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Abstract
In the assessment of cervical lymphadenopathy, both infectious and malignant disease, imaging plays a major role. In infectious disease the assessment of abscess formation and the relation of the abscess to surrounding vital structures is crucial for its management. In head and neck malignancies, imaging can be helpful for staging.
Lymphatic metastasis is the most important mechanism in the spread of head and neck squamous cell carcinomas. The rate of metastasis probably reflects the aggressiveness of the primary tumor and is an important prognosticator. Not only presence, but also number of nodal metastases, the level in the neck, the size of the nodes and presence of extranodal spread are important prognostic features.
The direction of nodal classification changed from that of a pure anatomic study to a nodal mapping guide for selecting the most appropriate surgical procedure among the various types of neck dissections.
The latest and most used of these classifications are the ones of the American Joint Committee on Cancer and the American Academy of Otolaryngology–Head and Neck Surgery.
This thesis on imaging of cervical lymphadenopathy gives an outline of neck anatomy and the patterns of lymphatic tumor spread. Radiological features of reactive and infectious lymphadenopathy and lymph node metastases are discussed.
The present work discusses the current status of MDCT with intravenous contrast administration for evaluation of patients suspected of having cervical lymphaenopathy.
The study included twenty five patients, fourteen male and eleven female, with already known or suspected cervical lymphadenopathy. Their ages ranged between 1and 80 years old.
The symptoms encountered in patients were variable. Twenty two patients presented with painless cervical swelling. Two patients presented with painful cervical swelling. Five patients presented with fever.
For neck examination CT assessment is performed following intravenous administration of contrast media (300 mg iodine/ml) in a biphasic manner: the first 50–60 cc of contrast medium (300 mg I|ml) are injected at a rate of 1cc/sec to impregnate the interstitial compartment. The other 50–60 cc of contrast medium are injected at a rate of 2 cc/sec approximately 1 min after the first injection. This protocol usually provides an adequate opacification of the different vascular structures, thereby allowing an accurate interpretation of head and neck CT images
All patients were examined using 4 and 6 multi-detector CT scanners – GE lightspeed and Siemens’ Emotion 6 – respectively. The scan parameters used were 120kVp and ≤ 240mA per slice; tube rotation 0.75s and slice thickness 1.25 mm.