Dept. of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Eur J Surg Oncol. 2019 Mar;45(3):347-352. doi: 10.1016/j.ejso.2018.11.018. Epub 2018 Nov 28.
Diffusion-weighted MRI (DWI) contributes to N staging of rectal cancers and diagnosis of colorectal liver metastases (CLM). About 15% of CLM patients have loco-regional lymph node (LN) metastases that impact prognosis and treatment strategy. This retrospective study is the first one to evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer.
All consecutive patients undergoing surgery for CLM between 2008 and 2015 were considered. Inclusion criteria were: intraoperative retrieval of at least one LN; LN ≥ 5 mm; DWI performed ≤2 months before surgery. The ADC and ADC (ADC/ADC) were computed by two radiologists for all the LNs.
Among 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADC in metastatic LNs were lower than in benign LNs (ADC = 1.37 vs. 1.83 × 10 mm/s, p < 0.001; ADC = 1.26 vs. 1.73, p < 0.001). The optimal cut-off value for ADC was 1.48 x 10 mm/s (AUC = 0.85, p < 0.001, sensitivity/specificity/accuracy 79%/93%/86% in per LN-analysis and 94%/86%/91% in per-patient analysis). The optimal cut-off for ADC was 1.15 (AUC = 0.80, p < 0.001, sensitivity/specificity/accuracy 69%/93%/81% and 76%,93%/84%). Excellent inter- and intra-operators' agreements were observed.
In patients with CLM, ADC values < 1.48 x 10 mm/s can be postulated as a cut-off to distinguish metastatic LNs.
弥散加权磁共振成像（DWI）有助于直肠肿瘤的 N 分期和结直肠肝转移（CLM）的诊断。约 15%的 CLM 患者存在局部区域淋巴结（LN）转移，这会影响预后和治疗策略。这项回顾性研究是第一个评估定量 ADC 测量作为工具，以识别结直肠癌肝转移患者中转移性 LN 的研究。
所有 2008 年至 2015 年间接受 CLM 手术的连续患者均被认为符合纳入标准。纳入标准为：术中至少取出一个 LN；LN≥5mm；DWI 在手术前 2 个月内完成。两名放射科医生为所有 LN 计算 ADC 和 ADC（ADC/ADC）。
在 555 例接受 CLM 手术的患者中，有 32 例符合纳入标准。分析了 56 个 LN，其中 28 个为转移性 LN。转移性 LN 的 ADC 和 ADC 低于良性 LN（ADC=1.37 比 1.83×10mm/s，p<0.001；ADC=1.26 比 1.73，p<0.001）。ADC 的最佳截断值为 1.48 x 10mm/s（AUC=0.85，p<0.001，在每个 LN 分析中，灵敏度/特异性/准确性分别为 79%/93%/86%，在每个患者分析中为 94%/86%/91%）。ADC 的最佳截断值为 1.15（AUC=0.80，p<0.001，灵敏度/特异性/准确性分别为 69%/93%/81%和 76%/93%/84%）。观察到了良好的观察者间和观察者内的一致性。
在 CLM 患者中，ADC 值<1.48 x 10mm/s 可以被假定为区分转移性 LN 的截断值。
