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MRI prognostic factors of tongue cancer: potential predictors of cervical lymph nodes metastases

Mohamed A.F. Mourad
Mohamed A.F. Mourad
 et 
Mahmoud M. Higazi
Mahmoud M. Higazi
   | 03 mars 2019
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Article Category: Research Article
Publié en ligne: 03 mars 2019
Pages: 49 - 56
Reçu: 20 oct. 2018
Accepté: 15 janv. 2019
DOI: https://doi.org/10.2478/raon-2019-0012
© 2019 Mohamed A.F. Mourad, Mahmoud M. Higazi, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Scatter plot showing strong negative correlation between MR tumour thickness and para-lingual distance (p-value < 0.001 and r = 0.84).
Scatter plot showing strong negative correlation between MR tumour thickness and para-lingual distance (p-value < 0.001 and r = 0.84).

Figure 2

Comparison graphs illustrating the significant differences between tumour thickness and para-lingual distance among nodes positive (N1) and negative (N0) patients (p-values 0.008 and 0.003 respectively).
Comparison graphs illustrating the significant differences between tumour thickness and para-lingual distance among nodes positive (N1) and negative (N0) patients (p-values 0.008 and 0.003 respectively).

Figure 3

Receiver Operator Characteristic (ROC) curve analyses for tumour thickness and para-lingual distance predicting nodes spread (p-values < 0.001 and AUC 0.864 and 0.848 respectively).
Receiver Operator Characteristic (ROC) curve analyses for tumour thickness and para-lingual distance predicting nodes spread (p-values < 0.001 and AUC 0.864 and 0.848 respectively).

Figure 4

MRI of a male patient 65-years-old with small lesion at left hemi-tongue (T1N0) disease. (A) Axial T2 (B) Axial T1 fat suppression post contrast (C) T2 coronal (D) Axial DWI. MRI and elective dissected neck revealed no positive cervical lymph nodes spread. The vertical black line was drawn as a reference line connecting maximum tumour-mucosa junctions. Two horizontal lines were drawn perpendicular to the reference line. Tumour thickness is the sum of both of these horizontal lines and was determined as 5.5 mm. The thick black line between the tumour and the para-lingual space represented the para-lingual distance = 10.5 mm.
MRI of a male patient 65-years-old with small lesion at left hemi-tongue (T1N0) disease. (A) Axial T2 (B) Axial T1 fat suppression post contrast (C) T2 coronal (D) Axial DWI. MRI and elective dissected neck revealed no positive cervical lymph nodes spread. The vertical black line was drawn as a reference line connecting maximum tumour-mucosa junctions. Two horizontal lines were drawn perpendicular to the reference line. Tumour thickness is the sum of both of these horizontal lines and was determined as 5.5 mm. The thick black line between the tumour and the para-lingual space represented the para-lingual distance = 10.5 mm.

Figure 5

MRI of a 75-years-old female with sizable tongue mass crossing the midline (T4N1 disease). (A) Axial T1 post contrast fat suppression (B) Axial DWI (C) Coronal T1 post contrast fat suppression (D) Coronal T1 post contrast shows metastatic cervical lymph nodes. Tumour thickness is the sum of the two horizontal black lines drawn perpendicular to the vertical black line connecting maximum tumour junction distance and was determined as 30 mm. The thick black line representing para-lingual distance between the tumour and the para-lingual space was determined as – 10 as the tumour margin extends beyond the midline by 10 mm
MRI of a 75-years-old female with sizable tongue mass crossing the midline (T4N1 disease). (A) Axial T1 post contrast fat suppression (B) Axial DWI (C) Coronal T1 post contrast fat suppression (D) Coronal T1 post contrast shows metastatic cervical lymph nodes. Tumour thickness is the sum of the two horizontal black lines drawn perpendicular to the vertical black line connecting maximum tumour junction distance and was determined as 30 mm. The thick black line representing para-lingual distance between the tumour and the para-lingual space was determined as – 10 as the tumour margin extends beyond the midline by 10 mm

Logistic regression analysis for independent variables predicting LN spread

P value R2 Odds Ratio 95% CI
Age 0.926 0.0005 1.004 0.917 to 1.099
Tumour Thickness <0.0001** 0.755 1.756 1.075 to 2.866
Para-lingual distance 0.0001** 0.697 0.325 0.107 to 0.982
ADC 0.472 0.023 1.003 0.995 to 1.015

Absolute values for TT, PLD and ADC for (N0) and (N1) LN spread

N0
TT (mm) PLD (mm) ADC
10 9.5 0.899
8.4 5.3 0.937
15 6.7 0.815
8.7 8.9 0.953
10.1 3.8 1.051
5.5 10.5 0.875
6.2 6.6 0.988
9 12 0.836
13 4.7 0.864
8.5 7.2 0.955
9.8 10 0.832
9 7.8 0.968
12.3 6.3 0.843
7.6 9.2 0.915
10.7 4.3 1.31
6.3 10.8 0.864
6.4 6.7 0.978
9.3 12.4 0.834
9.1 7.9 0.869
10 9.5 0.899
8.4 5.3 0.937
8.7 8.9 0.953
N1
19 5.8 1.18
17.8 3.3 0.928
10 4.5 1.16
15.5 0.8 0.795
13.8 2.7 0.961
18 5.6 0.793
16.9 3.1 0.874
12.3 4.7 1.17
13.7 0.5 0.778
14.8 3.7 0.959
19 5.8 1.18
17.8 3.3 0.928
15 6.7 0.815
13.8 4.4 0.83
35 -10 0.987
27.2 3.1 1.03
30 -5 0.976
25.6 0 0.892
34 -8 0.984
25 7 1.21
23.2 3.2 1.07
29.7 -3 0.938
22.8 0 0.792
21.4 5.8 0.724
27.8 -7 0.852
23.9 0 0.897
42.7 -15 0.893
43.2 -12 1.051

Summary of descriptive statistics for studied population

N N1 N0 P value
Age (mean+/-SD) 61 ± 10 61 ± 11 60 ± 9 0.794
Sex (male, no., %) 34/50 (68%) 20/28 (71%) 14/22 (64%) _
Tumour Thickness (mean+/-SD) 16.62 ± 9.45 19.8 ± 8.8 9.9 ± 2.6 0.008*
Para-lingual distance (mean+/-SD) 3.8 ± 5.12 0.9 ± 5.5 7.2 ± 2.5 0.003*
ADC (mean+/-SD) 0.944 ± 0.124 0.952 ± 0.112 0.928 ± 0.118 0.518
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