The purpose of this retrospective study was to compare the diagnostic value of four different imaging methods-computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT-and their combined use for preoperative detection of cervical nodal metastases in head and neck squamous cell carcinoma (SCC). Sixty-seven patients (58 men and 9 women; mean age, 60.1 years) with head and neck SCCs underwent CT, MR, US, and PET/CT before surgery. First, each study was reviewed separately for the presence of nodal metastases. Then, the value of combined images was assessed based on a confidence rating score for each modality assigned by observers. These results were verified, on a level-by-level basis, with histopathologic findings. Histopathologic examination revealed nodal metastases in 74 of 402 nodal levels. The sensitivity, specificity, and accuracy were 77.0%, 99.4%, and 95.3% for CT and MR; 78.4%, 98.5%, and 94.8% for US; and 81.1%, 98.2%, and 95.0% for PET/CT, respectively. The comparison of these modalities showed no statistically significant difference among them (p > 0.05). The combination of CT, MR, US, and PET/CT improved sensitivity (86.5%), without loss of specificity (99.4%) and accuracy (97.0%), although the difference failed to reach statistical significance.

We found at least a 9.4% (15/160) prevalence of malignancy among ITN detected on CT. The further evaluation with US or biopsy should be performed, if an ITN shows CT features suggesting malignancy (calcification; AP/T ratio, >1.0; or mean attenuation value, >130 HU).

Our study presents a detailed list and analysis of the 100 top-cited articles published in radiology journals, which provides insight into historical developments in the field of radiology.

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