title: Challenges in dynamic contrast-enhanced MRI imaging of cervical lymph nodes to detect metastatic disease.
abstract: OBJECTIVE
  To identify and overcome challenges in using dynamic contrast-enhanced magnetic resonance imaging (MRI) to distinguish tumor from nontumor in the cervical lymph nodes of patients with squamous cell carcinoma of the head and neck.
  
  
  METHODS
  Signal-to-noise ratio (S/N), motion, node heterogeneity, and tissue normalizations were examined. Twenty-one patients with squamous cell carcinoma of the head and neck were scanned before a neck dissection (two-dimensional fast spoiled gradient-echo: 10 locations/13 seconds). Peak time, peak enhancement, maximum upslope, and washout slope were measured in pathologically confirmed tumor and nontumor nodes and in the submandibular gland and the sternocleidomastoid muscle.
  
  
  RESULTS
  Surface coil arrays provided high coverage and high S/N. Motion averaged 1.1 pixels and was corrected. Large tumor nodes were heterogeneous in their contrast enhancement, while the nontumor nodes were homogeneous. The contrast enhancement parameters were significantly different for all regions except for the submandibular gland compared to the nontumor nodes.
  
  
  CONCLUSIONS
  Challenges of dynamic imaging of cervical lymph nodes were overcome and significant differences were found between the tumor and nontumor nodes, indicating that dynamic imaging is feasible and may aid this patient population.
authors.affiliation: The Magnetic Resonance Science Center, The University of California, San Francisco, California 94143-1290, USA. sue@mrsc.ucsf.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Noworolski
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kaplan
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Nelson
authors.forename: Lucas
authors.initials: L
authors.lastname: Carvajal
authors.forename: Roland G
authors.initials: RG
authors.lastname: Henry
mesh_terms: D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D019786:Gadolinium DTPA; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012372:ROC Curve
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA