ARRS 2022 Abstracts

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E1216. Imaging Review of Cervical Lymph Nodes: When to Worry?
Authors
  1. Johnny Kim; University of California - Irvine
  2. Edward Kuoy; University of California - Irvine
Background
Lymph nodes evaluation can be a confusing topic for radiology trainees. The different size criteria for abnormally enlarged nodes throughout the body and the multitude of ways to measure lymph nodes further complicate the matter. Although size is important in the assessment of lymph nodes, size alone is a poor predictor for the presence of metastatic disease. Small sub-centimeter nodes may harbor malignancy, whereas large nodes can simply be reactive. Since accurate nodal staging plays an integral role in the management of head and neck cancers, it is essential for radiologists to be aware of suspicious morphologic features that may indicate nodal metastases.

Educational Goals / Teaching Points
This exhibit will review cervical lymph node stations and highlight important anatomical landmarks to classify lymph node stations appropriately. We will review suspicious morphological features and highlight concrete examples of when to worry across various imaging modalities. We will compare cases with worrisome features to benign-appearing lymph nodes so that the reader will be able to confidently classify nodes as being benign or pathologic by the end of the exhibit.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The cervical lymph node classification system is integral to evaluating cervical lymph nodes. Nodal stations are classified by defined anatomical landmarks and distinct drainage pathways. Additionally, the classification system allows for clear and consistent communication with clinicians. CT and MRI are the most common modalities to assess for nodal involvement in head and neck cancers. Both modalities do well in depicting morphology and worrisome features such as nodal necrosis or extra-nodal extension. Ultrasound and PET-CT can also be used in certain scenarios, necessitating familiarity with the appearance of suspicious nodes across different modalities.

Conclusion
It is important for radiologists to be familiar with the cervical lymph classification system and suspicious morphologic features to evaluate lymph nodes in the neck accurately.