La radiologia medica

, Volume 124, Issue 1, pp 19–26 | Cite as

Cervical lymphadenopathy: can the histogram analysis of apparent diffusion coefficient help to differentiate between lymphoma and squamous cell carcinoma in patients with unknown clinical primary tumor?

  • Antonello VidiriEmail author
  • Silvia Minosse
  • Francesca Piludu
  • Raul Pellini
  • Giovanni Cristalli
  • Ramy Kayal
  • Giorgio Carlino
  • Daniela Renzi
  • Renato Covello
  • Simona Marzi



To retrospectively evaluate the value of whole-lesion histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating between lymphoma and metastatic squamous cell carcinoma (SCC) of unknown clinical primary in neck nodes.


A total of 39 patients, 20 affected by lymphoma and 19 affected by metastatic non-nasopharyngeal SCC, were included in this retrospective study. All patients underwent MR imaging with a 1.5 T scanner system, including diffusion-weighted imaging (DWI) with three different b values (b = 0, 500 and 800 s/mm2). The entire tumor volume was manually delineated on the ADC maps, using the T2-weighted images and DWIs with b = 800 s/mm2 as a guide to the lesion location. The Mann–Whitney rank-sum test for independent samples was performed to compare the histogram parameters of patients with lymphoma and SCC.


The SCCs showed significantly higher median ADC (ADCmedian) and mean ADC (ADCmean) values, compared to lymphomas (p < 0.001), while they exhibited lower kurtosis and skewness without reaching significance (p = 0.066 and 0.148, respectively). The ADCmean and ADCmedian had the best discriminative powers for differentiating lymphoma and SCC, with an area under the curve of 87% and 85%, respectively. The optimal cutoff values for ADCmean and ADCmedian as predictors for lymphoma were ≤ 0.83 × 10−3 mm2/s and ≤ 0.73 × 10−3 mm2/s, respectively.


The whole-lesion ADC histogram analysis of cervical lymphadenopathy may help to discriminate lymphomas from non-nasopharyngeal SCC in patients with unknown clinical primary tumor.


Diffusion-weighted imaging Head and neck cancer Neck nodes Quantitative imaging 



We thank Michele Farella, Elisa Tommasini, Pierfrancesco Rinaldi for their continued technical assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  • Antonello Vidiri
    • 1
    • 7
    Email author
  • Silvia Minosse
    • 2
  • Francesca Piludu
    • 3
  • Raul Pellini
    • 4
  • Giovanni Cristalli
    • 4
  • Ramy Kayal
    • 1
  • Giorgio Carlino
    • 3
  • Daniela Renzi
    • 5
  • Renato Covello
    • 6
  • Simona Marzi
    • 2
  1. 1.Radiology and Diagnostic Imaging DepartmentIRCCS Regina Elena National Cancer InstituteRomeItaly
  2. 2.Medical Physics LaboratoryIRCCS Regina Elena National Cancer InstituteRomeItaly
  3. 3.Department of RadiologyF. Policlinico Gemelli - IRCCSRomeItaly
  4. 4.Department of Otolaryngology and Head and Neck SurgeryIRCCS Regina Elena National Cancer InstituteRomeItaly
  5. 5.Department of HematologyIRCCS Regina Elena National Cancer InstituteRomeItaly
  6. 6.Department of PathologyIRCCS Regina Elena National Cancer InstituteRomeItaly
  7. 7.RomeItaly

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