From the Department of Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (C.N., T.E., T.M., B.H., I.S., S.R.M.G.); Division of Radiology, German Cancer Research Center, Heidelberg, Germany (C.N.); Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (T.E., C.F.); Institute for Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (U.G., L.M.); and Department of Radiology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (D.G., B.H.).
Invest Radiol. 2024 Nov 1;59(11):787-793. doi: 10.1097/RLI.0000000000001089. Epub 2024 Jul 2.
Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 is a clinical and research standard for evaluating malignant tumors and lymph node metastasis. However, quantitative analysis of nodal status is limited to measurement of short axis diameter (SAD), and metastatic lymph nodes below 10 mm in SAD are often not detected. The purpose of this study was to evaluate the value of multifrequency magnetic resonance elastography (MRE) when added to RECIST 1.1 for detection of lymph node metastasis.
Twenty-five benign and 82 metastatic lymph nodes were prospectively examined by multifrequency MRE at 1.5 T using tomoelastography postprocessing at 30, 40, 50, and 60 Hz (total scan time of 4 minutes). Shear wave speed as a surrogate of soft tissue stiffness was provided in m/s. Positron emission tomography-computed tomography was used as reference standard for identification of abdominal lymph node metastasis from histologically confirmed primary tumors. The diagnostic performance of MRE was compared with that of SAD according to RECIST 1.1 and evaluated by receiver operating characteristic curve analysis using generalized linear mixed models and binary logistic mixed models. Sensitivity, specificity, and predictive values were calculated for different cutoffs.
Metastatic lymph nodes (1.90 ± 0.57 m/s) were stiffer than benign lymph nodes (0.98 ± 0.20 m/s, P < 0.001). An area under the curve of 0.95 for a cutoff of 1.32 m/s was calculated. Using a conservative approach with 1.0 specificity, we found sensitivity (SAD/MRE/MRE + SAD, 0.56/0.84/0.88), negative predictive values (0.41/0.66/0.71), and overall accuracy (0.66/0.88/0.91) to be improved using MRE and even higher for combined MRE and SAD.
Multifrequency MRE improves metastatic abdominal lymph node detection by 25% based on higher tissue stiffness-even for lymph nodes with an SAD ≤10 mm. Stiffness information is quick to obtain and would be a promising supplement to RECIST.
实体瘤反应评价标准（RECIST）1.1 是评估恶性肿瘤和淋巴结转移的临床和研究标准。然而，对淋巴结状态的定量分析仅限于短轴直径（SAD）的测量，而 SAD 小于 10mm 的转移性淋巴结通常无法检测到。本研究旨在评估多频磁共振弹性成像（MRE）在 RECIST 1.1 检测淋巴结转移中的应用价值。
在 1.5T 下使用 tomoelastography 后处理，以 30、40、50 和 60Hz 的多频 MRE 对 25 个良性和 82 个转移性淋巴结进行前瞻性检查（总扫描时间为 4 分钟）。剪切波速度以 m/s 为软组织硬度的替代物提供。正电子发射断层扫描-计算机断层扫描（PET-CT）被用作组织学证实的原发性肿瘤腹部淋巴结转移的参考标准。根据 RECIST 1.1，比较 MRE 的诊断性能与 SAD，并使用广义线性混合模型和二元逻辑混合模型进行受试者工作特征曲线分析进行评估。计算了不同截断值的灵敏度、特异性和预测值。
转移性淋巴结（1.90±0.57m/s）比良性淋巴结（0.98±0.20m/s，P<0.001）更硬。计算出截断值为 1.32m/s 时的曲线下面积为 0.95。使用 1.0 特异性的保守方法，我们发现使用 MRE 可提高灵敏度（SAD/MRE/MRE+SAD，0.56/0.84/0.88）、阴性预测值（0.41/0.66/0.71）和总准确性（0.66/0.88/0.91），对于联合 MRE 和 SAD，甚至更高。
多频 MRE 基于更高的组织硬度可将腹部转移性淋巴结的检测提高 25%，即使是 SAD≤10mm 的淋巴结也是如此。硬度信息获取迅速，有望成为 RECIST 的一个有前途的补充。
