Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan.
Eur J Radiol. 2012 Nov;81(11):3326-31. doi: 10.1016/j.ejrad.2012.06.018. Epub 2012 Jul 17.
To compare the diagnostic ability of ultrasonography (US) and MR imaging for discriminating squamous cell carcinoma (SCC) nodes with extranodal spread (ENS) in the neck.
US and MR imaging was retrospectively evaluated for differentiating ENS-positive (n=28) from ENS-negative (n=26) SCC nodes (>10mm short-axis diameter) in 50 patients with head and neck SCCs. We assessed nodal size on US and MR images; irregular nodal margin on US; and vanishing nodal border, flare, and shaggy nodal margin signs on T1-, fat-suppressed T2-, and contrast-enhanced T1-weighted MR images, respectively. US and MR images were analyzed by 3 radiologists in consensus and the results were compared between ENS-positive and ENS-negative SCC nodes.
The nodal sizes of ENS-positive nodes (21±9 mm) were significantly larger than those of ENS-negative SCC nodes (14±4 mm) (p<0.001). Irregular nodal margins were more frequently observed in ENS-positive SCC nodes (75%) than in ENS-negative SCC nodes (12%). The vanishing nodal margin, flare, and shaggy nodal margin signs were more frequently observed in ENS-positive SCC nodes (93%, 89%, and 82%, respectively) than in ENS-negative nodes (46%, 19%, and 19%, respectively). A combination of size (≥22 mm) and imaging criteria (irregular margin or flare sign) best discriminated ENS-positive SCC nodes with 82% sensitivity, 89% specificity, and 85% accuracy for US and 89% sensitivity, 81% specificity, and 85% accuracy for MR imaging.
US discriminated ENS-positive from ENS-negative SCC nodes with comparable accuracy and higher specificity than MR imaging.
比较超声（US）和磁共振成像（MR 成像）鉴别颈部鳞状细胞癌（SCC）伴淋巴结外扩散（ENS）的诊断能力。
回顾性评估 50 例头颈部 SCC 患者的 28 个 ENS 阳性（短轴直径>10mm）和 26 个 ENS 阴性 SCC 淋巴结的 US 和 MR 成像，以区分 ENS 阳性和 ENS 阴性 SCC 淋巴结。我们评估了 US 和 MR 图像上的淋巴结大小；US 上的不规则淋巴结边缘；以及 T1 加权、脂肪抑制 T2 加权和对比增强 T1 加权 MR 图像上的消失淋巴结边界、闪烁和毛茸茸的淋巴结边缘征象。由 3 位放射科医生进行共识分析，比较 ENS 阳性和 ENS 阴性 SCC 淋巴结的结果。
ENS 阳性淋巴结（21±9mm）的大小明显大于 ENS 阴性 SCC 淋巴结（14±4mm）（p<0.001）。不规则的淋巴结边缘在 ENS 阳性 SCC 淋巴结（75%）中比在 ENS 阴性 SCC 淋巴结（12%）中更常见。在 ENS 阳性 SCC 淋巴结中，消失的淋巴结边界、闪烁和毛茸茸的淋巴结边缘征象更常见（分别为 93%、89%和 82%），而在 ENS 阴性淋巴结中，这些征象分别为 46%、19%和 19%。大小（≥22mm）和影像学标准（不规则边缘或闪烁征象）的组合对 US 诊断 ENS 阳性 SCC 淋巴结的敏感性为 82%，特异性为 89%，准确性为 85%；对 MR 成像的敏感性为 89%，特异性为 81%，准确性为 85%。
US 鉴别 ENS 阳性和 ENS 阴性 SCC 淋巴结的准确性与 MR 成像相当，但特异性更高。
