Ju Hee Lee1, Sung-Sik Han2, Eun Kyung Hong3, Hwa Jin Cho4, Jungnam Joo5, Eun Young Park4, Sang Myung Woo6, Tae Hyun Kim6, Woo Jin Lee6, Sang-Jae Park7. 1. Department of Radiology, Center for Liver Cancer, National Cancer Center, Republic of Korea. 2. Department of Surgery, Center for Liver Cancer, National Cancer Center, Republic of Korea. 3. Department of Pathology, Center for Liver Cancer, National Cancer Center, Republic of Korea. 4. Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. 5. Biometric Research Branch, Research Institute National Cancer Center, Republic of Korea. 6. Center for Liver Cancer, National Cancer Center, Republic of Korea. 7. Department of Surgery, Center for Liver Cancer, National Cancer Center, Republic of Korea. Electronic address: spark@ncc.re.kr.
Abstract
OBJECTIVES: To prospectively investigate the diagnostic potential of lymph node (LN) magnetic resonance (MR) imaging features. METHODS: A radiologist determined the maximum diameters in the short and long axes, shape, signal intensities on T1- and T2-weighted imaging, pattern of enhancement, and apparent diffusion coefficient (ADC) on diffusion-weighted MR images of LNs and annotated measurable (≥5 mm in short-axis diameter) LNs. Surgically harvested LNs were correlated with the pathologic findings. Univariable and multivariable generalized estimating equation analyses were performed to evaluate predictive power. RESULTS: Of 80 LNs, 29 (36.3%) were positive and 51 (63.7%) negative for metastasis. The mean short-axis diameter of metastatic LNs (10.59 ± 4.30 mm) was larger than that of benign LNs (7.96 ± 2.10 mm). The ADC was significantly (P < 0.001) lower in metastatic than non-metastatic LNs. The area under the curve (AUC) of a univariable model using only the mean ADC was 0.845 (95% confidence interval [CI], 0.743-0.927), and the mean-ADC cutoff value for predicting LN metastasis was 0.901 × 10-3 mm2/s. The AUC of a multivariable model including round shape, heterogeneous enhancement, and the mean ADC was 0.917 (95% CI, 0.845-0.972), with a sensitivity, specificity, overall accuracy, and positive and negative predictive values of 89.7%, 82.4%, 85.0%, 74.3%, and 93.3%, respectively. CONCLUSION: The short-axis diameter and ADC were different between benign and metastatic LNs in pancreatobiliary cancer. However, round shape, heterogeneous enhancement, and a low ADC value (<0.901 × 10-3 mm2/s) may be the most reliable diagnostic features of multiple metastatic LNs.
OBJECTIVES: To prospectively investigate the diagnostic potential of lymph node (LN) magnetic resonance (MR) imaging features. METHODS: A radiologist determined the maximum diameters in the short and long axes, shape, signal intensities on T1- and T2-weighted imaging, pattern of enhancement, and apparent diffusion coefficient (ADC) on diffusion-weighted MR images of LNs and annotated measurable (≥5 mm in short-axis diameter) LNs. Surgically harvested LNs were correlated with the pathologic findings. Univariable and multivariable generalized estimating equation analyses were performed to evaluate predictive power. RESULTS: Of 80 LNs, 29 (36.3%) were positive and 51 (63.7%) negative for metastasis. The mean short-axis diameter of metastatic LNs (10.59 ± 4.30 mm) was larger than that of benign LNs (7.96 ± 2.10 mm). The ADC was significantly (P < 0.001) lower in metastatic than non-metastatic LNs. The area under the curve (AUC) of a univariable model using only the mean ADC was 0.845 (95% confidence interval [CI], 0.743-0.927), and the mean-ADC cutoff value for predicting LN metastasis was 0.901 × 10-3 mm2/s. The AUC of a multivariable model including round shape, heterogeneous enhancement, and the mean ADC was 0.917 (95% CI, 0.845-0.972), with a sensitivity, specificity, overall accuracy, and positive and negative predictive values of 89.7%, 82.4%, 85.0%, 74.3%, and 93.3%, respectively. CONCLUSION: The short-axis diameter and ADC were different between benign and metastatic LNs in pancreatobiliary cancer. However, round shape, heterogeneous enhancement, and a low ADC value (<0.901 × 10-3 mm2/s) may be the most reliable diagnostic features of multiple metastatic LNs.
Authors: Dorine S J Tseng; Bobby K Pranger; Maarten S van Leeuwen; Jan Pieter Pennings; Lodewijk A Brosens; Nadja Haj Mohammad; Vincent E de Meijer; Hjalmar C van Santvoort; Joris I Erdmann; I Quintus Molenaar Journal: Radiol Imaging Cancer Date: 2021-03-19
Authors: Casper van Eijck; Stefan Löb; Friedrich Anger; Anna Döring; Jacob van Dam; Johan Friso Lock; Ingo Klein; Max Bittrich; Christoph-Thomas Germer; Armin Wiegering; Volker Kunzmann Journal: Ann Surg Oncol Date: 2020-09-12 Impact factor: 5.344