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Table 3: Locations and imaging appearance of cervical lymph node spread^a
Lymph Nodes No. of Patients (%)
Location (n = 14)
    Level I 8 (57)
    Level II 13 (93)
    Level III 7 (50)
    Level IV 1 (7)
    Level V 3 (21)
    Level VI 0 (0)
    Level VII 0 (0)
    RPN 6 (43)
General appearance on CT (n = 14)
    Completely cystic (no solid areas on CT) 0 (0)
    Predominantly cystic (<25% solid in appearance) 1 (7)
    Moderately cystic (25%–49% solid) 0 (0)
    Moderately solid (50%–74% solid) 0 (0)
    Predominantly solid (75%–99%) 4 (29)
    Completely solid (100% solid) 9 (64)
Degree of contrast enhancement on CT (n = 14)
    None (no enhancing tissue visualized) 0 (0)
    Mild (similar in density to normal lymph nodes) 1 (7)
    Moderate (similar in density to glandular tissue) 7 (50)
    Maximal (similar in density to vessels) 6 (43)
FDG avidity (n = 12)
    Low 3 (25)
    Medium 5 (42)
    High 4 (33)
a Metastases to level II lymph nodes occur in almost all patients with cervical disease. Levels I and III occur in >50% of patients, while RPNs are present in 43% of patients. On imaging, metastatic cervical lymph nodes are predominantly solid, with moderate-to-maximal contrast enhancement and medium-to-high FDG avidity.