Background: The purpose was to use MR imaging to document the patterns of nodal involvement in the upper neck in nasopharyngeal carcinoma (NPC).
Methods: The MR images of 150 patients with newly diagnosed NPC were reviewed retrospectively. Nodes were considered abnormal on MR criteria of size, necrosis, and extracapsular spread.
Results: Retropharyngeal nodes (RN) were more frequently involved than nonretropharyngeal nodes (NRNs) (94% vs 76% in 115 patients with nodal metastases). NRN involvement without RN was seen in only 7 of 115 patients (6%). Involvement of RN at the level of the oropharynx (82%) was as common as at the nasopharynx (83%) level. Internal jugular nodes were the most frequently involved NRN nodes (72%). Spinal accessory nodal involvement was also common (57%) but seldom in isolation (8%). Submandibular (3%) and parotid (2%) nodal metastases were uncommon and were always associated with advanced nodal metastases in the ipsilateral RN, internal jugular, and spinal accessory regions.
Conclusion: Retropharyngeal nodes are the first echelons of nodal metastases. Direct lymphatic spread to the neck without involvement of the RN nodes is uncommon. RN metastases at the level of the oropharynx are more common than previously suspected, and this should influence radiotherapy planning. NRN outside the internal jugular and spinal accessory chains are rare and only occur when the usual routes of lymphatic spread have already been blocked by tumor.