头颈部癌患者中利用扩散加权磁共振成像鉴别转移性颈部淋巴结
Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer.
作者信息
Sumi Misa, Sakihama Noriyuki, Sumi Tadateru, Morikawa Minoru, Uetani Masataka, Kabasawa Hiroyuki, Shigeno Koichiro, Hayashi Kuniaki, Takahashi Haruo, Nakamura Takashi
机构信息
Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Japan.
出版信息
AJNR Am J Neuroradiol. 2003 Sep;24(8):1627-34.
BACKGROUND AND PURPOSE
Metastasis to the regional cervical lymph nodes may be associated with alterations in water diffusivity and microcirculation of the node. We tested whether diffusion-weighted MR imaging could discriminate metastatic nodes.
METHODS
Diffusion-weighted echo-planar and T1- and T2-weighted MR imaging sequences were performed on histologically proved metastatic cervical lymph nodes (25 nodes), benign lymphadenopathy (25 nodes), and nodal lymphomas (five nodes). The apparent diffusion coefficient (ADC) was calculated by using two b factors (500 and 1000 s/mm(2)).
RESULTS
The ADC was significantly greater in metastatic lymph nodes (0.410 +/- 0.105 x 10(-3) mm(2)/s, P <.01) than in benign lymphadenopathy (0.302 +/- 0.062 x 10(-3) mm(2)/s). Nodal lymphomas showed even lower levels of the ADC (0.223 +/- 0.056 x 10(-3) mm(2)/s). ADC criteria for metastatic nodes (>/= 0.400 x 10(-3) mm(2)/s) yielded a moderate negative predictive value (71%) and high positive predictive value (93%). Receiver operating characteristic analysis demonstrated that the criteria of abnormal signal intensity on T1- or T2-weighted images (A(z) = 0.8437 +/- 0.0230) and ADC (A(z) = 0.8440 +/- 0.0538) provided similar levels of diagnostic ability in differentiating metastatic nodes. The ADC from metastatic nodes from highly or moderately differentiated cancers (0.440 +/- 0.020 x 10(-3) mm(2)/s, P <.01) was significantly greater than that from poorly differentiated cancers (0.356 +/- 0.042 x 10(-3) mm(2)/s).
CONCLUSION
Diffusion-weighted imaging is useful in discriminating metastatic nodes.
背景与目的
颈部区域淋巴结转移可能与淋巴结内水扩散率及微循环的改变有关。我们测试了扩散加权磁共振成像（DWI）能否鉴别转移性淋巴结。
方法
对经组织学证实的转移性颈部淋巴结（25个）、良性淋巴结病（25个）及淋巴结淋巴瘤（5个）进行扩散加权回波平面成像以及T1加权和T2加权磁共振成像序列检查。使用两个b值（500和1000 s/mm²）计算表观扩散系数（ADC）。
结果
转移性淋巴结的ADC（0.410±0.105×10⁻³ mm²/s，P<0.01）显著高于良性淋巴结病（0.302±0.062×10⁻³ mm²/s）。淋巴结淋巴瘤的ADC水平更低（0.223±0.056×10⁻³ mm²/s）。转移性淋巴结的ADC标准（≥0.400×10⁻³ mm²/s）具有中等的阴性预测值（71%）和较高的阳性预测值（93%）。受试者操作特征分析表明，T1加权或T2加权图像上异常信号强度标准（A(z)=0.8437±0.0230）和ADC标准（A(z)=0.8440±0.0538）在鉴别转移性淋巴结方面具有相似的诊断能力水平。高分化或中分化癌转移性淋巴结的ADC（0.440±0.020×10⁻³ mm²/s，P<0.01）显著高于低分化癌（0.356±0.042×10⁻³ mm²/s）。
结论
扩散加权成像有助于鉴别转移性淋巴结。
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