at same level as A
shows heterogeneous peripheral enhancement of node (solid arrow) and
external iliac artery (open arrow) opacification.
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Fig. 1C. —31-year-old woman with right hypogastric lymph node metastasis found
at pathology. Venous phase CT scan obtained at same level as B shows
peripheral rim enhancement of node (long black arrow). Prominence of
intranodal necrosis exceeds that seen in A and B. Note iliac
vein (short black arrow) enhancement and ureteric (curved white
arrow) opacification.
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Fig. 1D. —31-year-old woman with right hypogastric lymph node metastasis found
at pathology. Axial short-tau inversion-recovery fat-suppressed T2-weighted MR
image obtained at same level as C shows right hypogastric node
(solid arrow) with hyperintense area (open arrow) that was
hypointense on T1-weighted image (not shown), representing intranodal
necrosis.
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Fig. 2A. —39-year-old woman with left external iliac nodal metastasis at
pathology. Unenhanced axial T1-weighted MR image shows ovoid hypointense
nodule (arrow) in left external iliac region.
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Fig. 2B. —39-year-old woman with left external iliac nodal metastasis at
pathology. Dynamic contrast-enhanced MR image obtained at same level as
A shows heterogeneous peripheral enhancement (arrows) with
nonenhancing central necrotic region (asterisk).
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Fig. 3. —Receiving operating characteristic curves of maximal axial diameter
obtained with CT (dotted line) and with MR imaging (solid
line) show area under curve to be 85.7% and 83.5%, respectively.
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Fig. 4. —Receiving operating characteristic curves of minimal axial diameter
obtained with CT (dotted line) and with MR imaging (solid
line) show area under curve to be 81.7% and 86.8%, respectively.
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Fig. 5. —Scatterplot of unenhanced signal intensity of pelvic nodes measured
in patients with benign and in those with malignant pelvic lymph nodes at
histology. Although mean value of unenhanced signal intensity for malignant
nodes (704 ± 224) is lower than that for benign nodes (833 ±
252), significant overlap exists.
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Fig. 6. —Bar chart displays distribution of peak rate of enhancement on MR
imaging for nodes in patients with histologic benign (white bars) and
malignant (black bars) disease. Malignant nodes showed earlier peak
rate of enhancement compared with benign nodes, but difference was not
significant (p > 0.5).
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Copyright © 2000 by the American Roentgen Ray Society.
