Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China.
Second Clinical School, Lanzhou University, Lanzhou, China.
J Thorac Imaging. 2024 Sep 1;39(5):285-292. doi: 10.1097/RTI.0000000000000771. Epub 2023 Dec 28.
To explore and compare the diagnostic values of mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) parameters of primary lesions and lymph nodes (LNs) to predict mediastinal LN metastasis in patients with non-small cell lung cancer.
Sixty-one patients with non-small cell lung cancer underwent preoperative magnetic resonance imaging, including multiple b -value DWI. The DWI parameters, including apparent diffusion coefficient (ADC) from a mono-exponential model, true diffusion (D) coefficient, pseudo-diffusion (D*) coefficient, and perfusion fraction (f) from a bi-exponential model, distributed diffusion coefficient (DDC) and intravoxel diffusion heterogeneity index (α) from a stretched-exponential model of primary tumors and LNs and the size characteristics of LNs, were measured and compared. Multivariate logistic regression analysis was used to establish models for predicting mediastinal LN metastasis. Receiver operating characteristic analysis was applied to evaluate diagnostic performances.
The DWI parameters of primary tumors showed no statistical significance between LN metastasis-positive and LN metastasis-negative groups. Nonmetastatic LNs had significantly higher ADC, D, DDC, and α values compared with metastatic LNs (all P < 0.05). The short-dimension, long-dimension, and short-long dimension ratio of metastatic LNs was significantly larger than those of nonmetastatic ones (all P < 0.05). The D value showed the best diagnostic performance among all DWI-derived single parameters, and the short dimension of LNs performed the same among all the size variables. Furthermore, the combination of DWI parameters (ADC and D) and the short dimension of LNs can significantly improve diagnostic efficiency.
The ADC, D, DDC, and α from the mono-exponential, bi-exponential, and stretched-exponential models were demonstrated efficient in differentiating benign from metastatic LNs, and the combination of ADC, D, and short dimension of LNs may have a better diagnostic performance than DWI or size-derived parameters either in combination or individually.
探讨和比较原发性病变和淋巴结（LN）的单指数、双指数和拉伸指数扩散加权成像（DWI）参数的诊断价值，以预测非小细胞肺癌患者的纵隔 LN 转移。
61 例非小细胞肺癌患者术前均行磁共振成像检查，包括多 b 值 DWI。测量并比较原发性肿瘤和 LN 的 DWI 参数，包括单指数模型的表观扩散系数（ADC）、真实扩散（D）系数、假性扩散（D*）系数和灌注分数（f）、双指数模型的分布扩散系数（DDC）和体素内扩散异质性指数（α）以及 LN 的大小特征。采用多变量逻辑回归分析建立预测纵隔 LN 转移的模型。应用受试者工作特征曲线分析评估诊断性能。
LN 转移阳性组和 LN 转移阴性组的原发性肿瘤 DWI 参数无统计学意义。非转移性 LN 的 ADC、D、DDC 和α值明显高于转移性 LN（均 P<0.05）。转移性 LN 的短径、长径和短长径比明显大于非转移性 LN（均 P<0.05）。D 值在所有 DWI 衍生单参数中具有最佳诊断性能，而 LN 的短径在所有大小变量中表现相同。此外，DWI 参数（ADC 和 D）与 LN 短径的组合可显著提高诊断效率。
单指数、双指数和拉伸指数模型的 ADC、D、DDC 和α值可有效区分良性和转移性 LN，ADC、D 和 LN 短径的组合在组合或单独使用时比 DWI 或大小衍生参数具有更好的诊断性能。
