OBJECTIVES: To evaluate previously reported quantitative (tumor thickness 11 mm and depth of invasion [DOI] 7.5 mm) and qualitative (styloglossus/hyoglossus muscle invasion [SHMI]) magnetic resonance imaging (MRI) parameters for predicting occult neck node metastasis in clinical N0 oral tongue squamous cell carcinoma. METHODS: This single-center retrospective study included 76 patients. MRI images were independently reviewed by two radiologists for tumor thickness, DOI, and SHMI. Statistical analysis assessed the predictive capability of these parameters for 2-year potential lymph node metastasis. RESULTS: Among the 76 cases, 30.2% developed 2-year potential lymph node metastasis. For tumor thickness ≥ 11 mm, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 0.46, 0.68, 0.37, 0.75, and 0.61, respectively. DOI ≥ 7.5 mm exhibited a sensitivity, specificity, PPV, NPV, and accuracy of 0.73, 0.59, 0.42, 0.84, and 0.63, respectively. SHMI demonstrated a sensitivity, specificity, PPV, NPV, and accuracy of 0.87, 0.51, 0.46, 0.89, and 0.63, respectively. CONCLUSION: DOI ≥ 7.5 mm and SHMI demonstrated comparable diagnostic accuracy in predicting neck metastasis, surpassing tumor thickness of >
11 mm. These findings underscore their potential utility in guiding decisions concerning elective neck dissection.