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Qu J, Pan B, Su T, Chen Y, Zhang T, Chen X, Zhu X, Xu Z, Wang T, Zhu J, Zhang Z, Feng F, Jin Z. T1 and T2 mapping for identifying malignant lymph nodes in head and neck squamous cell carcinoma. Cancer Imaging 2023; 23:125. [PMID: 38105217 PMCID: PMC10726506 DOI: 10.1186/s40644-023-00648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND This study seeks to assess the utility of T1 and T2 mapping in distinguishing metastatic lymph nodes from reactive lymphadenopathy in patients with head and neck squamous cell carcinoma (HNSCC), using diffusion-weighted imaging (DWI) as a comparison. METHODS Between July 2017 and November 2019, 46 HNSCC patients underwent neck MRI inclusive of T1 and T2 mapping and DWI. Quantitative measurements derived from preoperative T1 and T2 mapping and DWI of metastatic and non-metastatic lymph nodes were compared using independent samples t-test or Mann-Whitney U test. Receiver operating characteristic curves and the DeLong test were employed to determine the most effective diagnostic methodology. RESULTS We examined a total of 122 lymph nodes, 45 (36.9%) of which were metastatic proven by pathology. Mean T2 values for metastatic lymph nodes were significantly lower than those for benign lymph nodes (p < 0.001). Conversely, metastatic lymph nodes exhibited significantly higher apparent diffusion coefficient (ADC) and standard deviation of T1 values (T1SD) (p < 0.001). T2 generated a significantly higher area under the curve (AUC) of 0.890 (0.826-0.954) compared to T1SD (0.711 [0.613-0.809]) and ADC (0.660 [0.562-0.758]) (p = 0.007 and p < 0.001). Combining T2, T1SD, ADC, and lymph node size achieved an AUC of 0.929 (0.875-0.983), which did not significantly enhance diagnostic performance over using T2 alone (p = 0.089). CONCLUSIONS The application of T1 and T2 mapping is feasible in differentiating metastatic from non-metastatic lymph nodes in HNSCC and can improve diagnostic efficacy compared to DWI.
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Affiliation(s)
- Jiangming Qu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Boju Pan
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xingming Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xiaoli Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Tianjiao Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jinxia Zhu
- MR Research Collaboration, Siemens Healthineers Ltd, Beijing, China
| | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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Arterial spin labeling and diffusion-weighted imaging for identification of retropharyngeal lymph nodes in patients with nasopharyngeal carcinoma. Cancer Imaging 2022; 22:40. [PMID: 35978445 PMCID: PMC9387018 DOI: 10.1186/s40644-022-00480-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate the parameters derived from arterial spin labeling (ASL) and multi-b-value diffusion-weighted imaging (DWI) for differentiating retropharyngeal lymph nodes (RLNs) in patients with nasopharyngeal carcinoma (NPC). Methods This prospective study included 50 newly diagnosed NPC and 23 healthy control (HC) participants. RLNs of NPC were diagnosed according to the follow-up MRI after radiotherapy. Parameters derived from ASL and multi-b-value DWI, and RLNs axial size on pre-treatment MRI among groups were compared. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic efficiency. Results A total of 133 RLNs were collected and divided into a metastatic group (n = 71) and two non-metastatic groups (n = 62, including 29 nodes from NPC and 33 nodes from HC). The axial size, blood flow (BF), and apparent diffusion coefficient (ADC) of RLNs were significantly different between the metastasis and the non-metastasis group. For NPC patients with a short axis < 5 mm or < 6 mm, or long axis < 7 mm, if BF > 54 mL/min/100 g or ADC ≤ 0.95 × 10−3 mm2/s, the RLNs were still considered metastatic. Compared with the index alone, a combination of size and functional parameters could improve the accuracy significantly, except the long axis combined with ADC; especially, combined size with BF exhibited better performance with an accuracy of 91.00–92.00%. Conclusions ASL and multi-b-value DWI could help determine the N stage of NPC, while the BF combination with RLNs size may significantly improve the diagnostic efficiency. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00480-4.
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Sakamoto M, Kojima I, Iikubo M, Ito K, Aoki T, Mori S, Ogawa T, Katori Y, Murata T, Ito D, Kodama T. Perfusion defects in non-enlarged metastatic lymph nodes using vessel wall magnetic resonance imaging: Detection performance and diagnostic value. Clin Exp Metastasis 2022; 39:421-431. [PMID: 35119560 DOI: 10.1007/s10585-022-10147-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
A perfusion defect (PD) in non-enlarged lymph nodes (LNs) of oral squamous cell carcinoma (OSCC) is the most reliable radiological criterion for the diagnosis of metastasis. However, conventional contrast-enhanced (CE) T1 weighted images using turbo spin echo (TSE) sequence is limited in detecting PD in non-enlarged LNs due to flow artifacts from cervical blood vessels. Vessel wall (VW) MR imaging with blood vessel flow suppression and high spatial resolution may provide new insights into the detection of PD. However, there are no reports in the literature on the usefulness of VW MR imaging for the diagnosis of LN metastasis. It is demonstrated that PD of non-enlarged LNs in CE VR MR imaging of OSCC patients is useful for the diagnosis of metastatic LNs. VW MR imaging was significantly more sensitive in detecting PD of non-enlarged metastatic LNs than conventional TSE imaging on visual evaluation. Furthermore, it was found that the image contrast between PD and surrounding intranodal tissue in CE VW MR images was higher than that in conventional CE TSE images. In the correlation between imaging and histopathological findings of metastatic LNs, all LNs that exhibited PD on CE VW MR images were at an advanced histopathological metastatic stage. The pathology of PD was necrotic tissue with keratinization. The results indicated that PD in CE VW imaging is useful in diagnosing non-enlarged LNs at an advanced metastasis stage. The addition of VW MR imaging to conventional MR examination achieves higher diagnostic performance for non-enlarged metastatic LNs.
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Affiliation(s)
- Maya Sakamoto
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan. .,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan. .,Department of Dental Informatics and Radiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.
| | - Ikuho Kojima
- Department of Dental Informatics and Radiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iikubo
- Department of Dental Informatics and Radiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Koichi Ito
- Department of Computer and Mathematical Sciences, Graduate School of Information Sciences, Tohoku University, Aramaki Aza, Aoba, Sendai, Miyagi, 980-8579, Japan
| | - Takafumi Aoki
- Department of Computer and Mathematical Sciences, Graduate School of Information Sciences, Tohoku University, Aramaki Aza, Aoba, Sendai, Miyagi, 980-8579, Japan
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.,Department of Oral and Maxillofacial Surgery, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Tohoku University, 2-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.,Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yukio Katori
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Tohoku University, 2-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Takaki Murata
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Daisuke Ito
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
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Freihat O, Pinter T, Kedves A, Sipos D, Cselik Z, Repa I, Kovács Á. Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Cancer Imaging 2020; 20:56. [PMID: 32771060 PMCID: PMC7414722 DOI: 10.1186/s40644-020-00334-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To determine the usefulness of Diffusion Weighted Imaging (DWI) derived from PET/MRI in discriminating normal from metastatic lymph nodes and the correlation between the metastatic lymph nodes with the grade and the localization of the primary tumor. METHODS Retrospective study of 90 lymph nodes from 90 subjects; 65 patients who had proven histopathological metastatic lymph nodes from (HNSCC) who had undergone 18F- PET/MRI for clinical staging and assessment and twenty-five lymph nodes were chosen from 25 healthy subjects. Apparent Diffusion Coefficient (ADC) map was generated from DWI with b values (0 and 800 s/mm2). ADC values of the metastatic lymph nodes were calculated and compared to the normal lymph nodes ADC values, ROC was used to determine the best cut-off values to differentiate between the two group. Metastatic lymph nodes ADC mean values were compared to primary tumor grade and localization. RESULTS ADCmean value of the metastatic lymph nodes in the overall sample (0.899 ± 0.98*10- 3 mm2/sec) was significantly lower than the normal lymph nodes' ADCmean value (1.267 ± 0.88*10- 3 mm2/sec); (P = 0.001). The area under the curve (AUC) was 98.3%, sensitivity and specificity were 92.3 and 98.6%, respectively, when using a threshold value of (1.138 ± 0.75*10- 3 mm2/sec) to differentiate between both groups. Significant difference was found between metastatic lymph nodes (short-axis diameter < 10 mm), ADCmean (0.898 ± 0.72*10- 3 mm2/sec), and the benign lymph nodes ADCmean, (P = 0.001). No significant difference was found between ADCmean of the metastatic lymph nodes < 10 mm and the metastatic lymph nodes > 10 mm, ADCmean (0.899 ± 0.89*10- 3 mm2/sec), (P = 0.967). No significant differences were found between metastatic lymph nodes ADCmean values and different primary tumor grades or different primary tumor localization, (P > 0.05). CONCLUSION DWI-ADC is an effective and efficient imaging technique in differentiating between normal and malignant lymph nodes, and might be helpful to discriminate sub-centimeters lymph nodes. TRIAL REGISTRATION The trial is registered in clinical trials under ID: NCT04360993 , registration date: 17/04/2020.
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Affiliation(s)
- Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
| | - Tamas Pinter
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Medicopus Non-Profit Ltd., “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
| | - András Kedves
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Dávid Sipos
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Zsolt Cselik
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Oncoradiology, Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Imre Repa
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Medicopus Non-Profit Ltd., “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Árpád Kovács
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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5
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Zhang A, Song J, Ma Z, Chen T. Application of apparent diffusion coefficient values derived from diffusion-weighted imaging for assessing different sized metastatic lymph nodes in cervical cancers. Acta Radiol 2020; 61:848-855. [PMID: 31615267 DOI: 10.1177/0284185119879686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lymph nodes metastasis is an important factor affecting survival rate and recurrence in cervical cancer patients. Currently, diagnosis of metastatic lymph nodes is mainly based on morphological changes on imaging. However, it is difficult to differentiate normal-sized metastatic lymph nodes with short axis of 5-10mm. PURPOSE To assess the diagnostic value of apparent diffusion coefficient (ADC) for discriminating different-sized metastatic lymph nodes in patients with cervical cancers. MATERIAL AND METHODS Pathologically confirmed cervical cancer patients were documented from January 2013 to July 2018 in our hospital. A total of 133 patients who underwent conventional MRI and diffusion-weighted imaging with complete pathology were finally enrolled. A total of 157 lymph nodes were harvested and analyzed. All lymph nodes were divided into three groups according to pathology and their short axis (S) measured on axial T2-weighted imaging: normal-sized (5 mm<S<10 mm) benign lymph nodes (Group 1); normal-sized (5 mm<S<10 mm) metastatic lymph nodes (Group 2); enlarged (S≥10 mm) metastatic lymph nodes (Group 3). Mean ADC (ADCmean), minimum ADC (ADCmin), and maximum ADC (ADCmax) values of lymph nodes were analyzed and compared among the three groups. RESULTS ADCmean of Groups 1 and 2 were significantly larger than those of Group 3 (P<0.001, P=0.005, respectively). ADCmin of Group 1 were significantly larger than those of Groups 2 and 3 (P<0.001, P<0.001, respectively). ADCmax was not statistically different among the three groups. ADCmean had the relatively highest area under the curve (AUC) of 0.644 for assessing enlarged metastatic lymph nodes, with a sensitivity of 64.4% and specificity of 67.9%. ADCmin had the highest AUC of 0.758 for assessing normal-sized metastatic lymph nodes, with a sensitivity of 84.7% and specificity of 60.7%. CONCLUSION Diffusion-weighted imaging can be used to differentiate enlarged metastatic lymph nodes from benign lymph nodes, and ADCmin can be further used to identify micro-metastasis in normal-sized lymph nodes.
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Affiliation(s)
- Aining Zhang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jiacheng Song
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Zhanlong Ma
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Ting Chen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Jović A, Fila J, Gršić K, Ivkić M, Ozretić D. Diffusion-weighted MRI: impact of the size of the ROI in detecting metastases in subcentimeter lymph nodes in head and neck squamous cell carcinoma. Neuroradiology 2020; 62:987-994. [PMID: 32418025 DOI: 10.1007/s00234-020-02449-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Our aim is to determine the impact of the size of ROI in detecting subcentimeter metastatic lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). Secondary aim is to determine the impact of the histopathologic grade of the primary cancer on the ADC value of the metastatic nodes. METHODS The prospective study included 51 patients with histopathologically proven HNSCC at the primary site. Primary site includes oral cavity, oropharynx, larynx, and hypopharynx. ADC values of the lymph nodes were measured on ADC maps by placing two ROIs in the lymph nodes (0.2 cm2 in the center of the node and the whole node). Lymph nodes were dissected by levels, marked by the surgeon, and sent to the pathologist. RESULTS By applying a smaller ROI, ADC values have greater sensitivity, specificity, NPV, PPV, and AUC in detecting metastasis compared to the ADC value of the entire node (88.0%, 80.73%, 90.7%, 75.9%, 0.912% versus 80.0%, 77.98%, 85% ,71.4%, and 0.819%, respectively) p < 0.001. Statistically significant negative correlation was established between the tumor grade and the ADC of lymph node at ROI 0.2 cm2and ROI of the whole lymph node (rho = - 0.425; p = 0.002, and rho = - 0.298; p = 0.038, respectively). CONCLUSION ROI size affects the ADC value of the nodes. The higher histopathological grade of the primary tumor is inversely correlated with the ADC value of the lymph nodes.
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Affiliation(s)
- Andrijana Jović
- Department of Neuroradiology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Jana Fila
- Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Krešimir Gršić
- Department of Head and Neck Surgery and Otorhinolaryngology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Mirko Ivkić
- School of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000, Rijeka, Croatia
| | - David Ozretić
- Department of Neuroradiology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
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Ianuş A, Santiago I, Galzerano A, Montesinos P, Loução N, Sanchez-Gonzalez J, Alexander DC, Matos C, Shemesh N. Higher-order diffusion MRI characterization of mesorectal lymph nodes in rectal cancer. Magn Reson Med 2019; 84:348-364. [PMID: 31850546 DOI: 10.1002/mrm.28102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Mesorectal lymph node staging plays an important role in treatment decision making. Here, we explore the benefit of higher-order diffusion MRI models accounting for non-Gaussian diffusion effects to classify mesorectal lymph nodes both 1) ex vivo at ultrahigh field correlated with histology and 2) in vivo in a clinical scanner upon patient staging. METHODS The preclinical investigation included 54 mesorectal lymph nodes, which were scanned at 16.4 T with an extensive diffusion MRI acquisition. Eight diffusion models were compared in terms of goodness of fit, lymph node classification ability, and histology correlation. In the clinical part of this study, 10 rectal cancer patients were scanned with diffusion MRI at 1.5 T, and 72 lymph nodes were analyzed with Apparent Diffusion Coefficient (ADC), Intravoxel Incoherent Motion (IVIM), Kurtosis, and IVIM-Kurtosis. RESULTS Compartment models including restricted and anisotropic diffusion improved the preclinical data fit, as well as the lymph node classification, compared to standard ADC. The comparison with histology revealed only moderate correlations, and the highest values were observed between diffusion anisotropy metrics and cell area fraction. In the clinical study, the diffusivity from IVIM-Kurtosis was the only metric showing significant differences between benign (0.80 ± 0.30 μm2 /ms) and malignant (1.02 ± 0.41 μm2 /ms, P = .03) nodes. IVIM-Kurtosis also yielded the largest area under the receiver operating characteristic curve (0.73) and significantly improved the node differentiation when added to the standard visual analysis by experts based on T2 -weighted imaging. CONCLUSION Higher-order diffusion MRI models perform better than standard ADC and may be of added value for mesorectal lymph node classification in rectal cancer patients.
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Affiliation(s)
- Andrada Ianuş
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Ines Santiago
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Nova Medical School, Lisbon, Portugal
| | - Antonio Galzerano
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | | | | | - Daniel C Alexander
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Celso Matos
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Noam Shemesh
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
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Texture Analysis of Multi-Shot Echo-planar Diffusion-Weighted Imaging in Head and Neck Squamous Cell Carcinoma: The Diagnostic Value for Nodal Metastasis. J Clin Med 2019; 8:jcm8111767. [PMID: 31652840 PMCID: PMC6912832 DOI: 10.3390/jcm8111767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/13/2019] [Accepted: 10/22/2019] [Indexed: 12/28/2022] Open
Abstract
Accurate assessment of nodal metastasis in head and neck squamous cell carcinoma (SCC) is important, and diffusion-weighted imaging (DWI) has emerged as a potential technique in differentiating benign from malignant lymph nodes (LNs). This study aims to evaluate the diagnostic performance of texture analysis using apparent diffusion coefficient (ADC) data of multi-shot echo-planar imaging-based DWI (msEPI-DWI) in predicting metastatic LNs of head and neck SCC. 36 patients with pathologically proven head and neck SCC were included in this study. A total of 204 MRI-detected LNs, including 176 subcentimeter-sized LNs, were assigned to metastatic or benign groups. Texture features of LNs were compared using independent t-test. Hierarchical cluster analysis was performed to exclude redundant features. Multivariate logistic regression and receiver operating characteristic analysis were performed to assess the diagnostic performance. The discriminative texture features for predicting metastatic LNs were complexity, energy and roundness. Areas under the curves (AUCs) for diagnosing metastasis in all/subcentimeter-sized LNs were 0.829/0.767 using complexity, 0.699/0.685 using energy and 0.671/0.638 using roundness, respectively. The combination of three features resulted in higher AUC values of 0.836/0.781. In conclusion, texture analysis of ADC data using msEPI-DWI could be a useful tool for nodal staging in head and neck SCC.
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9
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Differentiation of lymphomatous, metastatic, and non-malignant lymphadenopathy in the neck with quantitative diffusion-weighted imaging: systematic review and meta-analysis. Neuroradiology 2019; 61:897-910. [DOI: 10.1007/s00234-019-02236-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
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10
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Huang TX, Lu N, Lian SS, Li H, Yin SH, Geng ZJ, Xie CM. The primary lesion apparent diffusion coefficient is a prognostic factor for locoregionally advanced nasopharyngeal carcinoma: a retrospective study. BMC Cancer 2019; 19:470. [PMID: 31101029 PMCID: PMC6525458 DOI: 10.1186/s12885-019-5684-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/08/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To explore prognostic value of the pre-treatment primary lesion apparent diffusion coefficient (ADC) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). METHODS A total of 843 patients with newly diagnosed LA-NPC were enrolled from January 2011 to April 2014 and divided into two groups based on ADC values: the low-ADC group and high-ADC group. The 3-year local relapse-free survival (LRFS), distant metastasis free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates between two groups were compared using Kaplan-Meier curve, and Cox regression analyses were performed to test prognostic value of the pretreatment ADC in LA-NPC. RESULTS The cut-off value of the pretreatment ADC for predicting local relapse was 784.5 × 10- 6 mm2/s (AUC [area under curve] = 0.604; sensitivity = 0.640; specificity = 0.574), thus patients were divided into low-ADC (< 784.5 × 10- 6; n = 473) group and high-ADC (≥784.5 × 10- 6; n = 370) group. The low-ADC group had significantly higher 3-year LRFS rate and DFS rate than the high-ADC group (LRFS: 96.2% vs. 91.4%, P = 0.003; DFS: 81.4% vs. 73.0%, P = 0.0056). Multivariate analysis showed that the pretreatment ADC is an independent prognostic factor for LRFS (HR, 2.04; 95% CI, 1.13-3.66; P = 0.017) and DFS (HR, 1.41; 95% CI, 1.04-1.89; P = 0.024). CONCLUSIONS The pretreatment ADC of the primary lesion is an independent prognostic factor for LRFS and DFS in LA-NPC patients.
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Affiliation(s)
- Tao-Xiang Huang
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China.,Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630,, People's Republic of China
| | - Nian Lu
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China
| | - Shan-Shan Lian
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China
| | - Hui Li
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China
| | - Shao-Han Yin
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China
| | - Zhi-Jun Geng
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China
| | - Chuan-Miao Xie
- Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng Road East, 510060, Guangzhou, People's Republic of China.
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11
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Lee JH, Han SS, Hong EK, Cho HJ, Joo J, Park EY, Woo SM, Kim TH, Lee WJ, Park SJ. Predicting lymph node metastasis in pancreatobiliary cancer with magnetic resonance imaging: A prospective analysis. Eur J Radiol 2019; 116:1-7. [PMID: 31153550 DOI: 10.1016/j.ejrad.2019.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/26/2019] [Accepted: 04/12/2019] [Indexed: 01/04/2023]
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.
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Affiliation(s)
- Ju Hee Lee
- Department of Radiology, Center for Liver Cancer, National Cancer Center, Republic of Korea
| | - Sung-Sik Han
- Department of Surgery, Center for Liver Cancer, National Cancer Center, Republic of Korea
| | - Eun Kyung Hong
- Department of Pathology, Center for Liver Cancer, National Cancer Center, Republic of Korea
| | - Hwa Jin Cho
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute National Cancer Center, Republic of Korea
| | - Eun Young Park
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sang Myung Woo
- Center for Liver Cancer, National Cancer Center, Republic of Korea
| | - Tae Hyun Kim
- Center for Liver Cancer, National Cancer Center, Republic of Korea
| | - Woo Jin Lee
- Center for Liver Cancer, National Cancer Center, Republic of Korea
| | - Sang-Jae Park
- Department of Surgery, Center for Liver Cancer, National Cancer Center, Republic of Korea.
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12
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Suh CH, Choi YJ, Baek JH, Lee JH. The Diagnostic Value of Diffusion-Weighted Imaging in Differentiating Metastatic Lymph Nodes of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:1889-1895. [PMID: 30213809 DOI: 10.3174/ajnr.a5813] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/07/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Accurate lymph node staging is crucial for proper treatment planning for metastasis in patients with head and neck squamous cell carcinoma. PURPOSE Our aim was to evaluate the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes in patients with head and neck squamous cell carcinoma and to identify optimal cutoff values for ADC. DATA SOURCES A computerized literature search was performed to identify relevant original articles in Ovid MEDLINE and EMBASE. STUDY SELECTION Studies evaluating the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes were selected. DATA ANALYSIS Diagnostic meta-analysis was conducted with a bivariate random-effects model, and a hierarchical summary receiver operating characteristic curve was obtained. Meta-regression was also performed. DATA SYNTHESIS Nine studies with 337 patients were included. In all studies, ADC values derived from metastatic lymph nodes were significantly lower than ADC values derived from benign lymph nodes. The median ADC cutoff value was 0.965 × 10-3 mm2/s. The pooled sensitivity and specificity for the diagnostic performance of DWI in differentiating metastatic lymph nodes from benign lymph nodes were 90% (95% CI, 84%-94%) and 88% (95% CI, 80%-93%), respectively. In the meta-regression, sensitivity was significantly higher in the studies using a 3-mm slice thickness (93% [95% CI, 88%-98%]) than in studies using a slice thickness of >3 mm (86% [95% CI, 77%-95%], P < .01). LIMITATIONS A small number of studies were included in our meta-analysis. CONCLUSIONS DWI demonstrated high diagnostic performance for differentiating metastatic lymph nodes from benign lymph nodes in patients with head and neck squamous cell carcinoma, and the median ADC cutoff value was 0.965 × 10-3 mm2/s. A 3-mm DWI slice thickness can provide a slight improvement in sensitivity.
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Affiliation(s)
- C H Suh
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Y J Choi
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - J H Baek
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - J H Lee
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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13
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Wang YJ, Xu XQ, Hu H, Su GY, Shen J, Shi HB, Wu FY. Histogram analysis of apparent diffusion coefficient maps for the differentiation between lymphoma and metastatic lymph nodes of squamous cell carcinoma in head and neck region. Acta Radiol 2018; 59:672-680. [PMID: 28870086 DOI: 10.1177/0284185117730688] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background To clarify the nature of cervical malignant lymphadenopathy is highly important for the diagnosis and differential diagnosis of head and neck tumors. Purpose To investigate the role of first-order apparent diffusion coefficient (ADC) histogram analysis for differentiating lymphoma from metastatic lymph nodes of squamous cell carcinoma (SCC) in the head and neck region. Material and Methods Diffusion-weighted imaging (DWI) data of 67 patients (lymphoma, n = 20; SCC, n = 47) with malignant lymphadenopathy were retrospectively analyzed. The SCC group was divided into nasopharyngeal SCC and non-nasopharyngeal SCC groups. The ADC histogram features (ADC10, ADC25, ADCmean, ADCmedian, ADC75, ADC90, skewness, and kurtosis) were derived and then compared by independent-samples t-test and one-way analysis of variance test, respectively. Receiver operating characteristic curve analyses were employed to investigate diagnostic performance of the significant parameters. Results Lymphoma showed significantly lower ADCmean, ADCmedian, ADC75, and ADC90 than SCC (all P < 0.05). Setting ADC90 = 0.719 × 10-3 mm2/s as the threshold value, optimal diagnostic performance was achieved (area under the curve [AUC] = 0.719, sensitivity = 95.7%, specificity = 50.0%). Subgroup analyses showed no significant difference between lymphoma and NPC (all P > 0.05). Lymphoma showed significantly lower ADC25, ADCmean, ADCmedian, ADC75, and ADC90 than non-nasopharyngeal SCC (all P < 0.05). Optimal diagnostic performance (AUC = 0.847, sensitivity = 86.7%, specificity = 80.0%) could be achieved when setting ADC90 = 0.943 × 10-3 mm2/s as the threshold value. Conclusion Given its limitations, our study has shown that first-order ADC histogram analysis is capable of differentiating lymphoma from metastatic lymph nodes of SCC, especially those of non-nasopharyngeal SCC.
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Affiliation(s)
- Yan-Jun Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, PR China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Jie Shen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
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14
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Zhang SC, Zhou SH, Shang DS, Bao YY, Ruan LX, Wu TT. The diagnostic role of diffusion-weighted magnetic resonance imaging in hypopharyngeal carcinoma. Oncol Lett 2018; 15:5533-5544. [PMID: 29552192 PMCID: PMC5840528 DOI: 10.3892/ol.2018.8053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 12/29/2017] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to assess the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) values in hypopharyngeal carcinoma. A total of 40 hypopharyngeal carcinoma tissues and 15 benign lesion tissues were retrospectively analyzed. DWI, and T1- and T2-weighted magnetic resonance imaging (MRI) was performed. The sensitivity, specificity and accuracy of conventional MRI were 97.5, 66.7, and 89.1%, respectively. The mean ADC value [diffusion sensitive factor (b)=1,000× sec/mm2) for hypopharyngeal carcinomas was (1.0285±0.0328)×10−3 mm2/sec, which was significantly lower than the mean ADC value for benign lesions [(1.5333±0.1061)×10−3 mm2/sec; P<0.001]. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was 0.921 while the optimal threshold for the cut-off point of the ADC was 1.075×10−3 mm2/sec. The mean ADC value of the metastatic nodes was (0.9184±0.0538)×10−3 mm2/sec, lower than the mean value for the benign nodes [(1.2538±0.1145)×10−3 mm2/sec; P=0.005]. Two groups were created according to the mean of the ADC value of hypopharyngeal carcinomas [≤(1.0285±0.0328)×10−3 mm2/sec vs. >(1.0285±0.0328)×10−3 mm2/sec]. The 2-year survival rates of the two groups were 55.6 and 100.0%, respectively (P=0.024). ADC values may aid in distinguishing hypopharyngeal carcinomas from benign lesions and differentiating metastatic lymph nodes of hypopharyngeal squamous cell carcinomas from reactive cervical lymph nodes. In conclusion, mean ADC values may be useful prognostic factors in univariate analysis of hypopharyngeal carcinoma.
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Affiliation(s)
- Si-Cong Zhang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Department of Otolaryngology, People's Hospital of Cixi City, Cixi, Zhejiang 315300, P.R. China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - De-Sheng Shang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Ling-Xiang Ruan
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Ting-Ting Wu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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15
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Han Y, Fan X, Su L, Wang Z. Diffusion-Weighted MR Imaging of Unicystic Odontogenic Tumors for Differentiation of Unicystic Ameloblastomas from Keratocystic Odontogenic Tumors. Korean J Radiol 2018; 19:79-84. [PMID: 29354003 PMCID: PMC5768511 DOI: 10.3348/kjr.2018.19.1.79] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/27/2017] [Indexed: 11/21/2022] Open
Abstract
Objective Differentiating unicystic ameloblastomas from keratocystic odontogenic tumors (KCOT) is necessary for the planning of different treatment strategies; however, it is difficult based on conventional CT and MR sequences alone. The purpose of this study was to investigate the utility of diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADCs) in the differentiation of the two tumors. Materials and Methods We prospectively studied 40 patients with odontogenic cysts and tumors of the maxillomandibular region using conventional MR imaging and DWI. ADCs were measured using 2 b factors (500 and 1000). Results Unicystic ameloblastomas (n = 11) showed free diffusion on DWI and a mean ADC value of 2.309 ± 0.17 × 10-3 mm2/s. KCOT (n = 15) showed restricted diffusion on DWI with a mean ADC value of 0.923 ± 0.20 × 10-3 mm2/s. The ADC values of unicystic ameloblastomas were significantly higher than those of KCOT (p < 0.001, Mann-Whitney U-test). An ADC cut-off value of 2.0 × 10-3 mm2/s to differentiate KCOT and unicystic ameloblastomas resulted in a 100% sensitivity and 100% specificity. Dentigerous cysts (n = 3) showed restricted diffusion on DWI and similar ADC values (1.257 ± 0.05 × 10-3 mm2/s) to those of KCOT. Conclusion Diffusion-weighted imaging and ADC determination can be used as an adjuvant tool to differentiate between unicystic ameloblastomas and KCOT, although the ADC values of dentigerous cysts overlap with those of KCOT.
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Affiliation(s)
- Yifeng Han
- Department of Interventional Radiology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xindong Fan
- Department of Interventional Radiology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Lixin Su
- Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Zhenfeng Wang
- Department of Interventional Radiology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
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16
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State of the art MRI in head and neck cancer. Clin Radiol 2017; 73:45-59. [PMID: 28655406 DOI: 10.1016/j.crad.2017.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
Head and neck cancer affects more than 11,000 new patients per year in the UK1 and imaging has an important role in the diagnosis, treatment planning, and assessment, and post-treatment surveillance of these patients. The anatomical detail produced by magnetic resonance imaging (MRI) is ideally suited to staging and follow-up of primary tumours and cervical nodal metastases in the head and neck; however, anatomical images have limitations in cancer imaging and so increasingly functional-based MRI techniques, which provide molecular, metabolic, and physiological information, are being incorporated into MRI protocols. This article reviews the state of the art of these functional MRI techniques with emphasis on those that are most relevant to the current management of patients with head and neck cancer.
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17
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Differentiation of Benign and Malignant Head and Neck Lesions With Diffusion Tensor Imaging and DWI. AJR Am J Roentgenol 2017; 208:1110-1115. [DOI: 10.2214/ajr.16.16486] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Post-treatment 18F-FDG-PET/CT versus contrast-enhanced CT in patients with oropharyngeal squamous cell carcinoma: comparative effectiveness study. Nucl Med Commun 2017; 38:250-258. [PMID: 28099264 DOI: 10.1097/mnm.0000000000000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the accuracy of same-day therapy-assessment PET/computed tomography (PET/CT) and conventional contrast-enhanced computed tomography (CECT) in patients with oropharyngeal squamous cell carcinoma (OPSCC). METHODS A total of 110 (95 men and 15 women; mean age 59 years) patients with biopsy-proven OPSCC were evaluated with same-day PET/CT and CECT pair scans as part of follow-up therapy assessment. Scans were performed within 6 months after the completion of primary treatment (median time: 3.1 months; range: 0.5-6 months). PET/CT and CECT scans were reviewed retrospectively for residual primary site disease, and right and left cervical lymph node involvement. Histopathology or 6 month clinical/imaging follow-up were used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the primary site and cervical nodal disease. RESULTS Of 110 OPSCC patients, 90.9% were human papilloma virus positive, 80.8% were stage 4, and 76.4% received chemoradiation as the primary treatment. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT were similar in the evaluation of the primary cancer site (PET/CT: 75.0, 91.5, 25.0, 99.0, and 90.9, respectively, versus CECT: 75.0, 90.6, 23.1, 99.0, and 90.0, respectively). In evaluating cervical lymph node involvement, PET/CT appeared to have higher accuracy (96.8 vs. 81.7%), specificity (97.7 vs. 81.7%), and PPV (45.8 vs. 16.5%), comparable NPV (99.4% for both), and lower sensitivity (65 vs. 75%) compared with same-day CECT. CONCLUSION Same-day PET/CT and CECT scans had comparable accuracy in the evaluation of primary tumor sites after completion of therapy in patients with OPSCC. PET/CT showed higher accuracy in the evaluation of cervical lymph node involvement.
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19
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Xu XQ, Choi YJ, Sung YS, Yoon RG, Jang SW, Park JE, Heo YJ, Baek JH, Lee JH. Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging. Korean J Radiol 2016; 17:641-9. [PMID: 27587952 PMCID: PMC5007390 DOI: 10.3348/kjr.2016.17.5.641] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/17/2016] [Indexed: 12/25/2022] Open
Abstract
Objective To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. Materials and Methods We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D* and model-free parameters from the DCE-MRI (wash-in, Tmax, Emax, initial AUC60, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. Results No correlation was found between f or D* and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D* (p > 0.05, respectively). Conclusion Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.
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Affiliation(s)
- Xiao Quan Xu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ra Gyoung Yoon
- Department of Radiology, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea
| | - Seung Won Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.; Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Xu XQ, Hu H, Su GY, Liu H, Shi HB, Wu FY. Diffusion Weighted Imaging for Differentiating Benign from Malignant Orbital Tumors: Diagnostic Performance of the Apparent Diffusion Coefficient Based on Region of Interest Selection Method. Korean J Radiol 2016; 17:650-6. [PMID: 27587953 PMCID: PMC5007391 DOI: 10.3348/kjr.2016.17.5.650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/10/2016] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the differences in the apparent diffusion coefficient (ADC) measurements based on three different region of interest (ROI) selection methods, and compare their diagnostic performance in differentiating benign from malignant orbital tumors. Materials and Methods Diffusion-weighted imaging data of sixty-four patients with orbital tumors (33 benign and 31 malignant) were retrospectively analyzed. Two readers independently measured the ADC values using three different ROIs selection methods including whole-tumor (WT), single-slice (SS), and reader-defined small sample (RDSS). The differences of ADC values (ADC-ROIWT, ADC-ROISS, and ADC-ROIRDSS) between benign and malignant group were compared using unpaired t test. Receiver operating characteristic curve was used to determine and compare their diagnostic ability. The ADC measurement time was compared using ANOVA analysis and the measurement reproducibility was assessed using Bland-Altman method and intra-class correlation coefficient (ICC). Results Malignant group showed significantly lower ADC-ROIWT, ADC-ROISS, and ADC-ROIRDSS than benign group (all p < 0.05). The areas under the curve showed no significant difference when using ADC-ROIWT, ADC-ROISS, and ADC-ROIRDSS as differentiating index, respectively (all p > 0.05). The ROISS and ROIRDSS required comparable measurement time (p > 0.05), while significantly shorter than ROIWT (p < 0.05). The ROISS showed the best reproducibility (mean difference ± limits of agreement between two readers were 0.022 [-0.080–0.123] × 10-3 mm2/s; ICC, 0.997) among three ROI methods. Conclusion Apparent diffusion coefficient values based on the three different ROI selection methods can help to differentiate benign from malignant orbital tumors. The results of measurement time, reproducibility and diagnostic ability suggest that the ROISS method are potentially useful for clinical practice.
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Affiliation(s)
- Xiao-Quan Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hao Hu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Guo-Yi Su
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hu Liu
- Department of Ophthalmology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Fei-Yun Wu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
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21
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Jin GQ, Yang J, Liu LD, Su DK, Wang DP, Zhao SF, Liao ZL. The diagnostic value of 1.5-T diffusion-weighted MR imaging in detecting 5 to 10 mm metastatic cervical lymph nodes of nasopharyngeal carcinoma. Medicine (Baltimore) 2016; 95:e4286. [PMID: 27512841 PMCID: PMC4985296 DOI: 10.1097/md.0000000000004286] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of the study was to prospectively assess the diagnostic accuracy of 1.5 T diffusion-weighted imaging (DWI) for 5 to 10 mm metastatic cervical lymph nodes of patients with nasopharyngeal carcinoma (NPC). All patients with histopathologically confirmed NPC underwent DWI with 2 b values of 0 and 800 s/mm were enrolled. The shortest axial diameter and mean apparent diffusion coefficient (ADC) value were recorded when lymph nodes with a shortest axial diameter from 5 to 10 mm were measured. The correlation between the pathological diagnoses and mean ADC values in the benign and metastatic lymph nodes were compared using the Z test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of DWI. Three hundred fourteen nodes of 52 patients with NPC consisted of 46.5% (146/314) metastatic lymph nodes and 53.5% (168/314) benign lymph nodes. The mean ADC value (×10 mm/s) of benign lymph nodes was (1.110 ± 0.202), which was significantly higher than that of metastatic nodes (0.878 ± 0.159) (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value, accuracy for differentiating metastatic from benign lymph nodes using a cutoff ADC value of 0.924 × 10 mm/s was 83.56%, 82.74%, 80.79%, 85.28%, and 82.80%, respectively. The area under the ROC curve was 0.851 (95% confidence intervals: 0.807-0.889). This study demonstrated that DWI is helpful in detecting 5 to 10 mm metastatic lymph nodes of patients with NPC.
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Affiliation(s)
| | | | | | | | | | | | - Zhi Ling Liao
- Department of Pathology, Affiliated Tumor Hospital, Guang xi Medical University, Nanning, P.R. China
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Seber T, Caglar E, Uylar T, Karaman N, Aktas E, Aribas BK. Diagnostic value of diffusion-weighted magnetic resonance imaging: differentiation of benign and malignant lymph nodes in different regions of the body. Clin Imaging 2015; 39:856-62. [PMID: 26091745 DOI: 10.1016/j.clinimag.2015.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/01/2015] [Accepted: 05/08/2015] [Indexed: 12/24/2022]
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/mm(2.) 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) mm(2)/s (range: 0.6-1.2×10(-3) mm(2)/s), and the mean ADC value for malignant lymph nodes was 0.76×10(-3) mm(2)/s (range: 0.3-1.2×10(-3) mm(2)/s) (P<.001). In ROC analysis, the cut-off ADC value for malignant versus benign lymph node differentiation was 0.8×10(-3) mm(2)/s. Using an ADC value of 0.8×10(-3) mm(2)/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.
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Affiliation(s)
- Turgut Seber
- Dr. A. Y. Ankara Oncology Education and Research Hospital, Department of Radiology.
| | - Emrah Caglar
- Dr. A. Y. Ankara Oncology Education and Research Hospital, Department of Radiology.
| | - Tuğba Uylar
- Dr. A. Y. Ankara Oncology Education and Research Hospital, Department of Radiology.
| | - Niyazi Karaman
- Dr. A. Y. Ankara Oncology Education and Research Hospital, Department of General Surgery.
| | - Elif Aktas
- Dr. A. Y. Ankara Oncology Education and Research Hospital, Department of Radiology.
| | - Bilgin Kadri Aribas
- Dr. A. Y. Ankara Oncology Education and Research Hospital, Department of Radiology.
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