EURO PEA N JO URNA L OF RADIO LO G Y European Journal of Radiology 17 (1993) 191-194 Ultrasonography is more effective than computed tomography in excluding invasion of the carotid wall by cervical lymphadenopathies L. Zaragozaa, F. Sendra*b, J. Solano”, V. Garridob, M. Martinez-Morillob zyxwvutsrqponmlkjihg “Departmem of Otolaryngolog.v, hDeparrmeni of Radiology, Faculty of Medicine. Universiry Hospital. Virgen de la Victoria Universidad de Mhlaga. Campus de Teatinos. 29071 Mlilaga. Spain (Received 14 April 1993: revision accepted 23 June 1993) zyxwvutsrqponmlkjihgfedcbaZYXWVUTSR Abstract Twelve patients with head and neck cancer, bulky lymphadenopathies, and clinical suspicion of carotid artery infiltration, had preoperative CT and US. The results of both techniques were correlated with surgical findings (one case of invasion and 11 of non-invasion), to evaluate the role of CT and US in the preoperative diagnosis of tumor invasion of the carotid wall. While CT showed a high level of failures (11 false positives and one true positive), US (one true positive, one false negative, and 10 true nega- tives) appears to be an easy and helpful method for predicting non-invasion of the carotid wall. However, the usefulness of US in detecting invasion cannot be evaluated, due to the limited number of positive cases. Key words: Ultrasound, comparative study; Computed tomography, comparative study; Artery, carotid; Artery, radiography; Neo- plasm, staging zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA 1. Introduction In head and neck cancer (HNC), to achieve ex- haustive staging and correct management of the disease, it is necessary to evaluate for (1) the presence or absence of subclinical neck nodes, (2) the number, size, and exact location of lymphadenopathies, and (3) the spreading of cervical masses to adjacent structures such as muscle, bone, nerves, or vessels. The value of different diagnos- tic imaging modalities, CT, MRI, and US, on these three subjects has been studied in many reports [l-3]. The information that diagnostic imaging can offer about potential tumoral invasion of neck blood vessels acquires more importance in the late stages of HNC. In particular invasion of the carotid artery needs an ade- quate and rigorous preoperative evaluation. The purpose of this study was to evaluate the utility of CT and US in the diagnosis of invasion of the carotid wall in patients with cervical lymph node metastases who are clinically suspected of invasion. * Corresponding author. 2. Materials and methods From May 1991 to June 1992 we retrospectively reviewed 12 patients with HNC, bulky cervical lym- phadenopathies stage N3, and possible involvement of the carotid artery. Lymphadenopathies were predom- inantly located in the upper jugular and midjugular chain. In only three cases was the tumor observed in the lower jugular chain. Histopathology corresponded to 11 squamous cell carcinomas and one amelanotic melanoma. All patients received surgical treatment of the neck disease, and underwent preoperative CT and US evalu- ation of potential carotid wall involvement. Eight pa- tients received radical neck dissection and postoperative radiation therapy. In the remaining four cases, the cervi- cal masses were recurrences after previous surgery (two cases) or radiation therapy (two cases). CT and US were carried out in order to evaluate these recurrences. CT scanning was performed, after an i.v. injection of 100 ml of non-ionic contrast, in a Somaton HIQ unit. Slices were obtained at each 5-7 mm, in a 512 x 512 0720-048X/931$06.00 @ 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. SSDI 0720-048X(93)00441-Z