الفهرس 
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Abstract
Malignant tumors with initial locations in the head and neck often metastasize to the cervical lymph nodes. An essential prognostic factor for head and neck malignancies is lymphatic metastasis.
The diagnosis of metastatic cervical lymph nodes on CT was based on the following criteria, size (depending on short axis diameter), central necrosis, extra capsular spread and clustering of three or more lymph nodes.
This study discusses the role of multi-detector computed tomography in detection of metastatic cervical lymph nodes as early as possible in patients with head and neck cancer.
This study was conducted on 20 patients, 12 males (60%) and 8 females (40%) suffering from head and neck tumor. Their ages ranged between 34 and 87 years with mean age 61.5 year.
Every patient had a multi-detector CT scan of the neck that was enhanced with contrast. According to the criteria of cervical lymph node metastatic criteria at each anatomical level of the neck, images were assessed for the presence of cervical lymph node metastasis.
Following intravenous delivery of contrast medium (300 mg iodine/ml) in a biphasic manner for neck examination, CT assessment is carried out. The first 50–60 cc of contrast medium (300 mg iodine/ml) are given at a rate of 1 cc/sec to saturate the interstitial compartment. Approximately one minute after the initial injection, the further 50–60 cc of contrast media is administered at a rate of 2 cc/sec. The diverse vascular structures are typically sufficiently obscured by this technique, allowing appropriate interpretation of head and neck CT images. All patients were examined using 6 multi-detector CT scanner Siemen’s Emotion 6. The scan parameters used were 120 kVp and = or < 240mA per slice; tube rotation 0.75s and slice thickness 1.25mm.
The clinical presentation encountered in patients was variable. Five patients presented with hoarseness of voice, one patient presented with nasal obstruction, four patients presented with oral ulceration, eight patients presented with palpable neck swelling, one patient presented with headache and one patient presented with proptosis.
The location of head and neck primary tumors was as follows, five located in larynx, four located in tongue, four located in thyroid gland, two located in parotid gland and one from each of oral cavity, nasopharynx, orbit, maxillary sinus and nose.
In our study, the most common histopathology of primary tumors in head and neck primaries (n=20) was SCC in 14 (70%) patients, papillary carcinoma in two (10%), anaplastic carcinoma in two (10%) and last two patients, one of them with adenocarcinoma (5%) and other patient with plasmocytoma (5%).
Our study showed that the number of the lymph nodes with size <10 mm in shortest axial diameter was 13 (28.9%) while number of lymph nodes with size ≥10 mm in shortest axial diameter was 32 (71.1%).
Our study detected necrosis in 32 (71.1%) out of 45 lymph nodes in head and neck cancer and ECS appeared in 13 (28.9%) out of 45 LNs by CT. On the other hand, calcification and clustering were not detected in any lymph node.
In the present study, the most common levels that metastatic LN’s of HNSCC were located at level II 16(35.5%) lymph nodes including both levels IIa 11(24.4%) and IIb 5(11.1%) followed by level I 12(26.6%) including both level Ia 2(4.4%) and Ib 10(22.2%).
In our study, the nodal staging of CT head and neck squamous cell carcinoma were, N2c in nine (45%) patients, N0 in 5 (25%) patients, N2a in three (15%) patients N2b in two (10%) patients and N1 in 1(5%) patient.