title: Necrotic cervical nodes: usefulness of diffusion-weighted MR imaging in the differentiation of suppurative lymphadenitis from malignancy.
abstract: OBJECTIVE
  The purpose of this study was to assess the efficacy of diffusion-weighted (DW) MR imaging for the differentiation between suppurative lymphadenitis and malignancy in necrotic cervical lymph nodes.
  
  
  METHODS
  Fifteen patients with suppurative lymphadenitis, 40 with squamous cell carcinoma (SCC), eight with lymphoma, and six with thyroid cancer were accompanied by necrotic cervical nodes. All 69 patients underwent 1.5-T MR imaging including DW and 58 underwent gadolinium-enhanced MR imaging. Necrotic area-to-spinal cord signal intensity ratios (SIR) on T1-, T2- and DW images and apparent diffusion coefficients (ADCs) [10(-3)mm(2)/s] were correlated with the pathologies.
  
  
  RESULTS
  Nineteen necrotic cervical nodes with suppurative lymphadenitis, 67 with SCC, 10 with lymphoma, and 12 with thyroid cancer were identified. SIR on DW images was higher in suppurative lymphadenitis (2.50 ± 1.21) than in malignancies (1.29 ± 0.67) (p<.01), and ADC value was lower in suppurative lymphadenitis (0.89 ± 0.21) than in malignancies (1.46 ± 0.46) (p<.01). SIR on T1-weighted images was higher in thyroid cancer (1.95 ± 0.53) than in suppurative lymphadenitis (0.87 ± 0.17), SCC (0.92 ± 0.13), and lymphoma (0.95 ± 0.09) (p<.01). No significant difference in SIR on T2-weighted images was found between suppurative lymphadenitis (1.46 ± 0.50) and malignancies (1.61 ± 0.56).
  
  
  CONCLUSIONS
  DW imaging with ADC measurements may play a supplementary role in the differentiation of necrotic cervical nodes between suppurative lymphadenitis and malignancy.
authors.affiliation: Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan. hkato@gifu-u.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kato
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanematsu
authors.forename: Zenichiro
authors.initials: Z
authors.lastname: Kato
authors.forename: Takahide
authors.initials: T
authors.lastname: Teramoto
authors.forename: Keisuke
authors.initials: K
authors.lastname: Mizuta
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Aoki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Makita
authors.forename: Keizo
authors.initials: K
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008198:Lymph Nodes / Q000473:pathology*; D008199:Lymphadenitis / Q000473:pathology*; D008223:Lymphoma / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck; D009336:Necrosis / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013492:Suppuration / Q000473:pathology; D055815:Young Adult