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MR Microimaging of Benign and Malignant Nodes in the Neck

Misa Sumi1, Marc Van Cauteren2 and Takashi Nakamura1

1 Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan. Address correspondence to T. Nakamura
2 Philips Medical Systems, Toyko, Japan.


Figure 1
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  		Fig. 1A —27-year-old healthy male volunteer with enlarged node at level I. Axial T1-weighted (TR/TE, 550/10) MR microimage shows homogeneous parenchyma (arrow) associated with hilum structures containing fat tissue and blood vessels (arrowheads). M = mandible, SMG = submandibular gland. Scale bar indicates 1 cm.

 

Figure 2
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  		Fig. 1B —27-year-old healthy male volunteer with enlarged node at level I. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows same node as in A, with homogeneously hyperintense nodal parenchyma (arrow) contrasting with hypointense fat tissue and hyperintense blood vessels (arrowheads). Scale bar indicates 1 cm.

 

Figure 3
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  		Fig. 2A —76-year-old man with squamous cell carcinoma of mesopharynx. Axial T1-weighted (TR/TE, 550/10) MR microimage shows irregular or blending nodal margin of metastatic parotid node (arrows). PG = parotid gland. Scale bar indicates 1 cm.

 

Figure 4
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  		Fig. 2B —76-year-old man with squamous cell carcinoma of mesopharynx. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows hypointense parenchyma blending into surrounding tissue (arrows). Scale bar indicates 1 cm.

 

Figure 5
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  		Fig. 2C —76-year-old man with squamous cell carcinoma of mesopharynx. Photomicrograph shows extensive proliferation of metastatic cancer cells with destruction of nodal capsule (arrow). Necrotic areas are rarely seen. (H and E, original magnification x1.6)

 

Figure 6
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  		Fig. 3A —70-year-old man with squamous cell carcinoma in larynx. Axial T1-weighted (TR/TE, 550/10) MR microimage shows heterogeneous parenchyma of metastatic node at level IV (arrow). Scale bar indicates 1 cm.

 

Figure 7
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  		Fig. 3B —70-year-old man with squamous cell carcinoma in larynx. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows heterogeneous nodal parenchyma associated with large hyperintense area (arrow). Note thin intermediate to hypointense zone demarcating hyperintense area. Scale bar indicates 1 cm.

 

Figure 8
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  		Fig. 3C —70-year-old man with squamous cell carcinoma in larynx. Photomicrograph shows large area of necrosis (N). In juxtanecrotic area are proliferating cancer cells (C). (H and E, original magnification x1.6)

 

Figure 9
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  		Fig. 4A —62-year-old man with squamous cell carcinoma of mesopharynx. Axial T1-weighted (TR/TE, 550/10) MR microimage shows relatively homogeneous metastatic nodes at level II (arrows). SMG = submandibular gland. Scale bar indicates 1 cm.

 

Figure 10
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  		Fig. 4B —62-year-old man with squamous cell carcinoma of mesopharynx. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows heterogeneous parenchyma (large arrows) with hypointense focus (small arrows) in two metastatic nodes. Note that proximal node (P) also exhibits small hyperintense areas (arrowhead). Scale bar indicates 1 cm.

 

Figure 11
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  		Fig. 4C —62-year-old man with squamous cell carcinoma of mesopharynx. Photomicrograph shows metastatic node (node "P" in B) with cyst formation (N), which has cancer cell lining. C = cancer cell nests. (H and E, original magnification x1.6)

 

Figure 12
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  		Fig. 4D —62-year-old man with squamous cell carcinoma of mesopharynx. Axial T1-weighted (550/10) MR microimage shows homogeneous nodal parenchyma of metastatic node at level II (arrow). SMG = submandibular gland. Scale bar indicates 1 cm.

 

Figure 13
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  		Fig. 4E —62-year-old man with squamous cell carcinoma of mesopharynx. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows heterogeneous parenchyma (large arrow) with hypointense area (small arrow). Scale bar indicates 1 cm.

 

Figure 14
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  		Fig. 4F —62-year-old man with squamous cell carcinoma of mesopharynx. Photomicrograph shows large area of cancer cell nests (C) and residual lymphoid tissues of node (L). Arrowhead indicates dense fibrous stroma among cancer nests. Note that no apparent liquefaction necrosis is evident. (H and E, original magnification x1.6)

 

Figure 15
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  		Fig. 5A —53-year-old man with non-Hodgkin's lymphoma (follicular lymphoma) at level I. Axial T1-weighted (TR/TE, 550/10) MR microimage shows homogeneous node (large arrow) lacking hilar fat structure. Hypointense streaks ("small-vessel" sign) (small arrow) radiating toward periphery of node are evident. Scale bar indicates 1 cm.

 

Figure 16
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  		Fig. 5B —53-year-old man with non-Hodgkin's lymphoma (follicular lymphoma) at level I. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows homogeneously hyperintense parenchyma (large arrow) and small-vessel sign (small arrow). Scale bar indicates 1 cm.

 

Figure 17
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  		Fig. 5C —53-year-old man with non-Hodgkin's lymphoma (follicular lymphoma) at level I. Photomicrograph shows proliferating lymphoma cells occupying entire node. (H and E, original magnification x1.6)

 

Figure 18
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  		Fig. 6A —52-year-old woman with lymphadenitis of nodes at level II. Axial T1-weighted (TR/TE, 550/10) MR microimage shows homogeneous parenchyma (arrow). PG = parotid gland. Scale bar indicates 1 cm.

 

Figure 19
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  		Fig. 6B —52-year-old woman with lymphadenitis of nodes at level II. Axial fat-suppressed T2-weighted (3,000/90) MR microimage shows hypointense area (small arrow) in center of parenchyma (large arrow), from which hyperintense striations radiate to periphery. Scale bar indicates 1 cm.

 

Figure 20
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  		Fig. 6C —52-year-old woman with lymphadenitis of nodes at level II. Power Doppler sonogram shows blood flow signals in hilar region.

 

Figure 21
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  		Fig. 7 —Graph of box plots shows apparent diffusion coefficient (ADC) levels of metastatic nodes, nodal lymphomas, and benign nodes. Horizontal line in each box is median (50th percentile) of measured values; top and bottom of boxes represent 25th and 75th percentiles, respectively; and whiskers indicate range from largest to smallest observed data points within 1.5 interquartile range presented by box. Values for p were determined using Mann-Whitney U test. Circles = outliers.

 

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