HEAD AND NECK Prognostic CT and MR imaging features in patients with untreated extranodal non-Hodgkin lymphoma of the head and neck region Cuiping Zhou & Xiaohui Duan & Bowen Lan & Junjie Liao & Jun Shen Received: 9 December 2014 /Revised: 24 February 2015 /Accepted: 5 March 2015 # European Society of Radiology 2015 Abstract Objective To determine the prognostic CT and MR imaging features of extranodal non-Hodgkin lymphoma in the head and neck region. Methods The clinical data and CT and MR imaging features of 59 patients with histologically confirmed extranodal non- Hodgkin lymphoma in the head and neck region were retro- spectively reviewed. Subjects included 27 male and 32 female patients between 13 and 81 years of age, with a mean age of 60.3 years. The clinical outcomes were categorized according to whether relapse or metastasis occurred within 2 years after therapy. The association between the clinical outcome and radiologic factors including tumour size, margin, shape, local tumour invasiveness, regional lymph node involvement, num- ber of involvement sites, and contrast enhancement patterns was determined using univariate and multiple logistic regres- sion analysis. Results Radiologic factors including tumour size, margin, shape, and local tumour invasiveness were associated with poor clinical outcomes, as determined by univariate analysis (P <0.05). Only the lesion margin category (ill-defined) remained an independent risk factor for clinical outcome in multivariate logistic regression analysis, with an OR of 8.14 (P <0.05). Conclusion Ill-defined margin of the primary lesion was in- dicative of unfavourable survival outcome for patients with extranodal non-Hodgkin lymphoma of the head and neck region. Key Points • Tumour size, margin, shape and local tumour invasiveness were prognostically relevant. • Tumour margin was an independent risk factor for clinical outcome. • Ill-defined margin of primary lesion was indicative of unfavourable survival outcome. Keywords Extranodal lymphomas . Head and neck . Computed tomography . Magnetic resonance imaging . Prognosis Introduction Malignant lymphoma, including the non-Hodgkin and Hodg- kin groups, is the most common non-epithelial malignancy of the head and neck region. Approximately 40 % of non- Hodgkin lymphomas (NHLs) arise at extranodal sites outside the lymphoid system [1]. The head and neck is the second most common site of extranodal lymphoma, after the gastro- intestinal tract [2] Waldeyer’ s ring is the most common site in the head/neck region; the oral and maxillofacial region is a rare site of origin. The clinical features and management of extranodal NHLs have been well documented [3, 4], and CT and MR imaging findings of extranodal NHL in the head and neck region have been widely described [5–7]. Moreover, diffusion-weighted (DW) and dynamic MR imaging are con- sidered to be useful in the differentiation between NHL and squamous cell carcinoma (SCC) [8–11]. Previous studies have found that poor survival of patients with extranodal head and C. Zhou : B. Lan : J. Liao Department of Radiology, Huizhou Central Municipal Hospital, No.41 Eling Rood North, Huizhou 516001, Guangdong, China X. Duan : J. Shen (*) Department of Radiology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No.107 Yanjiang Road West, Guangzhou 510120, Guangdong, China e-mail: shenjun@mail.sysu.edu.cn Eur Radiol DOI 10.1007/s00330-015-3708-1