title: Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease.
abstract: BACKGROUND
  The purpose was to use MR imaging to document the patterns of nodal involvement in the upper neck in nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  The MR images of 150 patients with newly diagnosed NPC were reviewed retrospectively. Nodes were considered abnormal on MR criteria of size, necrosis, and extracapsular spread.
  
  
  RESULTS
  Retropharyngeal nodes (RN) were more frequently involved than nonretropharyngeal nodes (NRNs) (94% vs 76% in 115 patients with nodal metastases). NRN involvement without RN was seen in only 7 of 115 patients (6%). Involvement of RN at the level of the oropharynx (82%) was as common as at the nasopharynx (83%) level. Internal jugular nodes were the most frequently involved NRN nodes (72%). Spinal accessory nodal involvement was also common (57%) but seldom in isolation (8%). Submandibular (3%) and parotid (2%) nodal metastases were uncommon and were always associated with advanced nodal metastases in the ipsilateral RN, internal jugular, and spinal accessory regions.
  
  
  CONCLUSIONS
  Retropharyngeal nodes are the first echelons of nodal metastases. Direct lymphatic spread to the neck without involvement of the RN nodes is uncommon. RN metastases at the level of the oropharynx are more common than previously suspected, and this should influence radiotherapy planning. NRN outside the internal jugular and spinal accessory chains are rare and only occur when the usual routes of lymphatic spread have already been blocked by tumor.
authors.affiliation: Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: A D
authors.initials: AD
authors.lastname: King
authors.forename: A T
authors.initials: AT
authors.lastname: Ahuja
authors.forename: S F
authors.initials: SF
authors.lastname: Leung
authors.forename: W W
authors.initials: WW
authors.lastname: Lam
authors.forename: P
authors.initials: P
authors.lastname: Teo
authors.forename: Y L
authors.initials: YL
authors.lastname: Chan
authors.forename: C
authors.initials: C
authors.lastname: Metreweli
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D009333:Neck; D011379:Prognosis; D012680:Sensitivity and Specificity