Fernandes Maria Clara, Mazaheri Yousef, Fuqua James Louis, Horvat Natally, Pappou Emmanouil, Zheng Junting, Capanu Marinela, Rodriguez Lee, Gollub Marc J, Golia Pernicka Jennifer S
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur Radiol. 2025 Aug 25. doi: 10.1007/s00330-025-11945-y.
To investigate whether quantitative DWI and qualitative T2WI parameters can predict lymph node involvement in clinical early rectal cancer.
This retrospective study included consecutive patients who had rectal MRI from January 1, 2010, to March 31, 2021, showing T1-T2 rectal cancer before undergoing total mesorectal excision without neoadjuvant therapy. Visible mesorectal lymph nodes on DWI were segmented by a junior reader, and ADC values were extracted. Additionally, the junior reader and a senior reader independently recorded qualitative T2WI parameters of the most suspicious lymph node per patient. Histopathology was the reference standard for malignant (pN+) and benign (pN-) lymph node status.
Of 69 patients (37 men and 32 women) (median age, 55 years; IQR: 48-66), 23 (33%) had pN+ status; 46 (67%) had pN- status. ADC (in × 10 mm/s) of the most suspicious lymph node was not different between the two patient groups (junior reader: 1087 vs. 926, p = 0.31; senior reader: 1178 vs. 1086, p = 0.89). The Dutch criteria, based on the combination of T2WI size and morphologic parameters, showed better diagnostic performance for the senior vs. junior reader: accuracy, sensitivity, specificity, PPV, and NPV of 79.7% (95% CI: 68.3-88.4%), 56.5% (95% CI: 34.5-76.8%), 91.3% (95% CI: 79.2-97.6%), 76.5% (95% CI: 50.1-93.2%), and 80.8% (95% CI: 67.5-90.4%), vs. 69.6% (95% CI: 57.3-80.1%), 26.1% (95% CI: 12.2-48.4%), 91.3% (95% CI: 79.2-97.6%), 60% (95% CI: 26.2-97.8%), and 71.2% (95% CI: 57.9-82.2%).
Additional research on alternative and more objective methods for lymph node characterization is needed.
Question The performance of MRI for nodal staging in clinical early rectal cancer in particular is a knowledge gap in the literature. Findings The Dutch criteria, based on T2WI size and morphologic parameters, performed better in differentiating metastatic from benign lymph nodes than the quantitative DWI ADC parameter. Clinical relevance Accurate nodal staging in early rectal cancer is crucial for treatment decision-making. Our study highlights the need for additional research on alternative and more objective methods for lymph node characterization.
探讨定量扩散加权成像（DWI）和定性T2加权成像（T2WI）参数能否预测临床早期直肠癌的淋巴结受累情况。
这项回顾性研究纳入了2010年1月1日至2021年3月31日期间连续接受直肠MRI检查的患者，这些患者在未接受新辅助治疗的情况下接受全直肠系膜切除术，术前MRI显示为T1 - T2期直肠癌。由一名初级阅片者对DWI上可见的直肠系膜淋巴结进行分割，并提取表观扩散系数（ADC）值。此外，初级阅片者和一名高级阅片者分别独立记录每位患者最可疑淋巴结的定性T2WI参数。组织病理学是判断恶性（pN +）和良性（pN -）淋巴结状态的参考标准。
69例患者（37例男性和32例女性）（中位年龄55岁；四分位间距：48 - 66岁）中，23例（33%）为pN +状态；46例（67%）为pN -状态。两组患者最可疑淋巴结的ADC值（×10⁻³mm²/s）无差异（初级阅片者：1087对926，p = 0.31；高级阅片者：1178对1086，p = 0.89）。基于T2WI大小和形态学参数的荷兰标准，高级阅片者的诊断性能优于初级阅片者：准确率、敏感性、特异性、阳性预测值和阴性预测值分别为79.7%（95%置信区间：68.3 - 88.4%）、56.5%（95%置信区间：34.5 - 76.8%）、91.3%（95%置信区间：79.2 - 97.6%）、76.5%（95%置信区间：50.1 - 93.2%）和80.8%（95%置信区间：67.5 - 90.4%），而初级阅片者分别为69.6%（95%置信区间：57.3 - 80.1%）、26.1%（95%置信区间：12.2 - 48.4%）、91.3%（95%置信区间：79.2 - 97.6%）、60%（95%置信区间：26.2 - 97.8%）和71.2%（95%置信区间：57.9 - 82.2%）。
需要对用于淋巴结特征描述的替代且更客观的方法进行更多研究。
问题 尤其是临床早期直肠癌中MRI进行淋巴结分期的性能是文献中的知识空白。发现 基于T2WI大小和形态学参数的荷兰标准在区分转移性淋巴结和良性淋巴结方面比定量DWI的ADC参数表现更好。临床意义 早期直肠癌准确的淋巴结分期对治疗决策至关重要。我们的研究强调需要对用于淋巴结特征描述的替代且更客观的方法进行更多研究。
