Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
Department of Radiology, McMaster University, Hamilton, ON, Canada.
Eur Radiol. 2023 Sep;33(9):5976-5983. doi: 10.1007/s00330-023-09597-x. Epub 2023 Apr 1.
To determine the accuracy of qualitative and quantitative MRI features for the diagnosis of pathologic regional lymph nodes at standard lymphadenectomy in patients with pancreatic ductal adenocarcinoma (PDAC).
All adult patients with pancreatic MRI performed from 2011 to 2021 within 3 months of a pancreaticoduodenectomy were eligible for inclusion in this single-center retrospective cohort study. Regional nodes at standard lymphadenectomy were independently reviewed by two fellowship-trained abdominal radiologists for the following qualitative features: heterogeneous T2 signal, round shape, indistinct margin, peri-nodal fat stranding, and restricted diffusion greater than the spleen. Quantitative characteristics including primary tumor size, largest node short- and long-axes length, number of regional nodes, absolute apparent diffusion coefficient (ADC) values, and ADC node-to-spleen signal index were assessed. Analysis was at the patient-level with surgical pathology as the reference standard.
Of 75 patients, 85% (64/75) were positive for regional nodal disease on histopathology. None of the qualitative variables evaluated on MRI was associated with pathologic nodes. Median primary tumor maximum diameter was slightly larger for patients with pathologic nodes compared to those without (18 mm (10-42 mm) vs 16 mm (9-22 mm), p = 0.027). None of the other quantitative features was associated with pathologic nodes. Radiologist opinion was not associated with pathologic nodes (p = 0.520). Interobserver agreement was fair (kappa = 0.257).
Lymph node morphologic features and radiologist opinion using MRI are of limited value for diagnosing PDAC regional nodal disease. Improved diagnostic techniques are needed given the prognostic implications of pathologic lymph nodes in these patients.
• Multiple lymph node morphologic features routinely assessed on MRI for malignancies elsewhere in the body are likely not applicable when assessing for pancreatic ductal adenocarcinoma nodal disease. • Interobserver agreement for the presence or absence of pancreatic ductal adenocarcinoma lymph node morphologic features on MRI is fair (kappa = 0.257). • Many more lymph nodes are resected at PDAC standard lymphadenectomy than are detectable on MRI, median 25 vs 5 (p < 0.001), suggesting improved diagnostic techniques are needed to identify PDAC nodal disease.
确定定性和定量 MRI 特征在诊断胰腺导管腺癌（PDAC）标准淋巴结清扫术中病理性区域淋巴结的准确性。
本单中心回顾性队列研究纳入了 2011 年至 2021 年期间在胰十二指肠切除术前 3 个月内行胰腺 MRI 检查的所有成年患者。由 2 位接受过腹部放射学专业培训的研究员独立对标准淋巴结清扫术的区域淋巴结进行回顾性分析，评估以下定性特征：T2 信号不均匀、圆形、边界模糊、淋巴结周围脂肪条纹和弥散受限大于脾脏。评估定量特征包括原发肿瘤大小、最大淋巴结短轴和长轴长度、区域淋巴结数量、绝对表观扩散系数（ADC）值和 ADC 淋巴结-脾脏信号指数。分析基于患者水平，以手术病理为参考标准。
在 75 例患者中，85%（64/75）患者的淋巴结在组织病理学上呈阳性。MRI 上评估的定性变量均与病理淋巴结无关。与无病理淋巴结的患者相比，有病理淋巴结的患者的原发肿瘤最大直径稍大（18mm（10-42mm）vs 16mm（9-22mm），p=0.027）。其他定量特征均与病理淋巴结无关。两位研究员的意见与病理淋巴结无关（p=0.520）。观察者间的一致性为中等（kappa=0.257）。
在诊断 PDAC 区域淋巴结疾病时，MRI 上的淋巴结形态特征和研究员的意见价值有限。鉴于这些患者病理淋巴结具有预后意义，需要改进诊断技术。
用于评估其他部位恶性肿瘤的 MRI 上的多种淋巴结形态特征可能不适用于评估胰腺导管腺癌的淋巴结疾病。
MRI 上胰腺导管腺癌淋巴结形态特征的存在或不存在的观察者间一致性为中等（kappa=0.257）。
在 PDAC 标准淋巴结清扫术中切除的淋巴结比 MRI 上可检测到的淋巴结多得多，中位数为 25 个 vs 5 个（p<0.001），这表明需要改进诊断技术来识别 PDAC 淋巴结疾病。
