de Bondt R B J, Hoeberigs M C, Nelemans P J, Deserno W M L L G, Peutz-Kootstra C, Kremer B, Beets-Tan R G H
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Neuroradiology. 2009 Mar;51(3):183-92. doi: 10.1007/s00234-008-0487-2. Epub 2009 Jan 10.
The aim was to determine the diagnostic accuracy and additional value of diffusion-weighted imaging for detection of malignant lymph nodes in head and neck squamous cell carcinoma.
Two hundred nineteen lymph nodes, predominantly smaller than 10 mm (95.4%), in 16 consecutive patients were evaluated at 1.5 T. Lymph nodes were evaluated for maximum short axial diameter, morphological criteria, and apparent diffusion coefficient (ADC) values (b = 0 and b = 1,000 s/mm(2)). Sensitivity, specificity, positive and negative predictive values as well as diagnostic odds ratios (DORs) and areas under the curves (AUCs) of ROC curves were calculated for the various magnetic resonance imaging (MRI) criteria individually and in combination. Histological examination of lymph nodes in the neck dissection specimen was the gold standard to determine malignant involvement.
The optimal ADC threshold was 1.0 x 10(-3) mm(2)/s. Using this cutoff point, sensitivity and specificity were 92.3% and 83.9%, respectively. When used in combination with size and morphological criteria, ADC value <1.0 x 10(-3) mm(2)/s was the strongest predictor of presence of metastasis (DOR = 97.6). A model which added ADC values to the other MRI criteria performed significantly better than a model without ADC values: AUC = 0.98 versus AUC = 0.91 (p = 0.036).
In this study, with predominantly small lymph nodes, the ADC criterion is the strongest independent predictor of presence of metastasis. The use of ADC values in combination with the other MRI criteria significantly improves the discrimination between malignant and benign lymph nodes.
目的是确定扩散加权成像对头颈部鳞状细胞癌中恶性淋巴结检测的诊断准确性和附加价值。
对16例连续患者的219个淋巴结进行1.5T磁共振成像评估，这些淋巴结主要小于10mm（95.4%）。评估淋巴结的最大短轴直径、形态学标准和表观扩散系数（ADC）值（b = 0和b = 1000 s/mm²）。分别计算各种磁共振成像（MRI）标准单独及联合使用时的敏感性、特异性、阳性和阴性预测值以及诊断比值比（DOR）和ROC曲线下面积（AUC）。颈部清扫标本中淋巴结的组织学检查是确定恶性受累的金标准。
最佳ADC阈值为1.0×10⁻³mm²/s。采用此截断点时，敏感性和特异性分别为92.3%和83.9%。当与大小和形态学标准联合使用时，ADC值<1.0×10⁻³mm²/s是转移存在的最强预测指标（DOR = 97.6）。一个将ADC值添加到其他MRI标准中的模型比不包含ADC值的模型表现明显更好：AUC = 0.98对AUC = 0.91（p = 0.036）。
在本研究中，主要针对小淋巴结，ADC标准是转移存在的最强独立预测指标。将ADC值与其他MRI标准联合使用可显著提高恶性和良性淋巴结之间的鉴别能力。
