Abstract
Introduction
To evaluate the value of diffusion-weighted magnetic resonance imaging compared with
conventional magnetic resonance imaging (C-MRI) for the differentiation of benign
from malignant lymph nodes in different regions of the body.
Patients and methods
A total of 31 patients ranging in age from 18 to 75 years (mean age: 53 years) were
included in this study. The patients were examined using a 1.5-T magnetic resonance
imaging system with coils chosen according to lymph node locations. Diffusion-weighted
images were obtained using the single-shot echo planar sequence and had b values of 50, 500, and 1000 s/mm2. The apparent diffusion coefficient (ADC) values were measured from ADC maps. The
correlation between the pathological diagnoses and mean ADC values in the benign and
malignant lymph node groups were compared using the Mann–Whitney U-test with Bonferroni correction. Receiver operating characteristic (ROC) analysis
was performed to evaluate the diagnostic performance of the method.
Results
The mean ADC value for benign lymph nodes was 0.97×10−3 mm2/s (range: 0.6–1.2×10−3 mm2/s), and the mean ADC value for malignant lymph nodes was 0.76×10−3 mm2/s (range: 0.3–1.2×10−3 mm2/s) (P<.001). In ROC analysis, the cut-off ADC value for malignant versus benign lymph node
differentiation was 0.8×10−3 mm2/s. Using an ADC value of 0.8×10−3 mm2/s, the sensitivity, specificity, positive predictive value (PPV), negative predictive
value (NPV), and accuracy of the method for differentiating between benign and malignant
lymph nodes were 76.4%, 85.7%, 86.6%, 75%, and 80.6%, respectively. The sensitivity,
specificity, PPV, NPV, and accuracy of C-MRI were 88.2%, 78.5%, 83.3, 84.6%, and 83.8%,
respectively. The sensitivity, specificity, PPV, NPV, and accuracy of C-MRI findings
suspicious for malignancy combined with the ADC values were 76.4%, 64.2%, 100%, 81.8%,
and 91.6%, respectively.
Conclusions
C-MRI alone remained superior to diffusion-weighted imaging (DWI) and combination
C-MRI and DWI for differentiating malignant from benign lymph nodes; however, DWI
and ADC calculation may play a role in lymph node characterization.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparison of CT and MR imaging in staging of neck metastasis.Radiology. 1998; 207: 123-130
- Role of diffusion-weighted MR imaging in cervical lymphadenopathy.Eur Radiol. 2006; 16: 1468-1477
- Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging.Radiology. 2007; 245: 806-813
- Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer.Am Nucl Med. 2008; 22: 177-184
- Use of integrated (18)F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma.Head Neck. 2007; 29: 203-210
- Evaluation of diagnostic abilities of Ga-SPECT for head and neck lesions.Ann Nucl Med. 2008; 22: 297-300
- Laryngeal carcinoma after radiation therapy: correlation of abnormal MR imaging signal patterns in laryngeal cartilage with the risk of recurrence.Radiology. 1996; 198: 151-155
- Detection of recurrent head and neck squamous cell carcinoma after radiation therapy with 2–18 F-fluoro-2-deoxy-d-glucose positron emission tomography.Laryngoscope. 1999; 109: 970-975
- Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone.Radiology. 2000; 214: 683-687
- Recurrent inverted papilloma: diagnosis with pharmacokinetic dynamic gadolinium-enhanced MR imaging.AJNR Am J Neuroradiol. 1999; 20: 1445-1451
- Diffusion-weighted imaging (DW) in musculoskeletal MRI: a critical review.Skeletal Radiol. 2011; 40: 665-681
- MR imaging of lymph nodes in the head and neck.Neuroimaging Clin N Am. 2004; 14: 679-694
- Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US.Radiology. 2004; 230: 720-726
- MRI features of central necrosis in metastatic disease.Clin Radiol. 1996; 51: 103-109
- Comments on Castelijns and van den Brekel: imaging of lymphadenopathy in the neck.Eur Radiol. 2003; 13: 2236
- Diffusion MR imaging theory and application.Neuroimaging Clin N Am. 1999; 9: 343-361
- Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization.Eur J Radiol. 2003; 45: 208-213
- MRI and ultrasonography detection of cervical lymph node metastases in differentiated thyroid carcinoma before reoperation.Am J Transl Res. 2014; 6: 147-154
- Diffusion-weighted imaging of the liver: technical challenges and prospects for the future.Magn Reson Med Sci. 2005; 4: 175-186
- Diffusion-weighted magnetic resonance imaging and its application to cancer.Cancer Imaging. 2006; 6: 135-143
- Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free-breathing diffusion-weighted MR imaging of the liver.J Magn Reson Imaging. 2008; 28: 1141-1148
- Diffusion weighted magnetic resonance imaging in neck lymph adenopathy.Cancer Imaging. 2008; 8: 173-180
- Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions.Eur J Radiol. 2011; 77: 281-286
- Neck lymph nodes: characterization with diffusion-weighted MRI.Egypt J Radiol. 2012; 43: 173-181
- Diffusion weighted images of metastatic as compared with nonmetastatic axillary lymph nodes in patients with newly diagnosed breast cancer.J Magn Reson Imaging. 2014; https://doi.org/10.1002/jmri.24829
- Preoperative lymph node staging in patients with primary prostate cancer: comparison and correlation of quantitative imaging parameters in diffusion-weighted imaging and 11C-choline PET/CT.Eur Radiol. 2014; 24: 1821-1826
- MR microimaging of benign and malignant nodes in the neck.Am J Radiol. 2006; 186: 749-757
- Is diffusion-weighted MRI useful for differentiation of small non-necrotic cervical lymph nodes in patients with head and neck malignancies?.Korean J Radiol. 2014; 15: 810-816
- Longitudinal study of the assessment by MRI and diffusion-weighted imaging of tumor response in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy.NMR Biomed. 2009; 22: 104-113
- Diffusion tensor MRI: preliminary anisotropy measures and mapping of breast tumors.J Magn Reson Imaging. 2010; 31: 339-347
- Apparent diffusion coefficient values for discriminating benign and malignant breast MRI lesions: effects of lesion type and size.AJR Am J Roentgenol. 2010; 194: 1664-1673
- The effect of variation in slice thickness and interslice gap on MR lesion detection.AJNR Am J Neuroradiol. 1987; 8: 1057-1062
- Effect of thin-section diffusion-weighted MR imaging on stroke diagnosis.AJNR Am J Neuroradiol. 2005; 26: 560-565
- Thin-section diffusion-weighted imaging of the infratentorium in patients with acute cerebral ischemia without apparent lesion on conventional diffusion-weighted imaging.Neurol Med Chir (Tokyo). 2008; 48: 108-113
- Thin-section diffusion-weighted MR imaging of the brain with parallel imaging.Acta Radiol. 2007; 48: 456-463
Article info
Publication history
Published online: May 22, 2015
Accepted:
May 8,
2015
Received in revised form:
May 1,
2015
Received:
January 6,
2015
Footnotes
☆There is no conflict of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
