From Diagnostic Radiology and Radiation Oncology (H.Y., H.M., S.H., T.U.), Graduate School of Medicine, Chiba University, Chiba, Japan
From Diagnostic Radiology and Radiation Oncology (H.Y., H.M., S.H., T.U.), Graduate School of Medicine, Chiba University, Chiba, Japan.
AJNR Am J Neuroradiol. 2018 Jan;39(1):170-176. doi: 10.3174/ajnr.A5434. Epub 2017 Nov 9.
The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes.
This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients.
All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 × 10mm/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 × 10mm/s, < .001, and 0.73 ± 0.10 × 10mm/s, < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve ( < .001 to = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion ( < .001 to = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral.
The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.
颈上神经节和迷走神经下神经节可模拟病理性咽后淋巴结。我们研究了颈上神经节和迷走神经下神经节的横断解剖结构，以评估它们与咽后淋巴结的区别。
本回顾性研究分为 2 部分。队列 1 涉及 30 例患者的颈常规 MR 成像 2D 序列、表观扩散系数和颈上神经节对比增强与伴或不伴转移的淋巴结之间的信号强度比较。队列 2 使用 3D 神经成像评估 50 例其他患者颈上神经节、迷走神经下神经节和咽后淋巴结的形态和空间关系。
所有颈上神经节的增强程度均明显高于淋巴结，弥散加权成像上的信号也低于淋巴结。颈上神经节的表观扩散系数值（1.80 ± 0.28×10mm/s）明显高于正常和转移性淋巴结（0.86 ± 0.10×10mm/s， <.001，和 0.73 ± 0.10×10mm/s， <.001）。60 个颈上神经节中有 10 个和 13 个在 T2 加权图像上呈低信号，在 T1 和 T2 加权图像上均有高信号点，后者被认为是脂肪组织。最大的是颈上神经节，其次是咽后淋巴结，然后是迷走神经下神经节（ <.001 至 =.004）。在椎体水平，最高的是咽后淋巴结，其次是迷走神经下神经节和颈上神经节（ <.001 至 =.001）。咽后淋巴结、颈上神经节和迷走神经下神经节从前内侧到后外侧形成一条线。
通过评估信号、大小和位置，颈上神经节和迷走神经下神经节在 MR 成像上几乎总能与咽后淋巴结区分开来。
