Zhu Hai-Bin, Zhao Bo, Li Xiao-Ting, Zhang Xiao-Yan, Yao Qian, Sun Ying-Shi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
World J Gastroenterol. 2024 Jan 28;30(4):308-317. doi: 10.3748/wjg.v30.i4.308.
About 10%-31% of colorectal liver metastases (CRLM) patients would concomitantly show hepatic lymph node metastases (LNM), which was considered as sign of poor biological behavior and a relative contraindication for liver resection. Up to now, there's still lack of reliable preoperative methods to assess the status of hepatic lymph nodes in patients with CRLM, except for pathology examination of lymph node after resection.
To compare the ability of mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) models in distinguishing between benign and malignant hepatic lymph nodes in patients with CRLM who received neoadjuvant chemotherapy prior to surgery.
In this retrospective study, 97 CRLM patients with pathologically confirmed hepatic lymph node status underwent magnetic resonance imaging, including DWI with ten b values before and after chemotherapy. Various parameters, such as the apparent diffusion coefficient from the mono-exponential model, and the true diffusion coefficient, the pseudo-diffusion coefficient, and the perfusion fraction derived from the intravoxel incoherent motion model, along with distributed diffusion coefficient (DDC) and α from the stretched-exponential model (SEM), were measured. The parameters before and after chemotherapy were compared between positive and negative hepatic lymph node groups. A nomogram was constructed to predict the hepatic lymph node status. The reliability and agreement of the measurements were assessed using the coefficient of variation and intraclass correlation coefficient.
Multivariate analysis revealed that the pre-treatment DDC value and the short diameter of the largest lymph node after treatment were independent predictors of metastatic hepatic lymph nodes. A nomogram combining these two factors demonstrated excellent performance in distinguishing between benign and malignant lymph nodes in CRLM patients, with an area under the curve of 0.873. Furthermore, parameters from SEM showed substantial repeatability.
The developed nomogram, incorporating the pre-treatment DDC and the short axis of the largest lymph node, can be used to predict the presence of hepatic LNM in CRLM patients undergoing chemotherapy before surgery. This nomogram was proven to be more valuable, exhibiting superior diagnostic performance compared to quantitative parameters derived from multiple b values of DWI. The nomogram can serve as a preoperative assessment tool for determining the status of hepatic lymph nodes and aiding in the decision-making process for surgical treatment in CRLM patients.
约10%-31%的结直肠癌肝转移（CRLM）患者会同时出现肝淋巴结转移（LNM），这被视为生物学行为不良的标志，也是肝切除的相对禁忌证。到目前为止，除了切除术后淋巴结的病理检查外，仍缺乏可靠的术前方法来评估CRLM患者肝淋巴结的状态。
比较单指数、双指数和拉伸指数扩散加权成像（DWI）模型在区分术前接受新辅助化疗的CRLM患者肝良性和恶性淋巴结方面的能力。
在这项回顾性研究中，97例经病理证实肝淋巴结状态的CRLM患者接受了磁共振成像检查，包括化疗前后具有10个b值的DWI检查。测量了各种参数，如单指数模型的表观扩散系数、体素内不相干运动模型得出的真实扩散系数、伪扩散系数和灌注分数，以及拉伸指数模型（SEM）的分布扩散系数（DDC）和α。比较了阳性和阴性肝淋巴结组化疗前后的参数。构建了一个列线图来预测肝淋巴结状态。使用变异系数和组内相关系数评估测量的可靠性和一致性。
多变量分析显示，治疗前的DDC值和治疗后最大淋巴结的短径是转移性肝淋巴结的独立预测因素。结合这两个因素的列线图在区分CRLM患者的良性和恶性淋巴结方面表现出色，曲线下面积为0.873。此外，SEM的参数显示出很高的重复性。
所开发的列线图结合治疗前的DDC和最大淋巴结的短轴，可用于预测术前接受化疗的CRLM患者肝LNM的存在。该列线图被证明更有价值，与从DWI的多个b值得出的定量参数相比，具有更高的诊断性能。该列线图可作为术前评估工具，用于确定肝淋巴结状态，并辅助CRLM患者手术治疗的决策过程。
